HOSPITAL UNITY AT OXFORD
1
156 ANNOTATIONS HOSPITAL UNITY AT OXFORD OXFORD will soon have lost the reirains of her reputation as a home of lost causes. A pioneer in the hospital contributory scheme 17 years ago, she has now started a plan for the better coordinating of hospital services comparable to the one in opera- tion at Manchester.1 The Oxford and District Joint Hospitals Board, upon which the University, local public health authorities, and medical organisations are all represented, has been formed under Lord Nuffield as president. The primary function of the Board will be to make and keep continuous touch between the various hospitals in the area, the repre- sentatives of which will thus be able to confer often upon questions of local hospital service. One imme- diate and valuable effect of such liaison might be that cases which could not be admitted to one hospital, because all its beds were full, might be admitted without undue waste of time and money to another hospital not far away. The Board further suggests that appeals for contributions, at present circulated by each hospital separately, should be coordinated, thus saving expense and avoiding over- lapping. Provided that subscribers may earmark their subscriptions for a particular hospital if they so wish, the Board thinks that such coordination would lead to an increase rather than a decrease of contributions. Though it must be clearly under- stood that the Board will in no wise attempt to tamper with the actual administration of any of the hospitals, all of which will retain their identity and independence, it is hoped that, through their repre- sentatives on the Board, the hospitals will jointly consider schemes for hospital extension or the building of new hospitals suitable for the needs of the whole area. Further matters that might in the future be considered by the Board are the supplementing of present ambulance services and the provision of further facilities for convalescent treatment. More immediately, the Board has decided to cooperate in raising funds for the Banbury Hospital rebuilding scheme. Whether or no the voluntary hospital system itself is to be looked upon as a lost cause, it still has many staunch friends; and the best way in which they can help it to survive is to make it cooperate rather than conflict with municipal services. The Oxford and District Joint Hospitals Board is a step in the right direction and it seems likely that this attempt to secure local hospital unity will not long be confined to Manchester and Oxford. MASKS AND FACES WHEN our daily colleague grows a beard or our wife bobs her hair it is bound to be disturbing for a while to our companionship. There is no question as to whether the new style is better or worse than the old ; what upsets us is the fact of alteration, for nothing distracts us from the realities of life so much as chops and changes in its superficialities. Regular meals, a permanent Bradshaw, our own bed and old companions make for a free spirit which can go more easily and on better excursions if there is no disturb- ance in its temporal surroundings ; the real artist of the spirit is generally a steady family man of pretty fixed habits who cannot waste his capacity for adventure on wearing strange clothes and living a curious life. So there is bound to be some emotional 1 Lancet, 1936, 2, 1403. upset when one of the great English weeklies dresses up in new clothes, with as it happens a little lipstick thrown in. No one, except perhaps the printer, has thought of the British Medical Journal as a delicious example of typography, nor fondled its leaves with the affection of a bibliophile. We have known it and loved it as a faithful source of information and inspiration ; we wanted to listen to its talk, and never thought whether the familiar face we liked so well was handsome or ugly. The Practitioner and the Medical Press and Circular have also had a new outfit for Coronation year, and Nature not long since reformed its appearance. To readers and to writers it is all rather upsetting. But they are not the only people who are in fact concerned. The artistry of legible type and the technique of printing have devotees who are equally anxious for progress, and have equivalent progress to exploit, and if the new form is easier to read by so much will it make it easier for the reader to suck up advantage. And it will not be long before the new form becomes the familiar face. It reminds us of the kindly lady who looking at the memorial plaque of her husband which was just a fiasco said, " Oh, well, of course it isn’t a bit like him but people will soon believe that he was like it, so its all right." And so in the end we should be equally disturbed if the beard came off or the hair went back to a bun. A SURGICAL ATTACK ON PSYCHOSES THERE is at present no sign that timidity or con- servatism is holding up any advance in the treatment of mental disorder. Prof. Moniz, well known for his valuable and audacious work on cerebral angio- graphy, shows himself equally bold in attacking the problems of psychiatry. He decided, on theoretical grounds, to see what would be the effect of destroying tissues of the prefrontal region in each cerebral hemisphere of insane patients. His theoretical grounds, as presented here in detail, seem crudely neurological, naive, and faulty from the psychiatrist’s point of view, but that is not an important objection if the procedure so based leads to striking benefit. Prof. Moniz modestly puts forward the opinion, shared by his distinguished Lisbon colleagues, that striking benefit has in fact followed the operation in most of the twenty cases so far treated. He gives full details of these cases-in which excitement and anxiety were the prominent clinical features-to enable the reader to form an independent opinion. It is evident that in some of his patients the mental disorder cleared up surprisingly soon after operation, and there is no reason to dispute his provisional figures-viz., seven patients recovered, seven con- siderably improved, and six unchanged (of whom five were schizophrenics).]- Ten of the twenty patients were treated by injections of alcohol into the centrum ovale, ten by gouging out the tissue with a specially devised leucotome. Prof. Moniz, in his excellent account of what he did and what hap- pened afterwards, proves his point that the opera- tion has not had fatal or disconcerting effects, but he scarcely convinces the reader that it does more good than less heroic forms of treatment might. He is however so cautious, and even deprecating, in his gentle yet persuasive claims that others are sure to try the method and, if they follow his recommenda- 1 Tentatives opératoires dans le traitement de certaines psychoses. By Prof. Egas Moniz. Paris: Masson et Cie. 1936. Pp. 374. Fr. 40.
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Transcript of HOSPITAL UNITY AT OXFORD
156
ANNOTATIONS
HOSPITAL UNITY AT OXFORD
OXFORD will soon have lost the reirains ofher reputation as a home of lost causes. A pioneerin the hospital contributory scheme 17 years ago,she has now started a plan for the better coordinatingof hospital services comparable to the one in opera-tion at Manchester.1 The Oxford and District Joint
Hospitals Board, upon which the University, local
public health authorities, and medical organisationsare all represented, has been formed under LordNuffield as president. The primary function of theBoard will be to make and keep continuous touchbetween the various hospitals in the area, the repre-sentatives of which will thus be able to confer oftenupon questions of local hospital service. One imme-diate and valuable effect of such liaison might bethat cases which could not be admitted to one
hospital, because all its beds were full, might beadmitted without undue waste of time and money toanother hospital not far away. The Board furthersuggests that appeals for contributions, at presentcirculated by each hospital separately, should becoordinated, thus saving expense and avoiding over-lapping. Provided that subscribers may earmarktheir subscriptions for a particular hospital if theyso wish, the Board thinks that such coordinationwould lead to an increase rather than a decrease ofcontributions. Though it must be clearly under-stood that the Board will in no wise attempt totamper with the actual administration of any of thehospitals, all of which will retain their identity andindependence, it is hoped that, through their repre-sentatives on the Board, the hospitals will jointlyconsider schemes for hospital extension or the buildingof new hospitals suitable for the needs of the wholearea. Further matters that might in the future beconsidered by the Board are the supplementing ofpresent ambulance services and the provision offurther facilities for convalescent treatment. More
immediately, the Board has decided to cooperatein raising funds for the Banbury Hospital rebuildingscheme. Whether or no the voluntary hospitalsystem itself is to be looked upon as a lost cause,it still has many staunch friends; and the best
way in which they can help it to survive is to makeit cooperate rather than conflict with municipalservices. The Oxford and District Joint HospitalsBoard is a step in the right direction and it seemslikely that this attempt to secure local hospital unitywill not long be confined to Manchester and Oxford.
MASKS AND FACES
WHEN our daily colleague grows a beard or ourwife bobs her hair it is bound to be disturbing for awhile to our companionship. There is no questionas to whether the new style is better or worse thanthe old ; what upsets us is the fact of alteration, fornothing distracts us from the realities of life so muchas chops and changes in its superficialities. Regularmeals, a permanent Bradshaw, our own bed and oldcompanions make for a free spirit which can go moreeasily and on better excursions if there is no disturb-ance in its temporal surroundings ; the real artistof the spirit is generally a steady family man ofpretty fixed habits who cannot waste his capacityfor adventure on wearing strange clothes and livinga curious life. So there is bound to be some emotional
1 Lancet, 1936, 2, 1403.
upset when one of the great English weeklies dressesup in new clothes, with as it happens a little lipstickthrown in. No one, except perhaps the printer, hasthought of the British Medical Journal as a deliciousexample of typography, nor fondled its leaves withthe affection of a bibliophile. We have known itand loved it as a faithful source of information and
inspiration ; we wanted to listen to its talk, andnever thought whether the familiar face we liked sowell was handsome or ugly. The Practitioner andthe Medical Press and Circular have also had a newoutfit for Coronation year, and Nature not long sincereformed its appearance. To readers and to writersit is all rather upsetting. But they are not the onlypeople who are in fact concerned. The artistry oflegible type and the technique of printing havedevotees who are equally anxious for progress, andhave equivalent progress to exploit, and if the newform is easier to read by so much will it make iteasier for the reader to suck up advantage. And itwill not be long before the new form becomes thefamiliar face. It reminds us of the kindly lady wholooking at the memorial plaque of her husbandwhich was just a fiasco said, " Oh, well, of courseit isn’t a bit like him but people will soon believethat he was like it, so its all right." And so in theend we should be equally disturbed if the beard cameoff or the hair went back to a bun.
A SURGICAL ATTACK ON PSYCHOSES
THERE is at present no sign that timidity or con-servatism is holding up any advance in the treatmentof mental disorder. Prof. Moniz, well known for hisvaluable and audacious work on cerebral angio-graphy, shows himself equally bold in attacking theproblems of psychiatry. He decided, on theoreticalgrounds, to see what would be the effect of destroyingtissues of the prefrontal region in each cerebralhemisphere of insane patients. His theoretical
grounds, as presented here in detail, seem crudelyneurological, naive, and faulty from the psychiatrist’spoint of view, but that is not an important objectionif the procedure so based leads to striking benefit.Prof. Moniz modestly puts forward the opinion,shared by his distinguished Lisbon colleagues, thatstriking benefit has in fact followed the operation inmost of the twenty cases so far treated. He givesfull details of these cases-in which excitement andanxiety were the prominent clinical features-toenable the reader to form an independent opinion.It is evident that in some of his patients the mentaldisorder cleared up surprisingly soon after operation,and there is no reason to dispute his provisionalfigures-viz., seven patients recovered, seven con-
siderably improved, and six unchanged (of whomfive were schizophrenics).]- Ten of the twentypatients were treated by injections of alcohol intothe centrum ovale, ten by gouging out the tissuewith a specially devised leucotome. Prof. Moniz, inhis excellent account of what he did and what hap-pened afterwards, proves his point that the opera-tion has not had fatal or disconcerting effects, buthe scarcely convinces the reader that it does more
good than less heroic forms of treatment might.He is however so cautious, and even deprecating, inhis gentle yet persuasive claims that others are sureto try the method and, if they follow his recommenda-
1 Tentatives opératoires dans le traitement de certainespsychoses. By Prof. Egas Moniz. Paris: Masson et Cie.1936. Pp. 374. Fr. 40.
