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care and attention, both of a general nature and specifically nursing care. The
former may be provided by relatives or friends, or by home helps, or in welfare
hostels. The increasing numbers of the elderly are making greater demands on
all these. So far as relatives are concerned, a married couple have both the
husband's parents and the wife's parents to look after (to say nothing of their
own children). The home help service is invaluable. Here in East Suffolk in
I960 the home help service dealt with 875 chronic sick, aged and infirm out of
a total of 1,232 cases, doubtless the majority of these being "aged". Nursing
attention is required for bathing, "pressure points", injections, and dressings.
The care of the elderly requires more prolonged visits by the district nurse
over a longer period, but rather less frequently. An investigation in Lancashire
some while ago showed that the average number of visits per case was 50 per cent,
higher than 8 years previously; the average duration of cases had more than
doubled, but the average number of visits per case per week had fallen by
slightly less than one third. The Ministry of Health estimates that two-thirds
of the patients nursed by home nurses are over 65 years of age, and the proportion
will increase.
The mentally subnormal used to show a marked tendency to succumb to
respiratory infections. When I was a student I was taught that one almost never
saw a mongol aged over 20. That is no longer true. Mentally handicapped adults
need to be provided with suitable occupation and general supervision, and in
this connection it must be remembered that these people may now outlive their
parents. The Local Authority is responsible for making provision to meet these
needs.
The severely ill may be kept alive, but incapacitated. Rehabilitation of
the adult patient (work training and help in adjusting to a new way of life)
must be provided for. There is also the problem of providing assistance
throughout life for the infant who survives with severe congenital abnormalities,
cerebral palsy, and so on.
Modem treatment is not without its hazards, as witness the emergence of
organisms resistant to antibiotics, nurses' allergy to Penicillin and Streptomycin,
retrolental fibroplasia, and "Thalidomide babies". A subtler hazard is
the temptation to practise "lazy medicine" - for instance, putting a patient
on successive courses of antibiotics without having made a proper diagnosis.
Changes in the Administration of Treatment
The number of injections is declining as more and more treatment can be
given by tablets and other forms of oral administration, e.g. oral Penicillin,
Tolbutamide in the treatment of diabetes. A welcome innovation is the introduction
of pre-sterilised, disposable syringes, and also disposable caps, masks
and surgical gloves. For the incontinent patient we now have absorbent pads,
which greatly reduce the work of changing and washing bedding, or in some
districts a special laundry service is provided for these patients.
There is a move in some places to use the district nurse to carry out preoperative
or pre-Xray treatment at home before the patient goes into hospital.
Present Heeds
An increasing emphasis is being placed upon health education, both in the
course of other work and in special sessions.
There should be continuance of all forms of treatment, including physiotherapy,
when a patient is discharged from hospital, where necessary, and
especially is this needed in the case of the elderly. Simple physiotherapy
can be performed by the district nurse, such as passive and remedial movements
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