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THE HOSPITAL PATIENT FROM HIS OWN POINT OF VIEW.
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cough in 22 patients, measles in 11, and pneumonia public, providing a medium through which relatives in 22. In connexion with the last-named there is, and friends can blow off steam, whether by way of
fallacy that so-called pneumonia may anxious enquiry or complaint. This department been the first attack of asthma. Nasal would also take over some of the duties now undercatarrh was present in 73 cases, enlarged tonsils taken by the almoner, would see to the notification of in 29, a tendency to run a temperature without relatives when a patient is on the danger-list, and obvious cause in 27, and " chills " preceding the make sure that every patient on discharge had suitable asthmatic attack in 31. Climatic influences were clothing, hair-cut and shave, at least a shilling in also considered, and in 29 patients it was thought money, a proper destination, and an escort. It that the asthma was influenced by the weather. would also see to the reception of mourners and Psychical shock appeared to be responsible for undertakers if the patient died. The anxiety of precipitating the asthmatic attack in one case. As relatives is often very seriously increased by their regards pathogenesis, Tuscherer sums up in favour inability to get any interview with a doctor, and of an unstable respiratory centre where stimuli Dr. Goodale suggests that representatives of the both from higher parts of the brain and from other house staff should be present in the lobby or a special parts of the body may precipitate an attack. room at certain fixed hours of the day, ready and Prognosis can be summarised by saying that of the willing to meet the relatives of their patients. We 152 patients 35 had lost their asthma before puberty, are hardly yet ready in this country for his final and 39 became clear of attacks after puberty. comparison of a hospital with a hotel, and his suggestion that hospital management has much to learn from successful inn-keeping. Hotel employees, he THE HOSPITAL PATIENT FROM HIS OWN says, have been trained to assume the attitude that the guest is always right and hotel managers have POINT OF VIEW. accumulated fortunes by astutely commercialising THE charge is often levelled against hospitals that the Biblical aphorism " A soft answer turneth away the patient is regarded as merely a case, while his wrath." Hospital employees and managers have personality is largely, if not entirely, neglected. To both these lessons to learn. They are seldom, he a, certain extent this is inevitable, and for the most admits, positively cruel, but their ignorance of part those admitted are so appreciative of the medical psychology and their lack of attention to the personal .and nursing attention they receive that they do not aspects of their patient result in a negative cruelty greatly resent the lack of that personal interest expressed by a lack of that inexhaustible supply which forms a large part of the private practitioner’s of kindness, consideration, and forbearance that the business. They are also marvellously tolerant of sick guest needs so much more than the healthy. Dr. A. T. Holbrook, in an article accompanying long delays and complicated processes which are never explained to them. Nevertheless there Dr. Goodale’s, maintains that hospitals are used has been a definite change of attitude since the too much for cases which might be treated outside hospital service has been extended to the middle them if the general practitioner made more careful classes. Dr. W. S. Goodale who takes up the examinations and used comparatively simple laboracudgels on behalf of the patient as an individual, tory equipment in his own surgery. He also blames urges the speeding-up and synchronising of such the practitioner for the state of affairs of which he preliminaries as the admission history, the bath, complains so bitterly-i.e., that he is becoming a the interview with the almoner, the students’ and mere directing-post to specialists. The general house officer’s history and examination, and the practitioner of the future, he says, must have two delayed and all-too-brief and uncommunicative qualifications-competence and honesty. He must visit of the physician or surgeon. The patient’s be able to recognise and willing to call in help for next trouble is his food. The " house diet," says conditions that are beyond him, but he must also Dr. Goodale, " unalterable as the laws of the Medes be prepared to do conscientious and scientific and Persians, and garnished with a prune, apparently diagnostic work in a measure quite uncontemplated is planned for its calories and vitamins but with by his predecessors. little regard, if any, for individual taste, much less national appeal." Why should not attractive THE PATHOGENY OF ANGINA PECTORIS. alternatives be offered ? He next attacks hospital MANY hypotheses have been formulated to account smells and sounds, and contrasts the filtered, washed and cooled air of the picture palace with the mixed for the pain of angina pectoris, but of them two only odour of iodoform, carbolic, creosote, sweat, bad have received much support. The one attributes teeth, and boiling vegetables that the hospital patient the condition to disease of the aorta, the other to sometimes has to breathe. He also urges daily coronary arterio-sclerosis. Neither is completely visiting for all convalescent patients ; since this is satisfying, for the accused organ has been found allowed in private wards it cannot be consideration healthy at autopsy in unquestioned cases of angina, for the patient’s welfare that restricts visiting in while gross lesions of the aorta or of the coronary the public ward to four or five hours a week. He arteries may be present in patients who have never - criticises the inadequate supply of nurses, and experienced anginal pain. The absence of pain in " remarks, If there is one nurse allotted to 10 or 12 patients with advanced coronary disease may possibly patients during the day-watch and one nurse to be accounted for by a hyposensitive nervous 18 or 20 during the night-watch, the observing mechanism ; but the occurrence of angina in the patient is soon able to phrase a fairly good working absence of any obvious anatomical lesion calls for definition of ’delayed service.’ ..... Why not a further explanation. Probably it would be more patrol nurse whose sole duty is to visit all patients correct to speak of angina, not as a disease, but as a voluntarily and to inquire whether or not she can be syndrome which may be attributable to various causes of service ? " The tediousness of convalescence can which all act in a similar way-namely, by producbe greatly reduced by a good library service and an ing anoxaemia of the heart muscle. The whole subject educational occupation system. His proposed social is critically reviewed by Dr. Douglas Hubble elseservice involves several revolutionary suggestions. where in our present issue. Diagnosis cannot be The remark " no inquiries about patients can be regarded as satisfactory until it is possible to say answered by telephone " is familiar enough in the which cause of pain is operative in any particular telephone directory and is certainly necessary as case. Already one definite pathological entity has long as one harassed porter has to attend two large been separated off from the group of lesions which switch-boards as well as perform the ordinary duties may produce cardiac pain. That condition is cardiac of a door-man. Dr. Goodale suggests that a special infarction following thrombosis or embolic occlusion social service should deal with all contacts with the of one of the larger branches of the coronary arteries. In addition to pain following the anginal distribution cardiac infarction is accompanied by dyspnoea, 1 Jour. Amer. Med. Assoc., March 29th, p. 905. of course, the
really have
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cough in 22 patients, measles in 11, and pneumonia public, providing a medium through which relatives in 22. In connexion with the last-named there is, and friends can blow off steam, whether by way of
fallacy that so-called pneumonia may anxious enquiry or complaint. This department been the first attack of asthma. Nasal would also take over some of the duties now undercatarrh was present in 73 cases, enlarged tonsils taken by the almoner, would see to the notification of in 29, a tendency to run a temperature without relatives when a patient is on the danger-list, and obvious cause in 27, and " chills " preceding the make sure that every patient on discharge had suitable asthmatic attack in 31. Climatic influences were clothing, hair-cut and shave, at least a shilling in also considered, and in 29 patients it was thought money, a proper destination, and an escort. It that the asthma was influenced by the weather. would also see to the reception of mourners and Psychical shock appeared to be responsible for undertakers if the patient died. The anxiety of precipitating the asthmatic attack in one case. As relatives is often very seriously increased by their regards pathogenesis, Tuscherer sums up in favour inability to get any interview with a doctor, and of an unstable respiratory centre where stimuli Dr. Goodale suggests that representatives of the both from higher parts of the brain and from other house staff should be present in the lobby or a special parts of the body may precipitate an attack. room at certain fixed hours of the day, ready and Prognosis can be summarised by saying that of the willing to meet the relatives of their patients. We 152 patients 35 had lost their asthma before puberty, are hardly yet ready in this country for his final and 39 became clear of attacks after puberty. comparison of a hospital with a hotel, and his suggestion that hospital management has much to learn from successful inn-keeping. Hotel employees, he THE HOSPITAL PATIENT FROM HIS OWN says, have been trained to assume the attitude that the guest is always right and hotel managers have POINT OF VIEW. accumulated fortunes by astutely commercialising THE charge is often levelled against hospitals that the Biblical aphorism " A soft answer turneth away the patient is regarded as merely a case, while his wrath." Hospital employees and managers have personality is largely, if not entirely, neglected. To both these lessons to learn. They are seldom, he a, certain extent this is inevitable, and for the most admits, positively cruel, but their ignorance of part those admitted are so appreciative of the medical psychology and their lack of attention to the personal .and nursing attention they receive that they do not aspects of their patient result in a negative cruelty greatly resent the lack of that personal interest expressed by a lack of that inexhaustible supply which forms a large part of the private practitioner’s of kindness, consideration, and forbearance that the business. They are also marvellously tolerant of sick guest needs so much more than the healthy. Dr. A. T. Holbrook, in an article accompanying long delays and complicated processes which are never explained to them. Nevertheless there Dr. Goodale’s, maintains that hospitals are used has been a definite change of attitude since the too much for cases which might be treated outside hospital service has been extended to the middle them if the general practitioner made more careful classes. Dr. W. S. Goodale who takes up the examinations and used comparatively simple laboracudgels on behalf of the patient as an individual, tory equipment in his own surgery. He also blames urges the speeding-up and synchronising of such the practitioner for the state of affairs of which he preliminaries as the admission history, the bath, complains so bitterly-i.e., that he is becoming a the interview with the almoner, the students’ and mere directing-post to specialists. The general house officer’s history and examination, and the practitioner of the future, he says, must have two delayed and all-too-brief and uncommunicative qualifications-competence and honesty. He must visit of the physician or surgeon. The patient’s be able to recognise and willing to call in help for next trouble is his food. The " house diet," says conditions that are beyond him, but he must also Dr. Goodale, " unalterable as the laws of the Medes be prepared to do conscientious and scientific and Persians, and garnished with a prune, apparently diagnostic work in a measure quite uncontemplated is planned for its calories and vitamins but with by his predecessors. little regard, if any, for individual taste, much less national appeal." Why should not attractive THE PATHOGENY OF ANGINA PECTORIS. alternatives be offered ? He next attacks hospital MANY hypotheses have been formulated to account smells and sounds, and contrasts the filtered, washed and cooled air of the picture palace with the mixed for the pain of angina pectoris, but of them two only odour of iodoform, carbolic, creosote, sweat, bad have received much support. The one attributes teeth, and boiling vegetables that the hospital patient the condition to disease of the aorta, the other to sometimes has to breathe. He also urges daily coronary arterio-sclerosis. Neither is completely visiting for all convalescent patients ; since this is satisfying, for the accused organ has been found allowed in private wards it cannot be consideration healthy at autopsy in unquestioned cases of angina, for the patient’s welfare that restricts visiting in while gross lesions of the aorta or of the coronary the public ward to four or five hours a week. He arteries may be present in patients who have never - criticises the inadequate supply of nurses, and experienced anginal pain. The absence of pain in " remarks, If there is one nurse allotted to 10 or 12 patients with advanced coronary disease may possibly patients during the day-watch and one nurse to be accounted for by a hyposensitive nervous 18 or 20 during the night-watch, the observing mechanism ; but the occurrence of angina in the patient is soon able to phrase a fairly good working absence of any obvious anatomical lesion calls for definition of ’delayed service.’ ..... Why not a further explanation. Probably it would be more patrol nurse whose sole duty is to visit all patients correct to speak of angina, not as a disease, but as a voluntarily and to inquire whether or not she can be syndrome which may be attributable to various causes of service ? " The tediousness of convalescence can which all act in a similar way-namely, by producbe greatly reduced by a good library service and an ing anoxaemia of the heart muscle. The whole subject educational occupation system. His proposed social is critically reviewed by Dr. Douglas Hubble elseservice involves several revolutionary suggestions. where in our present issue. Diagnosis cannot be The remark " no inquiries about patients can be regarded as satisfactory until it is possible to say answered by telephone " is familiar enough in the which cause of pain is operative in any particular telephone directory and is certainly necessary as case. Already one definite pathological entity has long as one harassed porter has to attend two large been separated off from the group of lesions which switch-boards as well as perform the ordinary duties may produce cardiac pain. That condition is cardiac of a door-man. Dr. Goodale suggests that a special infarction following thrombosis or embolic occlusion social service should deal with all contacts with the of one of the larger branches of the coronary arteries. In addition to pain following the anginal distribution cardiac infarction is accompanied by dyspnoea, 1 Jour. Amer. Med. Assoc., March 29th, p. 905. of course, the
really have
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