AUSTRALASIA

876 the charge was in order and that no claim for emergency treatment could be made against the patient’s own panel doctor. Claims for emergency treatment can, they ruled, only be made if neither the insured person’s doctor nor his deputy is available. But surely although the patient’s doctor may be at home at the time, he may not be "available" to give immediate treatment if the accident occurred some distance from his house, or if, as in this case, the only person who knew the name of the responsible doctor was in a state of unconsciousness owing to an accident or other sudden emergency. And what is the meaning of the phrase in the distribution scheme that

"unless the panel committee are satisfied that there reasonable cause for not summoning the practitioner responsible for treatment the committee shall deduct ..." if it is not to provide for the extreme case such as this when there clearly was reasonable was

cause.

Is it too much to hope that the contribution of insurance practitioners to the campaign to encourage the wider use of the health services may be a resolute attempt to demonstrate that medical benefit under the N.H.I. Acts, although still restricted to a general practitioner service, is in its fullest sense a service rendered by the trusted family doctor ?

SPECIAL ARTICLES AUSTRALASIA

(FROM

OUR OWN

CORRESPONDENT)

THE NATIONAL HEALTH

THE

same tolerant pity that we feel for our unenlightened ancestors of the Middle Ages will doubtless be felt by our descendants for our vaunted Australian

civilisation and its attendant ills-tuberculosis, cancer, numerous acute infectious and chronic diseases, and influenza. There is also our relatively high maternal and infantile death-rate, not to mention the common cold. Prof. Harold Dew, who holds the chair of surgery at Sydney, spoke of some of these things in his Anne Mackenzie oration for 1937, delivered at the Institute of Anatomy in Canberra. The Australian standard of health, he said, is lamentably low, and only a small proportion of the population enjoys perfect health. The number of patients attending public hospitals in Australia is higher than it should be, and there is a vast amount of chronic ill health in Australia, causing unnecessary suffering, loss of time, and lessening of national efficiency. The death-rate would have to be greatly reduced, and if proper measures were taken there was no reason why Australia should not build up the highest national health standard in the world. It has been realised that education of the people on health matters is essential, and the Commonwealth Council for National Health and Medical Research was formed for this purpose. It has recommended the granting of money for research, and its other plans include the appointment of well-paid junior research workers for threeSenior research workers would be year periods. chosen from their ranks, given permanent positions, and employed in special work. Prof. Dew said it was impossible to forecast the future of medical practice in Australia. It might be a form of national insurance, a system of State medical

service,

or

perhaps

a

compromise.

POST-GRADUATE EDUCATION IN NEW SOUTH WALES

Since the beginning of the century Sydney has been a centre for post-graduate teaching in medicine, courses having been arranged at intervals by the University of Sydney and by the New South Wales branch of the British Medical Association. There is a now Permanent Post-Graduate Committee in Medicine, supported by government grant, and a general revision course, designed primarily for general practitioners, is held each year, including intensive instruction at all the larger metropolitan hospitals. Country practitioners may attend week-end courses held at country centres. Special courses are also provided for those seeking higher degrees and diplomas ; for example, during the current year a

course will be provided for entrants in Part I of the examination for the degree of master of surgery, this course being equally suitable for the primary F.R.C.S. Eng. Arrangements are made by the committee for lectures by visiting lecturers and also for residential post-graduate studentships for obstetric, children’s, and general hospitals. Instruction in the diseases of children and in infant is provided and attendance at clinics for the diagnosis and treatment of cancer and tuberculosis, and tuition in anaesthetics is arranged. The school of public health and tropical medicine in the University of Sydney

feeding

conducts diploma courses. A special hospital has now been inaugurated in New South Wales for the furtherance of post-graduate teaching. The constitution of the Prince Henry Hospital was recast by an Act passed a year ago, and a board of fifteen directors was appointed which is required to conduct and maintain the hospital for the treatment of public, private, and intermediate patients and to provide ample opportunity for postgraduate teaching and research work in medicine to be carried out under the auspices of the University of Sydney. The training of medical superintendents, hospital managers, hospital secretaries, hospital

matrons, nurses, masseurs, almoners, dietitians, X ray technicians, and pathological technicians may be undertaken by the board. Besides the medical staff of the hospital, a staff of honorary associate honorary medical officers has been appointed. This includes, ex officio, any professor or teacher in any of the subjects of the medical curriculum of the also

University. FOUNDATION OF INSTITUTE OF MEDICAL SCIENCE LAID IN ADELAIDE

The foundation-stone of the first Institute of Medical Science in Australia was laid in Adelaide on the first day of the 1937 Australasian Medical Congress. The plans for the spacious modern building, to cost over E50,000, had been sanctioned by the South Australian Government, which had also subsidised it. The building, which will be erected in the grounds of the Adelaide Hospital, adjacent to the University, will contain laboratories with every facility for research work in pathology, biochemistry, bacteriology, and veterinary pathology. Provision is made for a museum of pathology (the Martin museum), and for a collection of medical records illustrating the history of disease in Australia. The institute will be affiliated with the Adelaide University, the Adelaide Hospital, and the nutrition laboratory of the Council for Scientific and Industrial Research. It is anticipated that it will become the centre of learning of the biological, physiological, and pathological aspects of medical science in South Australia. Special consideration will be given to the

877

of records of race, occupation, nutrition, and climate. The institute will be controlled by a committee

compiling

representing the Government University and the Adelaide Hospital, who have appointed Dr. Weston Hurst of the Lister Institute,

London,

as

director, a

and will be jointly responsible for his salary of B1500 per annum. Towards the cost of the building:C15,000 was subscribed by Miss Edith Bonython, Mr. Norman Darling, and Mr. T. E. Barr-Smith, each of whom gave JE5000. The Government subsidised that sum pound for pound, and 10,000 has been given by the Commissioners of Charitable Funds from the Martin

bequest. The remaining :S13,000 will be provided for in this year’s estimates. The three stages of the evolution of medical science in South Australia were traced by the president of the Congress (Sir Henry Newland) in a speech at the official opening. In the first, pioneers had received medical service from doctors who migrated with them, or from the sons of settlers who went abroad and qualified ; there were no means of training students and no teachers. In the second stage, the training in medicine began with the birth of the medical school. By this time the number of medical men had greatly increased. Many kept in touch with scientific progress abroad, and passed their knowledge on to students, but it was beyond their compass to undertake independent scientific work, or to attack problems of medical research on a large scale. There were, of course, men in advance of their time, like Davies Thomas, Joseph Verco, and Prof. Watson, but they and others were handicapped by the lack of equipment. In the third stage, which had now been reached, the means for research in medical science had been provided. An able director and assistant director had been obtained from abroad. In the course of time they, and those associated with them, would train a new generation to take their places. It was only when a permanent institute of medical science or research had been established that medicine could really be said to have taken root in a young country. Science was the living source from which the practice of medicine derived its nurture. The establishment of an Institute of Medical Science was in keeping with Australia’s medical progress in other directions, said Prof. Grey Turner of London, who is a visitor to the Congress. He was impressed by the fact that provision was being made by endowments towards the salaries of the research workers, and he was also struck by the Government’s willingness to augment the private grants. PROBLEM OF MEDICAL RESEARCH IN

AUSTRALIA

Prof. F. Wood-Jones, F.R.S., who has just given up his post as professor of anatomy at the University of Melbourne, having accepted a similar appointment at Manchester, has expressed grave doubts on the future of medical research in Australia unless conditions of work can be improved. One of the handicaps affecting research workers in this country is the continual pressure of work, both teaching and administrative, in the medical schools. This routine work allows little or no time for continuous research. Often the occupant of a chair is required to do work quite outside his professional sphere, such as solving small’problems for, and answering innumerable letters from, practitioners in all parts of the State. Prof. Wood-Jones believes that Australia will continue to lose her most efficient workers unless she provides them with better opportunities. To carry out research work of national importance the coordination of effort and wise direction are essential. Until these

assured, especially close coordination between medical biologist, chemist, and physicist, the wisdom of providing funds for the endowment of research of a specific nature, such as cancer research, is doubtful. The likelihood of any individual investigator finding the answer to such a problem as cancer is almost negligible ; so for the present at least Australia would be well advised to provide ample funds for unrestricted research by individuals, though every effort should be made to achieve a basis of coördinaare

tion

as soon as

possible.

Another of the difficulties besetting Australia is the absence of a sufficient number of trained technical assistants. Owing to insufficient funds the teaching departments of medical schools cannot provide enough promise of promotion in work of this kind to attract men to a laboratory career. The outcome of Prof. Wood-Jones’s suggestions is that rather than allocate money to some definite purpose and then try to find workers, it would be wise to place adequate funds at the disposal of an individual worker to enable him to develop without hindrance his own ideas. EFFECT OF NEW ZEALAND TRAFFIC CODE

A remarkable decrease in the number of accidents in New Zealand has been evident since July, 1936, when a new strict traffic code was introduced and a speed limit of thirty miles per hour was rigidly enforced in "built up" areas. Statistics show that, the number of deaths from accidents has been reduced by 100 a year ; but the proportion of fatal accidents involving motor-cycles remains relatively large-almost a quarter of the total. It is expected that the adoption of a more serious attitude towards the problem of the intoxicated driver will reduce this menace to public safety.

MEDICINE AND THE LAW "

Under the Influence of Drink or a Drug " EVER since Section 15 of the Road Traffic Act of 1930 came into force, motorists have been indicted (if the case went before a jury) with the offence of driving a car " under the influence of drink or a drug." These are the exact words of the statute but the form is possibly objectionable as containingThe doubt is apparentlyan alternative allegation. to be settled in the Court of Criminal Appeal. A doctor was indicted last week at the London sessions in the words of the statute. He denied having been under the influence of either drink or drugs. He was convicted and fined 9100 with E50 costs, and his licence was ordered to be suspended for seven years. His counsel challenged the indictment. Thedeputy chairman ruled that it was good, but granted a certificate for an appeal to the Court of Criminal

Appeal. The ancient law of indictments was strict indeed. In 1829 one Puddifoot was indicted for stealing a sheep. It was proved that he stole a ewe ; but the statute used the word " ewe " as well as the wordsheep," and Puddifoot who had been convicted and sentenced to death was therefore pardoned because the indictment used the wrong word. In 1841 Lord Cardigan was indicted for shooting at Harvey Garnett Phipps Tuckett with intent tomurder him, &c. He was tried by his peers and the case is memorable as one of the last prosecutions for duelling. It is even more memorable because LordCardigan was acquitted on the ground that the Crown "