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THE HOSPITAL SERVICE
514
Letters to the Editor THE HOSPITAL SERVICE
SIR,—I read with great interest Professor Thomson’s article in your issue of Feb. 20, and, as a medical officer of health, I was particularly interested in the shorter average stay of patients in American hospitals, as compared with the custom here. This, of course, cannot be universal, for in Cambridge, for instance, a scheme for early discharge home is well established. This scheme was described at the annual summer school of the county-borough group of the Society of Medical Officers of Health last year, and it involves the closest cooperation between hospital staff, general practitioners, and the local-health-authority services. As coordination of the three artificial divisions of the health service improves in all areas, so it may be hoped an ever more economic use will be made of hospital beds. There is another. aspect of the matter to which some attention has been paid in Darlington-namely the training of housewives in the elements of home nursing. When all is said and done, illness, like most other things, is a family matter, and doctors, nurses, and other helpers are auxiliaries to what the family can provide for itself. At least, this would seem to be the natural order, and too great a reliance upon services supplied by the State seems to lead in due course to a disorder involving even The more that wives, these services themselves. daughters, mothers, and sisters are prepared to undertake, and the more responsibilities they will accept, the better for society ; and nursing is a natural and recurrent occasion for their service. A number of courses, each of six sessions given by health visitors, have been arranged for women in Darlington through various groups and organisations with whom the health department is in contact. At first the women came in response to fairly intense propaganda by talks and bulletin letters. When this barrage was halted no further applicants came forward and I thought that this would be one more good idea to end in failure. But after a lapse of some months a spontaneous demand a,rose for a continuation of the courses and more have been given during the last several weeks. It seems to me to be potentially a most useful development in health education. On quite another front, home nursing might be included as a subject in the last year of compulsory schooling, not only at senior modern but at junior technical and grammar schools as well. JOSEPH V. WALKER Health Department, Darlington.
tions who have shown a good deal of interest in the establishment of the fund and offered much help and
encouragement. Secondly, the trustees have examined a number of specific projects which they consider would bè appropriate for the Clare Wand Fund to undertake, and the following are among the suggestions that have been made :
(1) Travelling scholarships to study methods of practice, point of view of clinical method or of organisation. -(2) Financial help to general practitioners (a) to enable
either from the
them to carry out research, particularly in subjects which are regarded as primarily the concern of the general practitioner; and (b) to assist them to take postgraduate degrees or diplomas, including original work for a thesis. (3) Sponsored lectures and demonstrations for groups of general practitioners in their own localities for purposes of revision and keeping up to date.
Medical Officer of Health.
THE CLARE WAND FUND
SIR,—At the last Annual Conference of Local Medical Committees the chairman of the conference gave a brief report on the progress of the Clare Wand Fund, which it will be remembered was established as a mark of appreciation of the services rendered to the profession by the chairman and secretarv of the General Medical Services Committee during the course of the long negotiations which led up to the Danckwerts award. The trustees of the fund wish to express their grateful thanks to all those local medical committees and individual general practitioners who have responded to their appeal and are glad to be able to report that as a result upwards of ;E12,000 now stands to the fund’s credit. When making their appeal the trustees stated that the principal object of the fund would be to provide educational assistance to those in general practice, and since then a good deal of thought has been given to the precise use to which the fund should be put. Firstly, the trustees wish to encourage projects which will enhance the prestige of general practice itself, and they have been in touch with a number of organisa-
For the time being, the trustees havedecided to keep the allocation of grants approximately within the limits of the fund’s investment income, and this will mean that for the next twelve months about noo will be available to finance approved projects. It is obvious that this figure may restrict the trustees in making grants for research projects which they might otherwise have wished to encourage, and it is hoped that in certain cases it may be possible to provide financial assistance by means of a loan. These suggestions are tentative and exploratory and any additional suggestion which comes within the broad objective of the fund, whether designed to enhance the status of general practitioners, or individual items of research, will be sympathetically examined. The trustees are anxious to receive all the help they can in launching the fund, and they hope that practitioners who wish to avail themselves of the oppor. tunities which the fund offers, either for purposes on the lines indicated or for other projects which they themselves wish to suggest, will not hesitate to get in touch with them. Full details should be sent with any application, which should be addressed to the secretary of the Clare Wand Fund, Mr. R. H. Currer, at British Medical Association
general
House, Tavistock Square, London, W.C.1. S. WAND Chairman.
THE DUMPING SYNDROME on two assertions made in his Dr. Pulvertaft by very interesting article of Feb. 13 and discussed in your leading article. My comments are based on a series of over 100 Polya-type gastrectomies for duodenal ulcer, in which a Roux en-Y anastomosis was performed in order to prevent the post-gastrectomy syndrome. This series was published last year by Mr. P. St. G. Anderson and myself,l and showed the effect of deviation of the afferent loop on the
SIR,—I should like to comment
post-gastrectomy syndrome. Dr. Pulvertaft has claimed that the vasomotor symp toms after partial gastrectomy are caused by the exces-
of sugar from the intestine. In series of Y anastomoses undertaken to prevent the post-gastrectomy syndrome, with special reference to bilious vomiting, there is no single case with vasomotor Furthermore, I have converted 12 cases of symptoms. " dumping-" after Polya partial gastrectomy to a Roux en-Y anastomosis. All 12 patients had bilious vomiting and 5 had vasomotor symptoms. Not only were they all relieved of bilious vomiting, but also the vasomot-0r symptoms in the 5 cases completely disappeared. My second comment is concerned with the statement that the higher the level of transection of the stomach the " greater the risk of dumping," and that the incidence of vasomotor symptoms can be correlated with the extent of resection, but not with any particular modification of
sively rapid absorption our
1. Brit. med. J.
1953, ii, 598.
Letters to the Editor THE HOSPITAL SERVICE
SIR,—I read with great interest Professor Thomson’s article in your issue of Feb. 20, and, as a medical officer of health, I was particularly interested in the shorter average stay of patients in American hospitals, as compared with the custom here. This, of course, cannot be universal, for in Cambridge, for instance, a scheme for early discharge home is well established. This scheme was described at the annual summer school of the county-borough group of the Society of Medical Officers of Health last year, and it involves the closest cooperation between hospital staff, general practitioners, and the local-health-authority services. As coordination of the three artificial divisions of the health service improves in all areas, so it may be hoped an ever more economic use will be made of hospital beds. There is another. aspect of the matter to which some attention has been paid in Darlington-namely the training of housewives in the elements of home nursing. When all is said and done, illness, like most other things, is a family matter, and doctors, nurses, and other helpers are auxiliaries to what the family can provide for itself. At least, this would seem to be the natural order, and too great a reliance upon services supplied by the State seems to lead in due course to a disorder involving even The more that wives, these services themselves. daughters, mothers, and sisters are prepared to undertake, and the more responsibilities they will accept, the better for society ; and nursing is a natural and recurrent occasion for their service. A number of courses, each of six sessions given by health visitors, have been arranged for women in Darlington through various groups and organisations with whom the health department is in contact. At first the women came in response to fairly intense propaganda by talks and bulletin letters. When this barrage was halted no further applicants came forward and I thought that this would be one more good idea to end in failure. But after a lapse of some months a spontaneous demand a,rose for a continuation of the courses and more have been given during the last several weeks. It seems to me to be potentially a most useful development in health education. On quite another front, home nursing might be included as a subject in the last year of compulsory schooling, not only at senior modern but at junior technical and grammar schools as well. JOSEPH V. WALKER Health Department, Darlington.
tions who have shown a good deal of interest in the establishment of the fund and offered much help and
encouragement. Secondly, the trustees have examined a number of specific projects which they consider would bè appropriate for the Clare Wand Fund to undertake, and the following are among the suggestions that have been made :
(1) Travelling scholarships to study methods of practice, point of view of clinical method or of organisation. -(2) Financial help to general practitioners (a) to enable
either from the
them to carry out research, particularly in subjects which are regarded as primarily the concern of the general practitioner; and (b) to assist them to take postgraduate degrees or diplomas, including original work for a thesis. (3) Sponsored lectures and demonstrations for groups of general practitioners in their own localities for purposes of revision and keeping up to date.
Medical Officer of Health.
THE CLARE WAND FUND
SIR,—At the last Annual Conference of Local Medical Committees the chairman of the conference gave a brief report on the progress of the Clare Wand Fund, which it will be remembered was established as a mark of appreciation of the services rendered to the profession by the chairman and secretarv of the General Medical Services Committee during the course of the long negotiations which led up to the Danckwerts award. The trustees of the fund wish to express their grateful thanks to all those local medical committees and individual general practitioners who have responded to their appeal and are glad to be able to report that as a result upwards of ;E12,000 now stands to the fund’s credit. When making their appeal the trustees stated that the principal object of the fund would be to provide educational assistance to those in general practice, and since then a good deal of thought has been given to the precise use to which the fund should be put. Firstly, the trustees wish to encourage projects which will enhance the prestige of general practice itself, and they have been in touch with a number of organisa-
For the time being, the trustees havedecided to keep the allocation of grants approximately within the limits of the fund’s investment income, and this will mean that for the next twelve months about noo will be available to finance approved projects. It is obvious that this figure may restrict the trustees in making grants for research projects which they might otherwise have wished to encourage, and it is hoped that in certain cases it may be possible to provide financial assistance by means of a loan. These suggestions are tentative and exploratory and any additional suggestion which comes within the broad objective of the fund, whether designed to enhance the status of general practitioners, or individual items of research, will be sympathetically examined. The trustees are anxious to receive all the help they can in launching the fund, and they hope that practitioners who wish to avail themselves of the oppor. tunities which the fund offers, either for purposes on the lines indicated or for other projects which they themselves wish to suggest, will not hesitate to get in touch with them. Full details should be sent with any application, which should be addressed to the secretary of the Clare Wand Fund, Mr. R. H. Currer, at British Medical Association
general
House, Tavistock Square, London, W.C.1. S. WAND Chairman.
THE DUMPING SYNDROME on two assertions made in his Dr. Pulvertaft by very interesting article of Feb. 13 and discussed in your leading article. My comments are based on a series of over 100 Polya-type gastrectomies for duodenal ulcer, in which a Roux en-Y anastomosis was performed in order to prevent the post-gastrectomy syndrome. This series was published last year by Mr. P. St. G. Anderson and myself,l and showed the effect of deviation of the afferent loop on the
SIR,—I should like to comment
post-gastrectomy syndrome. Dr. Pulvertaft has claimed that the vasomotor symp toms after partial gastrectomy are caused by the exces-
of sugar from the intestine. In series of Y anastomoses undertaken to prevent the post-gastrectomy syndrome, with special reference to bilious vomiting, there is no single case with vasomotor Furthermore, I have converted 12 cases of symptoms. " dumping-" after Polya partial gastrectomy to a Roux en-Y anastomosis. All 12 patients had bilious vomiting and 5 had vasomotor symptoms. Not only were they all relieved of bilious vomiting, but also the vasomot-0r symptoms in the 5 cases completely disappeared. My second comment is concerned with the statement that the higher the level of transection of the stomach the " greater the risk of dumping," and that the incidence of vasomotor symptoms can be correlated with the extent of resection, but not with any particular modification of
sively rapid absorption our
1. Brit. med. J.
1953, ii, 598.