Now this is the baldest of sketches, yet does it not indicate that modern medicine is embracing not indeed the final purposes and issues but the springs and conditions of human and universal life and efficiency; yet while the central administration remains as acephalous as the peripheral parts are multifarious and incoordinate, can we wonder that ignorance, confusion, and vacillation still prevail? The medical officer of health is at the mercy of the caprices of any interested clique; his sphere is undefined, he has neither protection nor freedom. In his service there is no order of promotion, no assurance of pension. Thwarted in detail, and in no public cooperation with a consolidated service, he is apt to lose standards, to lose efficiency, and to lose heart. Without an organised State Department, Public Medicine lacks the corporate sense of a great official body like the Law, and the stability of the more coherent social groups which are favoured by natural selection. Moreover, being but human, its partial conceptions, cross purposes, and pedantries remain unmodified; its naturally strong positions are not fortified against lay criticism, and the public does not get at home with medical ideas and practices. Working behind the scenes, it loses the discipline and the chastisement, as well as the honour of public responsibility; while in the words of the President of the Royal College of Physicians of London, "the State thrusts upon us responsibilities which are not ours." Unrepresented by a Minister of its own in Parliament, by alien Ministers it is alternately used and betrayed; and in silence must submit to hear its motives misinterpreted, its methods mishandled, and its unrequited labours continually imposed upon.
To one more factor of medical organisation I can but allude, although it lies at the root—I allude to the making of knowledge, knowledge of all national stores the most precious, in spite of the overlords of society who, as I have said, are still clinging to a belief in the efficacy of ignorance and delay. Grave towards us as are the faults of the LocalBoard, we must gladly admit that in this department some research is fostered. It is clear that there must be administrative laboratories, and that without the atmosphere of disinterested
- The Lancet, Oct. 5th, 1907, p. 945.