548 



NATURE 



[June 22, 191 1 



The main object of the national medical service 

 would be twofold : — 



(i) To give instruction in the laws of hygiene and 

 healthy living, sowing this knowledge broadcast in 

 both school and workshop. 



(2) To take effective steps to stamp out infectious 

 disease, assuming compulsory powers for this purpose. 



We require a new system, including in organic 

 coordination the private practitioners, the hospitals 

 (voluntary and Poor Law), and their stafTs, the 

 infectious diseases and municipal hospitals and 

 their staffs, the dispensaries, public and provident, 

 the district medical officers and relieving officers, and 

 the present so-called public health service, 



" Let us wake up and be truly ashamed of our- 

 selves," and having taught the school teachers the 

 principles of hygiene, provide that this subject is 

 taught in our schools as a compulsory and important 

 one. Under our present medical service neither the 

 medical practitioner nor the public health officer has 

 any ambition to go forth and find the disease, not 

 even if an epidemic is on ; the disease must come to 

 the doctor. The service is the more defective and 

 incomplete in that many infectious diseases, and these 

 often the most dangerous, are not even compulsorily 

 notified. 



It is maintained that a national medical service 

 must arise in the end out of the general sickness and 

 invalidity scheme now being contemplated by the 

 Government. It is obvious that both the more 

 economical and scientific way of dealing with disease 

 is to catch it early and to stop it at its source. 



" So much of medical practice is becoming in- 

 efficient under the action of some of the local co- 

 operative systems, clubs, societies, and tontines, that 

 it is making the name of medical science a disgrace. 

 It is turning doctors' private practices into fraudu- 

 lently conducted business concerns, in which the 

 doctor loses all dignity and self-respect, and the 

 patient is cheated of that advice and treatment which 

 he imagines is being given to him, and upon which 

 his very life depends." 



The last thing in this world to have cheap is medical 

 advice. State insurance with a nationalised medical 

 service is the only way out from this chaos. The 

 medical officers should be transferable from one local 

 centre to another, and open to promotion from one 

 place to another. It is a liberal estimate to take the 

 average income of the profession at 250Z. per annum. 

 The average annual pay for the doctor, under the 

 State national medical service, would be somewhat 

 more than 300Z. a year, and taking it that a junior 

 commenced at about 150^. a year, this would mean a 

 system rising on ordinary promotions and good ser- 

 vice to a maximum of loooL, and a small number 

 of administrative officers at higher salaries. Probably 

 about one-third of the profession would elect to re- 

 main on in private practice. The whole scheme would 

 not be nearly so costly as the provision required under 

 the Old Age Pensions Act, and it would prove quite 

 as popular and as beneficial. The gain in disease 

 stopped at incipient stages, and in increased health 

 and corresponding power of his workpeople, together 

 with regularity of work, less interrupted by illness, 

 NO. 21-3, VOL. 86] 



would more than repay the employer for his part of 

 the contribution. 



".At least one adult in every seven of us is k 

 to die of consumption, all because of this nefai 

 'Wait till your ill system,* which no one has the 

 courage to attack, and because we will not send 

 doctors out on the highways and byways to find 

 disease and haul it apart, so that they may stand 

 between the healthy and infected, and the plague 

 be stayed. As it is with consumption so it is with 

 a hundred and one other disease conditions." 



The author deals with our hospital system, its evils 

 and abuses. It is argued that these provisions are 

 only capable of doing about 15 per cent, of the work 

 which they are intended to do; but they are a hope* 

 less failure and a positive drawback, because they 

 stand in the way of the introduction of a properly 

 organised scientific effort. An organised system 5f 

 State-controlled hospitals, in true coordination instead 

 of chaos, would bring about a reduction of at least 

 50 per cent, of both disease and expense. The pre- 

 sent hospitals are hopelessly out of touch with the 

 present medical practitioners throughout the country, 

 and this is highly detrimental to the public service, 

 the hospitals themselves, and to the medical profes- 

 sion. 



•* Under a State medical service and State hos- 

 pitals for all members of the wage-earning classes, 

 hospital abuse is done away with, because it simply 

 cannot exist. The out-patient departments of our 

 hospitals, like the 6d. dispensary practice of our 

 slums, are two disgraces on the fair name and repu- 

 tation of medical science. In both cases the times 

 given are wholly inadequate for observation, care, and 

 attention to the cases." 



The writer demonstrates that the race is not re- 

 lieved from suffering and death by the existence of a 

 cure for the individual. 



"There is only one way given under heaven by 

 which disease can be abolished and a finer and fitter 

 race evolved, and that is by stopping the cause of 

 disease, and throwing all our energies into the resist- 

 ance of its spread." 



Without a fairly complete separation of infective 

 consumptives, no progress of any kind is possible. 

 Therein lies the solution of that problem. 



"If we could only see the patients hit by the infec- 

 tion of phthisis as we do in smallpox the present order 

 of things would not long be tolerated. As we are free 

 from hydrophobia, so can we be free from tuberculosis 

 when we find a statesman of the courage and fortitude 

 of Mr. Walter Long to lead us to victory." 



It is pointed out that in the evolution of the national 

 medical service the friendly societies will be absorbed, 

 the service will be thrown open to the whole of the 

 medical profession, retiring allowances will be pro- 

 vided, and a State medical examination would become 

 the single portal of entry to the medical profession 

 which is so desirable. The voluntary hospitals would 

 soon step into line with the rest of the service, and 

 accept State support and control. The district 

 assigned to each doctor w'ould contain some four or 

 five hundred families or houses. He would have a 

 surgery ; he would have no rivals worrying him, no 

 bills to bother about, no suspense lest his patient 



