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for arthritic patients or those suffering the after-effects of a cerebral
catastrophe. This must be linked with the realisation that something can be
done for the chronic sick and the aged.
One class of patient for whom present provision is inadequate is the frail
incontinent patient who is more than the domiciliary services can cope with,
but who is refused admission to hospital (because he is only incontinent) and
to the old people's hostel (because the staff cannot cope with incontinence).
The patient needs someone on call full-time who has sufficient training to cope
with the problem. Where relatives or neighbours are available, they may be
trained by the district nurse. For the remainder, it is impossible for Local
Authorities to provide enough staff with even the most basic nursing training
for each of these patients to be attended full-time in their own homes. The
solution may be to equip the hostels suitably and provide, say, a State
Enrolled Nurse on the staff so that such patients may be admitted there.
Finally, I believe that we need to assist our patients to find a philosophy
of life. As Dr. Cullinan of St. Bartholomew's Hospital has said: "In this
scientific age man is often vague and uncertain about his fundamental beliefs.
He believes in science and has made it a sort of god. But that is not much use
to him ... Even if we learn 'how' life works we can never know the reason
'why' ... Man is obviously something more than the sum of his physical
parts."
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