View report page

In the realm of obstetrics improved antenatal care and management of
delivery have reduced maternal mortality and morbidity to a low level and
resulted in much saving of infant life. The ready availability of blood transfusion
and other intravenous fluids has saved many lives, and mechanical aids
such as the "iron lung" and the "artificial kidney" have also played their part.
The early mobilisation of patients post-operatively, after delivery, and
after coronary occlusion has been to the benefit of the patient and has also
resulted in earlier discharge from hospital. This in turn brings about increased
demands upon the domiciliary care services.
A remarkable transformation has taken place within our mental hospitals
where, due to modem psychiatric treatment - E.C.T., drugs, social therapy
patients with many types of mental illness may be admitted to hospital for short
periods of treatment and be so improved that they may be discharged home again.
This- is in marked contrast to the situation which used to exist when the patient
admitted to a mental hospital could expect to remain there for a prolonged
period, if not for the rest of his life. The pendulum has now swung so much
the other way that there is evidence that too many patients may be discharged
too soon, imposing an intolerable strain upon their relatives as well as upon
the facilities for community care. Increased experience should result in better
selection of cases suitable for early discharge.
While there have been these great strides forward in the treatment of
established disease, preventive medicine has by no means lagged behind. We
place great emphasis on the detection of abnormalities at the first possible
moment. In most parts of the country, testing for phenylketonuria is carried
our routinely on infants between the ages of 2 and 6 weeks. Congenital dislocation
of the hip should be diagnosed in the early months of life, certainly
before weight-bearing commences. We should detect severe deafness by the time
the child is six months old. These are just a few of the defects which should
be looked for routinely in all infants. Then, too, we must consider the great
reductions in the incidence of certain infectious diseases brought about by
immunisation procedures. Largely due to immunisation, diphtheria notifications
which in the decade 1933-42 averaged 55,000 a year, had fallen to only 51 by
1961. Notifications of poliomyelitis are falling, and not so long ago an outbreak
of this disease at Hull was rapidly brought under control by the use of
the oral vaccine.
Effects of the Changes
It is evident that modern treatments bring about more rapid and more complete
recovery from many illnesses and operations. This is very obvious in
the case of tuberculosis. Furthermore, prompt admission to hospital and faster
elimination of tubercle bacilli from the sputum reduce the risk of spread of
infection; hence new notifications fall. Round about the end of the war there
were 53,000 cases notified per annum. Prom 1948 to 1953 there was a slow fall
to about 47,000 cases, and thereafter there was a steady fall to the latest
figure of 21,747 (for 1961). This has made a great difference to the work of
the district nurse by reducing the number of cases of tuberculosis she has to
attend, although the number of visits per case may rise, due to old resistant
cases.
But there is another side to the picture. Our very success can create
other, long-term problems. We keep alive the elderly, the mentally subnormal,
and the severely ill who would formerly have died.
The elderly inevitably must deteriorate sooner or later, but this is no
reason to "write them off". They are subject to arthritis, diabetes, mental
deterioration, cancer, and general, increasing frailty. They require more
67