research the best laboratory must flag; still it is open to inquiry how far the State shall make knowledge for itself and how far it shall derive it from universities and other scientific bodies. But when, for science or for art, money is wanted we discover that we are the poorest nation in the civilised world.
What are we to propose, then, in reform of the services of public medicine? I understand that in high quarters the desire is to begin with the chaotic and inefficient periphery, in the hope that, secondarily, evolution may reach, recreate, and coördinate the sub-centres and the main centres. It is urged also that each department must have its medical bureau for its own continuous guidance and instruction. Again, there is the conventional dread of medicine as of all irresistible knowledge; and a proneness to the sinister device of "Divide et impera." Besides the English public has a wholesome dislike to the multiplication of officials; but by organisation the number of officials at any moment would be diminished rather than multiplied. It is true that each department would still need its own standing medical counsel, as it now has its standing legal counsel; but how far more valuable would such a counsellor be when speaking from the consolidated opinion of a corporate and disciplined public medical Ministry, or at any rate of a powerful parliamentary and official body such as the Law, than as an isolated medical expert expressing no more than private and individual opinions. The need of reform in the separate peripheral areas is urgent, it is true; nay, Dr. Bushnell is correct in attributing to me an "apprehension of harm in excessive or premature centralisation, lest the central machinery be too powerful for the peripheral equipment"; but, on the other hand, without parallel development, coördination, and distinction of central powers, how are local authorities and local medical officers, in all the far-reaching and various departments of national function now being intrusted to them, to derive their instructions and judgment, to command attention, to be furnished with knowledge, to be inspired with earnestness and devotion to duty, and to be supported by an instructed public in their legitimate functions.
- Brit. Med. Jour., August 24th, 1908.