Evening Post SATURDAY, AUGUST 20, 1938. THE DOCTOR AND HIS WORK

Evening Post, Volume CXXVI, Issue 44, 20 August 1938, Page 8

Evening Post SATURDAY, AUGUST 20, 1938. THE DOCTOR AND HIS WORK

In ali ils long history the profession of medicine has passed through many changes, but probably none! so great as that of the last generation, which has been almost revolutionary in its advancement in theory and practice. The care of. the health of the people has extended into fields unknown fifty years ago) and the adjustment of the profession, with its traditions dating back to ancient times, to these modern conditions has been, on occasions, inevitably difficult and painful. It is all very different now from the earlier simplicity of the complete physician and family doctor of Victorian days. The advent of the specialist, the modern hospital with elaborate and costly equipment and. above all, the intervention of the State with its public health services, and now in New Zealand, a farreaching "social security" scheme, have posed problems for the profession that gravely concern its independence. It is a far cry from the Father of Medicine, Hippocrates, and the Oath and aphorisms attached to his name, though the Oath will always stand for the ideal of the physician and the true spirit of healing. The regimen I adopt, runs the Oath in part, shall be for the benefit of my patients according to my ability and judgment, and not for their hurt and any wrong. Nor has time diminished the truth of the aphorism: Life is short and Art is long; the Crisis is fleeting, Experiment risky, Decision difficult. Not only, must the physician be ready to do his duty, but the patient, the attendants, and external circumstances must conduce to the cure. In this spirit, in the main, the physician passes through the ages, a "disciple of Aesculapius" in Rome, which instituted the first principles of public health with its aqueducts ahd sewers, a pupil of Galen later, ahd then with the beginnings of modern medicine a student of the science and art of curative healing at the medical schools of Padua and Leyden. A graduate of these was the great Sir Thomas Browne, the Elizabethan country doctor, who, in the spirit of his profession, could write, in his famous "Religio Medici": I feel not in me those sordid and unchristian desires of my profession; I do not secretly implore and wish for Plagues, rejoice at Famines, revolve Ephemerides and Almanacs in expectation of malignant Aspects, fatal Conjunctions and Eclipses. I rejoice not at unwholesome Springs, nor unseasonable Winters: my Prayer goes with the Husbandman's; I desire everything in its proper season, that neither men nor the times be put out of temper. Let me be sick myself, if sometimes the malady of the patient be not a disease to me. I desire rather to cure his infirmities than my own necessities. Where I do him no good, methinks it is scarce honest gam; though I confess 'tis but the worthy salary of our well-intended endeavours. lam not only ashamed, but heartily sorry, that, besides death, there are diseases incurable: yet not for my own sake, or that they be beyond ray Art, but for the general cause and sake of humanity, whose common cause I apprehend as mine own. It is in this spirit of Sir Thomas Browne, "for the general cause and sake of humanity," that the medical profession as a whole throughout the world is approaching its new problems. The care of health is no longer the care of the doctor alone; it is the care of the community or the State that represents the community. This was established first nearly a hundred years ago in the organisation of compulsory vaccination against smallpox. This was in 1840. Since then the process has advanced far and it may be taken today, in the words" of an authority, Sir Arthur Newsholme, in his recent work "Medicine and the State," as universally accepted that (1) the health of every individual is a social <p>ncern and responsibility, (2) medical care in its widest sense for every individual is an essential condition of maximum efficiency and happiness in a civilised community, and (3) no sick human being must be allowed to lack all that is practicable and really necessary for his skilful and humane treatment and for his expeditious return to health. That such ideals arc not yet fully attained anywhere is admitted, but everywhere there is progress in that direction with the best means available. The means differ in different countries. Sir Arthur Newsholme, in his monumental survey of the different countries of Europe, except Russia, conducted for the Milbank Memorial Fund, is inclined to place the Scandinavian countries, particularly Denmark, as foremost in their organisation of all the agencies conducive to a maintenance of a high standard of public health. Britain has far to go yet in co-ordination, but has achieved much in ihe improvement of public health despite the difficulties of conflicting interests and overlapping authorities. Despite "the steady trend in every country towards the supersession of voluntary effort by official provision in medico-hygienic services," Sir Arthur holds throughout I hat "the most important single agent engaged in medical work is the competent and

conscientious family medical practitioner." ' "He is," says this authority, "and I think will continue to be, an essential and indeed a chief factor in efforts for securing improved health for a community." But his work is handicapped by the "discontinuity in medical service" and it is in remedying this defect that the chief reform of the future is needed. The Council of the British Medical Association in 1930 emphasised three points: That a satisfactory system must be preventive no less than curative, that it should be based on the family doctor, and that consultant and specialist services should be available normallydhrough the agency of the family doctor. The emphasis on prevention as the first j essential and on the family doctor as the indispensable unit in the medical team is fundamental to the elaboration of any adequate general medical service. The whole aim of such a service is to secure the personal fitness of the individual, and through that the fitness of the nation as a whole. "Without this personal fitness," says Sir Arthur Newsholme, "all else lapses and loses its purpose. If fitness includes character-health as well as body-health, fitness, while it is the working capital of the community, is much more; it is the ultimate purpose of civilisation."