Serological Findings in a Case of Haemolytic Anaemia

dation. It was part of his concept that all grades of mental hospital staff should be offered part-time appointments, thus encouraging diverse extramural activities, and that general hospitals and mental hospitals should have staff in common. Although many general hospital patients may never enter a mental hospital there is certainly no natural clinical cleavage between those who do and those who do not. Experienice underlines similarities rather than the opposite, especially in techniques of management. If, then, one envisages a policy of treating as many psychiatric patients as possible in the general hospital, how is it best achieved ? Heifderson and Gillespie (1950) thought that treatment in the wards of a general hospital should be regarded as a provisional arrangement pending the establishment of specially constructed and equipped psychiatric clinics within general hospitals. Apart from observation wards, whose special function excludes them, the York Clinic stands out in this country as almost the only deliberate attempt at achieving such an aim, with close physical contiguity to other parts of the hospital. Such a unit is essentially what most mental hospitals try to supply in the form of admission wards. But can anything else be attempted ? In an address to the Association of Occupational Therapists Lord Webb-Johnson (1951) is reported to have said that one of his own great ambitions was to see all voluntary patients, and all borderline patients, treated in a general hospital. This would be a revolution indeed, and if widely developed it would inevitably mean bringing the present staffs of mental hospitals to work with in-patients in the general hospitals also. Sargant and Slater (1946) are among those who have suggested its clinical practicability. It would also be in line with the ideals of the joint memorandum already quoted. But is this not really a question which should be explored in a purposeful, experimental way, to supplement evidence which is at present tenuous ? For example, would it not be possible to arrange a clear-cut long-term experiment, within the ordinary administrative arrangements of a progressive general hospital, by which beds therein could become the part-time responsibility of a mental hospital consultant, assisted by his staff, and admission to which would be only by transfer from the mental hospital ? The mental hospital consultant would, in effect, be given generalhospital facilities for the experiment. We have to discover the answers to two main questions: first, how many patients can be treated successfully in the general hospital who are at present treated successfully in the mental hospital ? and, secondly, what special administrative arrangements and regimes would be necessary for this ? One has in mind the serial group relationships mentioned earlier, as well as such matters as provision of day-rooms, problems of staffing, and the use of convalescent homes for prolonged rehabilitation. The answers to these two questions cannot safely be assumed, and their investigation could play a powerful part in encouraging further integration of psychological and physical medicine.