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happens to be at the time. In Bath United Hospital theneed for a room in which relatives can be interviewedand in which on occasions a relative may spend thenight has been so strongly felt that side-wards have beenused for this purpose. It has often been suggested thatinterviews could take place in the doctors’ room, butthere is no guarantee that this room would be unoccupiedwhen needed. Privacy is essential, and experience showsthat a separate room with a neighbouring waiting-roomis desirable. The normal 25-30-bed ward produces enoughrelatives to justify a small interviewing-room and waiting-room, but these might prove adequate for a unit

containing as many as 60 patients.

Treatment Room

Only a minority of hospitals have treatment-rooms,and these use them in rather different ways. At theRoyal Victoria Hospital, Newcastle, there has been atreatment room for the past 3 years to which patients arewheeled on a stretcher to have their dressings changed.Beds are not wheeled into it and it is not a speciallysterile room. In one surgical ward in Bristol a treatmentroom is to be constructed as a ward annexe to whichmost patients will walk for dressings. The RadcliffeInfirmary at Oxford has well-equipped treatment roomswhich are comparatively new.A treatment room concentrates much of the work of

the ward into one " workshop," offers privacy, andremoves to a large extent the need for screens. Dressing-trolleys need no longer be taken round the ward frompatient to patient. A sterile atmosphere may be providedby air-conditioning and the patient is remote from thecontaminated dust of the ward. Moreover, patients canno longer see the sufferings of their neighbours throughcracks in the screens-a sight which is often upsetting.

Sir James Spence (1947) visualises a treatment roomin each unit, where " all dressings, lumbar punctures andother painful manipulations can be carried out, andwhere anaesthesia will be frequently used." Bourdillonand Colebrook (1946) point out that " the practice ofdressing ... wounds in a special room designed for thatpurpose should have. considerable advantages, butunless special precautions are taken it must involve thedanger of exposing each successive wound to a cloud oforganisms disseminated from the dressings of the

previous patients." In some hospitals, as for examplein Sir James Learmonth’s wards in the Royal Infirmary,Edinburgh, patients are taken into the nearby surgicaltheatre for dressings. This is convenient only if thetheatre is close to the ward.

It is clear that opinions vary as to the purpose andequipment of a treatment room. The demand has comeprincipally from surgeons for the dressing of wounds, andperhaps the best example of how this demand has beenmet can be seen in the burns unit of the BirminghamAccident Hospital.Although less is heard of the physician’s need for a

treatment room, this undoubtedly exists. Medical wardscontain many patients whose special treatments are

better carried out in a treatment room than in the wardbehind screens. For example, lumbar puncture, chestaspiration, blood-transfusion, sternal puncture, andcatheterisation are among the many procedures moresuitably carried out in a treatment room. There may bea conflict between the conception of a treatment roomas a place akin to a small operating-theatre with greatemphasis on sterility, and the rather different conceptionof it as a place where most treatments, whether bydoctors or nurses, can be done. In practice, a treatmentroom may be used for either purpose. The surgeon maytreat his wounds or burns, or dress his plastic cases inthis room, excluding infected patients if he wishes.Since most of his patients will be

" clean " this will suithis purpose well. The physician, paediatrician, or gynæco-

logist may equally well use the same type of roomattached to their own wards, for other kinds of cases.

Attention must always be paid to the prevention ofcross-infection, since concentrated risk may make a

treatment room unusable. Special ventilation is expensivebut necessary in rooms used for the dressing of burns,wounds, and plastic work, and it would be unreasonableto accept a lower standard of antisepsis for other’cases.One treatment room per ward of 30 patients may beexpected to meet the requirements of general medicinebecause there will be few dressings, and fewer treatmentsneeding the use of a treatment room ; its main use wouldbe for diagnostic tests. But in surgical wards and inwards admitting special types of patient more than onetreatment room may be required.

OUTPATIENT DEPARTMENTS

Whether consultations with outpatients should takeplace in the vicinity of the wards or in a separate out.patient department is still undecided. In either casesuitable rooms will be needed. Fortunately the require.ments of different specialists do not, in general, affect therooms but only their equipment.A consultant needs a room where he may interview

patients in privacy, an examination room with a bedor couch, and three dressing-rooms (so that one patientcan be examined, while the next is undressing and thethird is dressing). It is an advantage, particularly indealing with gynaecological patients or those with cancer,to be able to screeii off a part of the consulting-roomto accommodate a secretary. This room should have awash-basin and lavatory nearby.

Minor treatments, such as injections, can often begiven conveniently in the consulting-room, which shouldbe fitted with a steriliser and instrument cabinet. Wheremany tests and treatments are likely to be done it isbetter to have an additional room for this purpose and inwhich urines can be tested or specimens taken forlaboratory purposes. ,

In the interests of economy different consultants will

probably use the same suite of rooms at different times.Since more whole-time consultants are likely to be

appointed it is worth considering whether each teamunder a whole-time consultant should not be providedwith a suite of rooms for their exclusive use.

REFERENCES

Bourdillon, R. B., Colebrook, L. (1946) Lancet, i, 561.Lancet (1949) ii, 430.McIntosh, T. S., Coales, H. R. (1947) Ibid, i, 645.Spence, J. C. (1947) Brit. med. J. i, 125.Woodward, J. (1950) Employment Relations in a Group of Hos-

pitals : a report of a survey by the Department of SocialScience of the University of Liverpool. London.

CONTROL OF MEDICAL MAN-POWERStatement by Central Medical War Committee

MANY doctors, and in particular those who havereserve commitments to the Armed Forces, have ex-pressed anxiety about their position and possible liabilityfor active service in the event of war. For a long timethe Central Medical War Committee has been urging theGovernment to set. up suitable machinery for theprovision of advice as to the availability for recall in anemergency of individual doctors with reserve commit-ments. The committee is now authorised by theMinistries concerned to publish the information givenbelow.

It will be remembered that during the last war theallocation of medical man-power between the variousServices was arranged on the advice of a profes,sionalcommittee, the Medical Priority Committee, while theactual recruitment of doctors into the Services wasundertaken by other professional committees—the Central

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Medical War Committee, the Scottish Central MedicalWar Committee, and the Committee of Reference, withthe advice and assistance of local medical war com-mittees. The Medical Priority Committee, the CentralMedical War Committee, and the Committee ofReference have continued, since the end of the war, toorganise the recruitment of doctors with national serviceobligations.

Discussions have now been proceeding for some timebetween the representative medical organisations and theMinistries on the establishment of new machinery ofcontrol designed to take account of the changes in thestructure of the health services brought about by theNational Health Service Acts. Under these new arrange-ments, the control machinery will be broadly similar tothat now existing ; new area committees will be estab-lished to deal with the various branches of the medicalservice-i.e., the general-practitioner service, the hospitalservice, and the public-health medical service. It is

hoped that the new machinery will be fully establishedwithin the next two or three months.

In the meantime it has become necessary for theService Departments to begin reviewing the position ofdoctors with reserve commitments, and to earmarkthose who would be the first to be recalled to the coloursin the early stages of any future war. This procedureis part of a wider review which covers reservists in allwalks’of life, and is not confined to doctors. Arrange-ments have been made for the doctors concerned to be.,

screened " ; that is to say, for their commitments incivil life to be reviewed so that if the recall of a particular

doctor in the early stages of a war appeared likely toprejudice some important branch of the civilian medicalservice, cancellation or deferment of recall could beconsidered.

It has now been decided, after consultation with theCentral Medical War Committee and the General MedicalServices Committee, that the Central Medical WarCommittee shall undertake the interim " screening" ofreservists who are general practitioners, and that thelocal medical committees, established in accordance withsection 32 of the National Health Service Act, 1946,.should be invited to assist the Central Medical WarCommittee in this work, a lay member nominated by theexecutive council being coopted to the local medicalcommittee for this purpose. In Scotland similar arrange-ments are being made for the " screening " to be carriedout by the Scottish Central Medical War Committeewith the cooperation of the local medical committees.

Purely as a stop-gap measure, provisional " screeningof doctors in other branches of the medical professionhas already been carried out by medical officers of theHealth Departments. This " screening " will be reviewedby the appropriate professional committees as soon asagreed machinery for local consultation has been set up.

The " screening " procedure described above is con-cerned solely with the question of the effect of recallon the civilian medical services. It is not concerned atall with any question of personal hardship, which, in thecase of a reservist, whether a medical man or layman, is amatter for the consideration of the Service Departments,to which appeals may be made at the time of recall.

Before Our Time

FRANCISCO DE LA REYNA AND THE

CIRCULATION OF THE BLOOD

J. J. KEEVILD.S.O., M.A., M.D. Camb., F.S.A.

L. M. PAYNEF.L.A.

FROM time to time in medicine a brilliant guess ismade, holds the field for a while, and is forgotten, onlyto be revived later and established on a basis of scientificevidence. An example is to be found in Francisco dela Reyna’s book, published in Spain about 1546, wherehe asserts, a century before Harvey, that the bloodcirculates. In Spanish this work is generally known inbrief as Libro de Albeyteriá, but its full title may berendered in English as follows :

" The Book of the Craft of the Horse-leech in which maybe seen all illnesses and accidents whatsoever that maybefall all manner of animals and their cure. Similarlythere will be found the colours and features by which agood horse can be recognised, as well as a good mule. Themost extensive that has so far been seen. Expounded byFrancisco de la Reyna, farrier, resident at Zamora.This work must have been extremely popular among

Spanish veterinary surgeons, who could find in it anaccurate account of the signs and symptoms of innumer-able equine diseases, and of methods of treatment whichwere in general simple and practical, set out withconsiderable charm of style. As a result of thesequalities it passed through many editions, but its verypopularity has been the cause of its great rarity today :copies were so much used while actually carrying outtreatment that they became damaged or worn out.

THE ACCOUNT OF THE CIRCULATIONReyna divides his book into two parts, the first,

which deals with the work of a horse-leech, is writtenwholly by himself, the second, which is concerned withthe craft of the farrier, is an enlarged and amendedversion of the work of Juan de Linuesa. He sets outhis views on the circulation of the blood without any

particular emphasis ; and some of the techniques headvised show that he took it for granted. Thus his

technique in phlebotomy differs little from that practisedtoday. He dissected down to the vein with a lancet,lifted it up, and with needle and thread passed twoligatures round. it. After bleeding ’he tied the lower

ligature and then the upper. This order in itself indicatesthat he did not think that the movement of the bloodwas a simple pendulum one. Similarly in treatingbleeding from the palate he stresses the need to keep thehead high.Towards the end of the book he writes in the form

of question nd answer, addressing himself to apprenticesand beginning each section " If they should ask you...",and it is in this part of the book that the followingpassage occurs :

" If they should ask you why, when they bleed a horsefrom the fore-legs, or from the hind-legs, the blood comesfrom the lower part and not from the higher. The answer ?In order that you may understand this matter you mustknow that the main veins emerge from the liver, and fromthe arteries of the heart, and these principal veins aredistributed throughout the limbs in this fashion-inbranches and thin membranous vessels through the externalparts of the fore-legs and hind-legs.... And from there allthese membranous vessels turn round to flow throughthe main veins which ascend from the hoofs through thefore-limbs to the interior in such a way that the veins of theexterior have as their function to convey the blood down,and the internal veins have as their function to carry theblood upward in such a way that the blood travels in a circle[torno] and as a wheel, through all the limbs and veins ;it has the function of carrying nourishment to the innerparts right up to the emperor of the body which is theheart, which all the parts obey, and that is the reason[for bleeding coming from the distal end of a deep vein]."Without in any way anticipating the discovery of the

capillary circulation, Reyna appears to recognise theexistence of the gap in the closed circulatory systemwhich that discovery was to fill :

" Before the blood can enrich itself," he writes, " itmust first alter into the four humidities ; first it changesin order that it may pass from the little veins to infuseitself throughout the limbs and the porous tissues