1285

"Loeser himself did not cling tenaciously to testosteronetherapy, and from 1950 onwards he turned to thyroid hormone.These stemmed from a chance observation that some of his

patients with breast cancer had previously had thyroid surgery.This reminded him of his earlier work at the Warburg Institute,showing the influence of cell hormones on malignant metabol-ism. With no official hospital attachments, he arranged toattend numerous breast-cancer clinics in and around London,gathered patients free of charge to his rooms, and begged,cajoled, and coerced his colleagues to combine with him inthyroid therapy. He went into the problem with greatthoroughness, and, with Dr. W. S. Feldberg of the NationalInstitute of Medical Research, he gathered skin specimens toshow that there was a lack of histamine in the hypothyroidpatient. Loeser concluded that although thyroid did not destroythe actual cancer-cell, its effect on the intracellular protein-bound histamine was some sort of defence mechanism againstcancer.

" Loeser was sometimes criticised for his fanatical enthu-siasms; but this was a taunt he enjoyed, for without fanaticismthere would be but hesitation and no progress. He had a

lively, darting mind and was forever flighting ideas-not airyfantasies-sufficient to stimulate others to think and argue.He was not a man who was easily cowed, as was testified by hissabre-cut, handsome face. Upright as a lance, impeccablydressed, he bore himself in hochmutig manner. Of provocative,courageous spirit, he was not one for mincing phrases, and hehad no time for the diplomatic nuances of language in argu-ment. He eschewed inane witty trifles, and he was always -thethinker. But of him it is no mere hackneyed phrase to say thatbeneath this apparent sternness was the kindest of hearts andthe gentlest of men. At home he loved the quips and sallies ofhis family and friends, entertained freely and generously, andled a cultured life with particular interest in music." Loeser was not a man to lower the sails and gather in the

ropes as the allotted span of years approached, and before hedied he was hard at work writing of thyroid and the ageing.His name will endure, and he has a secure place in the annalsof cancer history."Dr. Loeser’s wife died a year ago. He leaves two

daughters, one of whom is a doctor.

AppointmentsCooK, E. H. L., M.B. Lpool, F.R.C.S., D.O.M.S. : honorary assistant consultant

ophthalmic surgeon, Providence Hospital, St. Helens, Lancs.CURRANT, E. J., M.A., M.B. Cantab.: deputy medical director, Lingfield

Hospital School for Epileptic Children, Surrey.INNINGS, H. C., M.B. Manc., D.P.H., D.OBST.: deputy M.O.H., Bournemouth.

Birmingham Regional Hospital BoardBARRY, D. R., M.D. Paris, M.R.C.P., D.C.P.: consultant ophthalmic patho-

logist, Dudley Road hospital group.ENocH, M. D., M.R.C.S., D.P.M.: consultant psychiatrist, Shrewsbury

hospital group.HANDSCOMBE, MARION C., M.B. Lond., F.R.C.S. : consultant ophthalmo-

logist, Coventry hospital group.McFARLANE, C. N., L.R.C.P.E., M.R.C.O.G., D.OBST.: consultant obstetrician

and gynaecologist, Walsall hospital group.RAMISHVILI, AKAKI, B., M.R.C.P., F.F.R., D.M.R.D.: consultant radiologist,

Selly Oak hospital group.SHARP, I. K., M.B., B.SC. St. And., M.CH.ORTH. Lpool, F.R.C.S. : consultant

orthopaedic surgeon, Coventry hospital group.

Diary of the Week

Monday, 17th DEC. 16 To 22

MANCHESTER MEDICAL SOCIETY9 P.M. (Medical School, University of Manchester.) Section of General

Practice. Dr. P. H. Dootson, Dr. C. R. Kay: Personal Preferencesin Maternity Care.

Wednesday, 19thROYAL SOCIETY OF MEDICINE, 1, Wimpole Street, W.1

5 P.M. Comparative Medicine. Dr. J. G. Campbell, Dr. R. J. C. Harris,Prof. B. Thorell (Stockholm), Dr. J. Hindley: Virus-inducedTumours in Fowls.

8.15 P.M. General Practice. Dr. R. F. J. Logan, Dr. H. B. Wright, Dr.R. R. Bomford, Dr. R. P. C. Handfield-Jones : The Medical

u.- Check-up, or Presymptomatic Diagnosis.HARVEIAN SOCIETY OF LONDON

8.15 P.M. (11, Chandos Street, W.1.) Dr. Linford Rees, Dr. M.O’Donnell: Use and Abuse of Drugs in the Treatment of MentalStress.

WIfiTTINGTON HOSPITAL, Archway Wing, Archway Road, N.1911.30 A.M. Prof. W. St. C. Symmers: Deep-seated Fungal Infections.

Notes and News

TOWARDS BETTER HOSPITAL ADMINISTRATION

THE conference of European hospital administrators whichwe mentioned last week (p. 1234) was held at the HospitalAdministrative Staff College of King Edward’s HospitalFund for London. Speaking at a conference dinner onNov. 29, Mr. Enoch Powell, the Minister of Health, said that,long before anyone thought of the National Health Service,the King’s Fund had had to address itself to the question," What is the difference between a good and a bad hospital,good and bad hospital administration, and how do you findout which is which ? " They had to find some way of estab-lishing standards because they had the duty of distributingmoney for the hospital services. Today a Minister of Healthhad to ask himself the same questions in distributing E500million a year to the nation’s hospitals.

" Unless we are to accept that the pattern of expenditure of oneyear shall just be reproduced, perhaps with some enhancement, inthe next; unless we are to be content with some simple and obviouslyfallacious population formula or other rule of thumb, then we all,all in the Health Service, have to ask ourselves ’ How do we determinehow money is best spent; how its sources are best applied, in thehospital service ? ’ and that means-by an almost exact translation-How the hospital service is best to be administered ? ’

" When one poses a problem of this kind, one grasps for someform of measurement, and the form of measurement is to hand infinancial terms. I believe that unless the financial control-the

estimating and accounting-of any administration, including a hos-pital administration, is strict and sound, then all else may well bein vain. But financial control is only the basis of a judgment uponvalue; it is only the pre-condition of answering the questions towhich we must know the solutions. Those questions are, ’Whatvalue are we getting for any particular expenditure of money ’ ? and’How are we to be sure of getting the maximum value ’ ? "

These were not matters which could be determined quicklyand simply: they would require continuing, intensive, andnation-wide study over years, and perhaps over generations.The few years in which the National Health Service hadexisted had increasingly shown the need for research intohospital administration-research in every form and at everylevel-and the Ministry was now allocating, year by year,sums of money specifically to such research.

" To quote just a few, we have on hand at the moment projects tostudy the incidence of mental subnormality in a whole region; tocompare the expenditure upon health services in two similar centresof population, which look as though they ought to behave in a similarway, but, in fact, act quite differently; in collaboration with ... theFund we are studying disposables in every form in hospitals; we aretrying in pilot form a new and, we hope, more effective form ofstatistics of hospital activity; and we are investigating what can belearnt if we track individual patients in their course through hospitaltreatment."

,

As time goes on, Mr. Powell believed, the field could becovered more systematically. Early next year, as a first essay,the Ministry would be publishing an attempt to list all theresearch projects going on under any auspices in this country.

" But ours is a long, deep, and continuing task. There will be noeasy or quick formulx discovered; only that year by year we shall beendeavouring by common effort, and by the extension of knowledgeand observation, to learn more and to apply more of what efficiencyin hospital administration means. What a misleading expression thatis ! What a misleading sound the words efficiency in hospitaladministration ’ have! They convey just the wrong implication;they convey something which is heartless, indifferent, and perhaps alittle ruthless. Yet everyone who is in this room knows that efficiencyin hospital administration is directly in the interests of the hospitalpatient, and that the reason why we, all of us, pursue it not for itsown sake, not for some economic advantage, but because only so canwe be sure that the resources of which in our respective ways wedispose are being applied to the best benefit of the hospital patient."

HOSPITAL COSTS IN 1961-62THE Ministry of Health’s costing returns 1 for 1961-62 show

that the weekly cost of inpatient treatment was 9% higher thanin the year before. In the London teaching hospitals it1. Hospital Costing Returns: year ended March 31, 1962. Part I. H.M.

Stationery Office. Pp. 57. 22s. 6d.