PUBLIC HEALTH

Dominion, Volume 12, Issue 284, 27 August 1919, Page 8

PUBLIC HEALTH

NATIONALISATION OF MEDICINE SUGGESTION FROM AUSTRALIA The need for a much wider application of measures for t\t> prevention of disease was emphasised recently by JDr. J. 11. Cuinpston, Federal Director of Quarantine, in the courso of a lecture delivered to the Molbourne University P.uKio Questions Society. The lecturer iulyociited greater use' of preventive medicine by t'he State through the medium of tlio prhate practitioner, but did not agree at present .with the full "nationalisation" of private, practice. Dr. Cnnipston said there toto signs, becoming increasingly numerous, that the matter of nationalisation of medicine was receiving so much attention that a definite verdict would very soon have to be given as to its place in the machinery of Government. The motives of the demand for nationalisation wore mainly twofold—firstly, dissatisfaction with certain phases of individual medical treatment; and, second' ly, the conviction that .much, more might bo done in the prevention of disease. Thu defects of medical practice to-day were stated to be—firstly, that considerations of the financial interest must obtrude forcibly'into all relationships between doctor and patient. These financial interests were served by the sickness of tho patient and were detrimentally affected by his continued health. Tho second defect was that no anedkhl man could have oven a working knowledge of all branches of medicine. This fact had developed a mistrust of the general practitioner, which threatened to take shape as a demand for somo change. The third defect to-day was the anomalous position of public hospitals. The remedy..that was suggested for the defects of private practice by all who had written on tho.subject was that the medical men should bo altogether paid servants of tliu State. Continuing, Dr. Cumpstoa quoted from tho works of Ellis and Shaw, showing tho trend towards the euggc-stion uf making doctors civil servants, and the dominant idea that it was more profitable to keep ■ people in health than to treat them when iK. It was significant that nono of the authors attempted to discuss in a practical way the accomplishment of the proposal to umko the treatment of all patients u Slate-controlled department, administered by a large body of medical public ear- • vants. Briefly, it inig-ht be said that prcloiwed consideration of the proposal from the aspect of administrative practicability led one definitely to the conclusion that, winterer might reauEt in the future from social evolution, the proposal to nationalise medicnJ treatment wiia an impracticable one. and a', doubtfully advantageous suggestion. Disease Prevention. The other aspect—that of preventing, disease—was one which received universal support, as a really practicable working suggestion. The medical profession had welcomed such a suggestion whenever it had been made. Its criticism had always been that legislation and State administration had failed to keep pace with the progress of knowledge in preventive medicine. No sound reason had been presented why r scheme should not bo devised to enable the private medical attendant to satisfy the demand ! that medical science should be applied 1 more directly, and by every doctor, for j tho prevention of disease. Actual accomplishments encourages warm hone of I triumphant success, and a beginning, j which would involve' the nationalisation I of part of the knowledge and time of i every practising doctor 'could at least jbe made. This could not involve the ! extinction of private practice, as no i system of prevention could 1 entirely preI vent disease and accident. Private/treat- ■ i inent, however, would diminish in..pro- ! portion to the success in prevention of ;! disease, but as the State would naturj ally pay adequate remuneration lo the dector for Ms preventive efforts, there ; would be no loss to the docior. As the I .object of the scheme was to keep peoplo well and to nrevent illness, it was obvious that effort* could be successfully applied only in the case of illnesses of ' which the causes were known, or cquid, by investigation, be discovered. Present knowledge offered a most fertile, but almost uncultivated, field for preventive effort, in which the labour of the practising doctor.had not yet been utilised. The present system of nominal con- . trol of transmissable diffuses of bacterial , origin in Australia had been a failure. I Something had been achieved bv saniI 1 taticm, but there, had been no effort to j control the personal infection factor. , i The importance of the infective carrier ! in tho starting of fresh epidemics of 'I typhoid and diphtheria wns known. Yet few doctors in private practice α-scertain- ' ed whether patients recovering remained [ infective after their return to health. , The importance of detection nnd con-- ' trol of incipient tuberculosis .amongst contacts in a house where there wns n caso 'of declared infectivity Had long ', been recognised, but few doctors examiii- : ed the contacts with'this in'view, and if detected, there wns no provision for control of th'ese cases. Few doctors, uudor existing conditions, would think of informing the Health Departments of facts which might be important.- Tor. 1 the nationalisation of medicine for pre- ' ventive purposes' the position of the pri- ■ vate practitioner was strategically almost ' perfect. He could, as a matter of national service, be "required to discharge those functions of prevention and investigation, which were already known to be practicable, and he could do this • without affecting in any direction his relationships with the pat'ent: In'so doing he would }k actually carrying out all that had been suggested in a practical way by those' demanding the nationalisation of medicine., The n;ori> nebulous demands could not be discussed until their shape had been definitely indicated. The Stato's Role. If the State imposed obligations upon ' a, section of the community it must assess the value of the service required, ' must define clearly the nature of the ob- ; ligations- imposed, and must provide tha inachiuory necessary. This would involve recognition by the State of public health as a dopartment of State activity of much greater importance than had hitherto been admitted, the intelligent direction of an exceedingly ■difficult lield of administration and the provision of laboratories, consultants in public health, aud other necessary adjuncts. Beyond question, there was a growing feeling of dissatisfaction with the present conditions of private medical practice and a growing demand that disease and ill-health must be prevented. It was widely recognised that tinkering with drain's aud the recurrent futility of rcsultless meetings of various statutory boards was not preventive medicine, and was unlikely to improve the general health of the public. Until Governments recognised that there was an onor-. nidus uncultivated field for effort in preventing illness in all kinds by the etuu , } of the individual as well m the environment, that the principal tillers n> the field must be, doctors in general practice who inuet be generously encouraged and .intelligently, directed « wise Government supervision; aud. until doctors were educated to the point at which they felt involuntary shame at he appearance of a case of preventable dhi ease, preventive medioine in Austral a 1 would leniaiu as at present the ■ only. TntnSL m t: pointedout that the science of inetaw no restricted to the diagnosis oi diseaco,but included also a knowledge ot how dwaso < came to be, of its earliest beginnings and 1 its prevention. It was, m fact, llio ! erience and art of health of W» could learn to live a healthy life at tutop of his capacity ot body and mind. This new world of preventive medicine 1 could not be developed .unleje may ■ medical practitioner individually 1M0&1 wised and actively discharged i, to dut , or was obliged to do so. There was a emphatic demand to-day for this .application of medical art. There was a torn, of nationalisation of medicine which was practicable, which was urgently, nece* 1 gory which the medical protossion lfesel ! "ted, and which was only delayed Iby the inertia-of Governments,