435 Notes and News A BIRTHDAY TRIBUTE Oy Feb. 22 Sir Gordon Holmes, consulting physician to the Xational Hospital, Queen Square, is 80. In opening the celebrations at the unveiling of his portrait on Feb. 7, Dr. Macdonald Critchley said that the physicians at Queen Square had felt that the reissue of some of Sir Gordon’s work in a monograph 1 was not enough to mark the occasion, and JIr. Harold Knight, R.A., had been commissioned to paint a portrait to hang in the medical school of the National Hospital. Former residents and students from all over the world had contributed. The artist unhappily could not be at the unveiling, though Dr. Critchley welcomed his wife, Dame Laura. Sir Francis Walshe described Sir Gordon as " the greatest teacher of clinical neurology of our time," and congratulated Mr. Knight, who had ’’ so cunningly and beautifully captured and put on canvas for us the inward spirit and the outward seeming of Gordon Holmes." Describing himself as one of Sir Gordon’s oldest pupils, and a friend of nearly fifty years’ standing, he paid tribute to his lessons in accurate observation and faithful and methodical recording. Many distinguished neurologists in North America were proud to recall how they had striven and suffered on his ward rounds while serving as his clerks ; for to suffer and to strive were among the necessary conditions for the acquisition of knowledge. Sir Francis then unveiled the portrait, and Sir Ernest Gowers, chairman of the committee of management, accepted it on behalf of the medical school. UNIVERSITIES AND PARLIAMENT THE House of Commons’ Committee of Public Accounts have repeatedly declared their uneasiness at the degree of freedom allowed to the University Grants Committee in its allocation of the funds put at its disposal by Parliament. The Treasury, to its credit, has long resisted additional control of the U.G.C.,2 3 and it has now refused its ccn- currence in the recommendation that papers and records relating to non-recurrent grants should be open to inspection by the Auditor General 4 The Exchequer’s subvention (the Treasury points out) would fail in its object if the independence of the universities were damaged by the imposition of Government control over academic policy or academic standards. This unique relation tetween the Government and the universities calls for financial arrangements which are also unique. " It is clear that, if the Government and Parliament are to abstain from the sort of control which would normally follow from the grant of such considerable sums of public money, while at the same time being unwilling to make grants without any condition as to their allocation and use, there must be a devolution of some of the functions of Government to some body standing between the Government and the Universities, and enjoy- ing the confidence of both." The ’U. G. C. has been appointed to this r6le and the Treasury has complete confidence in the C.&.C.’s determination and ability to discharge its functions with a full sense of responsibility both to the Government and to the universities. At the same time, the U.G.C. and the universities recognise that the obligation to observe the strictest canons of economy and financial propriety apply with even more than ordinary force to bodies spending public money without being subject to the ordinary processes of financial control on behalf of the Government and Parliament. To go some way towards the objectives of the Public Accounts Committee, the universities have agreed that in future each university and university college shall (1) formally notify its auditor of every non- recurrent grant received, and the purpose for which it was made; and (2) ask its auditor to give a certificate in general terms to the effect that every such grant received during the accounting period was duly applied to the purpose for which it was made. The Treasury expresses a hope-which will be widely shared-that the Committee of Public Accounts will be satisfied with this procedure. 1. Selected Papers of Sir Gordon Holmes. Edited by F. M. R. Walshe. London, 1956. 2. See Lancet, 1954, i, 423. 3. Ibid, 1956, ii, 420. 4 Committee of Public Accounts : Treasury Minute. H.M. Stationery Office, 1957. Pp. 20. 1s. COST OF HOME CARE FOR THE ELDERLY IT is often said to be cheaper to keep old people in their own homes than under any form of communal care. The National Corporation for the Care of Old People 1 had doubts about this, and, since no figures had apparently been published, they decided to look for a reasonable basis for estimating the actual cost of domiciliary services. Details were examined in 21 cases where different services had been provided in varying amounts for old people at home. The cost of each service was estimated with the help of figures given by the appropriate authorities in the area or from Ministerial statements in Parliament. To make possible a direct comparison with the cost of institutional care, a figure of f2 5s. a week, representing items such as maintenance of building, rent, rates, fuel, pro- visions, and clothing, was added to the cost of the services. This figure, the Corporation’s report adds, may seem arbitrary but " it can, it is thought, be justified." Estimated in this way, the cost of home care varied enormously. For example, for a patient of 93 who, but for the night attendance provided, might have been in hospital, the weekly average was 19 15s. 10d. ; for an old lady of 80, who should have been in hospital but refused to go, the cost was E8 5s. 7d. per week ; and for 4 old ladies, described as ’’ persons who might otherwise require part-in accommodation," the figures were £6 15s. 6d., E4 7s., :E4 6s., and :E2 14s. The hospital costing returns for England and Wales in 1954-55 gave the weekly average inpatient cost (adjusted by the vacant-bed factor) as £6 12s. 8d. for chronic-sick hospitals and 912 6s. for mainly general hospitals. The average weekly cost of all sizes of local-authority homes in the area concerned was £4 9s. 8d. The governors of the Corporation do not claim that these figures finally prove the case one way or the other, but they think they do show that it is not necessarily cheaper for old people to remain at home with the help of the domiciliary services. The cost and the call on available man-power may be such that, on these grounds alone, institutional care would be preferable. The governors hope that the publication of these figures will encourage others to make similar estimates. ATARAXICS IN NEW YORK THE Commissioner of Health of New York City asked the committee on public health of the New York Academy of Medicine to ascertain whether the present widespread use of tranquillisers was a menace to public health. At present 5-10% of all prescriptions in the city are for these drugs and the proportion is increasing. The committee has reported that there is no proof at present that they are a menace to public health, but it recognises the many dangers of their being taken without competent medical supervision. It recommends that the sanitary code of New York city be revised to make it accord more fully -with Federal rules. Prescriptions for potentially harmful drugs (including tranquillisers) could then be refilled only on the order of the prescriber, which is not the case now. Physicians, says the report, may be danger- ously misled by the extravagant claims in the advertising of certain manufacturers, who propose far too many indications for tranquillisers and ignore their harmful effects. The com- mittee advises the city board of health to survey the advertising literature " as the first step toward bringing about improve- ment in it." University of Cambridge On Feb. 9 the degree ofM.B. was conferred on Terry Buchan and, by proxy, on A. C. Fernando. University of London On Jan. 30 the degree ofM.D. was conferred on P. H. Connell and J. G. P. Hutchison. Royal College of Surgeons in Ireland At the charter day dinner the honorary fellowship of the college was conferred on Mr. T. J. D. Lane. Bill to Restrict Sale of Alcohol in France On Feb. 13 the National Assembly voted in favour of a Bill to forbid the sale to children under 12 years old, in bars and other public places, of drinks containing more than three degrees of alcohol. The Bill would also forbid the distribution or dispatch to people less than 20 years old of matter advertising any alcoholic drink. 1. The National Corporation for the Care of Old People, Nuffield Lodge, Regent’s Park, London, N.W.1. 9th annual report of the Board of Governors, for the year ended Sept. 30, 1956.
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435
Notes and News
A BIRTHDAY TRIBUTE
Oy Feb. 22 Sir Gordon Holmes, consulting physician to theXational Hospital, Queen Square, is 80. In opening thecelebrations at the unveiling of his portrait on Feb. 7, Dr.Macdonald Critchley said that the physicians at Queen Squarehad felt that the reissue of some of Sir Gordon’s work in a
monograph 1 was not enough to mark the occasion, andJIr. Harold Knight, R.A., had been commissioned to paint aportrait to hang in the medical school of the National Hospital.Former residents and students from all over the world hadcontributed. The artist unhappily could not be at the
unveiling, though Dr. Critchley welcomed his wife, DameLaura.
Sir Francis Walshe described Sir Gordon as " the greatest
teacher of clinical neurology of our time," and congratulatedMr. Knight, who had ’’ so cunningly and beautifully capturedand put on canvas for us the inward spirit and the outwardseeming of Gordon Holmes." Describing himself as one ofSir Gordon’s oldest pupils, and a friend of nearly fifty years’standing, he paid tribute to his lessons in accurate observationand faithful and methodical recording. Many distinguishedneurologists in North America were proud to recall how theyhad striven and suffered on his ward rounds while serving ashis clerks ; for to suffer and to strive were among the necessaryconditions for the acquisition of knowledge.Sir Francis then unveiled the portrait, and Sir Ernest
Gowers, chairman of the committee of management, acceptedit on behalf of the medical school.
UNIVERSITIES AND PARLIAMENT
THE House of Commons’ Committee of Public Accountshave repeatedly declared their uneasiness at the degree offreedom allowed to the University Grants Committee inits allocation of the funds put at its disposal by Parliament.The Treasury, to its credit, has long resisted additionalcontrol of the U.G.C.,2 3 and it has now refused its ccn-
currence in the recommendation that papers and records
relating to non-recurrent grants should be open to inspectionby the Auditor General 4 -
The Exchequer’s subvention (the Treasury points out)would fail in its object if the independence of the universitieswere damaged by the imposition of Government control overacademic policy or academic standards. This unique relationtetween the Government and the universities calls for financialarrangements which are also unique. " It is clear that, ifthe Government and Parliament are to abstain from the sortof control which would normally follow from the grant of suchconsiderable sums of public money, while at the same timebeing unwilling to make grants without any condition asto their allocation and use, there must be a devolution ofsome of the functions of Government to some body standingbetween the Government and the Universities, and enjoy-ing the confidence of both." The ’U. G. C. has been appointedto this r6le and the Treasury has complete confidence in theC.&.C.’s determination and ability to discharge its functionswith a full sense of responsibility both to the Governmentand to the universities.At the same time, the U.G.C. and the universities recognise
that the obligation to observe the strictest canons of economyand financial propriety apply with even more than ordinaryforce to bodies spending public money without being subjectto the ordinary processes of financial control on behalf of theGovernment and Parliament. To go some way towards theobjectives of the Public Accounts Committee, the universitieshave agreed that in future each university and universitycollege shall (1) formally notify its auditor of every non-recurrent grant received, and the purpose for which it wasmade; and (2) ask its auditor to give a certificate in generalterms to the effect that every such grant received during theaccounting period was duly applied to the purpose for whichit was made. The Treasury expresses a hope-which will bewidely shared-that the Committee of Public Accounts willbe satisfied with this procedure.
1. Selected Papers of Sir Gordon Holmes. Edited by F. M. R.Walshe. London, 1956.
2. See Lancet, 1954, i, 423.3. Ibid, 1956, ii, 420.4 Committee of Public Accounts : Treasury Minute. H.M.
Stationery Office, 1957. Pp. 20. 1s.
COST OF HOME CARE FOR THE ELDERLY
IT is often said to be cheaper to keep old people in theirown homes than under any form of communal care. TheNational Corporation for the Care of Old People 1 had doubtsabout this, and, since no figures had apparently been published,they decided to look for a reasonable basis for estimating theactual cost of domiciliary services. Details were examined in21 cases where different services had been provided in varyingamounts for old people at home. The cost of each servicewas estimated with the help of figures given by the appropriateauthorities in the area or from Ministerial statements inParliament. To make possible a direct comparison with thecost of institutional care, a figure of f2 5s. a week, representingitems such as maintenance of building, rent, rates, fuel, pro-visions, and clothing, was added to the cost of the services.This figure, the Corporation’s report adds, may seem arbitrarybut " it can, it is thought, be justified."Estimated in this way, the cost of home care varied
enormously. For example, for a patient of 93 who, but forthe night attendance provided, might have been in hospital,the weekly average was 19 15s. 10d. ; for an old lady of 80, whoshould have been in hospital but refused to go, the cost wasE8 5s. 7d. per week ; and for 4 old ladies, described as ’’ personswho might otherwise require part-in accommodation," thefigures were £6 15s. 6d., E4 7s., :E4 6s., and :E2 14s. The
hospital costing returns for England and Wales in 1954-55gave the weekly average inpatient cost (adjusted by thevacant-bed factor) as £6 12s. 8d. for chronic-sick hospitalsand 912 6s. for mainly general hospitals. The average weeklycost of all sizes of local-authority homes in the area concernedwas £4 9s. 8d.The governors of the Corporation do not claim that these
figures finally prove the case one way or the other, but theythink they do show that it is not necessarily cheaper for oldpeople to remain at home with the help of the domiciliaryservices. The cost and the call on available man-power maybe such that, on these grounds alone, institutional care wouldbe preferable. The governors hope that the publication ofthese figures will encourage others to make similar estimates.
ATARAXICS IN NEW YORKTHE Commissioner of Health of New York City asked the
committee on public health of the New York Academy ofMedicine to ascertain whether the present widespread use oftranquillisers was a menace to public health. At present5-10% of all prescriptions in the city are for these drugs andthe proportion is increasing. The committee has reported thatthere is no proof at present that they are a menace to publichealth, but it recognises the many dangers of their being takenwithout competent medical supervision. It recommends thatthe sanitary code of New York city be revised to make itaccord more fully -with Federal rules. Prescriptions for
potentially harmful drugs (including tranquillisers) could thenbe refilled only on the order of the prescriber, which is notthe case now. Physicians, says the report, may be danger-ously misled by the extravagant claims in the advertising ofcertain manufacturers, who propose far too many indicationsfor tranquillisers and ignore their harmful effects. The com-mittee advises the city board of health to survey the advertisingliterature " as the first step toward bringing about improve-ment in it."
University of CambridgeOn Feb. 9 the degree ofM.B. was conferred on Terry Buchan
and, by proxy, on A. C. Fernando.
University of LondonOn Jan. 30 the degree ofM.D. was conferred on P. H. Connell
and J. G. P. Hutchison.
Royal College of Surgeons in IrelandAt the charter day dinner the honorary fellowship of the
college was conferred on Mr. T. J. D. Lane.
Bill to Restrict Sale of Alcohol in FranceOn Feb. 13 the National Assembly voted in favour of a Bill
to forbid the sale to children under 12 years old, in bars andother public places, of drinks containing more than threedegrees of alcohol. The Bill would also forbid the distributionor dispatch to people less than 20 years old of matter
advertising any alcoholic drink.1. The National Corporation for the Care of Old People, Nuffield
Lodge, Regent’s Park, London, N.W.1. 9th annual report ofthe Board of Governors, for the year ended Sept. 30, 1956.
436
Queen’s University, BelfastDr. 0. L. Wade, senior lecturer in medicine in the University
of Birmingham, has been appointed to the chair of therapeuticsand pharmacology in the university. The duties of the postinclude charge of beds in the teaching hospital.
Dr. Wade, who is 35, was a scholar of Emanuel College, Cambridge,and gained a double first in the natural sciences tripos. At UniversityCollege Hospital he was Acheson scholar, and after qualifying in1945 he held house-appointments there and at Addenbrooke’sHospital, Cambridge. Later he was for a short time in the MedicalResearch Council pneumoconiosis unit at Cardiff. Since 1951 hehas been in the medical professorial unit at the Queen ElizabethHospital, Birmingham. In 1954 he held a Rockefeller travellingfellowship in medicine which he spent with Dr. Robert Loeb andDr. Stanley Bradley at the Columbia Medical Center. Dr. Wade’sinvestigations have been into the hsemodynamios of the pulmonaryand hepatic circulations.
Royal College of Surgeons of EnglandAt a meeting of the council on Feb. 14, with Sir Harry Platt,
the president, in the chair, Sir Henry Dale, o.M., was admittedas a member of the court of patrons. The honorary medal ofthe college was presented to Lady Webb-Johnson.
Mr. A. L. d’Abreu (Birmingham) and Mr. E. G. Muir (King’sCollege Hospital) were elected to the court of examiners forthree years. Mr. A. C. McEachern (Adelaide) was elected amember of the court of examiners for one year. Sir HarryPlatt was appointed visitor to the first primary fellowshipexamination of the College of Physicians and Surgeons ofSouth Africa. The Hallett prize was awarded to Darrel FelixWeinman, of Ceylon. The college agreed to a request from theUniversity of Ceylon for a primary F.R.C.s. examination to beheld in Colombo in January, 1958.A licence to practise was conferred on J. R. Anthony.Fellowships were granted in the Faculty of Anaesthetists to
the following :J. K. Trotter, T. R. Bomonji, H. M. C. Corfield, Peter Dinmore,
Alan Thorogood, Morag J. R. Bastable, June E. Brett, J. B.Montgomery. J. D. Holdsworth, D. I. Chisholm, Cecil Moss, R. H.Bolton, Wendy A. Clark, Michael Rosen, Frank Wilson, AzmyRagheb Boutros, T. D. W. Davies, W. J. Glover, R. P. Holmes,R. T. Pettigrew, H. G. Saunders, K. B. Holloway, James Moore,R. G. Waterhouse, 1. E. Purkis.
At the Hunterian Festival dinner on Feb. 14, Sir HarryPlatt, president of the college, reported that the NuffieldCollege of Surgical Sciences now had eighty postgraduatestudents in residence, and it was to be officially opened byLord Freyberg on April 5. By September, the third and finalphase of reconstruction would be completed as a shell. Two
years ago hopes had been high ; but now a halt would have tobe called until the country came to realise that the college mustbe restored, extended, and maintained in order that it mightfulfil its destiny as an international academy of surgery. Sir
Harry was responding to the toast of The College proposedby Sir Albert Richardson, past president of the RoyalAcademy, who spoke of that body’s debt to John Hunter’sbrother, William, who in 1768 became the Academy’s firstprofessor of anatomy. As a patron of the arts, William Hunterset an example which Sir Albert Richardson enjoined hishearers to follow. His speech ranged widely and wittily ;and the Archbishop of Canterbury, when he rose to reply forThe Guests to Mr. Lawrence Abel’s toast, complained thatthe sermon had already been preached ; for Sir Albert’s observa-tions had been marked by the exhortation, denunciation, andsalesmanship which were the proper functions of any sermon.More seriously, the Archbishop declared that doctors andothers should think of themselves as concerned with persons-not with problems or cases. Regarding people as problemsled to the formulation of principles ; principles must berelated to people, for dehumanised principles led to slogans ;and slogans were the work of the Devil. Sir Ernest Finch, asHunterian Orator, responded to Sir Russell Brock’s toast.
St. George’s Hospital LondonOwing to rebuilding in the medical school, the postgraduate
lectures in neurology and psychiatry have been cancelled untilfurther notice.
Institute of Dermatology, LondonA semi-permanent exhibition, by Dr. C. D. Calnan on
cosmetic dermatitis, will be held at this institute, Lisle Street,W.C.2, from March 4 to 25.
Royal Society of HealthA sessional meeting of this society will be held on Thursday,
Feb. 28, at 10 A.M. in the Town Hall, West Bromwich, whenthe programme will include a paper by Dr. J. F. Skone onthe coloured worker.
Army AppointmentDr. R. Bodley Scott has been appointed honorary consultant
in hæmatology to the Army at home, in succession to the lateSir Lionel Whitby.Council of Europe Medical FellowshipsThe council has allocated 9 million French francs for medical
fellowships for 1957. This sum will provide for 100 " fellowshipmonths." The duration of each fellowship will be at least3 months, and it will cover subsistence, travel, and incidentalexpenses. British applicants may obtain further informationfrom Mr. W. H. Boucher, Ministry of Health, Savile Row.London, W.I. The closing date for applications is March 15.
Royal Society of MedicineLeverhulme Associates.—The council of this society, through
the Leverhulme Trust Fund, is able to appoint 100 of theseassociates each year who, without payment of any subscription.enjoy nearly all the privileges of fellows.Men and women are eligible provided that they are not alread)
fellows of the society, that they hold a full-time clinical or non-clinical teaching or research appointment in a medical, dental, O!veterinary department of a British .university, and that their totalincome from academic or professional sources does not exceed£1500 p.a. Forms of application may be had from the deans ofmedical schools or from the secretary of the society, 1, V’impoleStreet, London, W.l. Applications may be made at any time, butmost vacancies are filled each year during the last week in March.For this reason it is advisable to apply between March 1 and 15.
Rockefeller Foundation GrantsDuring the last quarter of 1956 the Foundation distributed
over$8 million. Grants for medical education and publichealth amounted to$1,064,709 ; and for biological andmedical research,$1,147,260.
For the support of its field services in medical education andpublic health in 1957, the Foundation has appropriated$371,625, an increase of more than$50,000 over the amountappropriated for 1956. For the promotion of medical educa.tion and public health throughout the world, the Foundatimmaintains regional offices in Brazil, Chile, and India, and it isplanned to open one in the Middle East this year if politicalconditions permit.Hunterian SocietyAt the Society’s annual dinner, held in London on Feb. 14,
Lord Luke confessed himself a new recruit to the admirersof John Hunter. He was proposing the toast of The Societyand, in preparation, he had been reading the life of Hunterwhich the society’s officers had thoughtfully provided forhim. It was a fascinating story : if anyone had made amark on his age it was John Hunter ; he was a rebel, andthere was a great affinity between rebels and pioneers. Theessence of research, Lord Luke thought, was not to be satisfied:and though research in industry was more in his line thanmedical research he had a feeling that in both campaignthe enemies were the same : the war was being waged againetwaste, inefficiency, and high costs (or should it be high blood.pressure ?). One of the common denominators of this workwas a certain amount of vision : John Hunter had bada lot of vision, and that was an attribute which Lord Lukewould like to see more in evidence today. In his reply.Dr. C. D. Coyle, president of the society, referred warmly tothe work done on its behalf by Mr. A. E. Mortimer Woolf.Mr. C. R. Rudolf, Mr. R. S. Murley, and Dr. C. W. Kesson.This year, Dr. Coyle recalled, was the 50th anniversary oithe first attendance of the Lord Mayor of London at thesociety’s annual dinner ; and the toast of The Lord Mayorand Corporation, dashingly proposed by Dr. MacdonaldCritchley, was drunk with enthusiasm. Dr. Critchley thankedthe Lord Mayor, Colonel Sir Cullum Welch, for bringing’zest and buoyancy to all his duties and for making so man;’gay and good-natured contributions to our morale. In hisfriendly remarks about the society, Sir Cullum said he wasdelighted that the Hunterian Oration was to be deliverecin his home, the Mansion House. A reference to the Whittington Hospital then brought him to the stone on Highgate Hillassociated with his distinguished predecessor, and he pointedout that it was wrong on three points : Dick Whittingtonwas Mayor (the office of Lord Mayor came later), he occupiedthe civic chair four not three times, and there was no evidencethat he was ever knighted. Mr. Ian Robin dealt adroitlyand courteously with The Guests, who were in the fortunateposition of having Miss Rose Heilbron, Q.c., to reply for tlJeJJ1."
Prof. W. W. Mushin is to address the New York State Medica-Society at its sesquicentennial celebrations in February. In Marhe is to be a visiting professor of surgery (anæsthetics) in thUniversity of Ualifornia Medical Center in Los Angeles.
