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GUY’S HOSPITAL

Reappointed: Lord Cunliffe (chairman) ; Mrs. E. G. M.Barlas, J.P. ; Mrs. Iris Brook ; J. M. H. Campbell, o.B.E., M.c.,F.R.C.P. ; C. J. Conway, K.c.; Sir Patrick Ashley Cooper,LL.B. ; Sir William Kelsey Fry, C.B.E., M.c., M.R.C.S. ; 0. GayerMorgan, F.R.C.S.; F. J. 0. Prescott ; L. B. Wimble.New member: R. J. Mellish, M.P.

KING’S COLLEGE HOSPITAL

Reappointed Marquess of Normanby, M.B.E. (chairman) ;T. H. Barr; P. R. Colville ; L. M. E. Dent, D.s.o. ; M. V.Ely ; Viscountess Hambleden ; Hon. Mrs. S. L. Henley ;

. Sir Cecil Wakeley, x.B.E., C.B., P.R.C.S.New member W. 1. Daggett, F.R.c.s. ; one appointment

outstanding.’

ST. THOMAS’S HOSPITAL

Reappointed: Hon. A. J. P. Howard, c.v.o. (chairman) ;E. F. Crundwell; F. H. Elliott; W. G. R. Boys ; Sir Brunel

Cohen; J. R. Dickinson, F.R.C.S. ; Prof. T. Pomfret Kilner,c.B.E., F.R.C.S. ; A. H. Montgomery; R. H. 0. B. Robinson,F.R.C.S. ; L. H. Simmons.New member: Sir Max Page, 1,C.B.E., c.B., D.s.o., F.R.C.S.

HAMMERSMITH, WEST LONDON AND ST. MARK’S HOSPITALS

Reappointed: Somerville Hastings, M.r., F.R.C.S. (chairman);G. F. Grant Batchelor, M.c., F.R.C.S. ; Sir Allen Daley, F.R.C.P. ;His Honour Judge J. Norman Daynes, R.C.; Cuthbert Dukes,M.D. ; Sir Francis Fraser, F.R.c.p.; Geoffrey Huddle ; T. H.Jones ; A. E. Tyler ; one appointment outstanding.

HOSPITAL FOR SICK CHILDREN

Rearppointed T. H. Bischoff, M.c. (chairman) ; Sir AllenDaley, F.R.C.P. ; T. Twistington Higgins, o.i3.F,., F.R.C.S.;C. H. Hodge, J.r. ; P. K. Hodgson, C.M.G., c.v.o., o.B.E. ;Eric Lloyd, F.R.C.S. ; A. E. Middleton ; George Newns, M.D. ;Bernard Schlesinger, F.R.c.P.New member: Prof. T. H. Marshall, c.M.G.

NATIONAL HOSPITAL FOR NERVOUS DISEASES

Reappointed: Sir Ernest Gowers, G.B.E., K.C.B. (chairman) ;W. Russell Brain, P.R.C.P. ; E. A. Carmichael, c.B.E., F.R.C.P. ;Sir Archibald Gray, C.B.E., F.R.c.p.; A. C. Longland ; LadyMilverton ; P. D. Power.

New member : F. C. Wareham ; Mrs. 0. Deer.

ROYAL NATIONAL THROAT, NOSE AND EAR HOSPITAL

Recappoiroted E. E. Taylor (chairman) ; F. R. Eiloart ;Mrs. Haydn Davies ; G. H. Howells, F.R.C.S.; W. Humphrey ;R. N. Wright.New members Maxwell Ellis, F.R.c.s. ; J. C. Hogg, F.R.c.s.

MOORFIELDS, WESTMINSTER AND CENTRAL EYE HOSPITAL

Reappointed: Lord Luke, J.P. (chairman) ; E. P. Carter,o.B.E.; A. Gorman ; Mrs. A. L. Hollingsworth, J.P. ; GeorgeParker-Jervis ; Earl of Rothes ; G. C. Stanley.New members Frank Elliott, F.R.C.P. ; Harry Hutchinson.

’

BETHLEM AND MAUDSLEY HOSPITALS

Recvppoin,ted : C. P. Blacker, G.M., M.C., F.R.C.P. ; Mrs.Kathleen Wilson ; Alderman T. E. Morris, J.P.; Mrs. N. C.Runge, o.B.E. ; E. F. Scowen, F.R.C.P.New members Lady Norman, J.P.; Lieut.-Colonel G. J. C.

Welch, O.B.E., m.c. ; Alderman J. C. Maclean.

ST. JOHN’S HOSPITAL FOR DISEASES OF THE SKIN

Reappointed: : 1. A. M. Ellison-Macartney (chairman) ;A. Franklin; G. B. Mitchell-Heggs, O.B.E., F.R.C.P. ; A. D.Long; Miss Dorothy Fox; S. Cochrane Shanks, F.R.C.P.S. I. Salmon.

HOSPITALS FOR DISEASES OF THE CHEST

Chairman: Widdrington Stafford (for the rest of the

period of his office-i.e., to March 31, 1952).- ReappoMed R. C. Brock, F.R.C.S.; Sir John Gilmour ;

J. L. Livingstone, F.R.C.P. ; H.K.Eaton0stle; V.C.Thompson,F.R.C.S. ; Mrs. Sarah Candy ; Mrs. Marguerite Watson.New member: George Simon, M.D. ; three appointments

outstanding.

ROYAL NATIONAL ORTHOPAEDIC HOSPITAL

Reappointed: Louis Fleischmann, c.B.E. (chairman); SirHenry Floyd, c.B., c.B.E. ; W. Morgans ; H. C. Willig ; MissM. Joan Wood.New member Reginald Nassim, }<’.R.O.1’.; one appointment

outstanding.NATIONAL HEART HOSPITAL

Reappointed: J. M. Oakey, M.c., J.P. (chairman); J. M. F.Cohen ; T. F. Cotton, F.R.C.P.; Sir Francis Fraser, F.R.C.P.;B. T. Parsons-Smith, F.R.c.r.New menbber : E. G. Gooch, c.B.., M.P.

ST. PETER’S AND ST. PAUL’S HOSPITALS

Reappointed : : L. E. D. Bevan (chairman); A. MeN,Farquhar ; Sir Bertram Galer, J.p. ; A. R. C. Higham, J!’.R.C.S.’J. Russell Kelly ; L. G. Mitchell-Innes ; H. Short; H. p,Winsbury-White, F.R.c.s. ; one appointment outstanding.

ROYAL CANCER HOSPITAL

Reappointed: : Sir Edward Cripps (chairman); Prof.Ian Aird, F.R.C.S. ; P. E. Thompson Hancoek, F.R.C.P. ; G. L.Jacob ; Prof. W. V. Mayneord ; Mrs. Noel Patrick G. C.Stanley ; Claude S. Harvey ; E. A. Carmichael, F.R.C.P. *

QUEEN CHARLOTTE’S AND CHELSEA HOSPITALS

Reappointed : Sir Frederick Minter (chairman); H. G. E.Arthure, F.a.c.s. ; Aubrey Goodwin, o.B.E., F.R.C.O.G..Viscountess Jowitt ; E.142usgTOVe ; Charles Newman, F.B.c.p.;A. M. Niven ; Lady Ogilvie ; Alan Sainsbury : G. Whiffen.

EASTMAN DENTAL HOSPITAL

Reappointed: : Sir Frank Newnes (chairman); BrigadierR. A. Broderick, D.s.o., M.c., M.B., F.D.S. ; Sir William KelseyFry, C.B.E., M.C., M.R.C.S.; B. M. Lindsay.Fynn; G. Meekcoms;W. R. Young, F.D.S.New membe1’: G. J. Parfitt, M.R.C..3., L.D.S.

Public Health

THE LEEDS TUBERCULOSIS SCHEMEAN effective tuberculosis scheme depends on the

initiative of the regional hospital boards. It is instructiveto see how an energetic region is attacking the problem,and what progress has been made since the start of theNational Health Service, nearly three years ago.

THE SURVEY

When the Leeds regional hospital board took over,a panel of doctors was convened by the board to reviewthe existing tuberculosis facilities in the region, andto suggest, for the consideration of the Specialist ServicesCommittee, how to organise and develop them. A veryfull questionary was sent to hospital management com-mittees, and the information thus gained, supplementedby the local knowledge of members of the panel, wasassembled into a tabulated survey of the existing dis-pensaries, their housing, equipment, and staffing, thenumbers on their lists, and many other aspects of theirwork.On July 5, 1948, there were 42 dispensaries and clinics

in the region. Only 1 of these, at Scarborough, wasin a general hospital; 3 others were attached to sana-toria and 1 other was in hospital premises. Even so,not all of these had X-ray equipment. Indeed the panelfound that only one dispensary in the whole regionhad modern X-ray equipment ; 4 others had machines" in varying degrees of obsolescence," and the remaining37 had no X-ray equipment at all. Pneumothorax refillswere done in 24 of the dispensaries, 19 of which hadnot even the means of screening patients. None of thedispensaries had been designed as such, though 11were said to have been adapted to their purpose. Morethan half of them were in converted dwelling-houses,

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xnd in most cases they consisted of one or two officerooms and an unequipped examination room. Some ofthem were very oddly housed-one in the cloakroomsof a church hall, another in an old schoolhouse, anotherin a corrugated-iron building, and another in a woodenpavilion. But these standards of housing and equipmentof clinics matched those in many other provincialareas before the appointed day, and may have beensubstantially better than some.

Relatively few of the dispensaries had room for

expansion-only 10 in all-and some of these were housedin buildings which were in any case unsatisfactory. It is

noteworthy that the clinics and dispensaries doing thelargest amount of work were not necessarily the besthoused. Thus at 3 out of the 5 dispensaries housed inhospitals attendances (of patients and contacts) werebelow 500 a year ; only one session a week-or even onea month-was held, and the numbers of new cases seenwere negligible. The Scarborough Hospital clinic,however, had nearly 1250 attendances and about 55new patients yearly, and the dispensary at Bradford, ina converted dwelling-house, had an annual attendanceof some 7200, and a new-case roll of 920. The largestattendance&mdash;then some 26,500 yearly-was at the NewBriggate dispensary, Leeds, housed in a building put up in1866 as the Leeds Public Dispensary, which dealt mainlywith outpatients. Other dispensaries with large attend-ances were at Hull, Sowerby- Bridge, SouthKirby, and Pontefract ; only one of thesehad X-ray equipment, and that was outof date. In two of the clinics&mdash;at Upper-mill and Garforth-there was no properlighting, and in one of them no runningwater, and from one (Patrington) the

patients had to travel 25 miles for

pneumothorax refills.

PLANNING A POLICY

In making their proposals the panel didnot think in terms of tuberculosis alone,but had in mind a chest service of muchwider scope. But they had also to bear inmind, when making short-term recom-

mendations about staffing and beds, thatsanatorium accommodation, experiencedchest physicians, and nursing staff wereall scarce. They based their estimates onthe 200,000 unit of population adoptedbv the British Medical Association.1 Asa long-term measure they believe thereshould be 200 sanatorium beds, and 50beds in general hospitals, for each such unitof population, and taking this as their standard they found that, even supposingall the existing beds could be fully staffed,the region would still need a further 1000beds for the treatment of pulmonarytuberculosis. Moreover they judged that,for every population of this size, 66 sessionswould be needed weekly : 12 at sanatoria,6 in general hospitals, 24 at dispensaries,4 in hospital outpatient departments, 12for domiciliary visiting and social-welfarework, and 8 to allow time for X-ray exam-inations, and conferences with the thoracicsurgeon or other colleagues. Allowing 11 lsessions weekly for each doctor, such aunit of population would therefore need2 senior chest physicians, 3 assistant chestphysicians, and 1 registrar.1. Tuberculosis in the National Health Service :

Report of the Tuberculosis and Diseases ofthe Chest Group Committee of the BritishMedical Association, 1950. And see Lancet,1950, ii, 809.

In rearranging the dispensaries the panel rememberedthat the diagnostic service must keep in close touchwith the aftercare service, and so proposed administrativearrangements which fitted with the county, county-borough, and sanitary-district boundaries. Throughoutthey had in mind the convenience of patients and themeans they had of getting to the clinics. They wereanxious, wherever possible, to get rid of the unequippedvisiting station, and to link up each chest centre withthe outpatient department of a general hospital; andthis ’has been achieved to a very large extent. In18 cases it has been possible either to move dispensariesinto hospitals, or to arrange that they shall be movedthere at an early date. Already 7 new screening setshave been installed ; and 2 major X-ray sets and 4 morescreening sets are to be delivered this year. A newX-ray department has been set up at Goole, in the

hospital which is now to house the Goole chest clinic.Of the unequipped stations, 5 have either been closedor are to be closed as soon as new plans in the areaare complete ; 11 more are being retained as visitingstations for the convenience of patients, but 5 of thebusiest of these are to be transferred into hospitalsas soon as arrangements can be made. The two mapsshow the former and the new distribution of clinics andthe X-ray facilities in the various areas. A few exampleswill show clearly the kind of thing that has happened.

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A satisfactory dispensary in the outpatient department ofScarborough Hospital is being maintained. In this area

there were also dispensaries at Norton, Whitby, and Brid-lington-one in a general practitioner’s surgery, one on theground floor of a district health dffice, and one in a converteddwelling-house. None of these had X-ray equipment. Onthe advice of the panel, the Norton dispensary is beingtransferred to the Malton and Norton District Hospital inthe near future, and the other two have already been moved,one to the Whitby War Memorial Hospital and the otherto the Lloyd Hospital, Bridlington. Patients will thus havebetter care without having further to go.The Leeds clinics presented some special difficulties. As

already noted, the New Briggate dispensary is the largestin the whole region, and now has some 30,000 attendancesand over 2400 new cases yearly. The offices and X-raydepartment are on the first floor of the old-fashioned out-patient department in which it is housed. This busy clinicheld clinical and X-ray sessions daily, refill and X-ray sessionsin the evenings, and daily dental and ultraviolet light sessionsin addition. The panel found the premises quite inadequatefor the volume of work now being undertaken, and recom-mended that a major chest centre should be established ina general hospital in Leeds, and the outlying dispensaries atHorsforth, Garforth, Morley, and Rothwell should be closedas soon as the new centre could be opened and fully staffed.This has not been possible, and instead major alterations arenow being planned to the existing clinic. The Horsforth

dispensary has been closed and the patients distributed toother dispensaries in the area; the Rothwell dispensary(which is in the isolation hospital) and the Morley andGarforth clinics are being retained.At Hull conditions were very bad, for though there were

2 dispensaries in the city neither had X-ray equipment andpatients were being examined radiologically at a multipleclinic which was not the property of the board. There werealso outlying dispensaries at Beverley, Patrington, andHessle, in Driffield Sanatorium and Beverley WestwoodSanatorium (where there were X-ray facilities). The paneladvised that a main chest centre for the area should be set

up in one of the Hull general hospitals, with secondary clinicsat Beverlev Westwood and Driffield Sanatoria. Varioussites in the Hull general hospitals have been suggested forthe chest clinic, but none has been found really suitable,and the possibilities are still being examined. Meanwhile anew screening set has been provided in the larger of thetwo city clinics, one of the outlying dispensaries has beenclosed, one has been transferred to Beverley WestwoodHospital, and one is being retained as a visiting station. Theclinic at Driffield Sanatorium is to have a new screening setinstalled.The board’s greatest success has been at Bradford, where

a fine new chest clinic is being established in St. Luke’s

Hospital.STAFFING

Short-term recommendations on staffing took accountof the need for a close relation between the chest clinicsand the sanatoria. The panel unanimously decided thatthe chest physician should be on the staff of the sana-torium and visit regularly ; that the staff of the sana-torium should be regarded as a team with the medicalsuperintendent at the head ; and that the residentstaff of the sanatorium should do clinical work at thechest clinics and also domiciliary work on request. Theyrecommended that, in all, 1 senior physician, 2 assistantphysicians, 5 senior registrars, 1 other registrar, 1 medicalsuperintendent, 1 deputy medical superintendent, and1 medical officer should be appointed immediately ; andin fact, several of these appointments have been made.But increasing financial stringency, and the limitationsimposed on registrar establishments, have made it

necessary to modify the original recommendations.The panel made a careful estimate of the number of

beds needed by chest physicians for the treatment ofshort-term cases in the general hospitals of the region.These proposals were not exorbitant, amounting to only548 for the whole region, which meant less than 50 bedsin each administrative area except that of Leeds itself,where they proposed that 150 beds should be provided,in two hospitals. Hospital management committees are

beginning to recognise that the need is urgent, and areresponding to it ; and in fact the board hope to beable to report, in the course of the next few weeks,that enough beds have been found in general and infec-tious diseases hospitals to reduce the waiting-lists toreasonable proportions.

In an attempt to make the best possible use of sana-torium beds, 3 admission bureaux have been set up,those in Bradford and Hull under the direct control ofthe senior chest physicians in the areas, and that atLeeds under a sanatorium medical superintendent ofconsultant status. These have worked well, and havesubstantially reduced the waiting-lists already. Thoracic

surgery centres have been developed in the same threecities : two consultant surgeons were already at workin Leeds, and are carrying on, and two others have beenappointed at Bradford and Hull. Collaboration withthe health authorities varies : in Leeds it is very good,and the medical officer of health seconds full-timetuberculosis health visitors to the clinic.

There is of course much still to do. There are stilltoo many dispensaries without screening sets and othernecessary equipment, and without an adequate health-visitor service. Treatment arrangements for orthop&aelig;dicand other non-pulmonary tuberculosis, and for mentallyill and mentally defective patients, are still unsatisfactory.But good progress has been made in the periodunder review-enough to show that those regionalhospital boards which are willing to use the tools tohand can hope to make a respectable job of their charge.

Notification of LeprosyEvery doctor will shortly receive a copy of regulations

providing for the notification of leprosy, which came intoforce on June 22. In future, as soon as a doctor becomesaware that a patient has leprosy he must send to thechief medical officer of the Ministry of Health a certificatein the form set out in the schedule of the regulations. Hemust also notify the Ministry of any cases which he wasattending on June 22. Notification direct to the Ministryis considered advisable because it enables strict secrecy tobe maintained. In the past the whole family of the patienthas sometimes been affected by the local disclosure ofknowledge of the patient’s condition. A second reasonis that accurate knowledge of the location of cases ofleprosy is essential if the patient is to benefit fully fromrecent advances. The regulations contain no statutorypowers whereby a patient with leprosy can be removedto a hospital, for this might lead to concealment.The number of patients with leprosy in this country

is small, and almost without exception they have beeninfected abroad. Most of them are foreigners andcolonial subjects, and many have been repatriated ; butfor some, return to their own country is impracticable.At present some non-infectious patients are being treatedunder private arrangements, others as outpatients athospitals or as temporary inpatients at infectious-diseases hospitals or at a small private hospital restrictedto British nationals. Arrangements for treating infectiouscases have sometimes presented difficulty. To helpdoctors to deal with these patients the Ministry of Healthhas now appointed as their adviser in leprosy Dr. R. G.Cochrane, secretary of the British Empire LeprosyRelief Association, 167, Victoria Street, London, S.W.I.Dr. Cochrane will advise any doctor on the diagnosis andtreatment of leprosy. He will associate himself withpractitioners notifying cases, and he will be available toexamine close contacts. The Ministry also announcesthat a hospital for leprosy patients has been opened atReigate, Surrey, by University College Hospital as anannexe to the Hospital for Tropical Diseases.

PoliomyelitisIn England and Wales poliomyelitis notifications

during the week ended June 7 were as follow : paralytic32 (16), non-paralytic 20 (12) ; total 52 (28). This is anincrease of 24 compared with the previous week, thefigures for which are in parentheses.