MEDICAL SERVICE.

Auckland Star, Volume LXVI, Issue 22, 26 January 1935, Page 13

MEDICAL SERVICE.

SERIOUS DEFECTS.

EMINENT BIOLOGIST'S VIEW

STERILISATION PROPOSALS

The morality and effectiveness of sterilisation and also the varied character and efficiency of England's hospitals and nursing institutions were discussed bv Professor J. B. S. Ilaldane in a lecture on "Human Biology and Politics," delivered at the Goldsmiths Company's Hall, London.

In some preliminary remarks on the medical profession Professor Ilaldane said: "The application of science to other branches of life has led to increase in organisation, but though we do not go to an individual artisan for our car, or to an individual water-carrier for our water, we still go to an individual doctor for our healing. *

"The largest organisations for medical and surgical treatment arc the hospitals, which are neither capitalistic nor in this country socialistic, but survivals or imitations of medieval foundations. A few large clinics and nursing homes are run as business concerns. The Doctor's Versatility. "The result is most unfortunate. The patient consults a doctor who is supposed to understand the whole gamut of human ailments, from broken bones to madness. If poor, he or she may ultimately bo admitted to a hospital, but too often after a considerable delay. The middle-class patient is treated in liis own home or in a nursing home, where conditions arc generally far worse than in a hospital.

"There are generally fewer specialists available, less adequate apparatus and laboratory facilities, and less constant attendance by nurses. Only the very rich secure as satisfactory treatment as the hospital patient. I speak from experience of both. I have been in a really good nursing home. I have also been in one where the conditions were inferior to those of the better hospitals in Mesopotamia in 1017.

"The system is obviously unsatisfactory. Though I. should prefer to see a State medical service, I am sure that the middle-class patient would be much bette-r off with a capitalist type of medical organisation than at present. He could go to an institution where he would find a team of competent specialists including a radiologist and a bacteriologist, and would probably be able to avoid the heavy occasional costs of illness by paying a fixed annual fee.

"As medicine becomes more and more a matter of prevention as well as cure, the defects of the existing system show up more clearly. . The preventive and prophylactic side of medicine is represented by the medical officers of health, the school medical officers, and a few voluntary institutions such as the3Peckham Health Centre which are models of what should be. But under a system of individual medical attendance adequate disease prevention is almost impossible, if only because it as far harder to detect latent disease in an apparently healthy person than to determine the nature of a disease already existing.

"If the existing knowledge of human biology and that which is likely to come into existence in the near future were adequately applied, there would, as we shall see, be an enormous demand for experts. It is a serious question whether they should be members of the medical profession. Killer as Well as Healer? "Again, it has been suggested that sufferers from certain incurable diseases should bo killed, that persons with hereditary defects should be sterilised, and that abortion should be permitted in certain cases where the mother's life is not in danger. If any of these practices are legalised I sincerely hope that they will not be entrusted to the medical profession. The relation of the physician to his patient should always be that of a healer, never of a killer, and the whole psychology of that relation would be profoundly altered for the worse if this ever ceased to be the case.

"This fact was realised by the wise man or men who framed the Hippocratic oath. If public opinion demands the application of medical technique to such ends as I have suggested, the profession will be well advised to surrender some of their rather jealous guardianship of this technique rather than extend their functions unduly.

"For the same reason, I believe that it is desirable that the experts who in the future will be concerned, as I believe they will, with the enforcement of standards of diet, housing, reproduction, and so on, should not be medical men, though they will have to learn much of the- science which is now taught only to the medical profession. The alternative would be an hypertrophy of the medical profession such as occurred in the Middle Ages when the Church concerned itself not only with spiritual affairs but with government, education, and handicraft. Such an hypertrophy could only end in

disaster. An expert on human biology need not be a doctor, and in many cases should not be, any more than every clerk should be in holy orders.". Dean Inge and Population. Coming to his. main theme, Professor Haldane said: — "Dean Inge believes that a happy and healthy England would be more sparsely populated than at present, by a population largely engaged in agriculture. This is only true if it is impossible to keep an industrial population healthy and happy. It will be time to conclude that this is impossible when the attempt has been made on sclcntiiic lines, and not till then. . .

"An urban population living in unplanned houses and eating an unplanned diet is bound to be less healthy than a run.l population. An urban population which was adequately fed and had opportunities for sport and country travel might be healthy enough. When I climb Snowdon, as I have done at least once, without meeting anyone else I cannot resist the conclusion that our population is ill-distributed rather than too large." Pointing to the fact, which he regards as established, that England's population will decline greatly in the near future, the lecturer again refened to Dean Inge, who, he said, disapproved strongly of Communism, and thought that England should play an important part in combating it. "Jiut he approves of a trend in population which is rapidly rendering England and all other capitalist countries, save Japan, less and less capable of effective action against the Soviet Union, should such action be desired by those who regard our civilisation as superior to that of the Soviet s. If the population of Australia did not increase much more, while that of Japan did so, it would become increasingly diflieult, either morally or physically, to resist the Japanese claim to immigrate into that continent." Sterilisation's Consequences. On the question of a policy of "wholesale sterilisation," Professor Haldane said that any attempt to make it compulsory, or even alternative to seclusion in an institution, would be a violation of the principle of the sanctity of human life. If a Government once violated that principle it opened the door to serious consequences. The more intelligent politicians realised that if the Government started killing people, people would, sooner or later, start killing the Government. By sterilisation some hereditary diseases could bo abolished, but other? could only be dealt with if healthy as well as diseased persons were prevented from breeding. The sterilisation of mental defectives would lead to a slight ! fall in the incidence of mental defect, but was open to great abuses. The I sterilisation of women in particular would endanger their lives.

Professor Haldane advocated a system of family allowances, for three reasons. It would combat malnutrition and the falling birth-rate, and it would prevent the present social promotion of infertility, by which members of small families rise in the economic scale, so that the richer classes become congenitally infertile.