THE HOSPITAL.

Otago Witness, Issue 3756, 9 March 1926, Page 19

THE HOSPITAL.

COMMUNITY'S GREATEST ASSET. “The ;.rovji:io • raid* by a j ccmimiiity for the prev«a*%ioa ur.j cure gy disease is an index to the civihsafibn tea intelligence of that community,” said Dr Malcolm MacLuehern in an interview with our representative. “It is not always realised ns fully as it should be,” Lo said, "that the material comfort enjoyed nj the citizens of modern countries is wised upon the advances made by scientific medicine in recent years Indeed, it is scarcely too much to say that civilisation i-seif rests upon the same foundation. ‘For consider, through modern medicine many ravaging diseases have been either eliminated or put under absolute control. Think of some of these deadly scourges, and of what their removal or control means to our daily life- -bubonic plcague, Asiatic cholera, >ello.v fever, malaria, sleeping sickno6B, hookworm. Any one of these, if uncontrolled, could soon wipe out civilisation completely “TT.ore are many other better-known <jis«i;.:s which have also boon put under a control no absolute that the death-rates from thorn have been reduced bj from 75 to % piir cent, i am Blinking cl the control of smallpox through vtuudnstiim, of typhoid through vaccine, mi dip?. Iberia thro-..gh avu-tozh', and of diabases insulin. ‘•■in thesv \ ays and in many owSfcws, »w----.'r, i snorixdity has been reduced from •.’that it was nctfr so long ago, and from what it is ifcill in backward parts of too world—--200 to 3ft) per 100> -to bO or 00 per 1000 Tho gKriftz&i death-rate of the world has been ; .t ds?w/i from 20 and more per 1000 to 10 and even less in many areas. “We can iudet)i rejoice at the thought that the average length of life has increased in less than a generation from 40 years to over 56 voavs. It is one of tho indisputable triumphs of our :h-criticis» e d civilisation. Aril it U entirely duo to orgama.d medicine-doc tore, nurses, technicians, hospitals. and others, working in th e preventive* and curative fields of medicine and cooperating with an intelligent and instructed public opinion. “That is why 1. say that the attitude oi a community to its medical services ss an index of its intelligence. For, great as are the results which I have outlined, far more can still be accomplished. I’o-od hospitals with proper organisation, adequate facilities, competent personnel, and efficient supervision or ‘check-up’ can continue the progress that has already been made. ‘The value of their work to the community has two aspects which we can distinguish for purposes of explanation, however closely they may be connected in the long run. One is the humanitarian side, and about that one need say little. The time has gone by when the motto of a society, in practice, was ‘the weakest goes to tin wall.’ We no longer regard life as so bitter a struggle that the pain and suffering of a man are no concern of the community to which hs belongs, or that the man who is down and out must be 16ft to fend for himself. From this point of view medicine is the greatest and most effective weapon that human knowledge and skill can place in the hands of human benevolence, and the great public hospital is the outward and visible sign of man s sympathy and concern for his brother man

“The amount of pain and suffering that such institutions prevent or mitigate, both for patients themselves and for the families to whom they are so often restored alive and '.veil, if; enormous. “And while 1 am speaking of the huma-

nitarian side of the work of hospitals, there is one matter to which I should like to refer. Important as it is that a hospital should develop and progress on its scientific side, it is just as important that it should be made a human institution. If it degenerates into a soulless scientific machine, it gives up one-half oi its live function, if the right attitude of the true medical scientist animate.; a hospital, every patient in it should oi able to feel that he or she, as man or woman, is of concern to those who «ire tending hi* bodily ills The watchwords should be service and 00-opcration—co operation between patient and doctor and nurse, and everyone else concerned in the vast organisation. If that is lacking, Doth sides—patients and healera—suitei definitely by the loss, this is a fact well attested by science as well as by cominonsonse.’ Dr AlacKeachern said h e liad said something of the humanitarian side oi hospital work. But there was also another side—the economic. The value of a hospital to the community which maintained it, was measurable in hard cash, and a simple calculation revealed the ifood hospital as tai and away the most remunerative under taking to which any community could commit its money.

‘‘Let us consider tor u moment, tie said, "the hospital activities in the city of Dunedin in leference to the Dunedin Hospital. In the past year 4175 individuals were treated us ni-patients. The vulue of a human life to the nation to-day is esti mated by actuaries and other experts us DIOOU This is a very reasonable estimate when we realised that the average age of man to-day is over 56 years. Surely the overage person in his 26 or more years of usefulness is worth to his community at least £IOOO.

‘Suppose that the Dunedin Hospital has saved the lives of 10 par cent, of the patients admitted to it. This would be 418 patients. It is granted by all authorities that in u tact a far higher percentage of the patients is saved in all good hospitals. But we take this figure as the minimum, and as an extremely reasonable and conservative estimate.

‘The economic value of 418 patients is £418,000. Analysis of expenditures during the past year indicates that the entire cost of maintenance of the Dunedin Hospital wag £56,038 Therefore, through an irncetinent of this kind tho community actually receives a return of £418,000 in lives saved, which is an enormous dividend on the amount expended. “And this is only a small percentage of tho real return. For tho aotual saving of life among in-patients is only one port of a hospital's function. There is the prevention of chronic invalidism, deformity, and permanent disability among these same

patients, livery success of this kind means to the community—l do not speak of the individual—a saving of some proportion ot the £IOOO which is the economic value of a life. The preservation ol an arm or leg or eye which is threatened by disease or by the consequences cf an accident must mean the preservation of a very iarfco oportion of a citizen s economic value.

‘ The r*aa;e _ thing is true on a much larger scaie li we .wilder the economic e oi the hospitals u > the same basis for the whole Dominion ot New Zealand. During the past year the entire Dominion there were treated 63,068 in-patients of hospitals, the entire cost of maintenance being £963,626. Applying the very low minimum saving of lives as above would mean at least 6306 fuwrals les9 in the Dominion through the year, and placing the same economic value on these lives would mean no less than the sum of £6,306.000, an almost unbelievable fact. against this the entire cost of maintenance of these 63,0bC patients was only £963,626. This tiroves conclusively that a good hospital is the best investment that any community can undertake.

“And. indeed, to all this there is the fact that every big hospital is training students, doctors, arid nurses for service to the community outside its walls The economic value of this function is not measurable in figures, but there is no need of discussion to show how great it is.. “Taking all these things together, we have ample justification for the statement that hospitals are a community’s best investment The medical service as a whoie is an integral part of civilised social life, and in that service the hospital occupies a strategic point, both in the fields of curative and preventive medicine. “Every community should have at least five to seven hospital beds for every 1000 of population. It is estimated that. 3 per cent, of the population on the average is on the sick list at any one time. A considerable proportion of these require the services of a good hospital And I repeat again that.tho extent to which a community realises this fact is a mark of its civfiisa’ion and its power to think “Every hospital should offer diffcier? varieties c-f .vjoommodatioTi and all tho scientific services known to medical know lodge for each Mid everv man. woman. 8n child in every community All patienthowever, cannot receive free treatment Th public wards are for the necessitous poor only The various degrees of ray wards ar for those •ri-.o can afford to nay for thi accommodation and at the sam? time hav«> Ti* ‘dvantages of the magnificent faci!: ties that a metropolitan hospital 'ike Duned lore's " trust that thr- 'itkens of l>- • o • ralise if thev have not in f nest. what a great asset a good hospiia-

such as they have here is to their community, both from the humanitarian and economic aspects.” Dr MacEachern, M.D., C.M., D.Sc., Chcagi). i i Canadian. born near Toronto. i\* graduated from M'Giil

University, Montreal, in 1910, and after a few years’ clinical and adminjstrative experience in the Montreal hospitals—of one of which he was superintendent—he became general superintendent of the Vancouver General Hospital, Vancouver, 8.C., where he remained for F years during whichtime the hospital grew from 300 to 1400 beds—the largest m Canada and at that time the fifth largest on the continent. The institution soon oecame famous for its great organisation and efficiency. together with a good deal o* original work in the putting of hospital organisation on its present successful basis throughout Canada Through his efforts hospital standardisation in Canada developed rapidly and with great effect. He was. instrumental m organising or stimulating the organisation of several provincial association in the dominion, which are now doing good work. On account of his organising experience Dr MacEaeht was invited by he. Excellency Lady Byng, and the National Board of the Victoria Order of Nurses for Canada, to accept the position of Director General tor a period of a year or two for the pur

pose oi making a survey of Canada in respect to publit health nursing and with a view to re-organising the service to meei the newer conditions then presented He was given leave of absence and accomplished this work in 16 months Following this be vvas asked to take ovei the hospital standardisation movement as carried on by the American College of Surgeons, '"he American College of Surgeons is an organisation of leading surgeons chiefly trom Canada and the United States, but with membership in South America, New Zealand, Australia, and some 30 other countries of the world. This organisation has threefold objectives -first, the betterment of the practice of surgery and medicine generally; second, the betterment of hos pital service; third, the promotion of health scientific medicine, and research. It is a voluntarily endowed organisation supported mainly by fees from members. Dr MacEachern is director of hospitals for this organisation, which embraces an annual survey, through a staff of investigators, of 2400 hospitals each year, chiefly in Canada and the United States. This survey is made according to a standard of service set up by the College of Surgeons. After eight years’ operation it has improved hospital service and economy enormously in America. In addition, Dr MacEachern is past president of the American Hospital Association (Canada and the United States). He at present is on the professorial staff of the College of Hospital Administration of Marquette University, as well as holding many other positions of an advisory and administrative nature in both countries.

His services have been lent by Dr Franklin H. Martin, Director-general of the American College of Surgeons, and the Board of Regents of that organisation, to the Governments of New Zealand, Victoria, and New South Wales, in an honorary advisory capacity. He has completed an intensive study of the Victoria hospital system and a general survey of the New South Wales hospital system, and in reports to them is outlining suggestions for the future development of their respective hospital policies. Dr MacEachern’s full time in America is now given to hospital administration, policy, and research, and he has at his disposal for study the extensivo field covered by those 2400 hospitals.