WAR SERVICE OF DOCTORS

Press, Volume LXXXVI, Issue 26039, 16 February 1950, Page 3

WAR SERVICE OF DOCTORS

memorial address BY MR PORRITT

MEDICAL ADVANCES; STATE SCHEMES (N'tw Zealand Press Association) WELLINGTON, Feb. 15. “It is an odd. if rather grim, thought that war has brought to medicine in these last 50 years of our chequered lives untold benefits and advantages,” said Mr A. E. Porritt, C.8.E., surgeon to His Majesty the King, at the British Medical Association conference last evening in an oration to the memory of New Zealand doctors who lost their lives on military service. Just as the First World War established orthopaedic surgery as an entity, so the Second World War had opened up vast possibilities in surgery of the chest, of the brain, and of the blood vessels. Three handmaidens of surgery had made these possibilities relatively safe—a dramatic improvement in anaesthetic methods, the immensely increased use of blood transfusion. and the advent of sulphonamide drugs, penicillin, and antibiotics. "Many of us came to divide our medical war into three stages—presulphonamide. sulphonamide, ahd penicillin.” said Mr Porritt. “In the first stage, the B.E.F. in France during the first months of the war, sepsis in war wounds and septicaemia were still rife. In the second, the Middle East campaigns, sulphonamides had to a very large extent prevented generalised infections, but every local wound was potentially, if not actually, septic. In the third stage, Normandy, Italy, and the Far East, penicillin made septic wounds the exception rather than the rule. This alone made a vast difference to military strategy towards the end of the war. It was one of the debts the army owed to medicine.” Diseases Abolished

Now drugs had almost abolished those two scourges of armies fighting in hot climates —dysentery and typhoid —which accounted for more casualties in the First World War than did actual wounds. Medicine had also taken up such problems as the efficient protection of life and limb in tanks, varieties of food' and clothing to provide the correct level of sustenance and cover in a dozen different climates, the study of remedies to prevent sea sickness in assault landings, the investigation of the effects of variations in atmospheric pressure and speed on air pilots and submarine personnel, and many other problems of modem warfare, in which it had been found increasingly that clinical knowledge, physiological data, and scientific fact were of prime importance.

Even “the grisly business” of the atom bomb was slowly but steadily producing side-lines which merged into the therapy of malignant and other diseases. “One feels that it is only right that these things should be put on the credit side of a balance so heaily weighed down by the inevitable tragedy and useless waste of war.” said Mr Porritt.

One other point, he said, should be considered. In the services doctors were working in a regimented, Statecontrolled service. By and large the results were efficient and the personnel were happy in their work. Why then did the civilian State service go so largely against the grain in various parts of the world? Hard Lessons Learned 9 “Let us admit in the first place that circumstances are very different,” he said. “However much we would like it to be so in these difficult times of peace, we know that the sense of urgency to achieve cohesion of purpose at any personal sacrifice is not of anything like the same potency. Let us not forget that in all medical services it was only when the cast-iron bureaucracy of administration had been made reasonably malleable by the unquenchable clinical flame of those large numbers of our colleagues temporarily under arms that really co-ordinated - and efficient service resulted. There were many hard lessons learned on both sides, but it was worth it. No machinery, however good, will run a profession. “’Hie economic as well as efficient administration of any medical service depends upon its ability to encompass the personal idiosyncrasies of both patient and doctor within reasonable limits. Because the profession, being doctors, realised the many difficulties of achieving this end, it would appear to have lost the kudos for the conception of a comprehensive medical service for all. It was a medical idea—and ideal—long before it became one of the more important planks in many political platforms. “What the ideal State medical service should achieve is that no individual is denied the best facilities medicine has to offer, irrespective of his worldly wealth, and the key words are ‘denied’ and ‘facilities.’ If any patient is able, and wishes, to deal with his sickness in his own personal and private way, he should be free to do so. By facilities. I mean institutions, hospitals, sanatoria, health centres, apparatus, instruments, and drugs. These are inanimate objects that can be nationalised to the great advantages of all.” State Schemes “It is not the idea of State schemes which is at fault. It is the precipitate, relatively thoughtless implementation of them that has led to so many unfortunate and often so unnecessary complications and difficulties. I believe strongly that there is a great deal of good in most of these schemes, but that the good will be watered down to just the extent that any particular scheme inhibits the incenSVe. • u i n ttiative, or the independence of either partner in it, doctor or patient. It is not the politician of tp-day who will suffer from an ill-conceived scheme but the patient of the future. “Let each and every one of us take out of the back cupboard his moral n ues and see to what extent they allow him to support one scheme or part of a scheme or strongly oppose another. lam sure we have all got to niake this individual effort if we are to ensure the best treatment for our present and future patients; if we are going to safeguard the generations of me profession still unborn: and if we are going to be as good doctors as God and the Otago University can make us.”