N.Z. MEDICAL SCHOOL

Evening Post, Volume CIX, Issue 151, 30 June 1925, Page 7

N.Z. MEDICAL SCHOOL

FUTURE DEVELOPMENT.

THE PUBLIC HEALTH

SIR LINDO FERGUSON'S .^EWS,

Sir Lindo Ferguson, Dean of the Faculty of Medicine of the Otago Medical School, has at the request of the Chancellor of the Otago-Uni-versity, prepared a comprehensive report outlining the future.: development and requirements of the Medical School. This report has an important bearing on the question of the. general hospital policy! of the Dominion. ;; ... '■ ; - :

The following are in part the recommendations of Sir Lindo Ferguson,:—• '.■'.-

810-CHEMISTRY.

"It is, I'think, certain that themain developments in medicine during the next -20 years will be. along the lines :' of increased knowledge of 'bio-chemistry, and closer application of physiological knowledge to'.medicalvtreatment on the one hand;' and on the other to improved knowledge and broadened ; applicav tion. of bacteriological and serological .'■ knowledge, and hand in hand with\these ■' a great development in .the' direction"; of preventive medicine.and public'health. , '■" '{The importance of developing', pre- _ ventive medicine has'been recognised in every, teaching centre, and .has' been emphasised in the recent deliberations of ■'"the General Medical Council, which urges that the teaching of preventive medicine, should be' iiisisted.;;on throughout the whole- of the students' clinical teaching. -.>■■■...■"■.- ..■/, ■'.- ■'."■ '•■ -.':,' . '■/-■-. . THE EESEAECH SPIBIT. L ? "A good deal' of uninformed: criticism has been, directed against the school as to various .things which the students are ; taught or are not taught; and I wish to emphasise the fact that, • provided our students 'are well grounded .in ' essen-; : tials, and. have acquired 'the ; habit of-thought, the question of what : they are taught, beyond that;.becomes a comparatively; minor.'matteri- but -if they are;to become useful'members' of ' : the profession, and,, are •to-be.able to serve the public as they should. do, the . development in them of a scientific: spiritand the desire to acquire knowledge by their own observation;: is' of' the ; utmost importance: In '.other" words,-,,, we must inculcate'the .'.research spirit;'from the ,-' earliest period of" their Ytraining, and their/education should be carried "on in departments.. each .-of .which .is engaged: in some research Syork;; and.'in - which the. spirit of.research is'-in. active . operation. -,",;-. ■-.'..,^ : ; '■< '■■•";;"-. '■■'• :,';.; ■;';' ''In rio department.; is .this; more, essential in training' general; pfaetitioners than in Mie; departmehtVof public health, and if; aswe hayevreasbn'"to'.: Relieve, the medicino of thefiiturewillb'e largely: . preventive ■rather;; than curative, the research investigations "which ■' are':being .carried out at present in-: Professor Her- : cuss. classes" -will; form from -.year,to year . a more arid ..more important ": element ;in. our students-education. In the pasVuh- - fortunately our:;outputC. of i'research work has .been deplorably small; ;b'ut: as ( our professors have, had to';.carry; on' their . departments :with'.yeryV.inadequate "< assistance they, haVe 'been -dping ,'spade- ; work which should '.have been done by junior teachers,'and;have-npt been able ■ • to. devote -themselves to, .the higher branches of teaching or direefcthe inves.tigations. which |hould have been carried out in - their departments : under their supervision., . •'■"'■■■-■■ :.';.:,:;..: -*.. ' .', '.■.',- :;- MATERNITY;WOBK.r >,; :^ _"There is ■ another' problem : dealing ■with resident 'appointments, for our students;; which; will have to be/faced : before very : long. Our students ought; all of them to have the ..opportunityy of what is practically an intern ■: position in connection with maternity work. Vlt ought to be part of the training ;pf; every .member of "the class. Some .arrangementwill have to be made -whereby, if they are not absolutely resident in the maternity hospitals, they shall,b'e resident next door or in the immediate neighbourhood, and -"shall have, to carry out the duties of • an intern or resident modicaL officer. .-... .'... \r,': v x;^;V::'V•'■;.;"..-. ■■:.':'-..'.■' ■ CLINICAIi TEACHING. A:-S \. "I have left to ths last the most dif-, ficult problem the school. has "to face, the question of the fuller development : of cliriic'al.teaching and its closer co-or-dination with the work and teachingi'in the laboratory departments... .' -.'■ "The view, ofthe board that it should not fall on the ratepayers: of this district to undertake the burden of training medical . men for the 1- whole Dominion is as ".. reasonable as that of the-council that the .. support of a" national school is beyond : tlip, resources .of. any one university col-; : ].ego(._" ..The Government .has recognised ■ this iii th'o,cas'e,.of:tlieUniversity, and has,given;,a special .grant for,: Medical School-purposes. It will no doubtin ticio' recognise -tho justice of a .special grant to" -the "hospital bocauso'. of its special circumstances. .as n, . Medical. School,; but ..it will probably Heniand a very closii supervision, of expenditure to niiike sure that the funds given for train- . ing medical students are not used for expenditure justly chargeable to rates; Tins would probably mean the representation of.the council and the faculty on! the Hospital Board by members nominated by the Government. Closer co-opera-tion between the school and hospital is essential, and it looks to me.as if it will be necessary to combine the .positions of dean of the faculty and superinten'dentiof. the hospital in the person' of a director, of the school. . The question is a very thorny one, but I am not concerned now .. with the difficulties in the way. ;I ajii merely indicating the. direction "in which .the greatest efficiency is in my opinion, to be found.' : ..■,;. ■•.;■■ "The council and board are of necessity partners in the school, if their interests are divergent some way must b»foup.d of reconciling them, but the development and' efficiency of the school must not bo allowed to"suffer.' ■■>• -> ;' HIVING EFFECT TO THE SCHExVE: "The programme.l havo put forward may seem.'at iirst sight to involve niorooxpenditure than is in the meantime pr.-icticablo, and I recognise that it will tako some years, to carry into effect V comiirehcnsive scheme, of tho-sort,, and Hint the building developments will'" be obtained.one-by one, and not al! at the : fame time. This consideration supgests . thai possibly some sequence should be lai'.l down as to tho relative urgency.of the portions of tho complete scheme. . HOSPITAL SYSTEM. "Our present hospital .system conccntvales all special cuscs in each province in the base hospital of tho province, and patients from Marlborough or Ha'wkes .Day who wish to come to Dunedin Hos-pil.-il are not received here unless they . arc sent down hy the hospital hoard of .their own district, which, in-doing so renders itself liable for their maintenance here.' Tho hospital'hoards-'of', the West Coast and elswhere constantly -repudiate liability for patients from their district who find their way here because of the reputation tho Dnnedin Hospital has. "Am- alteration in the control of this. .•iMsiiUif.ii.il will involve legislation, an« 3 : w -Ihe jjcccsfary .Act a proviso, siiould bo

inserted that patients from any part of the Dominion will find an open door here when they c0m0,.; and that do sufferer should be debarred by local.interests or prejudice'from benofit'iiig by-the extra, efh'ciency and knowledge which, a tcaiihmg hospital ;affords. This is-in the interests not'only of tlie: school,--by .'increasing the amount and variety of clinical material,:but of the patients and of the community as a whole. ' Tho local hospital boards would be expected to pay a maintenanco rato _f or the. patients'.com-;-mg from.their districts ; bvit.as the main r tenancerate does not coyer! the-.overhead charges involved, it-would be only right that, as the school-is the magnet which draws them here, the Government should make an adequate grant; to prevent the ratepayers ,of this, district, bearing i the burden of the sick-.from other places. "I think that the.- council should endeavour; to approach the Government with;.the : co-pperatian :of the. Hospital Board, to obtain this' ■neces'sary^reform';" and it. is ;;suclv/a".-reasonable" : one that I have.-'. everyv; hope ii> :;will ;■;■■ be; carried through; In ths.meantime,l think,steps should be taken'to put' throu"gli the sutway to afford [close cdinmuhication, between':^ the . hospital and the.:. Medical School, ;which; was part of the plans-for", the present bl6ck,;but,whiclr'was left in abeyance.-through jack/of: funds. ; I; feel sure that.-; tho .co-operation of -the Hospital Board; and. of >the City Council can easily he.obtained- for this facility; for! our everyday:work. . -■:■ :; : :. • ; •'; "In preparing this (forecast; I', have ; endeavoured :as far as possiblo: to deal with.'.-the; subject ori^ broad .lines: and to avoid unnecessary 'detail.;"; : Tho i;eport has been placed in: the hands of the members: of, the faculty. 7;The document.as a whole 'was adopted, .but the; opinion ■ was expressed that it would have been better if more detail had ;been entered into a,s to tho 1 more. immediute ; heeds of £he s'chobl.;- '■-■-' ■'.■•;:;";: -^ '^:."v; •■':' •'-' ;: -- '.■: 'v;^;

!'■■.- It. was ..urged from, .the: surgical; side that", tho: clinical work required developing to obtain corresponding, efficiency' to that: existing, in;the.;laboratory;depart-, menls. : On the niedical sidexame a ror commendation '■-.that.' the.; development of the teaching of normal arid pathological psychology should'find aTplacb .in the curriculum,; and; this will 'probably, have' to bo provided for.ibefore'long; .and from the gynaecological side representationswere made that further expenditure' was urgently,; called; for in : connection with: the teaching in that department..; „ ,'..■". ,; ''With;these", views T.;am; in entire accord, and that-they; wereiiiot incorporated in the first draft of'the iorecast .was due to-the^act" that I hesitated -- about; ;-oyerloading ; ;;,;it^with detail,;" especially■ ;'with ;;d,etailabout:which- there might:be any'difference pf-iopinion.V.;;;;;;;: . - : , ::; i ;f-^^;;-;t;,Humming:Tjp;^';^;;;'; J-::: i ":;''To'reduce this-forecast tola-few sen-' - tences; the.scliobr will; continue', to -fulfil, a rhpst.yalua.ble part in the?life ofithe community with': increasing ■efficiency, but at., increasing:; cost; "Its"; completion; will ca11,,-for | further b.uildihgs:;which; 'apart from thejhpstel, will probably cost £100,'00P;.orJnibre; and iii the not 'distant, future; necessary ■•additipns ;to;..the; teaching; and!..auxiliary ;staff'and-itheir'.'adequate payment,-with;.'the.foundation; and;main-.: tenance-of- "a. library '■-. and;Jother ~\ riiaihr' tenance costs/:\vill' swell our annual bud-" get'from £16,000 \ t0,;;£25,000 a ;year. ;.,'