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The evening of life
PUBLIC
HEALTH
The Journal of the Society of Medical Officers of Health f
Vol. LXXII
September 1958
THE
EVENING
No. 6
OF LIFE
IT was not without reason that the last generation of doctors spoke of pneumonia as " t h e old person's friend." As the efficiency of the body's mechanisms began to decline and its powers of resistance b e c a m e less, the stage was set for a short and comparatively merciful final scene to the tragedy or comedy of life. Slowly, the natural advances of clinical and sodal medicine were increasing the expectation of life but at a pace which still aUowed time for thought and action to those whose task it was to care for the elderly. But there has come the antibiotic revolution and the si uation has been radically changed with a swiftness which has left medicine panting. Instead of the natural pattern of life ending with a short phase of decline and a quick terminal illness it is changing to one of a prolonged phase of decline interrupted by episodes of graver illness which yield to the antibiotics but leave the organism just a little more generally enfeebled and more vulnerable to the non-lethal chronic diseases and disabilities of body and mind. It was, we believe, Dr. Ffrangcon Roberts who coined the t e r m " medicated survival" to describe this condition and we can think of no apter term. But medicated survival, however much credit it may reflect upon clinicians, is not good enough, involving as it does the descent of the individual to a point at which he may be a burden to the community, his family and himself until he longs for the death which medical virtuosity has denied him. All men are mortal and must come to their end in a helplessness as great as that in which they began their earthly journey but until that end arrives it is important to sustain them in happiness and in that usefulness and lack of dependence on others which contributes so greatly to their happiness. Such is the purpose of the important medico-social side of geriatrics, to which we are devoting the whole of this special number of PUBLIC HEALTH. If another effect of the antibiotic revolution has been to make the care of young children simpler and less demanding on the resources of the community in general and the public health service in particular, here, in social geriatrics, 201
202
PUBLIC H E A L T H
VOL. LXXII
NO. 6
is a wide new field which is going to demand no less effort and ingenuity than was put into child welfare work in the years between the wars. It is a field which will not quickly be exhausted ; it may, rather, increase its demands. We are already impressed by the efforts which are being made to help this new group of vulnerable people and gratified to see that public health doctors are entering into the work in ever-increasing numbers, but we would not be so complacent as to suggest that all is yet going well, for many of the fascinatingly constructive schemes which our contributors mention are still only in the " p i l o t project" stage. For those in the public health service who have been complaining that there is nothing new to do, here is a challenge to their ingenuity and originality, particularly in the investigation of local problems and their special aspects and the adapting of present techniques and the devising of new ones to provide solutions. / f i t is true, as we believe it to be, that the M.O.H. has special opportunities and obligations as the co-ordinator of medico-social work in his area, social geriatrics is something which he cannot afford for a moment to ignore. It is work not only for the public health team but for the wider medical team, with the G.P. and the geriatrician taking their parts. It involves the local authority services outside the strictly medical departments--welfare, housing, parks, library and transport services have all something to contribute and it is for the M.O.H. to show them how to do it. It has been argued in recent years, not without truth, that doctors in the public health service have during the last decade been so distressed about what they have lost that they have not taken new chances which were ready to their hand. In this issue we hope that we indicate not only the scope of this particular new field but the success with which the more forward-looking of our colleagues are already tilling it. We trust that those who have been hesitant in their approach because of either the size or the unfamiliarity of this new branch of social medicine will be encouraged and stimulated by their example.
Readers will appreciate from the general form of this special number that the Society is fully aware of the many-sidedness of the subject of Geriatrics and of the need for team-work among doctors engaged on various aspects of the work. Some medical officers in the Public Health Service have found it useful from this point of view to join the Medical Society for the Care of the Elderly, and in case other medical officers are disposed to follow their example, we give the name and address of the Secretary of that Society. It is : Dr. A. N. Exton-Smith, Whittington Hospital, Highgate Wing, London, N.19.
HEALTH
The Journal of the Society of Medical Officers of Health f
Vol. LXXII
September 1958
THE
EVENING
No. 6
OF LIFE
IT was not without reason that the last generation of doctors spoke of pneumonia as " t h e old person's friend." As the efficiency of the body's mechanisms began to decline and its powers of resistance b e c a m e less, the stage was set for a short and comparatively merciful final scene to the tragedy or comedy of life. Slowly, the natural advances of clinical and sodal medicine were increasing the expectation of life but at a pace which still aUowed time for thought and action to those whose task it was to care for the elderly. But there has come the antibiotic revolution and the si uation has been radically changed with a swiftness which has left medicine panting. Instead of the natural pattern of life ending with a short phase of decline and a quick terminal illness it is changing to one of a prolonged phase of decline interrupted by episodes of graver illness which yield to the antibiotics but leave the organism just a little more generally enfeebled and more vulnerable to the non-lethal chronic diseases and disabilities of body and mind. It was, we believe, Dr. Ffrangcon Roberts who coined the t e r m " medicated survival" to describe this condition and we can think of no apter term. But medicated survival, however much credit it may reflect upon clinicians, is not good enough, involving as it does the descent of the individual to a point at which he may be a burden to the community, his family and himself until he longs for the death which medical virtuosity has denied him. All men are mortal and must come to their end in a helplessness as great as that in which they began their earthly journey but until that end arrives it is important to sustain them in happiness and in that usefulness and lack of dependence on others which contributes so greatly to their happiness. Such is the purpose of the important medico-social side of geriatrics, to which we are devoting the whole of this special number of PUBLIC HEALTH. If another effect of the antibiotic revolution has been to make the care of young children simpler and less demanding on the resources of the community in general and the public health service in particular, here, in social geriatrics, 201
202
PUBLIC H E A L T H
VOL. LXXII
NO. 6
is a wide new field which is going to demand no less effort and ingenuity than was put into child welfare work in the years between the wars. It is a field which will not quickly be exhausted ; it may, rather, increase its demands. We are already impressed by the efforts which are being made to help this new group of vulnerable people and gratified to see that public health doctors are entering into the work in ever-increasing numbers, but we would not be so complacent as to suggest that all is yet going well, for many of the fascinatingly constructive schemes which our contributors mention are still only in the " p i l o t project" stage. For those in the public health service who have been complaining that there is nothing new to do, here is a challenge to their ingenuity and originality, particularly in the investigation of local problems and their special aspects and the adapting of present techniques and the devising of new ones to provide solutions. / f i t is true, as we believe it to be, that the M.O.H. has special opportunities and obligations as the co-ordinator of medico-social work in his area, social geriatrics is something which he cannot afford for a moment to ignore. It is work not only for the public health team but for the wider medical team, with the G.P. and the geriatrician taking their parts. It involves the local authority services outside the strictly medical departments--welfare, housing, parks, library and transport services have all something to contribute and it is for the M.O.H. to show them how to do it. It has been argued in recent years, not without truth, that doctors in the public health service have during the last decade been so distressed about what they have lost that they have not taken new chances which were ready to their hand. In this issue we hope that we indicate not only the scope of this particular new field but the success with which the more forward-looking of our colleagues are already tilling it. We trust that those who have been hesitant in their approach because of either the size or the unfamiliarity of this new branch of social medicine will be encouraged and stimulated by their example.
Readers will appreciate from the general form of this special number that the Society is fully aware of the many-sidedness of the subject of Geriatrics and of the need for team-work among doctors engaged on various aspects of the work. Some medical officers in the Public Health Service have found it useful from this point of view to join the Medical Society for the Care of the Elderly, and in case other medical officers are disposed to follow their example, we give the name and address of the Secretary of that Society. It is : Dr. A. N. Exton-Smith, Whittington Hospital, Highgate Wing, London, N.19.