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THE EFFECTS OF CHANGES IN MEDICAL TREATMENT AND NPRSING
Care of Patients in their own Homes and Facilities
offered by Local Authorities
(Precis of a lecture given by Dr. J. M. Packer at the Nurses' Study Day,
East Suffolk County Council - 25th March, 1963.)
Before turning to the subject of this lecture, it is necessary to take a
look at certain changes in those who require medical treatment and nursing, for
there is a changing age structure of the population of this country. The Royal
Commission on Population in 1949 reported that between 1871 and 1947 the number
of people over 65 in Great Britain increased fourfold, and the proportion rose
from 4.8 per cent, to 10.4 per cent. They estimated that in 1977, 16 per cent,
of the population would be over 65. The latest figures available at the present
time show that in 1961, out of a total population of 46,000,000 in England and
Wales, there were 5½ million aged 65 and over. During the decade leading up to
this year the proportion of elderly persons in the population rose at the rate
of one per thousand each year, and now stands at the record level of 120 per
thousand. The numbers of births have risen sharply since 1955. In 1961 there
were 811,000 births, an increase of 3.3 per cent, above the figure for 1960,
and equivalent to a birth rate of 17.6 per 1,000 population. Couples are
marrying earlier now than they were a few years ago, and consequently commencing
child-bearing earlier. There is also a tendency for married couples to
reduce the average time interval between births. Whether or not there will be
an increase in the average size of family it is too soon to say, but if this
does come about it will alter the proportions of people in the various age
groups as estimated by the Royal Commission. What is certain is that the
numbers of people living to old age will increase, and this age group makes
great demands on the services of the local authorities.
Changes in Medical Treatment
Over the past twenty years, knowledge has increased so rapidly that
medical treatment has been revolutionised. The introduction of antibiotics
and chemotherapeutic agents has given us a large measure of control of infections.
The great majority of doctors who have qualified in recent years have
never seen the classical crisis of lobar pneumonia. I myself can remember, as
a student, a colsultant showing us with great pride his first case of tuberculous
meningitis whose life had been saved by Streptomycin. The child was
stone deaf and had severe brain damage, and would require intensive care for
the rest of his life. But it was a great advance, in those days, for a patient
even to survive the illness. Nowadays, of course, one would hope not merely
to be able to save the patient's life, but to make the diagnosis and commence
treatment early enough to enable the patient to make a full recovery.
Surgery and anaesthetics have also made great advances with the result
that operations can now be attempted on patients whose general condition would
have precluded operation in former times, for example the elderly patient with
a hernia or with intestinal obstruction. Intracardiac surgery, arterial
grafting, and embolectomy have given a new lease of life to many people. The
outlook for patients with carcinoma is continually improving, though the
problem still remains of getting patients early enough to secure the best
results. Neurosurgery is being developed rapidly and can bring about a
dramatic improvement in suitable cases. The patient with Parkinson's disease,
for example, who does not respond well to drugs and who may be severely handicapped
by his condition, may be completely cured and thereby rendered
independent by surgical intervention.
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