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and maths at school would depend on more science andmaths teachers. The Dainton Committee frankly ducksthis with one of those phrases beloved of official reportwriters: " It lies beyond our present task to assess whatadditional recruitment might be required." It includes arecommendation " as a very high priority " that specialincentives should be offered to recruit " more graduates ofhigh ability to science teaching ". Within hours of the

publication of this report both Sir William Alexander,secretary of the Association of Education Committees, andSir Ronald Gould, general secretary of the National Unionof Teachers-the two king-pins in the Burnham Commit-tee where teachers’ salaries are negotiated-had rejectedany idea of differential salaries for particular kinds ofspecialist teacher.

Unable to explain why there is a swing, the committeeconcentrates its suggested remedies on postponing thestage at which pupils must commit themselves to science orto the arts. It holds Scotland up as a model-the swingagainst science has hit Scotland less than most countries.It wants maths to be taught to everybody throughout theschool. It wants a non-specialised sixth form in which allwould-be university candidates would study four or fivemain subjects, including maths, a science, and English, toa standard below A level-the essential object being toleave the choice of university study open till the end of thesixth-form course, at which stage the student is more trulycapable of exercising a rational judgment. It contrastssuch a system with the present one in which most peoplewho go on to read science at the university have effectivelycommitted themselves at 13 or 14, when, two years before0 level, they choose between a second foreign languageand a second science: 10%, they discovered, in effectchoose three or four years before that in the fast streams of

preparatory schools. I

A reform of sixth forms on these lines would have con-

sequences above and below. Dainton wants to speed upthe process of curriculum reform-the redesign of mathsand science courses " to infuse breadth, humanity andup-to-dateness into the science curriculum and its teach-ing." All this would require a massive programme of in-service training and retraining. Even more radical wouldbe the changes needed in university first-degree courses.By implication these are criticised as dull and over-crammed. Dainton does not assume that a lower standardin the sixth form would necessarily entail a four-yeardegree course. Instead there might be much more varietyin science degree courses with possibly a fourth year forthose who needed a full honours specialism, but a three-year, broader degree for many who go into industry,commerce, and teaching. There is even the suggestionthat universities should be prepared to start sciencecourses ab initio-which would be possible, it is argued, ifeveryone had done maths to 18.

These are revolutionary changes which come back againand again to the stumbling-block of specialist teachingstaff. But something is going to happen sooner or later.The Dainton report does not stand by itself. The SchoolsCouncil-the body set up in 1963 to oversee school curri-cula and examinations on which the Department of Educa-tion, the local authorities, the teachers, the universities,and colleges of education are all represented-is workingon new sixth-form proposals aimed at reducing specialisa-tion. Its suggestions have so far been much less radicalthan Dainton but are now being discussed with the univer-

sities, through a body called the Standing Conference onUniversity Entrance. Indications are that S.C.U.E. mayback Dainton. The third-and possibly the most im-portant in the long run-ingredient in the recipe forchange is the reorganisation of secondary education oncomprehensive lines. This is bound to have a profoundeffect on sixth-form organisation in time, making less

specialisation inevitable. Shaken together, all these spellaction of some kind. But where the science and mathsteachers are going to come from is another matter.

WHERE TO NURSE THE ELDERLY

THE intramural and extramural problems of long-stayhospitals were among the considerations discussed in aninvestigation of geriatric nursing carried out in a singlehospital by Dr. A. N. Exton-Smith, Miss Doreen Norton,and Miss Rhoda McLaren in 1962. Now the NuffieldTrust has enabled Miss Norton to follow up this initial

study by a survey 1 of 330 hospitals particularly respon-sible for nursing old people (as opposed to assessmentand rehabilitation units). A questionary was sent to eachhospital. Valid returns were received from over 85%of these, a remarkably good response; the amount

of unsolicited material seems to reflect the sense ofisolation in these hospitals, and their staffs’ enthusiasticresponse to anyone who tries to understand their

problems.Complaints of old-fashioned facilities and wards too

cramped for proper nursing were common. Often the

larger hospitals were worse off than the smaller ones.Hospitals with over 200 beds had more overcrowding,less day space, fewer lavatories, worse sanitary and laundryfacilities than smaller ones. Before committing them-selves to the principle of large centralised hospitals forlong-stay patients, authorities would do well to ponderthis report. Size and deficiencies need not be synony-mous, but where resources are scarce, the long-stay partof a larger mixed hospital is always liable to come offsecond-best.

It also emerges from this report that many long-stayunits are housed in hospitals built for other purposes,often in remote places, badly served by public transport.As a result, patients are not only cut off from such activityas they are capable of, but also deprived of visits fromrelatives. Clearly much effort has been made to upgrademany of these hospitals. Decoration and amenities arebetter than they were, though day-space has sometimesbeen provided at the expense of overcrowding in theward itself. Furnishings, too, still leave much to be

desired, and clothing for patients needs a good deal morethought. A valuable chapter on terminal-care homessummarises information about six hospitals which do thiswork. Their situation is much more encouraging, withbetter visiting, equipment, and staffing than in otherlong-stay hospitals.

Staffing problems naturally receive much attention inthe report. Nursing these patients is arduous and some-times unpleasant, but can be very rewarding to those wholike old people and are prepared to meet them half-way.Probably the part-time married nurse will continue to beinvaluable to long-stay units, and in many ways this is1. Hospitals of the Long-stay Patient: a Study of their Practical Nursing

Problems and Solutions. By DOREEN NORTON, S.R.N. Oxford, NewYork, Toronto: Pergamon Press. 1967. Pp. 130. 35s. ($6.)

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desirable. Her maturity and outside interests and activi-ties make her peculiarly suited to this work. But if sheis to be attracted to it more attention will have to be paidto the siting of units, for inconvenient transport may bea decisive deterrent.Miss Norton’s findings suggest that units ought not to

be isolated from the populations they serve and shouldbe an integral part of the geriatric services for the area,with frequent visits from the centre. The best conditionswere consistently found in the smaller units, and it is alittle surprising that she recommends that long-stayaccommodation should be in purpose-built units in dis-trict general hospitals. If the present trend towards con-centration of accommodation in more widely spaced dis-trict general hospitals continues, not only will the unitshave to be very large but many patients will be separatedfrom their families and friends, so this recommendationneeds more consideration. All the same, the report givesan excellent, though depressing, picture of the presentsituation in geriatric nursing hospitals.

EMERGENCIES IN DENTAL PRACTICE

A BOOKLET 1 on emergencies in dental practice is nowbeing issued by executive councils to general dental

practitioners to guide them in the management of patientswith a history of illness and those receiving drug therapyand in the treatment of associated emergencies. Sincethe dental practitioner may well consult the patient’sdoctor in such circumstances, the Ministry of Health isalso sending copies to general medical practitioners. Thememorandum emphasises that any treatment whatsoevershould be preceded by a thorough inquiry into the

patient’s history, and he should be particularly questionedabout fainting or bleeding tendencies. Current medicaltreatment should be noted and the patient’s doctorconsulted before dental attention begins. Drugs whichcould precipitate emergencies in the dental surgery areconsidered in detail-for example, corticosteroids, anti-coagulants, insulin, oral hypoglycsemic drugs, hypnotics,sedatives, and monoamine-oxidase inhibitors (curiously,antihypertensive drugs are omitted). As the memorandumpoints out, antibiotic cover for the patient with heart-disease should be discussed with the patient’s doctor;and the dental practitioner must recognise and treat anincipient faint quickly, before the patient loses con-

sciousness, by lowering the head and raising the legs.If cardiac arrest is suspected resuscitation should begininstantly. Other possible causes of collapse are ana-

phylactic shock after injection of penicillin, epilepsy, andmyocardial infarction. When the fitness of patients forgeneral anaesthesia is being assessed, an additional pointis whether to seek some objective measure of respiratoryfunction 2 or whether to rely on a careful history.3 The

justification for using general anxsthetics in dentistry,both for extractions and for conservative treatment, andthe competence required for their safe administration werethe subject of an earlier report 4 which maintained that the1. Emergencies in Dental Practice. Memorandum prepared by the

Standing Dental Advisory Committee for the Central Health ServicesCouncil and the Minister of Health. H.M. Stationery Office, 1968.

2. Palmer, K. N. V., Diament, M. L. Lancet, Feb. 24, 1968, p. 421;Woodgate, D. J. ibid.

3. Bethune, D. W., Edmonds-Seal, J., Gabriel, R. W. ibid. Feb. 10, 1968,p. 277.

4. Dental Anæsthesia. Report of a Joint Subcommittee of the CentralHealth Services Council. H.M. Stationery Office, 1967. See Lancet,1967, i, 991.

work should ideally be restricted to specially trained andmedically qualified ansesthetists. Since the teaching ofresuscitation is largely a practical subject, we hope thisreport will encourage postgraduate centres to arrangeregular demonstrations on how to deal with emergencies.

FAMILY PLANNING IN MEDICAL EDUCATION

BELIEVING that fertility control and other aspects offamily planning deserve more attention in British medicalschools than they are now getting, the Association forthe Study of Medical Education and the Family Plan-ning Association called a small conference (mainly ofmedical teachers) in London last Monday to examinewhat was needed and who might do it. They heard fromDr. Peter Simpson of a survey by the British MedicalStudents’ Association which had drawn answers from1167 medical students to questions about what they hadbeen taught (or rather what teaching they had accepted).Of this sample only 19% said they had had any instruc-tion on marital adjustment; 36% had been introduced tosocial aspects of population control, and 41% acknow-ledged that they had been given guidance about sexualdifficulties unrelated to marriage. Asked whether theyjudged their knowledge of these matters professionallyadequate, few of the students who answered were

assured: only 19% thought they were reasonably wellinformed about marital adjustment, and no more than26% could be confident of their knowledge of sexualdifficulties unrelated to marriage. On the other hand,63% believed they had learned enough about contra-ceptive methods and 73% said they were satisfied withthe understanding they had acquired of infertility.

These figures are just pointers, and more informationmust certainly be gathered about what is actually beingdone and when (and how successfully) in the schools.Nevertheless, the conference was quite ready to acceptthat all was not well; and Miss Josephine Barnes remarkedthat the need for more and better teaching was madeall the plainer by the existence of the two new Actsconcerning abortion and family planning.

Students should be trained, Sir Theodore Fox

declared, not only for the work they had to do but alsofor the age in which they must live. That age was nowone in which problems of population control were out-standing ; and in countless homes nothing would domore for the future health of the family than the pro-vision of an effective contraceptive. In forming the

professional outlook that could meet this situation, theattitude of the teachers was, in Sir Theodore’s view,fundamental. Each medical school should have at leastone teacher who believed that family planning reallymattered and who was prepared to ensure that everyoneelse cared too and that no teacher lost a chance of relatinghis subject to this keenest of human problems.As all critics of curricula well know, agreement on the

need for reform is not a guarantee of action. And hereagain no very precise picture emerged of what should betaught, when, and by whom. As Prof. Norman Morrissaw it, instruction was being called for in the wholefield of psychosexual development; and whose job wasthat ? Sir John Peel, the chairman, and Dr. Hilary Hill,medical secretary of the F.P.A., hoped that the experi-ence and resources of the F.P.A. might be applied inboth undergraduate and postgraduate teaching. Otherssaw many advantages in the placing of family-planning