THE PERFECT MAN.

Manawatu Herald, Volume XLVIII, Issue 3693, 20 September 1927, Page 1

THE PERFECT MAN.

DOCTORS AND HEALTH.

A NOTABLE ADDRESS. PREVENTION OF DISEASE. London, July 27. In his presidential address at the British Medical Association Congress in Edinburgh, Sir Robert Philip, Physician to the King in Scotland and Professor of tuberculosis in the University of Edinburgh, gave an illuminating outline of the triumphs of surgery and medicine during the past half-century. “Medicine has ceased to be merely the healing art,” he submitted, and lie urged that more and more doctors must regard himself as preventive agent. Using as his text the question that was asked in 1852 by Sir William Hamilton, the distinguished exponent of philosophy in Edinburgh, “Has the practice of medicine made a single step since Hippocrates?” The president gave many instances of the advances of the past century—advances which he characterised as phenomenal. The State and individual beneficence had co-operated in the advancing tide, one of the latest outward expressions of which was the munificent gift to the nation by the Rockefellow Foundation of £400,000 for the erection of the London School of Hygiene and Tropical Diseases. He recalled that when the British Medical Association last met in Edinburgh in 1808 he publised an address on the universal applicability of the open-air treatment of pulmonary tuberculosis. “At that date,” he continued, “there were not more than two or three sanatoria in Great Britain. To-day there exist in England, Wales, and Scotland, under the control of the State, no fewer than 307 santatoria, excluding general hospitals receiving cases of tuberculosis, and 151 voluntary or proprietary sanatoria. At the date of last, meeting there was one tuberculosis dispensary. To-day there are in England, Wales, and Scotland, under the direction of the State, 515 dispensaries, and similar institutions have been established in most countries of the world. REDUCED MORTALITY.

“In 1875 the mortality from all forms of tuberculosis in Scotland was 361 per 100,000, while in 1925 it was 110. In 1875 the mortality from pulmonary tuberculosis in Scotland was 252 per 100,000, while jn 1925 it was 76. In other words, during the 50 years there has occurred in each case a total drop in mortality of over two-thirds. This is something more than part expression of the reduction of the general death rate of the country, in which the fall during the same period amounted to less than onehalf. The relative fall is illustrated by the fact that, while in 1875 deaths from pulmonary tuberculosis constituted 10.6 per cent, of deaths from all causes, in 1925 they constituted only 5.7 per cent. It was, Sir Robert believed, unchallengeable that Britain possessed the amplest machinery to be found anywhere for the prevention of disease, but we were far from the last lap in the race. Answering the question, “Wlhat is to be the line of further advance?” he said that if medicine were to be effective to-day il could only be by an alteration in the attitude both of doctor and patient. It would be to the mutual advantage of doctor and patient that the former should become a preventive agent, and the health of the community would be correspondingly advanced. WHAT IS NEEDED. “What is wanted,” the president went on to say, “is a scheme of intelligent protection against illness. Why should not private contracts be arranged on the Oriental line of payment for keeping the client well? At least there should be between doctors and patients common agreement as to the advisability of periodic physical examination, on the lines of inspection for recruitment or life insurance, so .that morbid tendencies or threatenings of disease may be nipped in the bud.

“Why should a system of medical examination not become general, and the family adviser be enabled to play his proper part in the prevention of disease? An approach to the method is already in vogue with the dentist, who enjoins his client to submit to a periodic dental review, to which the client, with experience of pains and penalties, commonly accedes. “The further disposition of the forces calls for a wider orientation of the field. The final triumph of

medicine will consist not in the exclusion of disease, but in the restoration to man of perfect form and natural function; the attainment of smooth activity of body, mind, and soul. Biology—anatomy and physiology—must be relied on to carry us further than pathology and thereopeutics, as commonly understood. Medicine, biology and constitutes, pro tanto, the science of human life. HEALTH IS BORN. “The eye of the doctor has been insufficiently directed towards the biological problem. Health is born and should be expected. Disease is, for the most part, made and should be excluded. The starting point of medical observation and the ideal of medicine must be health. Were students trained to think biologically throughout the entire course early departures from perfect,form or i function would quickly arrest attention and demand explanation. Our medical schools must turn out observers and thinkers on biological lines who will thereby be rich in suggestion and resource. The degeneration of our medical schools to mere training wokshops must be , stayed at all costs.” Proceeding to allude to hospitals, the President said: — “If hospitals are to have effective value in the larger field of prevention, there must lie developed fuller possibilities for scientific investigation, and a completer follow-up service in relation to individual patients and their environment. In addition to the extension of service rendered by the individual hospital, there is great need to link up and co-ordinate the various types of hospitals. The attitude of the Central Health Authority to the hospital question should be: Give us assurance that an adequate number of beds is available for the needs of the country, and that these are justly distributed in respect of the various areas and the various -groups of diseases, and that their links with each other and with ancillary services are sufficient; it matters not to us whether the hospitals are' maintained by voluntary effort or by the rates, or by such other machinery as may be found serviceable to the end. A CENTRAL AUTHORITY. “As a preliminary to this, it is essential that responsibilities and powers relating to everything that concerns national health be vested centrally in one supreme Health Authority in the several portions of the kingdom, and peripherally in the various local health authorities acting under the Central Authority towards the common end. In connection with the provision of hospitals, it is to be borne in mind that, in proportion as the preventive attitude is assumed by the medical profession, unofficial as well as official, the need for certain classes of hospital will grow less. This will bring economic advantage. The time will come when hospitals for •advanced disease and settlements for tuberculosis wrecks will be regarded as anachronisms. “What we want to ensure is that the growing individual has a working knowledge of the make-up of his own body and its functions, and can appreciate beauty of form and know when smooth activity is disturbed. He must get to understand the close dependence of health on environment. With youth sensibly trained about the m'achine which is peculiarly his own, it may be anticipated that within a generation the attitude of the nation to health questions will be completely changed. Meantime, existing ignorance and post-war restlessness must be faced. There is need of popular education in the wider sense, and the dissemination of sound knowledge regarding health and the factors which make for disease. It must be insistently urged, that the causes of disease being withdrawn, health is restored.” “The quest of health for the world,” said Sir Robert, in, the closing portion of his address, “is a great advantage. It is up to medicine to lead the way and si istain the brunt of front-line comba t. Medicine must anticipate, ins pire, and guide policy, and not res t content merely to carry out instruc riions imposed on her. With mind and eye fixed on perfection of form and function as the ultimate goal,, ttihe doctor’s increasing purpose as the years roll on is the physic ia! betterment of the race.”