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339 stiff and painful back in a position of flexion even for a few minutes. Furthermore, if he is sufficiently experienced and honest with himself he will also realise that the unnecessary trauma may well precipitate paresis which might otherwise not have occurred. It is, of course, agreed that lumbar puncture must be done when tuberculous meningitis, an inadequately treated pyogenic meningitis, and several other conditions, have to be taken into consideration, but in a febrile patient with symptoms and signs suggestive primarily of poliomyelitis the only clinical laboratory test which need be carried out in the first few days is a leucocyte count. In acute poliomyelitis this will be found to be normal or even low. West Dorset Poliomyelitis Diagnostic Unit, Diagnoetic unit, E. J, GORDON WALLACE. Weymouth. E. E. J, GORDON WALLACE. West Dorset Poliomyelitis Diagnostic Unit, Weymouth. 1. Municip. J. April 23, 1954, p. 897. Public Health Old People Needing Help SERVICES for the aged are increasing, but there are still some old infirm people, many of them living alone, whose needs do not fit into any pigeon-hole. Dr. J. Greenwood Wilson,’ as medical officer of health for Cardiff, has described how, in that city, the Women’s Voluntary Services (W.V.S.) have combined with the local authority to look after the old people in this group. Cardiff has a very good home-help service, with a staff of more than 100 women, able to give help to more than 200 people at a time ; but there are cases, he finds, for which the home-help cannot do all that is needed. Studying the case-load of the service, at the end of 1951, he found that of 113 aged and infirm and chronic sick people then receiving home help, 47 had needed it for more than a year, and 57 were living alone. The home helps were trying to do far more than it was ever intended that they should, and some means of supplementing their efforts seemed to him essential. The health and welfare authorities, between them, could send staff to visit the aged and chronic sick, and ascertain their needs ; they could, when necessary, supply a home nursing service ; and they could find places in hostels for those aged people who were not sick. But they could do little for, say, a bedridden arthritic widow living in one room with no-one to look after her, and no prospect either of a place in a hostel or a bed in a hospital. In 1952 Dr. Greenwood Wilson enlisted the help of the W.V.S., who are already working actively for the old, providing meals-on-wheels and clubs in many parts of the country. At that time there were 106 cases to consider, which he classified in three categories : 17 people who urgently needed more care than a home help could give ; 40 people whose needs home helps could barely cover, and whose situation was deteriorating; and 49 people needing regular domestic assistance. The 17 in the first group were aged between fifty-four and ninety-eight, and their disabilities included chronic arthritis, heart-disease, paralysis, the effects of fractures, and general infirmity ; 13 lived alone and 3 of these were bedridden. Of the 40 in the second group, all but 4 were over seventy and many were over eighty. Most of them had some chronic disorder such as diabetes, asthma, rheuma- tism, arthritis, or the results of a stroke, and some had been discharged from hospital as incurable ; two were blind. The 49 people in the third category wore in the worst case of all, most of them being disabled by their diseases, and all being over sixty-five. The W.V.S. assessed the needs in every case, and sought out people willing to give regular care and who could be relied on to go on giving it. The area onicer of the National Assistance Board was approached, and existing allowances were increased to cover the cost of these workers. The relationship formed with the board by the W.V.S. was very good, and they often discussed plans, in advance, with the officers of the board. Since the scheme was started they have been able to arrange this kind of help for 83 people in nine districts, and they send visitors once a month to make sure that both the patient and the " home aid " are content. The service has not only been a success in its own right, but has prevented the home- help service from breaking down in times of stress during the winter, and has thus saved the old and infirm from added hardship. This problem is not, of course, confined to Cardiff. A recent study 2 made at Hammersmith, London, of 100 people over seventy, shows some similar gaps in services there, and no doubt they exist all over the country. Dr. Greenwood Wilson’s sample, moreover, was not necessarily fully representative, being taken from the lists of those old people who were receiving home help. But many old people, it seems from the Hammersmith study, never come to the notice of the local authority or the Old People’s Welfare Association ; and this is not necessarily because they do not need their services. Of these 100 old people no less than 43 had no knowledge of the association ; thus they did not know where to go for help when they were in difficulties. It is true, as the report points out, that they might have been benefiting from the association’s work, none the less : they might be members of a club, or use a meals service run by the association, or they might have heard about the associa- tion and forgotten. Nevertheless, it would be as well, the report suggests, to make the association’s work better known-by means of posters (on hoardings, in doctors’ waiting-rooms, and in hospitals), and by personal explana- tions from home helps, National Assistance Board officials, and rent collectors. The committee, indeed, themselves encountered the difficulty of tracking down needy old people who do not come for help : the National Register is no longer maintained, and three Government depart- ments which were approached felt (understandably) unable to disclose names and addresses recorded for other purposes. The net result, however, is that unless the old find their own way to help, help cannot easily reach them. The report notices that the days and hours of attend- ance of home helps need to be extended in some cases, and draws attention, as other reports have done, to the value of cheap laundry services. Only 14 of the 100 were having cooked meals brought to the house and only 7 took any meals out ; and the report suggests there is little demand. But it seems possible that some of the old people might, after a little personal explanation and encouragement, have made better use of meals services and of clubs. As they grow older, people tend to go out less, and the effort of going. to a club outweighs the pleasure of being there. Some, too, find their con- temporaries gloomy and uncongenial, and prefer to be, when they can, with younger people. " Age," as one octogenarian used to say, " is catching." On the other hand membership of a club is a safeguard against neglect : if he is known at his club, and missed, an old person can be sought out, and perhaps spared a miserable end. The club habit, in fact, should be acquired soon after retire- ment, while people are still active and inclined for society : later it may not be possible to persuade them to join. The same sort of safeguard is provided by the regular and friendly visitor, who can put the old person in touch with the right agencies at the right moment. Lack of such a friend is the cause of much unnecessary tragedy, as the painful case-histories, quoted in the report, reveal. 2. Over Seventy. Published for the Sir Halley Stewart Trust, and the National Old People’s Welfare Committee, by the National Council of Social Service, 26, Bedford Square, London, W.C.1. 1954. Pp. 99. 5s. This study was undertaken by a special subcommittee of the National Old People’s Welfare Committee, whose vice-chairman, Mrs. M. M. C. Kemball, presided. The report was compiled by Miss K. M. Slack, lecturer in social science at the London School of Economics.
