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£Airsporing national prenses bly add one mone to the La A falures, no matter how well it may be Grafod or how ewerly administered. The establishment A a ceperiment for reserch in public health should be the means of widdy extending knowledge, and should prevent father uno und legislation which is certain to end in disappointment,

To antiopate likely criticisms, it is desirable to particularise more fully the type of research which it is proposed should be undertaken by the department. Speaking broadly, there are

two lines of research in medical and public health science. One of these is by observations at the bedside and by experiments in the laboratory; the other is by the collection and study of large masses of statistics. The first type of research is generally directed towards discovering the immediate pathological cause of a single disease or symptom, or the effects of a particular line of treatment, and is often best performed by a single independent observer or group of co-workers. The Research Committee, the Universities, various learned societies and other organisations are already doing much valuable work of this kind, or are disbursing grants for the purpose, and nothing is to be gained by interfering with this work, or placing it in any way under the control of a government office.

The second form of research can only be carried out adequately by a central department, which has power to prescribe returns from local authorities and to determine the form in which statistics must be compiled. It is the type of research most seriously deficient in this country. At the present time ten or a dozen annual reports are issued by government offices dealing with various branches of public health, and scarcely any two of them, even when issued by the same office, agree in their scientific nomenclature, or in the period of time covered by the return, or in the geographical unit, or in the age periods into which the classes of persons are divided. The result is that often they cannot be used together, and their value both individually and collectively is seriously diminished. To give but one instance: deaths from infectious diseases are tabulated in one volume, the annual report of the RegistrarGeneral; cases of infectious disease in another report, issued by the Local Government Board, and if we wish to use the two reports together in order to determine the case mortality in any district, we cannot do so for a large number of areas, because the geographical units do not coincide.

The most complete and reliable statistical work in public health at present conducted in this country is that carried out by the Registrar-General for births, deaths, and marriages for England and Wales. The report on the distribution and causes of death issued annually by his office is probably the best of the kind published in any country, and it provides the foundation of a large part of the statistical work issued by

No other forement department has qui a čaum to undertake these tunes is the ce ne legsar-GamĀ. The Research Committes sont III Sut I must. and has 10 power to prescribe remser user u Hiomay cas essenta ar melni UCSCES The Insurance Commissioners a start sma ime conten for the interests of public health among the many hundreds of car, rien, and other deuments winch ney have sued, there has not been me being frectly with the causes and prevention of sciness. The record of the Local Government Boards almost as scorraging. The Poor Law branch of this vice, with the conia can everase over the Pox Law Itimanes throghout the century, might have supplied us with statistics relating to sickness and ¿sease which would have been of much assistance when the Insurance Act was under consideration, and would probably have prevented some of the worst mistakes in that measure. But except for a brief return of births in infirmaries, it issues no medical or scientific report. An argument against making any of these departments a critical investigating authority arises from the fact that they are responsible for

ministration, and often for the initiation and success,

of the measures about which they report. The result is that few of the government Blue books are unbiased: nearly all of them exhibit a tendency to gloss over deficiencies for which the department might be held responsible, and to exaggerate the value of their work in improving public health. The Registrar-General is the only authority who does not risk condemnation of his own department by adverse criticism, and his cold hard facts alone give us an accurate picture of the real state of public health.

The scheme outlined above for the functions of a Ministry of Health differs from that generally proposed, which provides for uniting all the public health activities of the various government departments; either under an enlarged Local Government Board or the Insurance Commission, or in a new department altogether. But it is doubtful whether this would result in the improvement of administration which is claimed for it. Probably the ministry would fall into a number of separate branches, among which there would be as much friction and lack of co-ordination as there is among the present government departments, though it would be less obvious to the public eye. We have an example of such a development in the Local Government Board, which was formed in 1871 to take over the medical staffs and duties of the old Poor Law Board, the General Register Office, and most of the medical duties of the Privy Council. This union proved to be little more than one in name, for the Poor Law and Public Health branches of the Local Government Board have always remained separate and distinct, and the Registrar-General seems to have no other relation to the board than the fact that he addresses his annual report to its president. Incoordination among the government offices is worst in the matter of statistics, and if these were unified by transference to a single department, as proposed above, the most serious element of discord would be removed; and if, as will be suggested later, the powers of local authorities be increased, the Local Government Board, Home Office, Insurance Commission, and other authorities might be left to discharge their remaining duties undisturbed. In any case we must have separate staffs dealing with matters so distinct as: health of school children, conditions in factories, water supply etc., and the mere bringing of these separate staffs under one roof

would at the best be no more than a simplification and economy in internal administration.

We will now examine the question of local administration in public health, which presents very different problems. Here we can find strong reasons for advocating fusion of the different services engaged in preventive and curative measures. We are dealing now with the actual problem, i.e. the persons who require medical treatment, and it is no longer a question whether a number of clerks and officials who issue regulations shall be housed under one roof or several, but whether a number of sick people living in the same district and more or less subject to the same conditions shall be divided up into distinct classes, such as paupers, insured persons, school children, factory operatives etc., and their medical needs provided for by different systems and institutions, with the result that there is wasteful overlapping in some directions and big gaps in others. At the present time the following local bodies are engaged in some form or other of public health work. The Local Sanitary Authority in county boroughs is responsible for general sanitation, and has duties in connexion with infectious diseases, tuberculosis, venereal disease, infant mortality etc., which are carried out by the medical officer of health assisted by a staff of inspectors and health visitors. In urban and rural districts these functions are divided between the District Council and the County Council. The Boards of Guardians maintain infirmaries for sick paupers; provide outdoor medical relief through a staff of poor law medical officers; and undertake public vaccination. The Insurance Committee administers medical benefit under the Insurance Act, but must consult or act in conjunction with a number of other bodies, such as the Local Medical Committee, the Panel Committee, and the Pharmaceutical Committee. Sanatorium benefit is administered by a combination of the Insurance Committee and Local Sanitary Authority, which has led to endless confusion and delay. The Local Education Authority provides for the medical inspection, and to some extent for the treatment of school children, and has duties in connexion with schools for mothers. Besides these statutory authorities, there are numerous non-official bodies engaged locally in important public health work, such as the voluntary hospitals, pro