OUR HOSPITAL SYSTEM.

Press, Volume LX, Issue 18127, 17 July 1924, Page 12

OUR HOSPITAL SYSTEM.

DISTINGUISHED SURGEON'S

CRITICISM.

"HAMPERED BY TRADITIONAL

DRAWBACKS."

The Juno number of "Surgery, Gynecology, and Obstetrics," the official journal of the American College of Surgeons, contains a 10-page article from the pen of Dr. Franklin H. Martin, managing . editor of the journal, who, it mil be remembered, recently toured New Zealand with other distinguished members of his profession from America. Under the title of "Australia and New Zealand—-a Modical Pilgrimage," Dr. Martin devotes gome 10 pages to a most instructive review of the visit. His observations on hospitals are of special importance hero at the present time. "In New Zealand and Australia," he says, "much, interest was manifested in our American College of Surgeons and its programme of hospital standardisation. One morning of the Auckland conference of the British Medical Association was given over to tho discussion of hospital betterment. I was asked to outline the programme that the American College of Surgeons is carrying out in the United States and Canada. The subject was discussed by Dr. Mayo, Dr.'Harte, several New Zealand and Australian surgeons, and Mr William Wallace, tho lay president of tho Auckland Hospital. "In looking forward to my visit to New Zealand and Australia, I had anticipated with interest the pleasure I would derive from a comparison of their hospital system with that of Canada and tho United States. The medical men of the world, especially those who travel, are almost unanimous in the belief that the most satisfactory system of hospitals is that which prevails in the United States and Canada -—from the standpoint of serving the best interests of all patients, tho well-to-do and tho poor, and as well the best interests of the o'ntirc profession. It Was our hope that tho great island continents of the. South-west Pacific, which have shown so much independence of action in the establishment and conduct of their Governments, had exerted the saroo initiative in the organisation of their hospitals by breaking away from the. obsolete traditions of Europe, Alas', that it is not true; but the medical profession of these countries, especially those who have obsorved hospitals elsewhere, are fully aware that their hospital Bystem is hampered by traditional drawbacks, and they are extremely anxious to work out a plan that will preserve all of the advantages of the old and obtain .the advantages of the now. This jnus„ be done, too, they realise, with evolutionary rather than with revolutionary methods, and without incurring prohibi-, tive expense. . ' "I euriveyed cursorily the hospitaia in five of the largest cities of New. Zealand—vi?-., Auckland, . Wellington, Ohnstchurch, Dunedin, and Napier, two cities in Australia, Sydney ana Melbourne; one hospital in fcSuva, -Fiji Islands; and one in Honolulu. Almost overy general hospital in Now Zealand and Australia is of the same viz., supported either by the Governments, the States, the and in some instances by mora than one of these govoming authorities. Like tho great hospitals of London, these institutions are exclusively for the pauper poor, and for those who are able to pay a small fee for hospital care. The acting staff is known as the, honorary staff. The members serve without compensation, nor. are they allowed to receive fees from the pay : patients of the hospitals. Each hospital is, as a rule, in charge of a fulltime medical superintendent, who cares for all emergency cases and has general supervision over the care of the sick. If the hospital is of sufficient gize, he has one or more salaried assistants, a pathologist, an X-ray operator, etc. Ef*eh hospital has its own training school for nurses, with a competent matron and assistants in charge. The massive institutional architecture of most of the buildings dates back to the end of last century.: The later additions, as expansion - demanded, are of a similar type of architecture,. or very often of the conventional type of the period. A# artificial heating is not a necessity, and as land was not a problem when the sites were selected, the grounds are ample and the structures are of the pavilion type connected by passageways which hmve roofs, but are usually otherwise partially or wholly unenclosed. "The general hospitals of New Zealand and Australia, with the exception of the fundamental defects of organisar tion referred tjo aDove, are of the standard type, and in equipment compare favourably with those of Canada and the United States. They have attending staffs of the outstanding men of the profession,- who conscientiously devote their time and skill to the care of tho patients of the institutions. They do this without compensation, and with considerable sacrifice of time. As in lyondon, their private work of a hospital nature must he done in a private hospital or "nursing home." The ptaff meetings, where developed at all, are rather in the of clinical society meetings than for the purpose of discussing the professional conduct of the hospital. Each institution has a well-equipped laboratory with many of the latest refinements, some including up,tomato metabolic departments. These laboratories have full-time technician's, and in most instances a full-time paid pathologist is in charge. The 3£-ray departments are adequate, a few of ray n thTrapy. PParatUS f ° r aPplyin ® dee P The records are well looked after, and m nearly all of the institutions clerks are employed who aid in writing and filing the reports. It « a definite responsibility of the internes U keep these records complete.. Separate record findings for the various departments aro required by almost' all of the hospitals.

As po professional fees are collected froiu-the patients in these large general hospitals, they are devoid of the abomination of fee division, of general hospitals of the typo described above, there is a definite demand for private hospitals in which patients of means may be treated by the doctors of their choice, and in which the patients are privileged to pay for professional services rendered to them. For that reaSO v* smaU institutions abound which bear the name r>f the doctor who owns" the hospital: Some of these prij e hospitals ara reconstructed residences, with a matron (usually a trained nurse) in charge. Obviously these small institutions are dependent, to a greater or lesser degree, upon less adequate organisations than the general hospitals, especially in regard to laboratories, X-ray service, operating room equipmont, and the regular nursing organisation, all of which are abundantly supplied in the general hospitals. This anomalous state of affairs compels the most competent physicians and surgeons in the two countries tp utilise

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private hospitals, some with inadequate facilities,. and thereby places the con- : seientious man of the profession at a great disadvantage, because he ia unable, without great effort and incon* venience, to provide for his. patient of means the same facilities that are accorded to the poor in the general hospital. The people of means themselves are at an even greater disadvantage, and the private hospital is, consequently, a last resort for them instead of the haven of opportunity which i? afforded by the hospitals of the United States and Canada, As soon as the profession and the people of Australia and New Zealand learn of the inconsistencies and tho difficulties which are the result of this situation, they will do one of two things; either they will allow their general hospitals to degenerate into purely pauper institutions by encouraging the building of more comprehensive private hospitals, or they will do what would be xnnch more advantageous—eombine with their large and expensive equipment of general hospitals pavilions equipped to care for patient# of means) who may then pay not only for their hospital treatment, but also fthe professional services which they, receive from - ; their physicians or specialists.