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The development of the hospital library service
1934.
PUBLIC
HEALTH.
403
In the Annual Reports. HEALTH CERTIFICATESBEPORE 1V[ARRIAGE.--Itis the obvious duty of each party to such a vital step as marriage to make a full declaration of everything as regards physical health likely to affect the health and well-being not only of the partner but also of any offspring resulting from the marriage. It should clearly be the right of each partner to have this information before the irrevocable step is taken. Some day one may hope that such interchange of certificates will not only be customary but compulsory. In the meanwhile, the clergy might do much to introduce this reform if they would tactffilly inquire if health certificates have been exchanged before they agreed to publish banns. They may not at present have power to require it, but the mere making of such a suggestion would go a long way to bringing the reform about. If I may make a personal allusion, I would say that I myself have had four children married, and in each case an exchange of health certificates, as indicated above, took place between the young people and their prospective partners for l i f e . -
Dr. C. Killich MiUard, Leicester.
DIPHTHERIA : DANGER IN DELAY.---Several of these deaths have demonstrated the calamitous results of delay in administering anti-toxin. T h e y have also pointed out in no uncertain way the dire consequences of delay in diagnosis. Doctors have apparently not all learnt the lesson that it is dangerous to wait for the the result of the swab, and that it is imperative to treat every suspicious case of diphtheria in the only way which gives the patient every chance of recovery, namely, by the immediate administration of anti-toxin. Every opportunity has been taken to urge medical practitioners to administer anti-toxin to suspicious cases. A new method of drawing the attention of local doctors to this important matter has been adopted recently by enclosing a leaflet with every swab outfit issued from the council's pathological laboratory. This leaflet emphasises the importance of the early treatment of suspicious cases of diphtheria, and reminds medical practitioners that a free supply of anti-toxin may be obtained from the public health department for all patients whose home circumstances are poor.--Dr. Thomas Orr, Ealing.
THE DEVELOPMENT OF THE HOSPITAL LIBRARY SERVICE. Some time ago the Council of the Society considered the question of hospital libraries, and appointed representatives to a special committee dealing with it. In this note, Mrs. Marjorie E, Roberts~ Organising Secretary of the British Red Cross and Order of St. John Hospital Library, submits a number of details with regard to procedure in relation to the forming of libraries which will be found helpful and of interest by members of the Service. It is probably not going too far to prophesy that a few years hence a hospital which does not possess an " organised patients' library "--as distinct from mere collections of books in the wards--wilt be considered to that extent below standard. Many times ex-patients of the London County Council and voluntary hospitals have said to the writer, " When I was in such and such a hospital a few years ago there was no library ; but they have one now, and what a difference it makes." Reports from America, and several European countries, tell the same story, and it is only a matter of time before a patients' library wilt be accepted as part of the essential equipment of every hospital. So far as Great Britain is concerned, the immediate need is for a vigorous effort to be made throughout the provinces for a hospital library service such as now extends to nearly every hospital in London. It must not be thought by this that the service is by any means entirely lacking elsewhere. I n Sheffield, for instance, an excellent service is organised by the chief librarian of the public library., and in Liverpool, the Toc H organisation is gradually building up libraries in the hospitals. But the important fact remains that on the part of authorities throughout the hospital sphere, the principle has not yet been accepted that a hospital without a patients' library is minus a part of its equipment which has definite recreative and psychological value. There are several reasons for this gap in the hospital service, chief amongst them being that such libraries have not been regarded as the specialised work of any particular person, and have often fallen
to the lot of anyone with a little spare-time. I n fact, this task has frequently fallen upon the already too busy chaplains. Another reason is the lack of accommodation, since architects have not yet planned for library rooms. Yet another reason is that although many medical officers of health and medical superintendents believe that patients' libraries are valuable, they do not know to whom to turn for their organisation, except in a few centres in which there is a local hospital library committee. T h e Red Cross and St. John Hospital Library aim at establishing, as soon as possible, hospital library committees in all large towns, and for each county. O n these committees the medical officers of health should take a leading part ; and there is little that could help forward the movement so much as requests from medical officers of health to the Hospital Library Headquarters that an approach should be made to their respective centres. Such requests can set the ball rolling, and can open a channel of contact which is often the hardest part of the first stage in the work. Where these committees have been set up, they usually include the medical officer of health, representative authorities from every kind of hospital in the area, and representatives of bodies competent to supply" voluntary help for book collections and librarians, such as the British Red Cross, Order of St. John, Toe H, Scouts, Guides, Women's Institutes, etc. So far as accommodation is concerned, experience has shown that this can usually be overcome to an extent that makes a library possible, though not always
404
PUBLIC
perfect. A great deal of space is not necessary ; bookcases can, if required, reach to thq~'ceiling ; but there must be light, air, and freedom t o w o r k at reasonable hours. This means that waiting-rooms and chaplains' rooms, which are still often used for housing bookcases, are not satisfactory. A suitable end of a corridor partitioned off is sometimes better. Actually, experience proves that somewhere or other adequate, though perhaps not ideal, space is found whenever the will to possess a library is strong enough. But new buildings or extensions should undoubtedly be planned to include a suitable library room, and, best of all, a library reading-room, to which certain patients, fit to leave their wards for a short time, could have access. T h e workers for the library, once a local committee has been formed, can usually fairly easily be obtained ; b u t e,~en before that has happened a hospital that wishes to start a library will soon secure offers of voluntary service if publicity is given to the need for it. Some care, however, should be exercised in the selection of helpers. Hospital librarianship is now recognised as a speeialised form of work, and not merely as a useful job of book distribution. Knowledge of books, understanding of people, tact, method, energy and cheerfulness are qualities that librarians must possess, and each head librarian should have organising ability. I n the London area there are now four hospitals used as teaching centres for head librarians. T h e y are: Lewisham (London County Council), Guy's, St. Bartholomew's and Middlesex. Such teaching centres will, it is hoped, extend gradually to all large cities ; but in the meantime appointments can be made with the London teaching centres for prospective head librarians from the provinces to visit them, and to see something, during a two or three hours' stay, of the system of work. The n u m b e r of librarians required in a library is one for every 60-80 beds of reading patients, of whom one must be competent to be, and reeognised as, head. The formation of a Guild of Hospital Librarians is the natural outcome of the improved organisation of a library service for patients in hospitals and kindred institutions. T h e desire to unite the librarians engaged in this valuable form of social service first found expression at the annual meeting of the Hospital Library of the British Red Cross Society and Order of St. John of Jerusalem in the London County Hall in 1932, when a large audience cordially welcomed the suggestion. T h e proposal was discussed at a rceeting of hospital librarians held in St. George's Hospital in May, 1933, when it was decided to proceed with the formation of a body to unite them together. Shortly after, the Third Congress of the International Hospital Association in Knocke endorsed the proposal as one which would appeal to hospital librarians throughout the world. Accordingly, a Guild of Hospital Librarians was formed at a meeting held in Chaucer House, by the kind courtesy of the Library Association, on March 14th, 1934. Hospital librarians, members of library or hospital committees, librarians and other persons connected with the organisation and administration in hospitals and kindred institutions or interested in the objects of the Guild are eligible to become members. A complete hospital library service should include the whole hospital--medical, nursing and domestic
HEALTH.
SEPTEMBER, 1934.
staff, and patients--under the administration of a trained librarian. That, so far, is a counsel of perfection, although in some hospitals, librarians are already trying to meet the needs of the nursing staff as well as of the patients. For the purpose of this note, however, patients' libraries only will be considered. Books are supplied by the Red Cross and St. John Hospital Library to over 2,000 hospitals of all k i n d s - - n o n infectious, infectious, mental, and so on. So far as librarians are concerned, no attempt can be made to include them for infectious hospitals ; for these, the staff has to run the book service. Librarians should be found for all other hospitals. Mental hospitals stand as a problem apart, and for these the principle is slowly gaining ground that " outside " voluntary librarians should assist, even if they do not entirely take over the libraries. T h e library work in these hospitals requires much time and discrimination ; moreover, it can be regarded as occupational for certain patients. T h e basic facts remain that all types of hospitals should have a book supply, and a system of book distribution. Until fairly recently, it has been taken for granted that an unending supply of books, and of funds, with which to r u n this national set-vice were held by the Red Cross Hospital Library. Actually, however, it is of importance that a certain degree of decentralisation from headquarters should be aimed at. By decentralisation it is hoped that in co~,::., of time big cities, and even some counties, will become responsible for the library service to their own noninfectious hospitals, leaving to headquarters the infectious and mental hospitals. Whenever this is done, it will mean that the local committee will arrange for a depot, which should be rent free, to whicla books collected locally should be sent, of which a proportion should be kept for local non-infectious hospitals, and a quota sent to headquarters (unless it is desired to take over the entire service). Such a depot should be s.upervised by a volunteer, and it would be found that the expense connected with it would be exceedingly low. Indeed, transport and packing within a county are usually small matters, in so far as the county library vans and other forms of conveyance can often be used. On the other hand, there may be instances in which it is not found feasible to set up a committee and organise a depot : whenever this is so, hospitals in those districts can look for help to the Red Cross Hospital Library, but it is only reasonable to realise that where unnecessary reliance is placed on headquarters, without any attempt on the part of those in the hospitals or their localities to improve or build up their libraries, the service for all hospitals tends in the long run to be weakened to that extent. It is, therefore, a matter worthy of thought that medical officers of health and all those who are concerned to develop a permanent hospital library service for the country, should take steps to accept the principle of such libraries, and to formulate a policy for their development in their respective districts. Suggestions and enquiries in respect of further details, local meetings or personal visits, or with regard to the Guild of Hospital Librarians, will be gratefully received by the Organising Secretary, Mrs. M. E. Roberts, 48, Queen's Gardens, Lancaster Gate, London, W.2.
PUBLIC
HEALTH.
403
In the Annual Reports. HEALTH CERTIFICATESBEPORE 1V[ARRIAGE.--Itis the obvious duty of each party to such a vital step as marriage to make a full declaration of everything as regards physical health likely to affect the health and well-being not only of the partner but also of any offspring resulting from the marriage. It should clearly be the right of each partner to have this information before the irrevocable step is taken. Some day one may hope that such interchange of certificates will not only be customary but compulsory. In the meanwhile, the clergy might do much to introduce this reform if they would tactffilly inquire if health certificates have been exchanged before they agreed to publish banns. They may not at present have power to require it, but the mere making of such a suggestion would go a long way to bringing the reform about. If I may make a personal allusion, I would say that I myself have had four children married, and in each case an exchange of health certificates, as indicated above, took place between the young people and their prospective partners for l i f e . -
Dr. C. Killich MiUard, Leicester.
DIPHTHERIA : DANGER IN DELAY.---Several of these deaths have demonstrated the calamitous results of delay in administering anti-toxin. T h e y have also pointed out in no uncertain way the dire consequences of delay in diagnosis. Doctors have apparently not all learnt the lesson that it is dangerous to wait for the the result of the swab, and that it is imperative to treat every suspicious case of diphtheria in the only way which gives the patient every chance of recovery, namely, by the immediate administration of anti-toxin. Every opportunity has been taken to urge medical practitioners to administer anti-toxin to suspicious cases. A new method of drawing the attention of local doctors to this important matter has been adopted recently by enclosing a leaflet with every swab outfit issued from the council's pathological laboratory. This leaflet emphasises the importance of the early treatment of suspicious cases of diphtheria, and reminds medical practitioners that a free supply of anti-toxin may be obtained from the public health department for all patients whose home circumstances are poor.--Dr. Thomas Orr, Ealing.
THE DEVELOPMENT OF THE HOSPITAL LIBRARY SERVICE. Some time ago the Council of the Society considered the question of hospital libraries, and appointed representatives to a special committee dealing with it. In this note, Mrs. Marjorie E, Roberts~ Organising Secretary of the British Red Cross and Order of St. John Hospital Library, submits a number of details with regard to procedure in relation to the forming of libraries which will be found helpful and of interest by members of the Service. It is probably not going too far to prophesy that a few years hence a hospital which does not possess an " organised patients' library "--as distinct from mere collections of books in the wards--wilt be considered to that extent below standard. Many times ex-patients of the London County Council and voluntary hospitals have said to the writer, " When I was in such and such a hospital a few years ago there was no library ; but they have one now, and what a difference it makes." Reports from America, and several European countries, tell the same story, and it is only a matter of time before a patients' library wilt be accepted as part of the essential equipment of every hospital. So far as Great Britain is concerned, the immediate need is for a vigorous effort to be made throughout the provinces for a hospital library service such as now extends to nearly every hospital in London. It must not be thought by this that the service is by any means entirely lacking elsewhere. I n Sheffield, for instance, an excellent service is organised by the chief librarian of the public library., and in Liverpool, the Toc H organisation is gradually building up libraries in the hospitals. But the important fact remains that on the part of authorities throughout the hospital sphere, the principle has not yet been accepted that a hospital without a patients' library is minus a part of its equipment which has definite recreative and psychological value. There are several reasons for this gap in the hospital service, chief amongst them being that such libraries have not been regarded as the specialised work of any particular person, and have often fallen
to the lot of anyone with a little spare-time. I n fact, this task has frequently fallen upon the already too busy chaplains. Another reason is the lack of accommodation, since architects have not yet planned for library rooms. Yet another reason is that although many medical officers of health and medical superintendents believe that patients' libraries are valuable, they do not know to whom to turn for their organisation, except in a few centres in which there is a local hospital library committee. T h e Red Cross and St. John Hospital Library aim at establishing, as soon as possible, hospital library committees in all large towns, and for each county. O n these committees the medical officers of health should take a leading part ; and there is little that could help forward the movement so much as requests from medical officers of health to the Hospital Library Headquarters that an approach should be made to their respective centres. Such requests can set the ball rolling, and can open a channel of contact which is often the hardest part of the first stage in the work. Where these committees have been set up, they usually include the medical officer of health, representative authorities from every kind of hospital in the area, and representatives of bodies competent to supply" voluntary help for book collections and librarians, such as the British Red Cross, Order of St. John, Toe H, Scouts, Guides, Women's Institutes, etc. So far as accommodation is concerned, experience has shown that this can usually be overcome to an extent that makes a library possible, though not always
404
PUBLIC
perfect. A great deal of space is not necessary ; bookcases can, if required, reach to thq~'ceiling ; but there must be light, air, and freedom t o w o r k at reasonable hours. This means that waiting-rooms and chaplains' rooms, which are still often used for housing bookcases, are not satisfactory. A suitable end of a corridor partitioned off is sometimes better. Actually, experience proves that somewhere or other adequate, though perhaps not ideal, space is found whenever the will to possess a library is strong enough. But new buildings or extensions should undoubtedly be planned to include a suitable library room, and, best of all, a library reading-room, to which certain patients, fit to leave their wards for a short time, could have access. T h e workers for the library, once a local committee has been formed, can usually fairly easily be obtained ; b u t e,~en before that has happened a hospital that wishes to start a library will soon secure offers of voluntary service if publicity is given to the need for it. Some care, however, should be exercised in the selection of helpers. Hospital librarianship is now recognised as a speeialised form of work, and not merely as a useful job of book distribution. Knowledge of books, understanding of people, tact, method, energy and cheerfulness are qualities that librarians must possess, and each head librarian should have organising ability. I n the London area there are now four hospitals used as teaching centres for head librarians. T h e y are: Lewisham (London County Council), Guy's, St. Bartholomew's and Middlesex. Such teaching centres will, it is hoped, extend gradually to all large cities ; but in the meantime appointments can be made with the London teaching centres for prospective head librarians from the provinces to visit them, and to see something, during a two or three hours' stay, of the system of work. The n u m b e r of librarians required in a library is one for every 60-80 beds of reading patients, of whom one must be competent to be, and reeognised as, head. The formation of a Guild of Hospital Librarians is the natural outcome of the improved organisation of a library service for patients in hospitals and kindred institutions. T h e desire to unite the librarians engaged in this valuable form of social service first found expression at the annual meeting of the Hospital Library of the British Red Cross Society and Order of St. John of Jerusalem in the London County Hall in 1932, when a large audience cordially welcomed the suggestion. T h e proposal was discussed at a rceeting of hospital librarians held in St. George's Hospital in May, 1933, when it was decided to proceed with the formation of a body to unite them together. Shortly after, the Third Congress of the International Hospital Association in Knocke endorsed the proposal as one which would appeal to hospital librarians throughout the world. Accordingly, a Guild of Hospital Librarians was formed at a meeting held in Chaucer House, by the kind courtesy of the Library Association, on March 14th, 1934. Hospital librarians, members of library or hospital committees, librarians and other persons connected with the organisation and administration in hospitals and kindred institutions or interested in the objects of the Guild are eligible to become members. A complete hospital library service should include the whole hospital--medical, nursing and domestic
HEALTH.
SEPTEMBER, 1934.
staff, and patients--under the administration of a trained librarian. That, so far, is a counsel of perfection, although in some hospitals, librarians are already trying to meet the needs of the nursing staff as well as of the patients. For the purpose of this note, however, patients' libraries only will be considered. Books are supplied by the Red Cross and St. John Hospital Library to over 2,000 hospitals of all k i n d s - - n o n infectious, infectious, mental, and so on. So far as librarians are concerned, no attempt can be made to include them for infectious hospitals ; for these, the staff has to run the book service. Librarians should be found for all other hospitals. Mental hospitals stand as a problem apart, and for these the principle is slowly gaining ground that " outside " voluntary librarians should assist, even if they do not entirely take over the libraries. T h e library work in these hospitals requires much time and discrimination ; moreover, it can be regarded as occupational for certain patients. T h e basic facts remain that all types of hospitals should have a book supply, and a system of book distribution. Until fairly recently, it has been taken for granted that an unending supply of books, and of funds, with which to r u n this national set-vice were held by the Red Cross Hospital Library. Actually, however, it is of importance that a certain degree of decentralisation from headquarters should be aimed at. By decentralisation it is hoped that in co~,::., of time big cities, and even some counties, will become responsible for the library service to their own noninfectious hospitals, leaving to headquarters the infectious and mental hospitals. Whenever this is done, it will mean that the local committee will arrange for a depot, which should be rent free, to whicla books collected locally should be sent, of which a proportion should be kept for local non-infectious hospitals, and a quota sent to headquarters (unless it is desired to take over the entire service). Such a depot should be s.upervised by a volunteer, and it would be found that the expense connected with it would be exceedingly low. Indeed, transport and packing within a county are usually small matters, in so far as the county library vans and other forms of conveyance can often be used. On the other hand, there may be instances in which it is not found feasible to set up a committee and organise a depot : whenever this is so, hospitals in those districts can look for help to the Red Cross Hospital Library, but it is only reasonable to realise that where unnecessary reliance is placed on headquarters, without any attempt on the part of those in the hospitals or their localities to improve or build up their libraries, the service for all hospitals tends in the long run to be weakened to that extent. It is, therefore, a matter worthy of thought that medical officers of health and all those who are concerned to develop a permanent hospital library service for the country, should take steps to accept the principle of such libraries, and to formulate a policy for their development in their respective districts. Suggestions and enquiries in respect of further details, local meetings or personal visits, or with regard to the Guild of Hospital Librarians, will be gratefully received by the Organising Secretary, Mrs. M. E. Roberts, 48, Queen's Gardens, Lancaster Gate, London, W.2.