By Henry Guly (auth.)

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At Guy’s Hospital, Patrick Clarkson, who had a distinguished war service as a plastic surgeon, had been appointed consultant in charge of casualty after the war and there were nine consultant sessions per week allocated to casualty with about half of them being done by him. 59 He was very enlightened for the time in believing that casualty officers needed at least a weekly seminar at which current work and results could be closely reviewed and topics of interest to casualty work discussed. Departments outside London also had consultants with sessional commitment to casualty.

The only things helping to fill posts in casualty were the requirement by the Royal College of Surgeons (RCS) that applicants for the Fellowship exam had to have completed a six-month post in a casualty department and (later), immigration of doctors. There were several reasons why casualty was unpopular. Some of these are detailed in letters to the Lancet. 41–43 A more severe problem, which exacerbated the medico-legal problem, was the lack of back up and support for inexperienced doctors. ‘Theoretically advice is available; but in practice surgical registrars and others are busy with their own work.

These show much variation and the pattern is little different from the early 1950s. About 60 or 70 departments had a SCO as noted above. Teaching hospitals made much use of medical students who had service role for preliminary clerking of patients, assisting with dressings and doing practical procedures as well as being taught. The Nuffield study investigated the most senior person working in the casualty department in those hospitals which did not have SCOs. 6. The Nuffield team also tried to assess the quality of different aspects of the casualty department in the 18 hospitals they visited.

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