DR. F. E. FREMANTLE'S PAPER 53 



and County Borough Councils and Insurance Com- 

 mittees. By thus enabling the County Authority to 

 combine its contributions for nursing in connection with 

 schools, tuberculosis and infancy with the private pro- 

 vision for sick nursing and midwifery, the State should 

 before long have provided a complete home-nursing 

 service for the country, with provision for its gradual 

 improvement in training and efficiency. 



Medical attendance must also be provided as soon 

 as possible for the children of all insured persons. 

 For this purpose the machinery of the Insurance Act 

 is already available ; but the time is surely come to 

 advocate an advance also in institutional treatment. 

 The Poor Law infirmaries, with their considerable field 

 of medical and surgical practice, should be removed 

 from the pauper system and made the nucleus of a 

 single municipal hospital to be compulsorily provided 

 for every medical and surgical purpose sanatorium 

 and fever hospital excepted in every town. Here 

 could be concentrated with great advantage to finance 

 and efficiency the school clinics, the tuberculosis dis- 

 pensaries and the babies' welcomes, with quarters for 

 the district nursing staff and with private rooms for 

 surgical operations or private patients. The municipal 

 hospital, with its laboratory, library and committee 

 rooms, would form a professional centre for the doctors 

 and nurses of the whole district. But for this purpose 

 it must be in the hands of an authority large enough 

 to ensure a satisfactory service for the medical and 

 nursing staff. What shall this authority be ? 



Consolidation of the Public Health Service. It is 

 now time for the State to gather together the various 

 agencies concerned with public health administration 

 into one systematic army, with due regard to the 

 value of local initiative and responsibility. The 

 central department cannot properly undertake the 

 detailed supervision of the thousands of local bodies 

 concerned, any more than a commander- in-chief can 



