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SCOPE FOR MODIFICATIONS

This scheme was designed solely to replace the medicinelist; possible variations at once spring to mind.

1. Would it not be better for the doctor to write his pre-scription directly on to the patient’s sheet in the file ? Theheadings of the columns would have to be modified: a separatesection would have to allow the sister to record the times, dosesand other instructions to her nurses. It would be necessary tosend the sheets from the file to the pharmacy for dispensing;and difficulties might arise from missing sheets during themedicine round. With this modification carbon copies wouldseem to be essential; and carbon copies increase the number ofpossible sources of error.

2. Could not a column be provided so that the prescribingdoctor could countersign the sister’s entry ? This would meanthat already overworked house-officers would have to sign eachprescription twice; but this modification has undoubted merits.

3. Could not nurses sign for each dose of medicine adminis-tered ? This was seriously considered and could work quitewell in small wards. In large medical wards, however, thenumber of signatures collected would be enormous; and

inevitably prescriptions would have to be transcribed againand again. This would reintroduce one of the risks we aretrying to avoid.

4. Could the medicine file not be combined with the similarfile kept for special nursing requirements-massage, feeding,and the like ? The main objection to combining these tworecords is that the medicine file is in use for most of the day-during medicine rounds and injection rounds—and would notbe readily available for other purposes.

I should like to thank Southmead General Hospital Group Manage-ment Committee for permission to publish this paper. I should alsolike to thank Mr. D. J. Britton for his assistance in devising the schemeand also the matron, sisters, and nurses for their cooperation inperfecting it. I much appreciated encouragement and constructivecriticism from the medical staff.

Dialogues of Today

"GROW OLD ALONG WITH ME!THE BEST IS YET TO BE"

SOCRATES : I’m glad to see you about again, Nestor. Someonetold me you had pneumonia.

NESTOR : So I had, Socrates; but Eryximachus here with hisnew magic pricked me into life again. Grateful though I amto him, however, I’m not sure that he has done me a service.

SOCRATES: Why not?NESTOR: Pneumonia used to be called " the old man’s

friend ", but it is no longer the obol paid to Charon for a quietdeparture, and I suspect that Eryximachus has kept me aliveonly to develop in time some more unpleasant disorder forwhich he has no remedy. And I believe that if I had a strokeand got pneumonia again he would make sure I didn’t die of it.ERYXIMACHUS: Naturally, for it is a precept of Hippocrates,

and a principle of true religion, that the doctor must always doall in his power to prolong life. If we had no such principlewhere should we draw the line ? Are we to refuse to cure ayoung woman of appendicitis because she may die many yearslater from cancer ?

NESTOR: I am not speaking of the young, Eryximachus, butof the old; and is it not true that you have in your hospitalsmore and more old patients who suffer from permanent anddistressing disabilities because modern medical treatment hassaved their lives in the past ?

ENTHUSIASTICUS : Not only that, Nestor, but the consequencesare quite paradoxical. For, these old people, who often need nomore than simple nursing care, occupy beds in the most

expensive hospitals for long periods, and thereby actuallydelay the admission of younger people, for whom much morecould be done.

ERYXIMACHUS : It is true that we haven’t as yet adequateprovision for the growing number of disabled old people, butthat is another problem. We cannot help it if advances inmedicine occur faster in some spheres than others. What weneed now is more knowledge about the causes and preventionof the diseases of old age, so that we may be able not only toprolong life but also to ensure that the life so prolonged isactive and healthy.

SOCRATES: Do you think it likely, Eryximachus, that in timeit will be possible to prevent strokes and to prevent or curecancer ?

ERYXIMACHUS : That is almost certain, Socrates, for thecauses of strokes and cancer so far as we know are no differentin kind from those of diseases which are already cured orprevented. All that we need is more knowledge of disorderedphysiology in order to prevent them too.

SOCRATES : And does that apply to many other diseases of oldage ?ERYXiMACHUS: Certainly.SOCRATES: And do human beings die of old age itself or only

of the diseases which happen to occur in old age ?ERYXiMACHUS: As far as we know, only of diseases; for there

is no recorded case of anyone, however old, dying without somedisease to explain his death.

SocatnTES : So we may expect, may we not, that as medicalscience progresses human beings will live longer and longer?Is it possible that eventually some may live indefinitely?ERYXIMACHUS: It is certainly theoretically possible.SOCRATES: Now you must enlighten me, Eryximachus, on a

question which puzzles me. You tell me it is a principle ofreligion that life should be prolonged whenever possible. Itwould follow, would it not, that it is a religious duty to do allthat is possible to prolong life indefinitely ?

ERYXIMACHUS : So it would seem.

SOCRATES: But does not religion also teach that this life is apreparation for another, and, as some hope, a better one?

ERYXiMACHUS : Yes indeed.

SOCRATES : Tell me then, which man can the more reasonablywish life to be prolonged indefinitely-the religious man, wholooks forward to a better one, or the unreligious man whobelieves that this life is all ?

ERYXIMACHUS: The unreligious man.

SOCRATES: But if it is a religious principle that the doctormust do all in his power to prolong life, is not the unreligiousman in this matter imbued with a religious principle, and thereligious man putting into practice the beliefs of the un-religious one ?

ERYXIMACHUS: Apparently so.

SOCRATES : Tell me something more. If we prolong life andpostpone death will there be more people in the world thanthere were before ?

ERYXIMACHUS : Obviously, if people continue to be bomSOCRATES : In that case the population of the world will go on

steadily and ever more rapidly increasing. But if the old wereto live on indefinitely, and the birth-rate were to be restrictedaccordingly, would not the world be populated by the samepeople growing older and older ?

ERYXIMACHUS : That also must be true.

SocRATES: Which course do you think the more consonantwith true religion ? Or can it be that when you cured Nestor:pneumonia you had not considered all the implications of theprinciple you were applying ?