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these sick persons comprise possibly only one quarter of those
needing medical attention. The health visitor is concerned with
the promotion and maintenance of health and the prevention of
breakdown in everybody - especially the three quarters who
rarely if ever visit their practitioner and yet still need medical
attention. Initially she makes the contact and offers her
professional skill, seeking to create attitudes of mind which take
a positive and active interest in maintaining health and developing
individual and family potential and resource to the full. She
works in the school health service, is a link between home and
school, is a contact with the hospital, gives group health
education lectures, contacts societies and clubs, is engaged in
training others, and takes part in research. We may seriously
ask ourselves whether the three-quarters who receive services
other than through practitioners would do better or worse by
"schemes of attachment." In one experimental attachment in this
area we have given a group of doctors the clinic medical officer
and all the ancillary services part-time for the needs of their
practice. We have thus preserved the expertise of the health team
for the use of this practice and the remainder of their time to
the needs of the authority services.
Progress in the Prevention Clinic for Older People.
In the prevention of disability in older people we have made
important advances. The techniques at our experimental clinic have
been vastly improved this last few years. We have come to understand
much better the causes of failing health in later life and
how to detect them at an earlier stage. These disabilities are
partly due to defective diets and partly to the deterioration of
the endocrine glands with diminution of the output of the body
hormones. We have devoted intense study to this problem and
believe we have made important contributions to the techniques
of replacement therapy. This work shows the urgent need for a
vast expansion of this service to the whole of the aged population
in the same way as the school health service and the infant welfare
service were brought in to look after the special needs of children.
If we were to do this there need be no retiring age at all; a
worthy contribution would be made towards the solution of the
problem of mental health and the prevention of mental deterioration
which so frequently comes on in later life; and substantial savings
would be made on the vast expenditure on supporting services for
the elderly both private and public.
Unifying the Service
Dr.N.Coghill and Dr.J.D.B. Andrews have recently commented
on the inadequacy of the provision of beds for older people at the
West Middlesex Hospital. At a recent meeting of the British Geriatric
Society a speaker put forward the view that the hospital beds and
the places in the Part III homes should be under the charge of the
hospital consultant geriatrician. I would go further than this and
say that the provision of hospital facilities for older people,
places in Part III homes, the provision of day treatment centres,
the prevention clinics for older people and certain special
screening techniques should all be in the hands of a unified
medical team.
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