Discussion.

Dr. Caughey instanced the work done by Dr. Ryle, the first Professor of Social Medicine at Cambridge, and the use of the social investigator in diagnosis of medical ills. On discussing a medical case, Professor Ryle had not only the clinical reports to go on, but the report from the social worker regarding family, work, and other environmental conditions which might have a bearing on the causation of the illness, and on which the treatment of the case might depend. Dr. Caughey considered this was a very considerable advance in medical practice, since at present so much medical treatment was carried out without adequate regard being paid to the environmental social factors which had a hand in the causation of the disease being treated. He stressed the need for more social workers, and the need for the inclusion of such social workers in the medical team, if satisfactory medical treatment were to be given. Moreover, this applied not only to the case, but to the family as a whole. He stated that at the Auckland Hospital they had one such social worker available to report on home conditions of cases, but although this was a stait, it was in need of great expansion. He also mentioned the work at Brompton Hospital on the ambulant treatment of the early symptomless case of tuberculosis, which had been shown to be of extreme value. This also contradicted the often-heard statement that by intensifying the search for tuberculosis a greatly increased need for hospital beds would be shown, since many of the early cases found by mass X-ray could be treated satisfactorily without occupying beds in either hospital or sanatorium. Early cases found in this way were given artificial pneumothorax treatment and sent back to work in four weeks, to be kept under observation as ambulant cases, but without the tremendous social dislocation caused by prolonged hospitalisation. The clinical results had also been found excellent.

Dr. Hubert Smith asked Dr. Turbott his views as to how the trends outlined by him could be brought to fruition in New Zealand. Dr. Turbott replied that it would be necessary for the general practitioner to take up the preventive aspects of medicine and join this with the curative side, which was all exclusive at present. He envisaged health centres giving a complete coverage of preventive and curative medicine, where the whole family was taken as a unit. The health centre would work in conjunction with specialists and hospital services to ensure a complete medical service, and prevention of illness and the building of positive health would become the major portion of medical work.