The history of geriatric medicine and hospital care of the elderly in England between 1929 and the 1970s
Before the 1930s chronic sick, elderly hospital patients were often medically neglected: they were not properly examined or treated but received 'benign guardianship' and expected a 'bed for life'. The first doctors interested in geriatric medicine showed that many such patients, previously considered untreatable, could be treated and remobilised. These doctors had to contend with considerable ignorance: 'not only is the problem of the treatment of the chronic sick not being met, but also most people do not realise there is a problem.' 1. Post-war consultant geriatricians faced huge numbers of in-patients, substantial waiting lists, poor quality ward accommodation, inadequate investigative facilities and insufficient staffing. However by diligent application of diagnosis, treatment, home visiting, development of day hospitals together with improving social service support, patient throughput slowly increased and length of stay decreased. Many obstacles to progress remained. General physicians continued to be generally hostile, viewing consultant geriatricians as inferior physicians. Geriatric medicine was disparaged as 'a second-rate speciality, looking after third-rate patients in fourth-rate facilities.' 2. Health authorities were not always supportive and some failed to establish geriatric units even when firmly encouraged by the Ministry of Health and the Department of Health. Universities were slow to introduce teaching of geriatric medicine. Arguments about 'bed blocking' by elderly patients continued. Geriatricians and local authorities were blamed. However as Sir George Godber maintained, the Ministry, although supportive of geriatric medicine, could not enforce change, it could only persuade or encourage.