Medical supervision

“ With the development of health administrations, governmental supervision has been increasingly instituted in all countries and one can consider all that was admitted in medical experiments with the consent of the administration and without opposition as the sediment of the existing law. ”

“ Supervision, both by the medical officers and by the attendants, becomes much more easy and effectual when the patients are collected in rooms, affording them no corners or hiding-places for moping and indulging in their mental vagaries, their selfishness and moroseness. ”

“ The administrative details necessary to the successful operation of a large institution are such as to require the entire time and attention not only of the superintendent but usually of an assistant superintendent. In a large hospital the activities of the medical staff should be under the immediate supervision of a specialist whose training and experience qualify him to direct the clinical and psychiatric work of others. ”

“ This corps is in charge of a chief surgeon and chief medical examiner, both prominent in their professions; and although the number of men in their charge exceeds forty thousand, any complicated or persistent disability of an employee secures the personal supervision of the chief surgeon. ”

“ A comparison of countries in which there is and is not a comprehensive system of State supervision of the insane by a competent board seems to me to reveal so unquestionably the fact that such a system alone provides the proper protection for the insane, and the needed variety and uniformly high standard of excellence in the provisions for their treatment, that I hope to see the medical profession using its vast influence upon public opinion to secure it. ”

“ As reformers they are bound to assert that the national body requires for the time being a good deal of medical attendance, and many of them anticipate that even after the doctors have discontinued their daily visits the patient will still need the supervision of a sanitary specialist. ”

“ The experience of many years has shown quite conclusively that the supervision and general direction of a hospital for mental diseases should be delegated to a medical superintendent with such clinical and administrative assistants as the nature and size of the institution may indicate. The dual system of management frequently suggested by politicians, with a layman as the executive head and a medical director subordinated to his authority, has proved to be a failure in every instance in which it has been tried. ”

“ Is it not obvious that there should be a staff of medical officers and orderlies, detached altogether from any association with the treatment of disease, who should devote themselves entirely to the problem of prevention? ”

“ PROPOSED NATIONAL BOARD OF PUBLIC HEALTH, CONTROLLED BY ONE SCHOOL OF DOCTORS, CONDEMNED A typical instance of the dangerous tendency of the medical profession to extend its power over the people is shown in the recent scheme of the proposed National Department of Public Health, to be composed chiefly of doctors of one sect, with a head doctor having a seat in the President’s Cabinet. ”

“ He entered the Marine Hospital Service by competitive examinations, where, rising rapidly to the rank of supervising surgeon-general, he reorganized the whole department; he introduced the physical examination of seamen and managed campaigns against yellow fever. ”

“ 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. ”

“ The medical department of an army, like every other, is controlled by a system, and it is this which regulates its connections with the soldier more than the qualifications of individual surgeons. In the army the system takes care of everything, even to the minutest details. Hygienic regulations for preserving the salubrity of camps and the cleanliness of the troops and their tents, are prescribed and enforced. Every day there is a 'sick call' at [Pg 9] which men who find themselves ill present themselves to the surgeons for treatment. ”

“ 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. ”

“ To go, therefore, to the station, make a cursory examination, and then write a certificate that the person is seriously ill and must be removed without delay, or in the case of a simply cut head send it at once away to the infirmary for the workhouse surgeon to get out of bed and dress it, is, in my judgment, an entirely unsatisfactory procedure, especially as the latter is paid no special fee, be his trouble ever so great. There was nothing in all my duty as a workhouse medical officer, which irritated me more than these police cases. ”

“ In my opinion the best interests of sick officers and soldiers require that the medical staff of the army should, in all its operations, act in the most complete harmony with the medical profession of the United States, and I can not do otherwise than express my belief that the discordance in practice, which would be imposed by such a statute as is suggested, would be fraught with the most unfortunate consequences. ”

“ One of the provisions of the Bill was, as I have before stated, that every district Poor Law medical officer should be the health officer of his district, and that his reports of insanitary conditions should be sent to the Board of Guardians, many members of which Board would be found to be the principal offenders against sanitary requirements. ”

“ There is no doubt that the commander of a hospital must be a medical practitioner, and there is no doubt that in all matters relating to his hospital his authority must be final. In the last resort he must decide whether a patient is to leave the hospital or to stay; who should be admitted, and what the treatment should be. In a good organisation he will probably be very rarely required to express an opinion respecting these matters, but in the event of a conflict of opinion between say the consulting surgeon or physician and himself, there can be but one final arbitrament. ”

“ 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 ”

“ The officials controlling the Medical Department in ninety-five per cent. of our prisons and workhouses do not provide a proper equipment or staff of trained surgical and medical specialists, and they fail to recognize the importance of the medical department in educational and reform work. ”

“ 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. ”

“ Let us take, for example, a State hospital of one thousand patients. The staff would consist of a medical superintendent, five assistant physicians, and a woman physician. In a hospital of that capacity there would never be more than one hundred patients who would be considered curable, and the number would probably not exceed sixty. More than nine hundred patients would be hopelessly incurable, for the most part the wrecks of past disease, who practically need nothing but kindly custodial care with incidental medical treatment. ”

“ But of the prophylaxis of disease they have little trained knowledge, and they are not seriously interested. The prophylaxis of disease really implies organised and co-operative effort, and can only be effectively undertaken by those public-health officials who are charged with it as a definite function. In Australia at all events the inducements to enter the public-health service as a profession are not very great. The influence of the department is not very far-reaching, and the prophylaxis of disease is still in its infancy. ”

“ If an assistant-surgeon, he must be prepared to practice his profession in the most comprehensive sense of the word: no distinction is made between medicine and surgery. Every medical officer must act in either capacity, as circumstances demand, (which is more reasonable after all than drawing a line between two branches which cannot be separated) ,and perform the duty of aurist, oculist, accoucheur, chemist, and medical jurist, as occasion presents itself. ”

“ 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. ”

“ I took with me my assistant who had been principally called out of bed to attend to these cases, sometimes only to dress a wound which the police surgeon was too indolent to do himself although he was paid a fee for each visit. On arrival we stated our complaint, but, although the Commissioners listened to us attentively, not much benefit accrued. It is true they stated that an inquiry should be made and instructions given and that [Pg 173] more care should be exhibited. ”

“ The organization is complete and excellent. There is a supervising Surgeon-General, who has great powers and great responsibilities, a medical purveyor, surgeons, passed-assistant surgeons, and assistant surgeons. These treat an immense number of cases, and not a few have lost their lives in combating epidemics. These officers are selected by examination and entirely removed from any politics, and are bound to go wherever they are ordered, and obey regulations. ”

“ Under the terms of the Veterans’ Bureau Act, the Director is charged with the responsibility for proper examination, medical care, treatment, hospitalization, dispensary and convalescent care, necessary and reasonable after care, welfare of and nursing service to beneficiaries of the Veterans’ Bureau, and since he is so charged, the manner in which dispensary and 203reasonable necessary after care can be afforded is a matter of immediate importance. ”

“ The medical organization of the District Office has been developed primarily for the purpose of establishing claimants of the Veterans’ Bureau as patients entitled to treatment, and the furnishing of proper treatment, under regulations, orders and instructions issued by the Central Office. ”

“ We want independent Medical Officers of Health—appointed by the County Council, and removable only by them—men trained up for this as a profession; we want Sanitary Inspectors, with a proper qualification, appointed with the Medical Officer's approval; we want that each Medical Officer should be informed as to all approaches of dangerous disease, and bound in his turn to supply the information for other neighbouring districts ”

“ There is in the city one principal sanitary officer, a duly qualified medical man elected by the Municipal Council, whose sole duty it is to watch over the sanitary welfare of the place. Under him, as sanitary officers, are all the medical men who form the poor law medical staff. ”

“ New Code of Regulations for Sanitary Service of Army, 1857-9 The second sub-commission was appointed for re-organizing the New Code of army medical department, and for framing a code of regulations for Regulations the hospital and sanitary service of the army. This commission found that, according to existing practice, no provision was made for systematically caring for the soldier's health, but only for his sickness. The chief recognised function of the army medical officer was attending men in hospital ”

“ 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 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. ”

“ It would be no imputation on the merits of a general medical practitioner that he was found unsuited to the performance of the duties devolving on an officer of public health. The working of the Parisian administrative arrangements shows the injury done to the public service by the difficulty of retrieving any mistaken appointment, and suggests the desirableness of an arrangement to facilitate changes of the officers of health even where there is the security of a previous special examination as to the qualifications for the office. ”

“ Were all these changes made there is no doubt that the efficiency of the administration would be increased and the burden of the work lightened.
As regards clinical work other desirable changes might be made. Senior men who have been in full practice, and who come to a base hospital as physicians or surgeons with the rank of lieutenant-colonel, are apt to be entrusted with the detailed administration of medical or surgical wards. They are often unfitted by training for such administration and are frequently disinclined [192] to undertake the work. ”