19

H—3l

Records, however, when kept, should be used if their value is to be made evident, and it is only by the institution of regular monthly meetings of the staffs of hospitals at which the professional work of the hospital is revised and considered, when the production of information compiled from accurate records takes place, that advance and reform in the desired direction will take place. Hospital Boards should realize that clerical assistance and the provision of a record-room arc alike essential to help in tho work, for it is only by tho production of what may be termed periodic professional balanceshoots that the exact nature of the professional work done in a hospital can be realized, its degree of efficiency ascertained, and progreos made towards that degree of perfection which it is hoped to obtain. It is in association with the hospitals record department that a " follow-up " system can be instituted by which patients are kept in touch with, the real or eventual results of treatment ascertained, and proper progress made. Thousands of operations are being done yearly in our hospitals with, thanks to advances in surgical and nursing technique, a low mortality rate. The patients leave hospital and are in very many cases lost sight of. The ultimate results of certain classes of operation — e.g., radical cure of inguinal hernia, appendicectomy, operations for cancer of breast, colon, uterus, and removal of enlarged prostate, &c. —are not systematically and accurately ascertained, as they should be, six months, one year, two and three years subsequent to operation, and until information of this kind is forthcoming and made periodically available it is difficult to see how wo can ascertain properly the value of the work which is being done. (b.) Clinical Laboratory. On the importance of tho work done in this department of the professional life of a hospital there is no need to dwell, and one of the best moves made by the Health Department in recent years has been the establishment of clinical laboratories with specially trained men in charge at hospitals such as those at Invercargill, Napier, Gisborne, and Palmerston North. Of the stimulating effects of these laboratories there can be no doubt, and steps are being taken to establish them at the Waikato and Whangarei Hospitals. The following hospitals will, I consider, require them as well: New Plymouth, Wanganui, Thames, Grcymouth, Timaru, and Nelson. It is difficult to overestimate tho value of these laboratories, not only in the maintenance of a high standard of work, particularly on the medical side of a hospital, but also to the medical men engaged in private practice in hospital districts where laboratories have been established. (c.) X-ray Departments. The general standard of X-ray work is poor in tho majority of our hospitals, and in my opinion this is duo to the following causes : — (1.) The initial equipment installed has not been kept up to date by suitable additions of fresh apparatus. Many Boards must be made to realize that an X-ray department once established must necessarily be the cause of regularly recurring annual expenditure if results worth having are to be obtained. (2.) In many cases the apparatus is looked after and worked by a busy Medical Superintendent who, with the best will in the world, cannot devote the time, to the work which it requires. In other cases too many people have access to the apparatus, the responsibility for which should be a one-man job. X-ray work, like many other branches of medical activity, is a special branch of work, and to procure first-class and reliable results requires the services of personnel with special training and experience. (3.) Insufficient number of X-ray technicians. I consider that what is required very urgently in all New Zealand hospitals in which satisfactory X-ray plants have been installed is tho services of trained laymen, such as is the case in many hospitals in Great Britain, where these men are known as " radiographers," to distinguish them from the trained medical specialist who is known as a " radiologist." I suggest that efforts be made to secure and train a number of suitable men as radiographers to occupy positions in hospitals analogous to that occupied by assistant bacteriologists. It should be possible to train these men at some of our largest hospitals, and at the same time provide for necessary theoretical training in physics, electricity, &c, at the local University college. Tho services of these men would also be required at hospitals where radiologists are on the staff. Even if only half a dozen were trained to commence with, lam satisfied that a very definite advance would be made towards achieving a higher general level of X-ray work than is the case at present. (d.) Physio-therapeutic Department. The value of the work accomplished in this department of a hospital is to be felt in every aspect of the institution's professional work, and more especially in the treatment of injuries of all kinds. Even yet, however, the value of the work of a physio-therapeutic department in securing efficient restoration of function after injuries is not appreciated sufficiently, and much remains to be done to place this matter on a sound basis. To secure the best results the physio-therapeutic departments in our largest hospitals will require the services of a trained medical man, who will be able to co-ordinate the whole of the work of his department with tho rest of the activities of tho hospital in question. This is being done at present with excellent results at both Dunedin and Christchurch, Fortunately the services of many masseurs and masseuses who wore trained during the late war are now available for our hospitals, and they are gradually being utilized for this purpose.