Poliomyelitis Vaccination

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hospitals have their own kind of success. Thus a pxdi-atrician with beds in a teaching hospital, and also in thechildren’s hospital attached to it, remarked that, thoughthe parent undergraduate hospital attracts students ofbetter education, the nursing care of children is verymuch better at the children’s hospital-the explanationbeing that the young women there have taken up thiswork because they particularly want to do it. Both thechildren’s hospitals and the larger paediatric units ingeneral hospitals could usefully give three months’

training to many student nurses working for the generalregister, but only on condition that they have enoughfully trained paediatric nurses to give the teaching, andthat the students are regarded for the most part as super-numeraries. For such students, doing their generaltraining, a small and poorly staffed children’s unit in ageneral hospital where the handling of children is

unsatisfactory affords experience which is rather worsethan useless.

The reasons why there is less demand on children’sbeds than in 1948 are: (1) the physical health of childrenhas improved; (2) their illnesses are often shortened bymore effective treatment; (3) probably more of them aretreated at home; (4) additional children’s wards havebeen opened in general hospitals; and (5) many childrenwho would previously have gone into children’s hospitalsand general hospitals now go into fever hospitals-where there are always empty beds. We have no recentfigures for the distribution of child patients, and in par-ticular we do not know how many are in adult wards;but the returns of one regional board for a day in theautumn of 1955 showed that of the 1568 in children’swards 1082 were " medical ", and that only a little overhalf of these were under the care of a paediatrician. Ofthe other 532 medical cases 243 were in fever hospitals.Because admission is easy, children nowadays go to suchhospitals with pneumonia, meningitis, septicaemia,gastroenteritis, and rheumatism, not to mention a goodmany undiagnosed conditions ranging from coeliacdisease to congenital hxmolytic anaemia. Sometimes,of course, the child thus admitted finds medical and

nursing care which is fully equal to the occasion; andthis iournal, like others, has recorded fine work forchildren which has been done in fever hospitals-as alsoelsewhere-by physicians who would neither claim tobe paediatricians nor wish to limit themselves by such atitle. On the other hand, many fever hospitals-including some of the large ones, have poor facilities(e.g., in pathology), insufficient nurses, and no arrange-ments for educating the children while they are in hos-pital or for following them up when they have left: andsome of the smaller ones have no resident medical staff.To the hard-pressed family doctor, anxious about hisyoung patient, such a hospital’s willingness to accept thecase has often been a godsend ; and very often, as wehave said, excellent care has been given despite all thedifficulties. But the development of fever hospitals a’

supplementary children’s hospitals can scarcely b(defended now that there are said to be too many chil.dren’s beds and some of the children’s hospitals are

themselves faced with closure. Instead of making feverhospitals responsible for children with non-infectiousdiseases, it would be better to make children’s hospitalsand general hospitals responsible for fevers-equippingthem with units for the purpose, as has been done inthe U.S.A. and many Continental countries.

In the region we have mentioned, 28 of the hospitalswhich had children’s beds (medical; surgical; ear, nose,and throat) had fewer than 15; and we do not believethat a number like this, or anything like it, permits theformation of a psediatric group or environment capableof giving the varied yet specialised care that childrenso often require. If the treatment of sick children is to

improve, the policy should be not only to discontinuethe routine admission of children to adult wards butalso to eliminate, progressively, the children’s unitswhich are too small to be pxdiatrically viable. On thepositive side, support should be given to the largerunits-children’s hospitals and big departments in

general hospitals. The Ministry of Health would setthe ball rolling in the right direction if it officiallyendorsed and made known to administrative bodies the

report of the Royal College of Physicians committee,lon which it was represented. A circular to regionalboards could emphasise:

1. The need to build up, in each region, a relatively smallnumber of big paediatric units, fully staffed and fully equipped-with special attention to any children’s hospitals, from whichwill come much of the paediatric staff of the future. As the

college suggests, branch outpatient pxdiatric departments canbe based on these units.

2. The need to discontinue the use of fever hospitals forchildren not suffering from the so-called infectious fevers, tolink the fever hospitals with paediatric hospitals or units,2 andto arrange eventually for the treatment of these fevers inisolation wards forming part of children’s hospitals and generalhospitals.

3. The need to, stop indiscriminate admission of children toadult wards.

Where there are more children’s beds than an area

can use, the units to be closed should be those that aretoo small to give the special kind of care, the specialskills, and the special knowledge which children require-and to which they are entitled no less than adults.

Poliomyelitis VaccinationTHE Government’s programme of vaccination against polio-

myelitis is to be extended from the present age-limit of 15to 25; a wider range of hospital staff and their families are

to be included; and a start is to be made with third injectionsof people already vaccinated twice. This was announced byMr. DEREK WALKER-SMITH in the House of Commons on

Monday. Those hitherto eligible for vaccination are childrenborn in 1943-57, expectant mothers, general practitioners, andhospital and ambulance staffs and their families. At June 30a total of 6,570,157 had registered, of whom 4,481,837 hadreceived two doses and 856,388 one dose; 1,231,932 wereawaiting vaccination. The registration-rate for children under15 at June 30 was 536°0. The number of doses needed to

complete registrations was 3,320,252; and 3,766,651 doseswere held by local health authorities. Of the new groups thoseaged 15-24 total some 6,250,000 and hospital staffs and families500,000; and those eligible up to March 31, 1959, for a thirdinjection may total 6,500,000. It is proposed to ask localhealth authorities to offer as soon as possible third injectionsto children vaccinated in 1956-about 200,000.

2. Ministry of Health circular R.H.B. (48) 1.