686

of general practitioners particluarly experienced in thework. Unfortunately this has not always worked out inpractice, and for the most part it is open to any generalpractitioner to undertake midwifery if he so chooses. Weshould like to see this work restricted to keenly interestedpractitioner-obstetricians who, though probably withsmaller lists, would continue in general work so as toremain in touch with the whole field of general practice.Family doctors not doing maternity work should refertheir cases to these colleagues. A group practice wouldalmost always include at least one practitioner-obstetri-cian. Future entrants to the " obstetric list " would

gain their experience and qualify for admission to the listby association with practitioner-obstetricians.Where local-authority medical officers continue in the

service they should be given the opportunity to conducttheir midwifery practice on the same terms as generalpractitioners-i.e., he, or she, must be able to visit theexpectant mother at home where necessary and attendthe confinement in this labour-ward unit.

In any maternity scheme the needs of the mother andbaby are paramount. For some years now it has beenour experience that mothers approach their confinementwith much less fear than formerly. This is due, we feel,to over-all antenatal supervision as well as instruction inrelaxation. We make a point of telling the mother, bydiscussion, film strips, and diagrams, as much as we

think she ought to know about the course of labour andassure her that we will be with her when she needs us.All the same there remain the hazards of any normal

delivery, and many mothers are aware of these. It maybe said that " the only normal delivery is the absolutelynormal one which has just been completed."We feel that our scheme would have a wide appeal, for

the mother would know that she could be delivered in a

place where all the resources of a maternity hospitalwere readily available should things go wrong, and yet beable to return home immediately for her subsequent care.We should like to record our appreciation to Dr. R. C.

Wofinden, medical officer of health, Bristol, for his adviceand constructive criticism in the preparation of this article.

REFERENCES

Farquharson, E. L. (1955) Lancet, ii, 517.Redman, T. F., Walker, S. C. B. (1954) Brit. med. J. ii, 41.

HOSPITAL FARMS

IN his reports 1 on the National Health Service accountsfor 1954-55, the Comptroller and Auditor-General, SirFrank Tribe, again refers to hospital farms and marketgardens. An expert committee reviewed the farmingactivities of 190 hospitals with 40,000 acres of farmlandand nearly 4000 acres of market gardens. They foundthat, in a number of instances, farming had been devel-oped for its own sake,

" and the maintenance of pedigreeherds and dairy farming had become a major preoccupa-tion with some hospital authorities." In the light of thecommittee’s report, the Ministry of Health advised hos-pitals that they had no authority to run farms except inso far as they were an essential part of hospital manage-ment, and they asked hospitals to review their farms. ByOct. 31, 1955, 207 farms had been surveyed by regionalboards. Decisions had been reached about the future of126, and it had been decided that farming should ceaseat 47 hospitals and be reduced at a further 38, involvingthe disposal of 17,598 acres of land.

Trading accounts for hospital farms and gardens inEngland and Wales in 1954-55 showed an excess ofincome over expenditure of £60,000. Farms showed asurplus of £140,000 and market gardens a deficiency of£80,000 (these figures do not include small marketgardens). In Scotland farms recorded a net profit ofover £58,000, but market gardens showed a loss of justunder £10,000.1. National Health Service Acts, 1946 to 1952, Accounts 1954-55.

H.M. Stationery Office. Pp. 41. 2s. 6d. National HealthService (Scotland) Acts, 1947 to 1952, Accounts 1954-55. H.M.Stationery Office. Pp. 26. 1s. 9d.

In England Now

A Running Commentary by Peripatetic CorrespondentsART critics have come under the brush at Burlington

House this year. Sir Alfred Munnings leads the way.Besides the usual reliable na,gs from his stable, he hasentered a likely outsider-his witty but good-naturedsatire on modern art, Docs the Subject Matter Of hiscircle of critics, I got the feeling that Munnings wasbacking the dog. Mr. A. R. Thomson urbanely offersus The Selection Committee 1955 in an entertaining andelegant crescent before a red curtain. But withMr. Richard Eurich the gloves are off and his versionof The Critics is as harsh as it is accomplished.

There is no formal royal portrait of the year, and theplace of honour is given to a large study of The Duke ofWellington in ducal robes. People seemed to be turningwith relief from its uncertain grandeurs to the smallerportraits, such as Sir Gerald Kelly’s blue and greypicture of Sir Geoffrey Jefferson, M.S., F.R.S., who sitsat ease looking out sleepily yet shrewdly from beneathheavy lids. Though Mr. A. R. Middleton Todd haspainted Lord Adrian, O.M., F.R.S., in academic robes,he too sits at ease before a not too tidy bookcase, lookingover his well-known half spectacles. In Mr. FrederickHlwell’s picture. lllrs. Rosemary Adams, F.R.C.S.,sits in a draped dress of rich red before a small opendesk. Mr. Uric Kennington’s effective pastel of Sir RussellBrain, P.R.C.P., hangs in the select small south room.Among the sculpture there is the now almost inevitablehead of The Lato Sir Alexander Fleming, F.R.S.-thistime a less familiar one of him in his early 50s-and abronze of Dr. Roger Bannister, by Josephina de Vascon-cellos. Mr. Allan U. Wyon’s silver medallion will laterbe a suitable prize for 111eritorious anatomy students atLeeds.

Sir Winston Churchill, who has been an honorary R.A.longer than he has been an honorary F,R.C.S., hws twopictures hung. including a dark but attractive interiorof Sir John Latwry’s Studio. After-dinner speakers willturn with a shudder from Mr. Buskin Spear’s Unaccus-tomed us I am. But surely no medical dinner was everhalf as horrible as this macabre postprandial occasion.

* * *

Now that automation is so much used in anaesthesia,I am occasionally able to contemplate phenomena notdirectly concerned with the unconscious patient in frontof me.

1 have e two long orthopædic sessions each weekand here some curious problems have so far eludedsolution.

A popular method of securing a bloodless field in limbs isto apply an Esmarch’s bandage and then to inflate a modifiedsphygmomanometer cuff, after which the rubber bandage isremoved. On the pressure-gauge of the instrument are twored lines at 250 and 500 mm. Hg respectively marked " arm

"

and " leg." Now why use a pressure considerably higher thanthe systolic blood-pressure and why use twice this pressure,on the leg ? I have posed these queries to two orthopaediesurgeons, a physicist, and a hydraulic engineer, and they allgave different answers.

I pass over briefly the peculiarities of orthopods as to thetime for which tourniquets or their equivalents can be applied.One is insistent that I remind him when twenty minutes haveelapsed in the ease of an arm while his opposite number seemsquite annoyed if I venture to remark that an hour has gone by.Even more remarkable is the attitude towards asepsis

In the private wing of a London teaching hospital, if a generalsurgeon drops an instrument it is boiled for ten minutes by theclock and handed back. If, however, an orthopaedic surgeondoes the same thing in the same theatre, twenty minuteselapse. At an equally famous London teaching hospital, theyboil dropped instruments for two minutes " just to makesure " as their professor of bacteriology has shown that thirtyseconds is ample provided that the water in the steriliser doesnot go off the boil when the instrument is dropped in.

It is all very puzzling and I think that in future Imust keep my mind on really simple matters of anæs-

thesia, such as the mode of action of chlorpromazine.* * *