Medical department

“ We have a medical department well equipped with all the facilities of a first-class hospital. The regular staff of that department consists of four physicians and two trained nurses who live on the grounds, besides specialists who visit the institution at regular intervals. In addition to this we have a staff of consulting surgeons and physicians, each of whom visit the department at least once a week. No better attention is given patients in any hospital than our inmates receive. ”

“ The work of this department should be the investigation of clinical problems, and not of academic problems of pathology, chemistry or physiology. General practitioners, clinical assistants in the school and even those at the head of clinical departments are constantly meeting problems which demand solution, but find no adequate opportunity to investigate them in departments as now constituted. These men would find a place in the department suggested and should constitute an enthusiastic working staff which should be exceedingly productive in the advance of medical knowledge. ”

“ The most able of the guardians would confess that if they are not entirely incompetent to supervise medical service, they are at the best but imperfectly qualified for such a task, and the medical officers would act with more satisfaction to themselves from the supervision of officers from whom they might derive aid and confidence. ”

“ The Commissioners request your aid in conducting the inquiry in the of The Commissioners have obtained valuable information in England from the medical practitioners who have the care of hospitals and dispensaries, where those contagious febrile diseases to which their attention has been specially directed come under the observation and treatment of experienced professional men. ”

“ The services of the relieving officer are highly important, as he has an opportunity of observing the state of filth and the obvious predisposition, and perhaps of causes of disease, preventing it before the visits of the medical officer, who is of course only called upon to attend when disease has arisen. The relieving officers visit more frequently than the medical officer, and give the tickets or orders requiring his attendance. ”

“ The department of health may, from time to time make rules and regulations fixing the time of rendering, and defining the form of returns and reports to be made to said department by the office of chief medical examiner of the city of New York, in all cases of death which shall be investigated by it ”

“ The specialists in surgery on the staff of the Bureau shall be recommended by the medical sanitary department, with the consent of the Board of Directors, preferably from among the surgeons connected with the hospital fund, and shall be confirmed by a general meeting of the office.
3. During the examination of a person at the Bureau of the Medical Commission, all persons who have applied for the examination may be present.
4. An application for the determination of the loss of working ability may be made by any person or institution. ”

“ One of the most important services, therefore, of a superior medical officer of a district would be to ensure the entries of the causes of death with the care proportioned to the important uses to be derived from them. The public should be taught to regard correct registration as being frequently of as much importance for the protection of the survivors as a post-mortem examination is often found to be. ”

“ The practice of the Poor Law Board at this time was to assert on paper the supremacy of the medical officer in his own department, to give him no personal support when he did his duty, to visit on his head all the consequences of their own negligence or dilatoriness, and, right or wrong, to support the Guardians when they took offence at conscientiousness and zeal. ”

“ In each district, which may include several Counties, there is a physician in full charge of the district, with permanent headquarters. There is also a supervising nurse of the district, whose headquarters should be the same as the District Chief’s, unless an emergency should make another arrangement desirable. All other Department officers are subordinates to these two representatives of the Medical and Nursing service respectively. Reports by wire or ’phone are required daily at 1 p.m. ”

“ Another of the duties of the Department of Health was to examine every person that applied to practice medicine and surgery or to engage in any professional calling. The law required a medical examination to be made of the person, who was granted a license every year, so as to keep the professions up to a high standard. ”

“ The regular routine business of the Hospital is about equally divided among the resident medical staff. A number of wards constitute the department of one physician or surgeon, to which his labor and attendance are mainly devoted. The Physician-in-Chief has the general supervision. The assistants have to report to and to consult with him, and to carry out his suggestions or orders. The Medical Board meets regularly every fortnight, to Medical Boardconsult upon all matters relating to the Hospital and the welfare of its inmates ”

“ To get an idea, however, of the great variety of work undertaken by the largest hospitals, it may be well to glance at the various departments of medicine and surgery represented at St Bartholomew’s Hospital, the oldest of these London institutions. In addition to the out-patients’ rooms, and wards devoted to the treatment of ordinary medical and surgical diseases and accidents, there are the following special departments: A department for skin diseases; for diseases of the eye, ear, and throat; an orthopædic department; a dental department; a department for the special diseases of women ”

“ That for the prevention of the disease occasioned by defective ventilation, and other causes of impurity in places of work and other places where large numbers are assembled, and for the general promotion of the means necessary to prevent disease, that it would be good economy to appoint a district medical officer independent of private practice, and with the securities of special qualifications and responsibilities to initiate sanitary measures and reclaim the execution of the law. ”

“ Adjoining the administration building is the admitting department and Outdoor Clinic where students can see every variety of emergency, medical, obstetric and surgical cases. They can also follow up and see final results in those who have recovered sufficiently to leave the hospital, but return as out-patients for treatment until entirely cured. The basement of the admitting department is well lighted by wide areaways. Every patient's clothing passes through the large sterilizer located here, and then goes to the tailor-shop to be cleaned, mended and pressed before being stored away ”

“ Our Medical Corps is especially entitled to praise for the general effectiveness of its work, both in hospital and at the front. Embracing men of high professional attainments, and splendid women devoted to their calling and untiring in their efforts, this department has made a new record for medical and sanitary proficiency. ”

“ The health department of a modern city is charged with a double duty: it has to care for cases of disease, and it has to suggest and enforce laws to keep the city sanitary. The former task—the treatment of sickness—is much more widely recognized as the proper function of the medical profession ”

“ Qualification.—No person can lawfully practise medicine in any department unless he be a graduate of a medical college, or unless upon examination before a board composed of the [194] superintendent of public health and two other physicians to be selected by the territorial board of health, he be found proficient in the practice of medicine and surgery, and shall be found upon proof to have been actually engaged in the practice of medicine not less than five years. No person shall practise medicine unless he be of good moral character, and is not an habitual drunkard. ”

“ I resolved to watch the action [Pg 80] of the Department, and to do my best to make the permanent officials do their duty, so far as my observation could aid me. With that object in view, I arranged for an aggregate meeting of the profession, at the Freemason's Tavern, to discuss the composition of the so-called Board at Whitehall, and the grievances of the Poor Law medical officers. ”

“ In 1862 he was made medical director of the fifth army corps, and later in the same year was appointed medical director of the department of Washington, having charge of all the hospitals in and about the capital, together with all the hospital transports. ”

“ When pensions can be earned by medical officers of health and by all medical men on the public health staff, their position will become more attractive for men of good standing; and this reform has become more important in view of the steadily increasing complexity of the medical work now undertaken in a large public health department. It will include inter alia the following officers and activities: superintendent medical officers of health; district medical officers of [Pg 65] health; tuberculosis officers; medical officers of maternity and child welfare centres, of venereal disease centres ”

“ The guardians who, in our union, are men of business, consider that their time is fully occupied at the Board, and they object to any attendance out of the Board, and would give it reluctantly. If the cases are taken before the magistrate, it appears desirable that the medical officer should not be compelled to attend unless it were absolutely requisite, and that the relieving officer should be allowed to prove the facts as to the state of the dwellings recited in the medical officer’s certificate, which could rarely be disputed. ”

“ The later and better knowledge of the real nature of fever cases has been obtained by a similar range of observation gained from the cases in fever hospitals. Applications have been several times made to the Commissioners by medical men engaged in particular researches to aid them in the removal of the impediments to extended inquiry, by collecting the information to be derived—from the sick-wards of the workhouses and the out-door medical relief lists. ”

“ Whilst experience gives little promise even of inquiries from such a body as Boards of Health without responsibilities, still less of any important results from the mere representations of such bodies separated from executive authority, I would submit for consideration what appears to me a more advantageous application of medical science, viz., by uniting it with boards having executive authority. ”

“ It will frequently be found that there is the like need of immediate local inspection of the medical treatment of the destitute that there is of a grade of inspecting surgeons for the military hospitals. It cannot be otherwise than that amidst a numerous body of men there must be much error and neglect in the treatment of the destitute, in the absence of immediate securities against, neglect. ”

“ By pointing out the real causes, warning will be given for their avoidance, and indications extended for the application of more certain remedies. Medical men who see only a few patients of the same occupation at distant intervals; who see them in their own dispensaries or in the hospitals, and who have no opportunities of observing such patients under the varied circumstances in which the disease may have been contracted, are left to mere guesses as to its cause. ”

“ The HSS response may be in the form of special medical augmentation teams (SMART) support from US Army Medical Command resources or HSS (table of organization and equipment [TOE] ) units may be directed to respond. Normally, responding TOE units will provide HSS to nonmedical military responders. However, the HSS mission may be to provide support to the lead federal agency or civilian public health organizations, emergency medical services (ambulance crews) , or hospitals. ”

“ Medical officers, as private practitioners, are often dependent for their important private practice, and even for their office, on persons whom its strict performance might subject to expense or place in the position of defendants. ”

“ Initial triage, EMT, and decontamination are accomplished on the "dirty" side of the hot line. Life-sustaining care is rendered, as required, without regard to contamination. Normally, the senior health care sergeant performs initial triage and EMT at the BAS. Secondary triage, ATM, and patient disposition are accomplished on the clean side of the hot line. When treatment must be provided in a contaminated environment outside the CPS, the level of care may be greatly reduced because medical personnel and patients are in MOPP Level 3 or 4. However, lifesaving procedures must be accomplished. ”

“ The Commissioners have not asked for returns in any prescribed form from the medical practitioners in the towns of Scotland, because they are uninformed as to the nature of the existing records of facts relating to medical statistics in the towns, and they wish to consult the practitioners’ convenience, and be guided by them as to the best use to be made of the local circumstances for obtaining information. ”

“ The Chairman having appealed to this official, who was present, as to what should be done, he stated that the resolution was only carried in committee by one vote, and that the Chairman of the Committee, had voted against it. Thereupon the Guardians of the Weymouth Union directed that the official letter [Pg 82] should lie on the table, and no expensive medicines were found. I took care that a report of this meeting should be sent to every Poor Law medical officer, and to the Department, as well as to every influential Member of Parliament I could reach. ”