PREVENTION OF DISEASE.

Auckland Star, Volume L, Issue 155, 1 July 1919, Page 11

PREVENTION OF DISEASE.

PROGRESS IN MEDICAL c SCIENCE. i a -HO>HTA!.s AND RESEARCH WORK- P The avium that prevention is better than cure is being adopted by the medical profession in England to stimulate in medical science and to 1 raise the national standards of health F and physical fitness. In the past it was the chief aim of doctors to cure their patients, but to-day the outlook of the profession i- much" broader, and their aim is to prevent illness by lighting against the conditions which create disease, luring a p.itient sines one life. but the prevention of di.-ease r-aves * hundred.-. The governing l.odie- of the great • voluntary hospitals of Kngland are aware of the broadened possibilities that i lie before their institutions under the ! new conditions with regard to the war against disease which the establishment ' of a Ministry of Health will create. t These voluntary hospitals correspond to I the .State-aided hospitals of New Zealand. They carry out their great < humanitarian work'on simil.tr lines, but they receive no aid from the State. The ' t-tate's contribution to medical work among the poor is to I*- found in the 1

infirmaries and hospitals attached to the ' ■workhouses and other poor law institutions. The voluntary hospitals are maintained by voluntary subscriptions from the public, and by the income from the money and property bequeathed to them b.v "private per-ons. Nominally some of these hospital are exceedingly wealthy in the amount of funds and property that have been bequeathed to them during several generations, but actually they are always in a state ot impoverishment, because the large incomes they receive in interest, rents and subscriptions are spent in extending their work among the sick. In the pat-t the chief aim of each voluntary hospital was to excel its rivals in the number of beds it contained and in the number of patients treated. The standards by which they sought to be judged by the public to whom they appealed for subscriptions, ■were a low cost of maintenance per bed and a low death rate. But under the stimulating axiom that prevention is better than cure, they are setting before themselves a new ambition. They seek •by means of prevention to reduce the size of hospitals instead of increasing them, and to empty the wards instead ot filling them with patients. Their new aim "is to lead the way in research work which will prevent disease. Although the governing bodies of the voluntary hospitals are unable to predict what the future of their institutions will be under the Ministry of Health (as no announcement on the subject has been made by the Minister in Charge ot this new department) they are preparins for a wider sphere of activity which will increase their usefulness to the comunitmy. Mr. E. W. Morris, house governor of the London hospital, speaking at the annual meeting of the Hospital Saturday Fund, said with reference to the training of medical students, which is such an important phase of the work of the great voluntary hospitals, "If the hospitals taught the" doctor that his duty was to get a biff practice they had failed in their duty. If they taught him that his duty was" to cure disease they had partially failed.' They had to teach the doctors that the prevention of disease was much more important than Jha cure pt disease." q * ~fc

The British Hospital Association "has agreed that the future work of the voluntary hospitals should be focussed on the education of medical students, the treatment of difficult cases of disease, and the advancement of research, leaving to the [Ministry of Health the provision of facilities for tbe cure of tbe sick, and the treatment of ordinary cases of disease. In their extended sphere of labour the voluntary hospitals will need the assistance of State subsidies, but they are not waiting for any formal guarantee of this nature from the Minister of Health, before extending their work. The three most important voluntary hospitals iv London—the London, St. Bartholomew's and Guy's—are taking steps to extend research work in preventive •medicine. The first step In this direction is the appointment of whole-time Ealairied physicians and surgeons, instead of honorary consultants. The consulting physicians and surgeons of the great hospitals are men who are in the front rank of their profession. They are in consulting practice in the "West End, by which they earn comparatively large incomes, and they give

their services to the voluntary hospitals free of charge. As teachers of the medical students at these institutions, the task of training the doctors of the future, rests upon them. They are also responsible for directing the research .Work carried out nt the hospitals. "The result of this system," writes a medical authority, "is that the energies of the teacher are divided between bis practice and his hospital work. The more successful he becomes in his practice the less time he can afford to give to hospital work. The tendency is for this work to be relegated to assistants who themselves are naturally anxious to acquire a practice. The system has this to recommend it—that the rewards of the Tery successful are very high, and that consequently it is likely to attract a certain type of ambitious men. On the other hand the obvious disadvantage of the system is that it divides the mind. The teacher serves two masters, both of them very exigent. He is at the beck and call of the public: scientific work which demands not o_"*f a man's time but also his allegiance, claims him like Wise. The hospitals are the teaching schools, and they are also great in>-titu lions for the cure of disease, and for tlu discovery of means of diagnosing anc of preventing it. This work is too vital too momentous, to be relegated to th< second place in any man's life. Moden medicine is so big, so important, tha: only those who are prepared to devoti themselves whole-heartedly to its stud} are competent to teach others. More over, the beginnings and not the end ings of disease demand most earnes attention. This means a reorganisatioi within the hospital itself, and the raisinj

of the out-door department to an equal status with the indoor. It means the intensive study of diseases; it means team work; it means the seeking of first causes, and the refusal to think merely in terms of symptoms. You cannot achieve ends of this kind without a paid staff pledged to devote its whole energies to the work in hand. Consulting practice and hospital practice once so advantageously united, are no longer compatible with one another. The hospitaL physician while he holds his appointment, must devote himself wholly to his hospital duties. "The step which the voluntary hospitals are taking amounts to a great revolution in the medicine of Kngland. When the hospitals become staffed by v hole-time men they will lead the profession, as the military hospitals have recently been leading "it. Their vast stor. . of clinical material will be utilised after a now fashion. Departments will be >et aside for the intensive study of particular diseases, and this study will absorb the whole energies of talented research workers. Preventive medicine will then come into its own. Knowledge gained in studying diseases will be applied to prevent its occurrence. This knowledge will come forth with authority, and it will not be possible for anyone to disregard it. The teaching of medicine will be transformed. That which is first—prevention—will have the first place: that which is second— cure —the second."