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job has, by its nature and traditions, always been linkedup closely with the special structure of the day ; onlyin quite recent times does the doctor seem to have beenaloof from the rapidly changing pattern that has discloseditself.When I use the phrase " general social scheme " I do

not mean yet another plan ; I mean, pragmatically,things as they are at this moment in the unbroken streamof human welfare ; and of course I have in mind also the

probable continued trend of things in the future.I want to see a " close-up "-or it would be more

accurate to say a " closer-up "-between the physicianand the social services. Is the physician-and when Isay physician in this connexion I mean the familyphysician, than which I can give him no better or moresignificant title-is the physician going to continue onlyto cure or relieve disease, or is he going to make contactwith this health business that we are finding to be such avital national asset ? ‘? This rigid distinction between theG.P. and the s.H.o. (State health officer), and, alas ! theantipathy so often seen between them, are surely due toa misconception on both sides as to what the medicineman’s function really is ; he was the " health man " tothe tribe, and he should be still, and only, that, to themen and women of today.We all pay lip service to the great importance of

preventive medicine. But again and again we say " thatis the State health officer’s job," when really it is everydoctor’s job. To do the G.P. justice; he does make manycontributions to preventive medicine that are not recog-nised as such, but they should be recognised and it is thebusiness of the State to recognise them. Inevitably, ifthe G.P. does not accept the challenge of this position, andis not helped by all of us to accept it, the s.H.o. servicewill expand whilst that of the G.P. contracts and therewill then be intensified that rivalry between private andpublic medicine which we all of us surely deplore.

I want to see the physician not only make use of thepublic-health services, but show some passionate con-viction about them in his patient’s interest. Take schoolmeals as one example if the physician is only doctrinaireon the matter, and not intensely practical, Mrs. Jonesisn’t stimulated and the local education authority doesn’tget busy.

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THE BASIC NEEDS

Take the case of industry. Work is good ; work is

health-giving. But it is the doctor’s duty to protect theworker against excess fatigue, against dullness, and

against the various hazards of his job. In all thesematters Medicine has accumulated a mass of facts, butthey are very largely wasted because they are not imple-mented in terms of social service. If I embarked uponthe subject of Nutrition, and the light which our rapidlygrowing knowledge in regard to it has thrown upon food,I could, of course, give equally striking examples of theneed for the physician’s direction and execution. To saythe truth, there is very little in the life of John Citizen,whether he be in a factory, an office, or a public-utilityservice, that does not give the physician scope for thepractice of Social Medicine.Consider the basic needs of the citizen-I have long

ago stated and re-stated them :1. Sufficient of the proper food.2. Suitable shelter and clothing.3. A satisfactory job of work.4. Access to the fresh air and sun.5. Reasonable leisure and the amenities of life.

In every-one of these the doctor must stake out his claim,for in every one of them his is the knowledge that shouldguide and it is his enthusiasm that can stimulate toachievement. It is not as mere passengers that wephysicians must take our part in these affairs. We mustlead; we must guide the politicians since they cannot

act effectively without expert help, and we must keep thecitizen’s end up, since he learns to rely upon us for this.But suppose the politician won’t be guided ? Suppose

it is as S)vift wrote in a letter to Pope : " Although I haveknown many great Ministers ready enough to hear

opinions," said Swift, " yet I have hardly seen one thatwould ever descend to take Advice ; and this pedantryariseth from a maxim which they themselves do notbelieve at the same time they practice it, that there issomething profound in politicks, which men of plainhonest sense cannot arrive to." In that case the physicianhas no alternative but to appeal to public opinion, con-tinuing to serve his patient in the manner which hebelieves to be in the patient’s best interest....

THE FUTURE

If, finally, any one of you should ask me, point-blank :" Do you see hope in the future of Medicine ? " I shouldreply : " Yes-I see more hope for ourselves as doctorsand for the people who will come under our care, in thefuture of Medicine than perhaps in any other single thingin the new world towards which we are hacking our way.We at least have not-yet-forfeited the trust of peoplefor whom we work ; we at least have not-yet-turnedinwards in despair, bartering our spirit of adventure fora mere hope of security. We stand for sane knowledge,selflessness, and mercy in a world gone mad. We cannotlet these people down who trust our profession, and it isin this firm resolve that we shall face the future ofMedicine."

A MEDICAL SERVICE FOR STUDENTS

FROM OUR EDINBURGH CORRESPONDENT

FOR the past 17 years students at Edinburgh Universityhave been entitled to free medical examination at entryand at other times as they wish ; they have also beenencouraged to engage in physical education. Domiciliarytreatment, though sometimes arranged unofficially, hashitherto not been organised by the university.

Lately the service has been extended, and every newstudent is now advised to avail himself of the chance offree clinical examination and chest radiography. Duringthe present academic year 752 (about 60 %) of the malestudents have taken advantage of the scheme ; andthe proportion of women is about the same. Amongstthe men pulmonary tuberculosis was disclosed in 8, allof whom had been unaware of it.

Besides routine medical examinations, consultationsare now held three days a week for students wantingadvice ; and any student unfit to attend may obtainfree domiciliary treatment. The medical service worksin liaison with the department of students’ social service,the director of which makes a point of getting into touchwith the parents of sick students. The service has beendevised for the benefit of those whose homes are notin Edinburgh ; and local students are encouraged toseek the advice of their family doctor rather than callupon the university medical service. The RoyalInfirmary has for many years provided a separatestudents’ ward, which is still used to the full. A dentalservice, organised through the Dental Hospital, isalready in existence.

Discussions which are now being held will, it is hoped,eventually result in the establishment of a university" sick bay " or

" sick dormitory " in one of the universityhostels : and a scheme for the full care of students withtuberculosis is also being considered. The physiciansoperating the medical service hope to obtain useful dataon students’ health and on their physical and psycho-logical reactions to environmental circumstances.

" ... No-one can foresee the basic discoveries of tomorrow ;the predictable belongs to the level of applied research.At best we can merely select phenomena which we do notunderstand, confident that if we investigate them in a truescientific spirit, some useful knowledge will emerge."-Dr. JAMES CRAIGIE, F.R.S., in his presidential address to theSociety of American Bacteriologists. Bact. Rev. 1946, 10, i 3.