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logy. Nevertheless, he was always able to maintain withinhis department an active group of research workers. and tothem he gave considerable help and encouragement. Manyof us-A. W. Downie, D. T. Robinson, S. T. Cowan,D. G. Evans, H. G. Pereira, N. W. Preston, to mentiononly a few-will always remember, and be grateful for, theprofound and lasting influence which Maitland had onour work, especially on our approach to research."

Diary of the Week

JANUARY 30 TO FEBRUARY 5

Sunday, 30thMANCHESTER ROYAL INFIRMARY

10 A.M. Dr. Morton I. Grossman (Los Angeles): Clinical Assessmentof Gastrointestinal Hormones.

Monday, 31stROYAL POSTGRADUATE MEDICAL SCHOOL, Hammersmith Hospital,

London W.12 24.30 P.M. Dr. J. D. H. Slater: Renin-angiotensin.

Tuesday, lstINSTITUTE OF DERMATOLOGY, St. John’s Hospital for Diseases of the

Skin, Lisle Street, London W.C.24.30 P.M. Dr. R. S. Wells: Genodermatoses.

Wednesday, 2ndROYAL COLLEGE OF PATHOLOGISTS

5.30 r.M. (Royal Society, 6 Carlton House Terrace, London S.W.I.)Dr. John Paul: Molecular Pathology of Cancer. (Kettlememorial lecture.)

ROYAL COLLEGE OF PHYSICIANS, 11 St. Andrew’s Place, Regent’s Park,London NW1 4LE

5.35 P.M. Dr. T. R. C. Fraser: The Metabolic Disorders in DiabetesMellitus. (Humphry Davy Rolleston lecture.)

ROYAL POSTGRADUATE MEDICAL SCHOOL4 P.M. Prof. S. J. G. Semple: Acid-base Problems in Clinical Practice.

INSTITUTE OF DERMATOLOGY4.30 P.M. Dr. Ronald Marks: Cutaneous/intestinal Relationships.

INSTITUTE OF DISEASES OF THE CHEST, Brompton, London S.W.35 P.M. Dr. Raphael Balcon: The Investigation of Patients with

Coronary Artery Disease.INSTITUTE OF NEUROLOGY, National Hospital, Queen Square, London

W.C.17 P.M. Prof. John Marshall: Measurement of Regional Cerebral

Blood-flow in the Human Subject. (Sandoz Foundationlecture.)

INSTITUTE OF ORTHOPEDICS, 234 Great Portland Street, LondonWIN 6AD

8.15 P.M. Mr. E. O’G. Kirwan: Operative Techniques of LumbarSpinal Fusions.

INSTITUTE OF PSYCHIATRY, De Crespigny Park, Denmark Hill, LondonS.E.5

5.30 P.M. Prof. M. G. Gelder: Psychotherapy Research, 1972.INSTITUTE OF UROLOGY, 172 Shaftesbury Avenue, London W.C.2

5 P.M. Dr. R. C. B. Pugh: The Pathology of Urothelial Tumours.ROYAL FREE HOSPITAL, Gray’s Inn Road, London W.C.1

5.15 P.M. Dr. H. A. Lee: The Role of Intravenous Nutrition in ClinicalPractice.

THE MEDICO-CHIRURGICAL SOCIETY OF EDINBURGH8 P.M. Mr. Peter Edmond: The Infertile Male.

UNIVERSITY OF DUNDEE5 P.M. Dr. M. J. Purves: The Possible Mode of Excitation of Arterial

Chemoreceptors.

Thursday, 3rdROYAL POSTGRADUATE MEDICAL SCHOOL

4.45 P.M. Mr. J. M. Rice-Edwards: Raised Intracranial Pressure.INSTITUTE OF LARYNGOLOGY AND OTOLOGY

5.30 P.M. (Royal College of Surgeons, Lincoln’s Inn Fields, LondonWC2A 3PN.) Dr. L. H. Capel: Airway Resistance in theUpper and Lower Respiratory Tract in Health and Disease.

MIDDLESEX HOSPITAL MEDICAL SCHOOL, Mortimer Street, LondonW1P 7PN

5 P.M. (Windeyer Building.) Dr. D. B. Gower: Role of CytochromeP450-Control of Steroidogenesis.

Friday, 4thROYAL POSTGRADUATE MEDICAL SCHOOL

11 A.M. Prof. R. Y. Calne: Donor-specific Immunosuppression.INSTITUTE OF LARYNGOLOGY AND OTOLOGY, 330,332 Gray’s Inn Road,

London WCIX SEE5.30 P.M. Dr. Leonard Sinclair: Parents and Children Who do not

Communicate.ROYAL COLLEGE OF SURGEONS OF EDINBURGH

3 P.M. Mr. Andrew Logan: The Surgery of the (Esophagus.

Notes and News

HOUSING THE ELDERLY

ONE of the most pressing problems that elderly peoplehave to face is housing, and it is a problem which is liableto recur as they become older and less able to manage witheveryday living on their own. Many old people in their60s and 70s wish to remain in their own homes, and,where possible, and provided help is available, this shouldalways be encouraged. However, for those with no homesof their own, or homes beyond their capabilities, and forthose in their 80s and 90s, sheltered housing of varioustypes is needed-and needed now in increasing quantitiesas the elderly population in Britain grows in numbers andage. Old people’s homes (particularly those run by localauthorities) are traditionally thought of as large, griminstitutions where the elderly are allowed little privacy orindependence. Local-authority homes are, in fact, oftenovercrowded and have to refuse many applications for

admission, both because of long waiting-lists and becausethey cannot provide the attention that a great many oldpeople, though not requiring hospital care, need; inaddition, these homes are often situated in rather isolatedplaces where contact with the local community and visitingby friends and relatives are difficult.

Voluntary groups have been quicker than local authori-ties to experiment with different types of housing for theelderly, and there are now a number of voluntary housingassociations which try to provide the elderly with accom-modation which is both convenient and congenial andwhich allows them the maximum possible amount ofindependence in relation to their age and degree of handi-cap. One such Association is the Bedford Citizens HousingAssociation, Ltd., which was formed in 1957 with thepurpose of housing elderly people of limited means. Withloans and grants from Bedford Corporation, the Associationover a period of years converted 8 houses into flatlets for oldpeople, with warden supervision in each house. It becameevident to the Association that, while the tenants appre-ciated being able to look after themselves in their ownrooms, some of them needed more attention than could be

given by the wardens, despite the provision of home-helps, meals-on-wheels, and the services of the districtnurse. As a result the Association asked for, and eventuallyobtained, a loan from the borough council with which tobuild a residential home-not only for the Association’sown tenants, but also for others in the Bedford area whoneeded such help.The home-Bedford Charter House-was opened in

1970 and provides accommodation for 48 elderly people.The building, which is two-storeyed and has two wings,contains 32 single rooms, for married couples 6

double rooms, and 4 2-roomed suites with bathroom andlavatory. All the rooms have their own ventilated lavatoryand wash-basin cabinets and, no doubt as a result, incon-tinence has proved to be no great problem in the home.There are 6 communal bathrooms; all the baths have

safety poles, and there are facilities for showering residentswhile they remain seated in a chair. The walls of thecorridors are painted in panels of different colours, so thatresidents can easily recognise the doors to their own rooms.They are encouraged to bring their own furniture, and asa result the rooms all look different, though basicallysimilar in structure. The residents do, in fact, appear tovalue their privacy greatly, making full use of their rooms,but also meeting in the lounges when they feel like com-pany. There are two lounges on each floor, and a laundry,sewing-room, library, television-room, hairdressing-room,and hobbies room. All meals and other services are pro-vided, but residents may use electric kettles in their rooms

273

and prepare simple meals in the communal pantries.There are at present two resident staff-a matron and

deputy matron-and there is accommodation for furtherresident staff if they should be needed. A doctor has beenappointed to give general supervision and advice to thehome, but most of the residents are looked after by theirgeneral practitioners. Visiting is freely allowed, andresidents who intend to be out late at night inform thematron and are given a key to let themselves in. Thehome is set in a large piece of ground adjacent to BedfordGeneral Hospital, but close to the town centre; the resi-dents can use the garden for their constitutional, and thereis a terrace where they may sit in warm weather.Many of the residents are very frail-most of them being

in their 80s and 90s. Without the home, a large numberof them would probably be in hospital, and it is clear,therefore, that it would be in the interests of the statutoryauthorities to provide just the sort of accommodationoffered by the home, if only to reduce the strain on thehospital service. In fact, although most of the residentspay E18 a week to the home, the county council hasagreed to make maintenance grants for 12 residents withlow incomes, and an endowment trust is being set up togive further help with fees. The home was built with twoideals in mind-the need to provide continuity of care forthe elderly, first in the flatlets while they can fend forthemselves, and later in the home; and the need to givethe elderly as much independence and interest in life aspossible by seeing that they avoid the dangers of institu-tionalisation. The local authorities have so far been slowto realise these aims (certainly they have lagged behindtheir counterparts in Holland and the Scandinaviancountries); part of the trouble is their reluctance to

regard housing as a social problem, and the consequentlack of coordination between social service and housingdepartments.

INSTITUTE OF MENTAL SUBNORMALITY

THE Institute of Mental Subnormality, which is at presentbased at Lea Castle Hospital, Worcestershire, has beenestablished with the object of trying to improve servicesfor the mentally handicapped both in hospital and inthe community. It is proposed that the council of theinstitute will have representation from the University ofBirmingham, the Birmingham Regional Hospital Board,the Royal College of Physicians, the Royal College ofNursing, and the British Psychological Society, and froma number of national voluntary organisations, includingthe Spastics Society, the National Society for MentallyHandicapped Children, and the National Association forMental Health. The institute hopes to set up a library ofinstructional films which have been made at hospitalswhere specific measures have been successfully intro-

duced, and these will be on loan to other hospitals. Theinstitute will also arrange courses for the various discip-lines involved with mental subnormality; it has alreadyestablished research projects on biochemistry, on thetreatment of cerebral palsy and blindness and deafness inmentally handicapped children, and on methods of assess-ing such children. Advice will also be available to hospitalson measures which can be taken to overcome presentdeficiencies in the service-for example, long waiting-lists,overcrowding, and lack of staff. The institute is closelyassociated with the departments of psychiatry and p2ediat-rics at the University of Birmingham and its activitieswill initially involve the hospitals in the BirminghamRegional Hospital Board area, but later it is hoped to coverthe rest of the country. The institute will receive somefinancial support from the Birmingham R.H.B., but willbe sponsored mainly from voluntary funds. The medicaldirector of the institute is Dr. G. B. Simon, Lea CastleHospital, Wolverley, near Kidderminster, Worcestershire.

DRIPS AND DROPS

ARE all drops equal ? Obviously not; but people whouse the drop-rate to regulate the flow of an infusion or thedose of an intravenous drug assume that they are. Doesthe difference matter ? Ferenchak and his colleagues 1became interested in the problem when devising a computer-controlled system employing a photoelectric drop-counter.First they noted a linear increase in drop-size with thediameter of the orifice, which was expected because a dropfalls when its weight equals surface tension times thecircumference of attachment. (Different brands of drip-sethave different sizes of orifice, and there are lesser variationsin individual brands.) Next they found that the faster thedrop-rate, the larger the drops. Except with blood, whichhas special characteristics, the relation is linear, and themean drop-size may increase by 30% or more. Finally,drop-size is influenced by specific gravity and surfacetension: solutions of parenteral nutrients or solutions withadded alcohol, for example, tend to emerge in small

drops. For manual infusers, probably the most importantobservation is the influence of rate on drop-size. Doublingthe drop-rate will more than double the rate at which thepatient receives a drug in the solution.

DRINKING-WATER QUALITYTHE control of water quality requires reliable methods

of examination and knowledge of the levels of constituentswhich may be harmful to man, animals, and plants. Anumber of countries have national standards, and theWorld Health Organisation publishes International stand-ards and also European standards for drinking-waterquality. Many people object to the word " standards "as being too rigid, and prefer to regard the figures in thesepublications rather as guidelines. In Britain the onlyspecified standards are for bacteriological quality. Never-theless, the European and International publications canbe of great help to people dealing with water treatmentand pollution. International Standards first appeared in1958, and a third edition has just been published.2 It ismuch shorter than the previous edition, because it no

longer includes detailed descriptions of examinationmethods; also it gives much less space to the evidence onwhich the W.H.O. expert committee based its recom-mendations. There is new information on examinationsfor viruses, toxic chemicals, pesticides, and polynucleararomatic hydrocarbons. In the section on toxic substancesa tentative limit for mercury is given for the first time.Most of the recommendations are based on an averagewater intake of 2-5 litres daily, and adjustments must bemade where intakes are higher. The recommended levelsof fluoride are, however, related to ambient temperatures.

Examination of water for trace substances is made

especially difficult by their extreme dilution, and specialmethods of analysis are often needed-for example, fordetergents, pesticides, and complex synthetic organicchemicals. The analyst is continually having to devisenew procedures. It is interesting how the assessment ofwater pollution has turned full circle in the past hundredyears. In the middle of the 19th century the only means ofestimating pollution was by chemical analysis for mineralcontent, together with some empirical tests for organicmatter. Then, with the discovery of bacteria as the causeof infectious diseases, many of which are waterborne, themore delicate bacteriological tests for sewage-indicatingintestinal bacteria became the dominant method of assess-

ing the safety of a water-supply. Today we have to dealwith traces of toxic elements and other trace substances

1. Ferenchak, P., Collins, J. J., Morgan, A. Surgery, St. Louis, 1971, 70,674.

2. International Standards for Drinking Water. World Health Organ-isation. Geneva, 1971. 90p.

274

that may also have long-term ill-effects upon health.Thus, there has been a return to chemical analysis, but of amore sophisticated kind, with complex and expensiveapparatus. Although the trace of organic matter remainingin river-derived treated water may be no more than it wasa century ago, its very nature may have changed, andresearch into the state and nature of this trace material isa major part of the programme of analytical research intowater quality now being undertaken in the U.K.

University of BirminghamThe honorary degree of D.sc. is to be conferred on

Sir John Peel.

University of Newcastle upon TyneThe honorary degree of D.C.L. is to be conferred on

Sir George Godber.

University of GlasgowThe following degrees have been conferred:CH.M.-I. A. McGregor (with commendation).PH.D.-Maria A. Brito de Sousa, 1. A. R. More.

Queen’s University of BelfastMr. D. B. Archer has been appointed to the newly

established Sir Charles Blackmore chair of ophthalmology.Mr. Archer was educated at Methodist College, Belfast, and

the Queen’s University ef Belfast, where he graduated M.B.in 1959. He was assistant lecturer in physiology at Queen’sfor a year, then in 1961-62 he was senior house-officer inophthalmology at the Royal Victoria Hospital, Belfast; heobtained the D.O. in 1962. After a further year at the RoyalVictoria Hospital as senior house-officer in general surgery, hewas registrar in ophthalmology at the Benn Hospital, Belfast,and in 1964-65 he held a similar post at the Westminster Hos-pital, London. He then became registrar in ophthalmology atMoorfields Eye Hospital, London, and later senior registrar.He was also, in 1966-68, a clinical assistant at the NationalHospital for Nervous Diseases, and, in 1967, registrar in oph-thalmology at Great Ormond Street Hospital. In 1968 he took

up a Wellcome travelling scholarship and went to America asresearch associate at the University of Chicago; in 1970 he wasappointed professor there. He became F.R.c.s. in 1968. He haspublished a great deal of work, and has prepared two reports oneye diseases in Ethiopia, one for the World Health Organisationand one for the Royal Society of Medicine.

Dr. R. G. Shanks has been appointed to a personal chairin clinical pharmacology.

Dr. Shanks was educated at Methodist College, Belfast, andat the Queen’s University of Belfast, where he graduated B.sc.with honours in physiology in 1955, M.B. in 1958 (with a goldmedal in child health), M.D. (with honours) in 1963, and D.sc. in1969. Following a year as resident medical officer at the RoyalVictoria Hospital, Belfast, he was awarded a Mackay Wilsontravelling scholarship to the Medical College of Georgia, wherehe was research fellow in the departments of physiology andpharmacology; he also held a fellowship awarded by the AmericanHeart Association. In 1960-62 he was tutor in physiology at theQueen’s University of Belfast. From 1962 to 1966 he was headof cardiovascular research in the pharmacology department ofI.C.I. at Macclesfield. Since 1966 he has been senior lecturer inclinical pharmacology in the department of therapeutics andpharmacology at Belfast and consultant in clinical pharmacologyto the Northern Ireland Hospitals Authority. He is deputychairman of the Specialist Advisory Committee on HigherMedical Training in Clinical Pharmacology, which was estab-lished by the Royal Colleges of Physicians.

Mathilda and Terence Kennedy Institute ofRheumatologyDr. L. E. Glynn, deputy director of the Medical Research

Council Rheumatism Research Unit, Taplow, and directorof the department of pathology, Canadian Red CrossMemorial Hospital, has been appointed director of theinstitute (on a part-time basis).

Faculty of AnaesthetistsA series of meetings and a dinner are being organised

on May 3-6 to celebrate the bicentenary of the discovery ofnitrous oxide. Details may be had from the Faculty Office,Royal College of Surgeons of England, 35-43 Lincoln’sInn Fields, London WC2A 3PN.

Rock Carling FellowshipProf. A. L. Cochrane, Rock Carling fellow for 1971,

will introduce his monograph, Effectiveness and Efficiency:Random Reflections on Health Services, by a lecture tobe given on Monday, March 20, at 6 P.M., at the Universityof Edinburgh Medical School. Applications for ticketsshould be sent to the secretary, Nuffield Provincial Hos-

pitals Trust, 3 Prince Albert Road, London N.W.1.

Democracy in the N.H.S.This is the subject of a conference, organised by Needle

magazine, to be held on Feb. 5-6, from 10.30 A.M. to 5.30P.M., at the Middlesex Hospital Medical School, ClevelandStreet, London W.l. Details may be had from Mr. JohnRobson, 27 Pearman Street, London S.E.1.

Endocrines of the Gastrointestinal Tract

This is the subject of a symposium to be held on Saturday,March 4, organised by Northwick Park Hospital and Clini-cal Research Centre. The fee will be E1.25. Details may behad from Dr. Lisa Hill, Clinical Research Centre, WatfordRoad, Harrow, Middlesex HA1 3UJ.

CORRIGENDA: Antibodies to Intestinal Microbes in Serum ofPatients with Cirrhosis of the Liver.-In this article by ProfessorBjorneboe and his colleagues (Jan. 8, p. 58), the patient numbersin the figure do not correspond to those in table i. The corre-

sponding numbers are shown below.

Figure no. 1 2 3 4 5 6 7 8 9 10 11112 13Table Ino. 18 11 22 14 17 23 12 19 6 8 24 20 10

I

Figure no. 14 15 16 17 18 19 20 21 22 23 24 25 26Table I no. 2 9 21 7 1 3 15 25 13 26 5 4 16

In the figure, patient 3 (not patient 1) should be shown ashaving a portacaval anastomosis.

How Safe is Abortion ?-Through an oversight on our part, anerror persisted in the last sentence of the letter by Dr. Mettersand Dr. Milton (Jan. 22, p. 197). " Local operation " should haveread " legal abortion ".

AppointmentsLeeds Regional Hospital Board:

JAIN, S. K., M.D.Lucknow, D.M.R.D.: consultant radiologist, ClaytonHospital and Pinderfields General Hospital, Wakefield.

PAYNE, R. B., M.D.Wales, PH.D.Leeds, M.R.C.PATH. : consultant chemi-cal pathologist, St. James’s Hospital, Leeds.

ROBERTSON, COLIN, M.B.Birm., F.R.C.S., F.R.C.S.E. : consultant ortho-psedic surgeon, Clayton Hospital and Pinderfields GeneralHospital, Wakefield.

North East Metropolitan Regional Hospital Board:HOPPER, P. K., M.B.Lond., M.R.C.PATH.: consultant pathologist

(microbiologist), Hackney hospital group.IMPALLOMENI, MARIO, M.D.Florence, M.R.C.P.: consultant geriatrician,

Enfield and Tottenham hospital groups.LIGHTOWLER, C. D. R., M.B.Lond., F.R.C.S. : consultant orthopaedic

surgeon, South Essex hospital group.Oxford Regional Hospital Board:BABINGTON, P. C. B., M.B.Lond., F.F.A. R.C.S., D.A.: consultant

ansesthetist, Swindon and Cirencester area, with duties mainly atPrincess Margaret Hospital.

MALE, B. M., M.B.Lond., D.C.H., D.P.M. : consultant in child psychiatrylmental handicap, Swindon and Cirencester area.

WHARTON, B. K., M.R.c.s., M.R.C.PSYCH., D.P.M.: consultant psychia-trist, Crispin hospital group and associated clinics.