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LONDON TEACHING HOSPITALS

THE Minister of Health has issued an order designating26 teaching hospitals in the London area, comprisinga total-of approximately 60 constituent hospitals. Eachteaching hospital will be administered by a new board ofgovernors, who will shortly be appointed by theMinister when he has considered the nominations andrecommendations of the authorities and organisationsconcerned.Under the Act these teaching hospitals have been

given a separate identity and status, and,.besides treatingthe sick, they will provide facilities for clinical teachingand research for the undergraduate medical and dentalschools and postgraduate institutes of the Universityof London. As the group comprising each teachinghospital will be one entity for administration, somehave been given a new title. But the Minister wishesthe names of the constituent hospitals, many of whichare of long standing and have valuable associations andtraditions, still to be used for everyday purposes.An earlier order designated teaching hospitals in the

provinces.. Royal Hospital of St. Bartholomew.-St. Bartholomew’s

Hospital (including Alexandra Hospital for Children with

Hip Disease and Zachary Merton Convalescent Home,Northwood).London Hospital.-London Hospital (including Croft Home

and Marie Celeste Annexe, Reigate ; Zachary Merton Annexe,Banstead ; London Hospital Annexe, Brentwood ; and Hermande Stern Convalescent Home, Felixstowe) ; Queen Mary’sMaternity Home, Hampstead.

Royal Free Hospital.-Royal Free Hospital (excluding theEastman Dental Clinic) ; London Fever Hospital ; ElizabethGarrett Anderson Hospital (including Rosa Morrison House,New Barnet, and Garrett Anderson Hospital Maternity Home,Belsize Grove) ; Hampstead General and North-West LondonHospital; Children’s Hospital, Hampstead ; North-WesternHospital (L.C.C.).. University College Hospital.-North London or UniversityCollege Hospital (including Obstetric Hospital and RoyalEar Hospital, Huntley Street); Hospital for Tropical Diseases;St. Pancras Hospital (L.C.C.).

Middlesex Hospital.-Middlesex Hospital and Cancer Wing(including Middlesex Branch Hospital and Hulke EndowedConvalescent Home, Clacton-on-Sea) ; Woodside Hospitalfor Functional Nervous Disorders (including the countrybranch, Welders House, Chalfont St. Peter, Bucks) ; Hospitalfor Women, Soho Square ; British Red Cross Society’s Clinicfor Rheumatism, Peto Place.

Charing Cross Hospital.—Charing Cross Hospital ; Harrow

Hospital; Wembley Hospital.St. George’s Hospital.-St. George’s Hospital (including

Atkinson Morley. Convalescent Hospital, Wimbledon) ;Victoria Hospital for Children (including Victoria ConvalescentHome, Broadstairs) ; Princess Beatrice Hospital; RoyalDental Hospital.

Westminster Hospital.-Westminster Hospital (includingthe convalescent homes at Chartham Park, Sussex, andSwanley, Kent, and Yarrow Home for Convalescent Children,Broadstairs, Kent) ; Infants Hospital; Gordon Hospitalfor Diseases of the Rectum and Colon ; All Saints’ Hospital.

St. Mary’s Hospital.-St. Mary’s Hospital (including JoyceGrove House, Nettlebed, Oxon, and Adair Lodge, Aldeburgh) ;Paddington Green Children’s Hospital (including convalescenthomes at Clear Springs and Pinecroft, Lightwater, Surrey) ;Princess Louise Kensington Hospital for Children (includingconvalescent home at 19-20, South Terrace, Littlehampton;Samaritan Free Hospital for Women ; Western OphthalmicHospital ; St. Luke’s Hospital for Advanced Cases.

Guy’s Hospital.-Guy’s Hospital (including York Clinic,Nuffield House, and Holmesdale, Nutfield, Surrey) ; Evelina

Hospital for Sick Children (including Eleanor WemyssRecovery and Convalescent Home, Crazies Hill, near Reading).

King’s College Hospital.-King’s College Hospital (includingBaldwin Brown Convalescent Home, Camberley) ; RoyalEye Hospital or Royal South London Ophthalmic Hospital(including Royal Eye Hospital Branch, Surbiton) ; Belgrave

1. National Health Service (Designation of Teaching Hospitals[No. 2]) Order, 1948. H.M. Stationery Office. 1d.

2. See Lancet, April 10, p. 571.

Hospital for Children (including convalescent home at

Minstead, Hants).St. Thomas’s Hospital.-St. Thomas’s Hospital ; Royal

Waterloo Hospital for Children and Women; General Lying-inHospital; Grosvenor Hospital for Women ; Roffey ParkRehabilitation Centre, Horsham, Sussex.

Hammersmith, West London, and St. Mark’s Hospitals.-Hammersmith Hospital ; West London Hospital; St. Mark’s

.

Hospital for Cancer, Fistula, and Other Diseases of theRectum.

Hospital for Sick Children.-Hospital for. Sick Children(including Tadworth Court Branch Hospital, Tadworth,Surrey;

" Runabouts " Convalescent Home, Chipping Norton,Oxon; and Sarah Louise Convalescent Home, Hove, Sussex).

National Hospitals for Nervous Diseases.-National Hospital,Queen Square (including National Hospital Convalescent

Home, Finchley) ; Maida Vale Hospital for Nervous Diseases..

Royal National Throat, Nose, and Ear Hospital.-RoyalNational Throat, Nose, and Ear Hospital (including Central’London Hospital Division, Golden Square Hospital Division,and Dame Gertrude Young Memorial Convalescent Home,Castle Bar Hill).

Moorfields, Westminster, and Central Eye Hospital.-TheMoorfields, Westminster, and Central Eye Hospital.

Bethlem and Maudsley Hospitals.-Bethlem Royal Hospitalfor Nervous and Mental Disorders, Beckenham ; MaudsleyHospital.

St. John’s Hospital for Diseases of the Skin.—St. John’sHospital for Diseases of the Skin.

Hospitals for Diseases of the Chest.-Hospital for Con-

sumption and Diseases of the Chest (including Brompton ’Hospital Sanatorium, Frimley, Hants) ; London Chest

Hospital (including London Chest Hospital Annexe, Arlesey,Beds).

Royal National Orthopcedic Hospital.-Royal NationalOrthopaedic Hospital (including country branch and con-

valescent branch, Stanmore).National Heart Hospital.-National Hospital for Diseases

of the Heart (including country branch, Maids Moreton,Bucks).

St. Peter’s and St. Paul’s Hospitals.-St. Peter’s Hospitalfor Stone and Other Urinary Diseases ; St. Paul’s Hospitalfor Urological and Skin Diseases.

Royal Cancer Hospital, Queen Charlotte’s and Chelsea

Hospitals.-Royal Cancer Hospital (Free) ; Queen Charlotte’sMaternity Hospital; Chelsea Hospital for Women (includingChelsea Hospital -Convalescent Home, St. Leonards-on-Sea).Eastman Dental Clinic.-Eastman Dental Clinic.

AFTER THE PLEBISCITE

IN a statement issued after a meeting on May 5, thecouncil of the British Medical Association said :

" The council’s view is that the profession should recognisefirstly that on some fundamental issues the profession hasgained a substantial victory and, secondly, that the professionmust now prepare itself by continued solidarity to strivefor improvements by every means at their command. Weshall need as never before a strong organisation and a unitedprofession. We have learnt what can be achieved by solidarity,even if that achievement is not enough.

" The council advises the profession to stand together andto strengthen the one representative body of the profession,the British Medical Association. It appeals to those membersof the profession who have shown by their votes their gravemisgivings to accept the fact that an insufficient number ofgeneral practitioners share their view. The Minister has

appealed to the profession to cooperate. The time hascome to do this to the best of our ability, though withunrelenting vigilance. In this way the strength of the

negative vote will not be lost in the many and importantnegotiations which lie ahead." .

The council has accepted the Minister’s invitationimmediately to enter into discussions on the AmendingBill and other matters, " his attention being drawn tothe large section of the profession which is still opposedto the service and whose good will is essential if theservice is to succeed." A report on such discussions will

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be made to the Representative Body on May 28. Thecouncil will recommend to the Representative Body :

(a) That, despite the insufficiency of the safeguards to theprofession’s freedoms and the misgivings of a substantialsection of the profession, the Representative Body, anxiousas ever that in the public interest a comprehensive healthservice should be made available to the community, is preparedto advise the profession to cooperate in the new service onthe understanding that the Minister will continue negotiationson outstanding matters, including terms and conditions ofservice for consultants and specialists, general practitioners,public health officers, and others.

(b) That the Representative Body urges the profession tomaintain its strength and unity in order to mould the servicein accordance with the public interest and with enlightenedprofessional opinion, and continuously to protect the profes-sion’s legitimate freedoms and interests.

(c) That the public be informed that, for reasons outsidethe control of the profession, the inception of the new servicecannot be followed for some time by all the improvementspromised by the Government in the medical services of thecountry, because of the shortage of personnel, medical andnursing, and of the difficulty of providing the necessarypremises and equipment.

A CENTURY OF PUBLIC HEALTH

ON May 7 the Corporation of the City of London helda dinner in the library of Guildhall to celebrate thecentenary of the Public Health Act of 1848.

Mr. ANEUBIN BEVAN, Minister of Health, proposed thetoast of the Pioneers of Public Health-the men who hadmade possible a comprehensive service for the health ofthe public. In 1848, he said, they were faced with anappalling task, complicated by the bitter opposition ofvested interests. At that time none thought publichealth a good investment: even leading Radicalsignored it, and John Bright during his twenty years in

Parliament spoke only once on the topic, and then tooppose a measure for smoke abatement.The men whom he specially wished to recall, Mr. Bevan

said, were Edwin Chadwick, John Simon, F.R.S., whowas appointed M.o.H. for the City in 1848, and WilliamFarr. With them he coupled the name of LordMorpeth, who steered the Public Health Act throughParliament after one failure, where the unyieldingChadwick would have failed. No social reform, Mr.Bevan concluded, could come to fruition until the publicaccepted it or could be induced to tolerate it, and thepolitician’s part was to modify ideas while keeping intactthe kernel of principle.

Sir GEORGE ELLISTON, chairman of the public-healthcommittee of the Corporation, welcomed among theguests three past Ministers of Health-Lord Addison(a son of the City hospital of St. Bartholomew’s), LordHennet, and Mr. Ernest Brown. He was glad to rememberthat Simon had founded the Society of Medical Officersof Health and was its first president.Lord ADDISON, replying for the guests, turned to later

developments in the progress of public health. Herecalled the committee on which he himself had served in1917, with Lord Milner, Arthur Henderson, and BeatriceWebb, which in two weeks decided that a Ministry ofHealth should be established. After the 1914-18 war, asMinister of Reconstruction, he had worked to implementthis decision, till in October, 1918, formal blessing wasgiven to the Bill setting up the Ministry.The BISHOP OF LONDON, who also replied, sympathised

with Mr. Bevan as one who had often to deal withaggrieved parishioners. Sir ALFRED WEBB-JOHNSONclaimed Sir John Simon as a surgeon, for he had combinedhis public-health work with active surgery and had beenpresident of the Royal College of Surgeons. The Act of1848 had brought great progress in public health. Today,Sir Alfred believed, we were on the eve of great develop-ments in the care of the sick.Lord BALFOUR OF BuRLEEGH proposed the toast of the

Lord Mayor and the Corporation, and the LoRD MAYOR,Sir Frederick Wells, replied.

In the picture gallery the guests were able to study anexhibition of documents arranged by Dr. Charles White,the present M.O.H. for the City, showing the Corporation’sconcern for public health during the 500 years before theAct of 1848.

Disabilities

4. DOUBLE FOREARM AMPUTATION

THE injury for which I had both forearms amputatedbelow the elbow took place in May, 1942. Before I receivedmy artificial limbs in the following December, I wasin a small hospital in Surrey under treatment for shrapneland blast injuries to my eyes. While there, I fed,washed, and ’shaved myself with the aid of two chamois-leather " cuffs" which I tied round the ends of mystumps with tapes. Each cuff had a small sleeve intowhich I put a spoon, fork, razor, toothbrush, pencil, orother implement. I managed quite well with these" home-made " improvisations. I spent most of my sparetime playing bagatelle, holding the cue inside the sleeve-of my jacket and using a dent in my bandages as a rest ;I eventually became the champion of the hospital.When my limbs came I determined .to use the hands

to the fullest extent in preference to the accepted normalworking appliance, the " split hook." I have kept tothis principle, and I consider that I can do as much withthe hands as an amputee using hooks. My hands areof the standard type used by most double amputees,made of moulded linen and glue which is light and strong. _

The left hand is of the fixed-finger "

carrying "

type,only the thumb being movable, and the fingers beingcurved towards the palm to form a natural rest forthe handle of a suitcase, bucket, or the like. The righthand has three articulated fingers with knuckle-jointslike a real hand ; these are not operated mechanically.The thumbs of both hands are opened and closed bya very simple system. By flexing the opposite shoulderand slightly moving the arm away from the body acontrol cord which runs from the shoulder to the thumbis tightened, and this opens the thumb against the pressureof a spring. When the tension on the shoulder is releasedthe spring automatically closes the thumb against theindex finger, which is permanently fixed. The " splithook " and most of the other appliances work on thesame principles. With experience the flexing of theshoulders and arms to operate the hands and appliancesbecomes quite natural. ’

After a few months the limbs come to feel part of one’snatural self. The first hesitation about how to do aparticular thing gradually lessens, and soon coordinationbetween mind and limb becomes automatic. Findingthe easiest, quickest, and most efficient ways of doingdifferent things with the limbs is a gradual process,mostly of trial and error. For instance, in performingone’s toilet, is it better to wash first and then shave, orvice versa One way round would perhaps save havingto put on an appliance twice over. Then the properplacing of the appliances in the bathroom can be themeans of establishing a quicker routine. All thesesmall points are worth studying by the double amputeewho wants to get the best out of the mechanical aids.A new form of appliance which greatly simplifies the

toilet consists of two rubber sleeves called gauntlets(fig. 1), which are shaped to the stump and held on thelimb by suction.At the end ofeach gauntlet a

metal nipple ismounted on a ball-

spring. This metalnipple slips intoa recess in therounded rubber

pads which are

Fig. I-Rubber gauntlet withflexible metal nipple forattachment of toothbrush,shaving-brush, &c., eachmounted on rubber pad.

attached to one’s ordinary razor, shaving-brush, tooth-brush, comb, &c. There is also an attachment for holdinga face-flannel, with which almost every part of the bodycan be reached when bathing. I wash my face with a

sponge hollowed out to fit over my stump or the gauntlet,