Community care of infirmity.

IT IS an honour to be invited to join the company of distinguished speakers who have given this address in previous years. Of those who have referred to the care of the aged I can remember Dr. Marjory Warren, Lord Amulree, and especially our own great physician Sir William Thomson. He anticipated the days of guest speakers, and was invited to move the adoption of your annual report 18 years ago. I have always regretted that there is no record of the polished piece of oratory he entertained us with that afternoon, but at one stage he quoted the remark that "the 'chronic' problem has become acute". It is no less so today, and it must seem to many of you, as it does to me, that in spite of the knowledge and experience of great social reforms, and in spite of greater prosperity, we are no better placed now than we were then to cope with the pressing demands of mental and physical infirmity. This problem is most evident in our old people, though it is not exclusively theirs: it involves handicapped children, young and middle-aged people with multiple sclerosis, the victims of accidents, and the wreckage left in the wake of medical progress-the half-successes of new advances. But it seems to be more pressing or more clamorous amongst the aged than in these others, and present company will only need a brief reminder of the reasons for this. Contrary to popular belief progress has added little to the lives of old people, but it has greatly lengthened the lives of the young. Social reforms, through better education, housing, nutrition, hygiene, and working conditions, have matched advances in medicine (immunisation, asepsis, chemotherapy, and antibiotics) to suppress many of the killing diseases of infancy and childhood, and since 1900 to add 25 years to the average life span. Unfortunately old age increases susceptibility to various degenerative diseases such as those affecting the heart and blood vessels, the nervous system, and the bones, muscles and joints. Modern medicine may make some of these disorders more tolerable, but can seldom effect dramatic cures comparable to those obtained in infectious disease by antibiotics, or in a surgical emergency by operation. The elderly victims of degenerative diseases may survive in a state of slow physical or mental decline for many years, and their disabilities are often aggravated by want-not only financial, although this is common enough, but by want of good housing and proper care. Disease, disability and domestic difficulty, therefore, are prime movers creating problems in an ageing population, and society today has to contend with infirmity in old age on a scale unknown to former generations. Resolute efforts have been made to anticipate and to provide for this growing need; efforts to eliminate poverty by pensions and supplementary grants; to extend the domiciliary service provided by home nursing, home help, pre-cooked meals, and laundry; to augment this service by voluntary visiting, "extra care", and free