The Medical Profession.

Then, as to the third factor of which I have spoken, a highly qualified medical profession: To enable one to page 5 judge of the proficiency of a profession it is necessary to look to the quality of the education the students and members of that profession receive at their own University. The Otago University provides for a five-years course for the M.B. degree, and, if we may judge by the high position taken by the graduates of the Otago University when they visit the Old Country in order to take degrees in different examining centres, it is safe to say that the standard aimed at and attained is a high one. But, in order to obtain a high standard of proficiency throughout the profession in New Zealand, it is essential that no graduates of a foreign school whose standard of education falls below our own—those, for instance, which only have a three or four-years course—should be permitted to practice the profession of medicine in New Zealand without first passing the final examination which is held every year at the Otago University. And I consider, moreover, that, although it may be seeking protection for the medical profession in New Zealand, medical men from those countries in which New Zealand graduates are debarred from practising should not be allowed to practice in New Zealand without first passing the Otago University examination.

I have briefly endeavoured to show that in New Zealand at the present time we have a strong partnership, consisting of the Government, a highly educated public, and a profession willing to do all that lies in its power to bring about such a condition of things as would conduce to a still lower death-rate and the making of an improved physical condition of the people. In order to bring about a diminution of the death-rate not only is it necessary to make a careful study of diseases in the living subject, but it is necessary also that fullest opportunities should be afforded of acquiring a more accurate knowledge of the results of disease after death.

In all large hospitals and kindred institutions for the teaching of the medical profession there are appointed pathologists whose duty it is to study and report upon the results of disease in the dead, and students are given ample opportunity of studying these same results at the hospital, but as soon as a student has taken his qualifications and leaves the hospital to page 6 start in private practice his opportunities of studying after death the effects of disease become very limited. For my own part, I believe it would be to the interests of public health if a post mortem could be made after every case, or almost every case, of fatal sickness. To allow of such a proposition being carried out it would be necessary to appoint one or more pathologists in each city, whose duty it would be to make a special study of those diseases which are affecting most largely the public health of the colony. Under such a system an individual who had the misfortune to succumb to a particular disease would be handing down to the rest of the community valuable material for an accurate knowledge of the effects of the disease of which he died—a knowledge which might and probably would have a decided effect on the earlier recognition and treatment of the disease in future generations. Moreover, this would also enable medical men to systematically gauge the importance of the symptoms which were present during life, and would be the means of forearming the profession to combat that form of disease in its earlier stages in the future. They would become familiar with the changes produced in the different organs during the course of the malady. A regular system of post-mortem examinations would also do away with the slur which is sometimes cast upon medical men that their mistakes are buried with their patients, and it certainly would lead to greater care and attention to the patient if that wore possible. To the general practitioner, often when opportunity offers and a post-mortem examination appears advisable it is impossible for him to make it owing to the risk involved of afterwards attending sick persons, more especially confinement cases. A post-mortem examination in every case would act as a deterrent to crime, and more particularly the crime of poisoning. The poisoner would know that before the body of his victim would be disposed of there would be a careful examination. An examination after death would also protect the helpless infant and young child from the sufferings: of starvation and neglect. It would also act as a deterrent against the crime of abortion.

I have said before that one of the most ennobling effects of education is to induce people to give their page 7 best energies to the State, and if we carry that argument to its logical conclusion it may be assumed that the same education will remove from them any objections to conferring such a benefit upon the community as a more accurate knowledge of the disease from which they died. It would be a part of the duty of the pathologist to certify the cause of death to the Registrar-General. By this means there would be an absolutely certain and accurate compilation of the death statistics. There would be no such class as ill-defined and non-specified causes. If, then, a person has during life exercised his educated intelligence for the benefit of the commonweal—speaking from a public-health point of view—by preserving in himself the highest standard of health that he is capable of, by preventing the spread from himself to others of any contagious disease from which he may have suffered; if by his death he has given up what knowledge the study of the disease to which he has succumbed may reveal for the sake of his fellow-creatures, then I believe he will have exercised his duty of citizenship as far as public health is concerned to its fullest extent.