STATE MEDICAL SERVICE.

Otago Witness, Issue 3280, 24 January 1917, Page 9

STATE MEDICAL SERVICE.

INTERVIEW WITH DR 11. R. RHODES. Ur Miisou Russon Khodes, who is at present in Dunedm, made sonic interesting remarks last week concerning the establishment oi a State Alodioal Service. Dr Rhodes is making a tour of the dominion with the special object of bringing prominently before tiie public the desirability ol such a step being taken, and is evidently a very strong advocate ot its effectiveness. Lr Rhodes directed his remarks entirely to the establishment of a universal State medical service. He said thoie was no doubt that such a service was the next national evolutionary step in any legislation contemplated in regard to the health of the people. It was, in fact, the national r 1 suit of our ever-widening scientific knowledge as to tlie causation ol disease, Jn the old clays our knowledge of disease' had been limited to the idea that the patient was the source of the disease: hence the patient only was considered and treated, ifc was true that in stii] more ancient days there was not only a consideration of the patient himself, but the source from which the disease sprung, was often thought 10 be a witch. Curiously enough, as our knowledge had widened we had come back to a similar position; only from a very different standpoint of scientific knowledge, and we realised that the poor unfortunate patient was not the source of disease, but that he had been attacked in many cases by micro-organisms. Then, with our widening knowledge we established our public health service with medical officers to combat many forms of disease. This much iiad been done in a general way to prevent people being attacked by disease. \\ ith a widened horizon us to causation of disease, we had come to recognise that in any epidemic some persons seemed to be immune, and that m infectious and contagious diseases we could produce artificial immunity by the injection of serums, or antitoxins, winch would counteract, or prevent or destroy the power of the micro-organisms. Thus we had conic to recognise tliat because a disease was epidemic it did not necessarily loliow tnat everyone should be attacked by it. We, therefore, came to the point, that prevention was possible by the production of artificial immunity. JJr Rhodes went on to discuss what was done at the present time in the direction of prevention, and expressed the opinion that it was very little. In order to ensure a healthy, vigorous, and efficient nation we must bo careful that the health of the individual was so established by skill and careful treatment that every man. woman, and child, _ so far as possihle, Mas made naturally immune from contact with the deadly enemies of humanity and human happiness. This could only be effected by placing the health of every individual under the supervision and care of the medical man, so that the health of the individual should become the medical man's duty and responsibility and not, as at present, only the ill health of the individual concern him. Tho whole of the medical profession should be one great State Medical Service to maintain the health of each individual member of tlie community. The Insurance Act at Home was a expression of the realisation of that fact, but Jailed, and had been proved to have faded signally in reaching the end contemplated, because it had placed old wine of an old principle—the care of ill health—in the new legislative wine skins, with the result that tiie people and the doctors alike were dissatisfied with the results, and realised that the Ace totally failed to achieve its object. Tho fact was that the new wine of the new piinciplc—the maintenance of tho health of the people - should have' been placed in the new legisativc wine; skins. Everyone would then have been satisfied, and a State Medical Service could have been much more easily and efficiently worked than under tho present Home Insurance Act. The way was easy and simple:—Lot the medical profession bo made a branch of ihv Civil Service with salaries rang.ng from £4OO to i-ICCO per annum. Let every medical man lie placed on that service and lot one State examination lit him for that service. Let every householder or lodger already in or coming into a neighbourhood put his name down to the medical man of his choice. Let such medical man's duty be to call on and sec such household and note where constitutional tendencies, sueli as indicated above, exist, and I where medical or surgical assistance is needed; and thus his duly will bo the prevention of disease and the maintaining the health of his patients. Lot such medical man be allowed only a certain number of families, say 300 to SUD. and as soon as i he number is made up for one doctor, then the neighbourhood must choose one ot the others. Let any medical man newly started be drafted to a plaeo where he is required, or he may take up his stand where im re is :i vac ; n: place. The advantages of such a medical service as that outlined wero principally: —Prcven,'i,u of disease rather than the cure of disease already widely established, as in all s..sting sy.-ieins. including the National Insurance Act. Tho question of medical assistance is not left to the lay mind, but is man. Hence great saving of life and suffering. The interests of the public and the medical profession are identical under this svstem ,for it will bo to tho interest of the medical man to keep his patients well, and lie will therefore not lie under the ban of benefiting by his patients' ids. The regular salary, like that of a clergyman, will do away with tho keening of a multitude of petty account 5 , with all tho loss of time, speak of the vexation of spirit and the souldestroying work the obtaining of such means

to a sensitive nature, sapping the vitii energies, which should be given rather to lnimg iiniclf mental!; and physically for his arduous day and n.giit duties, and yet which terrible loss to ionised, and tints to lie public, is tiie usual lot of the general prao uiioiier. J iie advantage to the public will i, ■ that the great coat of administration oi tins ni dical branch of t'Tiu Civil Service .oi be practically nothing compared with that under lue present Insurance Act. The present gross inequalities of justice to public and profession a.ike will bo remedied Wo recognised now, continued Dr Rhodes, that the individual is a link in tho chain of diss asc. Wo have seen he is not the cause of disease, and wo have seen that it is our duly and the duty oi tiie .Slate, and of everyone in the State, to ensure that ihe health of every individual is so maintained that he does not becomo a receiver of m.cro-organisms of disease, for to become a receiver of disease is to become a carrier, an incubator, and a transmitter ol disease. For example, in the case of tuberculosis, the patient, if his health had been attended lo previously, would in all probability never have contracted consumption and tluis become, by the multiplication of organisms, a danger to everyone else. Thus tho individual and community are indissolubly joined together, and the interests of the one are the interests of the other; and henco the responsibility of everyone is apparent. This brings us to the financial aspect of the question. By a wider knowledge of disease, wiien the public realise that medical men, in attending patients, are not ouiy treating the unhealthy, but also are protecting tno healthy, I hey would willingly give support by suitable taxation for a State medical service. It would not only be tin advantage to the public from a health point of view, but would mean a financial saving, because, in place oi spending £6O or iJIOO a year, they would have their expenditure spread over a number of years, it suitable taxation was introduced. r .i he simplest, way to meet the expense of a State medical service is, naturally, by a graduated income tax, extending to tho poorest worker. Under a State system the income of people with unsecured incomes would bo already known, and, with regard to the paid worker, the employer could become the tax collector in the* .simplest manner possible by deducting o. certain amount from the weekly wages of his employees —a very much simpler method than that adopted under the Insurance Act. Wo know that at Home and in the dominions vast sums of money have been spent on sanatoriums and hospitals, evidently in the expectation that such are to be constantly filled in the future with patients. How much greater would be the value of this money if spent in maintaining the health of the people so as to prevent these very diseases which populate and (ill our sanatoriums and hospitals. In oik; case the money is spent to temporary advantage on those attacked by disease; in the other it would be spent on the permanent maintenance of the health of the people. In other words, we have been for generations placing tho cart b"foro the horse, and it is now our duty to place the horse before the cart. It is spei ialiy important, in view of the terrible war raging, with all tho loss of life and health and employment entailed, that a State medical service should be established for maintaining tho health of not only men, but women and chldrcn, and of women expectng to become mothers. It would be of special value to ; the State, as it would menu tho supervision ! and care of mothers and young girls on | whom the future race, depends. Dr Rhodes concluded with some remarks ; with regard to the aspect of tho effect of such a system upon medical men. He said there was no doubt that, with all working in combination for the good of the community generally, and not on a competitive system, there would a-ise that esprit do corps, and a spirit of zeal for the good of the public health, and for the health if all in the communities. He mentioned that, at the last I meeting of the medical profession and British Medical Association in London, a resolution had been passed to tho effect that a special committee be formed to consider what steps should be taken to organise public opinion and the medical profcss : on for the advance- i incut of medical and allied, sciences . in view of the obligations, etc., likely to result from tho war, and take action and report fo tho council of the representative body. In view of that fact, said Dr Rhodes. it is well that the medical profession in tho dominion should also consider what : ts obl : gations aro to tho public in comic-' tion with tho war and its deadly toll of young , lives. Surely they will agree that in no way j cm the lo l r be made good to tic dominion better thnn by a State medical service such i as that outlined. I