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had taken six years, but all the effort was worth-while. I was
anxious to begin, but I needed a certain amount of equipment at the
clinic to start me off. I knew there was nothing the in County
estimates because we could not anticipate when the consent would
come, or even if it would have come at all, and I was anxious to
exercise the greatest economy and keep the initial expenditure to
the absolute minimum.
Disappointment.
I asked the County Medical Officer to obtain consent for expenditure
of about £200 for the instruments which I could not improvise.
He refused. He said this clinic should be an advisory
clinic aimed at helping old people to understand the proper measures
to adopt to safeguard the maintenance of their health, and that
any departure from normal would be referred either to the patient's
own doctor or to the hospital for further investigation. It was
thought that in the course of an ordinary interview with the old
person, by some magical means it would be revealed to me whether
or not there was anything wrong; and that this would form a firm
basis for advice about the maintenance of health or the need to go
to another doctor or hospital. The clinic would thus be run on
"conventional" lines. As no examinations were to be carried out,
no equipment for medical examination would be necessary. I was
supposed to rely upon insight or flair.
The local practitioners thought little of this idea. They said
in effect "do not send us rubbish". I was thus in a dilemma. If I
pretended to examine my visitors, and then pronounce them either
fit or else in need of medical attention because of some particular
disability, the hollowness of such a method would at once be apparent.
But if I were to set about dicovering the diseases and disabilities
which were found in cur earlier survey and which I knew quite well
existed in the so called healthy population, then I would have to
do examinations and I would have to have the equipment to do them
with.No other course seemed to me to be possible. I felt it to be
unethical and inhuman to try to do the work anything but professionally
and properly.
A "conventional" clinic for babies is presumably one where
advice is given about the health of the baby. But the baby is examined
to see if there is anything wrong and nobody objects to
that. A "conventional" school clinic is again one where children
are examined and advice given. I should have thought that a conventional
geriatric health clinic would be one where also the
elderly are examined and advised. It is impossible to give advice
without examination. The difference between clinics for babies and
children, and clinics for older persons is that diseases and disabilities
are present in the older people which never appear in the
children. The detection of these disabilities requires much more
complicated equipment than it does for children; our children's
clinics have never been equipped for this work.
The refusal of consent for expenditure on the instruments was
disheartening and I was bitterly disappointed. For the fundamental
reason for the clinic had evidently been quite forgotten that there
exist in the population people with disabilities who do not know
they have them, and that it is good business to get these people
back to health and to keep them healthy.
Progress.
I had been going to the local hospitals for years, and very
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