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these recommendations its highly subjective and may notreflect what the G.N.C. has in mind as its ultimate goalfor psychiatric nurses. However, there is a most encourag-ing recent report by the Royal College of Nursing (1963)which incorporates much of the material discussed in thispaper.

My own feeling is that it is high time we stoppedthinking of medical education, psychiatric training, andpsychiatric-nurse training as though they existed in a

unidisciplinary vacuum. It seems to me that two pre-liminary steps are necessary before a really effective nursetraining can be instituted. We must have a greaterawareness of the social environment and the socialsciences generally in the undergraduate and postgraduatetraining periods for both doctors and nurses. If the tradi-tional hospital environment can be humanised to the pointwhere we are prepared continually to examine what we aredoing and why we are doing it, and to listen to staff at alllevels, including patients whom we are attempting to treat,then we will, I think, have the necessary preliminary to anyteam approach. Given such an introduction to medicineand nursing in the general-hospital setting there wouldnot be the same need to decondition the highly conditioneddoctor or nurse in order that he may become a goodpsychiatrist or psychiatric nurse. Already there are

hopeful signs of such trends in the education ofmedical and nursing students, particularly in the UnitedStates.

With such a modified image of his role as doctor and thegreater appreciation of the social environment it would,I think, be much easier to establish multidisciplinary

training programmes in psychiatry which would allow forconsiderable overlap in the training of all ward personnel,such as doctors, nurses, social workers, psychologists,occupational therapists, work supervisors, and in fact allpeople who come into contact with the patient in his dailylife. I have said nothing here about the exciting newpossibilities for nurses in community psychiatry, workingin liaison with the local authorities. These training needshave already been discussed (Macmillan 1961, Rehin andMartin 1963, May and Moore 1963), and will clearlyintegrate readily with a programme such as I have

attempted to outline above. I have limited myself to thehospital because, as yet, this is the setting in which basictraining for both psychiatrists and psychiatric nurses

occurs.

For many years we have talked about psychiatric nursesas though we were colleagues in a treatment team. Wehave flirted with them so long in this context that unless wereally make a positive decision to establish an equalrelationship the situation may well share the fate of allprolonged and protracted engagements.

REFERENCES

John, A. L. (1961) A Study of the Psychiatric Nurse. Edinburgh.Jones, Maxwell (1962) Social Psychiatry in the Community, in Hospitals and

in Prisons. Springfield, Ill.Macmillan, D. (1961) Wld ment. Hlth, 13, 1.May, A. R., Moore, S. (1963) Lancet, i, 213.Rehin, G. F., Martin, F. M. (1963) in Freeman and Farndale’s Trends in

Mental Health Services; chap. 20. Oxford.

Royal College of Nursing and National Council of Nurses of the UnitedKingdom (1963) Role of Psychiatric Ward Sisters and ChargeNurses in the Rehabilitation of Patients, London; see Lancet, 1963,ii, 310.

NEW ROYAL AIR FORCE HOSPITAL

IN CYPRUSTHE Royal Air Force Hospital at Akrotiri in Cyprus,

which was to be formally named by H.R.H. the PrincessRoyal, on Nov. 21, occupies a site of rare beauty. Thenarrow headland on which it is built is called CapeZevghari, a picturesque corruption of the Greek word meaning twins or oxen in yoke. Off the cape aretwo rocks and, a short way from them, a reef seen only atlow water: and these, the local legend has it, were a yokeof oxen and their driver turned into stone by Saint

Spyridon for ploughing on his saint’s day.The hospital is almost at the end of the cape and there-

fore closely surrounded by water on three sides. Tothe south, no more than 200 yards from the main

buildings, there are cliffs dropping 80 feet: to the westand north the sea is further and the descent more

gradual. The whole coast is rocky and unfriendly-butmagnificent.When the Royal Air Force left Egypt, a temporary

hospital was made at Akrotiri, the new base looking out tothe bay of Limassol. The new hospital was put in hand inAugust, 1961, in order to serve the western SovereignBase Area established by the treaty which gave Cyprusits independence. It draws its patients from all themembers of the Services and their families on the westernside of the island. For all these people, and for theBritish civilians attached to the Armed Forces, the newhospital provides all the normal medical, surgical, andmaternity care: but like other service hospitals overseas itis bound to take on some of the welfare functions which in

England are the province of the local authorities. It has,moreover, to be far more self-sufficient than many of thecivilian hospitals at home, since there are no convenientspecial centres to which to send premature babies or otherpatients needing an extraordinary degree of care: yet it isnot medically isolated, because, if help is needed, the air-craft of Royal Air Force Transport Command can bringone of the senior consultants or a special unit-for

Fig. 1—Aerial view of rear of hospital (with tip of cape to left).

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Fig. 2-Main entrance.

example, a renal unit-from England within a day.Similarly, at regular intervals, Comet air ambulances takehome to the Royal Air Force hospitals in the UnitedKingdom long-stay patients whom it is not economical tokeep overseas or any who need very special facilities-cases for plastic surgery, for example.The architect was Mr. Alistair Macdonald, who had pre-

viously designed the British Military Hospital at Dhekelia,the main hospital for all the Services on the eastern half of theisland. The plans were drawn some nine years ago but shelvedduring the political troubles. Not all the ideas on hospitaldesign of the last few very eventful years could, therefore, beincorporated: but, wherever possible, the best of the new

thinking has been introduced by modification. The fabric issteel and concrete, built as a number of physically separate butapparently continuous units in order to limit damage by earth-quakes, which are not uncommon in Cyprus. There are twomain wings, four storeys high, in which are the wards: a two-storey administrative building, built round three sides of acontrol quadrangle, the fourth side being devoted to the

operating-theatres and the X-ray department; and a single-storey outpatient department. The theatre block, the X-raydepartment, one maternity ward, the pathology and dentallaboratories, the dental surgeries, and the mortuary are all air-conditioned. A striking architectural and very practicalfeature is the large vertical sun-breakers which cover all thewindows and may be adjusted from within. Around the build-ings are lawns and gardens already well established, beingwatered by the hospital sewage effluent which, after it has

passed through the sewage plant, is filtered and chlorinatedthen pumped back for irrigation. The hot weather is madethe more tolerable by a number of fountains which playin the enclosed courtyards. Close at hand is the hospital’shelicopter pad and, a little further away, the nursing officers’mess.

The officers and airmen of the Royal Air Force areamong the healthiest of our citizens. It is no surprise,therefore, that a very considerable proportion of the workof the hospital is among the women and children of theServices and civilian families. The design capacity was155 beds, but the accommodation is so spacious that thereis room for more than 200. The maternity department,which is exceedingly busy, has its own premature-babyand exchange-transfusion unit. Apart from this, the

organisation of the hospital is based upon the principleof intensive care, but modified to suit the physical shapeof the wards. On the theatre floor there are two wards,each in a separate wing but no more than 20 yards fromthe entrance to the theatre unit. These are the male andfemale wards for all who are acutely ill, or need specialcare, whether they are surgical or medical cases. Eachward is divided into a number of separate bays and smallwards, so that it is possible to grade the patients accordingto the needs of the moment. The configuration is suchthat isolation presents no difficulty, but particularlyinfectious cases, which are rare, are nursed in a separateward on another floor. Thus, except on these rare occa-sions, it is possible to concentrate nursing skill on these

two main wards, each of which contains a nursery. Theother component of this " intensive-care floor " isthe recovery ward, which is part of the theatre suite. Herethe patients recover consciousness after operation, with theanaesthetist and surgeon close at hand. All resuscitation

apparatus is built into the walls or is immediately availablein the ward.

When the patients no longer need intensive nursingthey are moved to convalescent wards, where their stayis made as pleasant as possible. They are encouraged totake their meals in the up-patients’ dining-room, which issome distance from the wards on the ground floor.

Throughout their stay in hospital they are allowed tochoose their meals for the day, so far as their diet permits,from a menu offering several choices for each course.

The outpatient department, where medical, surgical,orthopaedic, ophthalmic, ear, nose, and throat, andobstetric clinics are run, is large and well-equipped withwaiting-rooms: but most of the patients prefer to sit onthe patio of a coffee-shop in the gardens nearby whencethey are called by loud-speaker when the doctor is readyfor them.

The physiotherapy department, as in all Royal Air Forcehospitals, is large and active. Patients are treated in thewards or in the department and are also taken to thebeaches at Akrotiri. There is also a central sterile supplydepartment, of sufficient capacity to supply not only thehospital but the various Royal Air Force sick quartersand families clinics on the island with sterile packagedequipment. The welfare services play their part, ladies ofthe St. John’s and Red Cross providing a library, reading-room, and the equipment for handicrafts. Newspapers arebrought round each day by the Y.W.C.A. The hospitalhas its own chapel where the Royal Air Force Chaplainshold regular services.

This new hospital is part of the Near East Air Force,and its responsibilities reach out everywhere in the NearEast. Patients come by air from North Africa, Persia,Turkey-wherever there are members of the ArmedForces-and the specialists visit these communities tohold occasional clinics. Moreover, the members of thehospital staff are ready at all times to go wherever they areneeded. The Near East Air Force parachute medicalteam, staffed partly by the hospital, partly by the RoyalAir Force Akrotiri sick quarters, and aided by non-medical personnel, is always at readiness. Some months

ago it brought off a spectacular rescue of a sick woman onthe little Greek island of Kastellorizon during a gale andbad visibility-an operation which resulted in the grati-tude of the King and Queen of Greece, who invited theteam to Athens where they were received with greathospitality at the Royal Palace. The hospital has also ajoint team with the Royal Air Force Regiment, readyto go at short notice to help in any disaster in the NearEast.

The Princess Royal was last in Cyprus in March, 1962,when she inspected the temporary hospital and saw theplans for the new. In declaring the hospital open she wasto give it her name: so The Princess Mary’s Royal AirForce Hospital, Akrotiri, will appear as a new entry inService gazeteers: but its tradition is almost forty yearsold, and it traces its history from Akrotiri back throughFayid and Habbaniyah to its origins at Hinaidi, nearBaghdad.