132 DR. ARTHUR RANSOME ON THE 



I should be very unwilling to defend the present chaotic, 

 inefficient, and extravagant method of carrying on public- 

 health government. Under it the local medical officers have 

 no security of office ; many are appointed over petty areas 

 upon paltry salaries, the aggregate of which would produce 

 a good income for well-trained men. Most of them have 

 had no special training ; and none of them have any means 

 of proving their capacity by a state quahfication. They 

 have no well organized system for obtaining immediate 

 information of the outbreak of disease ; and, from the want 

 of proper instruction and central assistance, they are driven 

 to make experiments in sanitation which, by their failure 

 or by their cost, raise a formidable local opposition to all 

 their efforts. 



It will be seen then that I entirely agree with Mr. Bax- 

 endell in thinking that " the present sanitary system is 

 very defective ;" but it by no means follows that it has 

 done no good. 



In auditing carefully the several items of a profit-and- 

 loss account, there may well be found an equipoise between 

 the two sides of the account, or even a loss on the whole, 

 and yet it may be possible to see that, unless certain ad- 

 verse circumstances had occurred, such as a rise in ^\'ages, 

 increased price of raw material, &c., the result would have 

 been a decided gain. 



The general death-toll of a country is in truth under the 

 influence of many most various conditions. It is only 

 possible to discover the full effect of sanitary measures 

 when all these conditions are taken into account. 



It would be a weak form of defence for these measures 

 if we were to say that if they had not been taken " things 

 might have been worse;" for they might, perhaps, even 

 have been better. But the argument changes its character 

 altogether if it can be shown that the death-rate certainly 



