The Care of the Chronic Sick: I. Medical and Nursing Requirements

Abstract

If we are not now aware that old age and chronic sickness are among the most urgent of contemporary medical problems, it is not the fault of the numerous writers who have tried to persuade us. Their case is supported by national statistics, and stated briefly amounts to this: the fact that preventive medicine (to use the term in its most inclusive sense) has reduced the incidence of disease in younger age groups means that a higher proportion of the general population suffers from the diseases of old age; the relative contribution of these diseases to the total Incidence of disease is already high and is increasing; we are comparatively ignorant about the diseases of late life and have the best of reasons for learning more about them (in this matter we have the double interest of the actuary and of the insured). In this paper, the first of a series based on an Investigation of the chronic sick in hospital, we deal mainly with administrative difficulties created by these diseases. It will be useful first to consider the reasons which have led to the coupling of the problem of chronic sickness with that of old age, for If we use the term chronic sickness in reference to diseases which continue or recur over a considerable period, it is quite evident that it is not limited to late life. Bronchitis, rheumatic heart disease, and disseminated sclerosis are examples, in the respira tory, circulatory, and nervous systems respectively, of chronic diseases which commonly appear for the first time in young people. The fact that we associate chronic sickness with old age reflects a natural preoccupation with the administrative problem. As scientists we should like to know the proportion of the chronic diseases which first appear in each age group, but as medical administrators we are more concerned with the proportion of individ uals in each age group who require attention.