135

man’s time is occupied in private practice or in someactivity outside either the N.H.S. or research.

,

RESEARCH WORK ABROAD

Although research abroad is catered for to some extentthrough travelling fellowships, secondment, study leave,and the like, existing powers under the N.H.S. Acts donot extend to the financing of a unit abroad. In certaincircumstances, it might be an advantage to send clinicalresearch-workers or even units abroad-e.g., when itwould be profitable to study some tropical conditionrelated to the subject of research at home. The white-

paper recommends that the central research organisa-tion should be empowered to make, when necessary,arrangements for work abroad. -

TREATMENT OF POLIOMYELITIS IN

HOSPITALS

THE following recommendations, which have beenendorsed by the Central Health Services Council, havebeen circulated to hospital authorities by the Ministryof Health (R.H.B.[53]75).Wherever practicable, poliomyelitis should be treated

in hospital units with a highly trained and experiencedteam equipped to deal with the disease. Some con-centration of cases in such units is essential if the teamsare to have sufficient work to give them the experiencethey require. The team should include a surgeon or

physician competent to deal with the respiratory compli-cations of poliomyelitis and-most important-a seniorresident of at least registrar grade, specially trained forthis work, who would be available to be called in at amoment’s notice to deal with the sudden changes whichare a characteristic of the disease. Orthopaedic adviceshould also be available at the unit, together withfacilities for physiotherapy in paralytic cases, andnurses who have had training in the management of

patients in artificial respirators as well as the more usualtechniques.The concentration of cases in suitable units would of

course be limited to some extent by the undesirabilityof long ambulance journeys during the acute phase ofthe disease.

Facilities for isolation are, of course, more readilyprovided in hospitals for infectious diseases than in

general hospitals, whereas the facilities for treatmentoutlined in preceding paragraphs are most readilyavailable in general hospitals. Since hospitals forinfectious diseases are usually included in groups withgeneral hospitals and are now increasingly used in partas general hospitals, it should be practicable to providethe necessary treatment facilities in any large infectiousdiseases hospital chosen to house a poliomyelitis unit.Failing this, a special unit might be provided in a generalhospital if adequate arrangements for isolation are

practicable.When a properly equipped and staffed special unit is

not available within a reasonable distance, it may be

necessary to arrange special separate isolation accom-modation in other hospitals, e.g., general or orthopedic.The hospital selected should be within an hour’s ambu-lance journey and preferably well within this limit.Except in an emergency, acute cases of poliomyelitis

should not be nursed in cubicles attached to children’swards, and all multiple bed isolation wards should havethe customary 12 feet between bed centres and a separatestaff (if possible living apart from the other nurses).Acute cases of poliomyelitis amongst the hospital staffshould be segregated in the same way as with otherpatients.No confirmed cases of poliomyelitis should leave

hospital within 3 weeks of a(tiiiis,-4ion. Poliomyelitis

patients should not, however, be allowed to return to a,

susceptible community of children-e.g., a school,children’s home or day nursery-until the expiry of6 weeks after the onset of the disease.Boards are asked to review the position in their

regi’ons forthwith and to consider how to give effect tothe above recommendations where something on theselines has not already been done.

1. See Lancet, 1953, i, 191.

WORK OF THE KING’S FUNDH.R.H. the DUKE OF GLOUCESTER, presiding at the

annual meeting of ’King Edward’s Hospital Fund forLondon on July 7, said that in the five years since theinstitution of the National Health Service a good partof the energies and moneys of the Fund had gone intoeducational activities, and with the inauguration ofthe course for prospective matrons the present serieswould be complete.

" We believe that if the different members of the hospitalstaff-administrators and matrons, ward sisters and financeofficers, caterers and the rest-can be encouraged to workclosely together and to foster a good understanding some-thing really important will have been achieved. The constant

entry to our various training centres of people with day-to-day knowledge of hospital work, and their discussions with themany experts who help us in our educational activities, shouldresult in real advance in the whole pattern of hospitaladministration, understood in its widest sense."

Speaking about other sides of the Fund’s work, theDuke welcomed the Minister of Health’s encouragingwords to the National League of Hospital Friends lastJanuary.1 They had cleared away many misunder-standings about the part that voluntary workers couldplay in hospital service. There was now a lively spiritof enterprise on the part of many groups of hospitalfriends. The Fund was resuming the old system of thevisiting of hospitals by doctors and laymen working inpairs. The work of the distribution committee waschanging and they were now, for instance, helping’hospitals to devise gardens and to erect recreation hutsfor their staffs. They had recently opened a homefor nurses who had themselves become patients. Anotherproblem which the Fund had tackled, he continued, wasthe heavy pressure on hospital accommodation for oldpeople. It was beyond the power of the hospitals andtheir almoner staffs to visit the patients in their homesand decide on the spot what would be most useful.Much had been done to stimulate and encourage thevolunteer organisations, and for two years now theFund has been giving a special grant to the South EastRegional Hospital Board to make a liaison possible" in the detailed personal way that always brings results."There had been a striking improvement, and the waiting-lists were down to more manageable proportions evenin that populous area with its none too extensivehospital provision.

Sir EDWARD PEACOCK, the treasurer, said that thetotal income for 1952 was ;S467,000. Income frominvestments amounted to £340,000, legacies to over

.S65.000, and a further .850,000 was received from theNuffield Trust for the Special Areas. Grants to hospitalsand convalescent homes totalled .6171,000, a further;S100,000 was set aside for homes for the aged sick,whilst jB95,000 was absorbed by the staff colleges andother activities administered by the Fund. Totalexpenditure during the year thus amounted to .8413,000.Sir ERNEST PooLEY, chairman of the managementcommittee, said that the scheme for training prospectivematrons had been welcomed by many hospitals. Thefirst small group of candidates would begin their coursein September at 22, Holland Park, London. The Fundhad been helped during a new approach to training foradministrative work of this kind by Professor Whitehead,of the Harvard School of Business Administration, andit was hoped that this new venture would afford insightnot only into the best hospital practice but also into theways in which other big institutions were run so as toget the best out of their staff.