NATURE 



THURSDAY, APRIL i8, 1918. 



A MINISTRY OF HEALTH. 

 CTUDENTS of public health have long- been 

 ^ aware of the fact that the application to the 

 leral community of the methods of preventing- 

 . ul curings disease is seriously incommensurate 

 with our knowledg-e of these methods. TulDcr- 

 losis we believe to be an almost, if not entirely, 

 rentable disease, yet it is still the larg-est single 

 ise of death; rickets, probably an exclusively 

 \ ironmental disorder, produces defects and 

 u lormities persisting through life in a large pro- 

 portion of the poorer classes ; infant mortality is 

 probably exactly double what it would be if we 

 rould place every infant in a healthy environment; 

 Sir George Newman has told us that a million 

 school children suffer from physical or mental 

 (k'ficiencies, which render attempts to educate them 

 almost useless, yet here also the physique and 

 I healthiness of the average public-school boy prove 

 once more that the elementary-school child is the 

 victim of pernicious surroundings. 



When we turn to curative measures we find that 

 the refinements of modern medicine, the skill of 

 the specialist, the use of instruments of pre- 

 cision, and the scientific methods of diagnosis are, 

 to a large extent, only available to the masses 

 through the hospitals, and though these institu- 

 tions are rendering services of the utmost value to 

 the nation, they are very far from being able to 

 meet the demand for their help owing to their 

 limited accommodation. 



The relative inefficiency of the public health and 

 medical services in this country has been to a 

 considerable extent concealed by the fact that since 

 the middle of last century there has been a great 

 decline in disease and a considerable fall in the 

 death-rate. This improvement followed the work 

 of Chadwick, Southwood Smith, Farr, Simon, and 

 other pioneers of modern sanitation, and synchro- 

 nised with the steady advance in the methods of 

 disposal of sewage, removal of refuse, and pro- 

 vision of pure drinking water. It is no disparage- 

 ment to these great names to say that modern 

 scientific opinion tends to attribute to natural 

 causes a larger share in the disappearance or dimi- 

 nution of diseases than a previous generation or 

 even the uninstructed public of to-day would be 

 pnepared to allow. The remarkable decline in 

 typhoid we owe almost certainly to sanitary effort, 

 but biological influences, not yet fully understood, 

 ; probably led to the disappearance of typhus, while 

 a process of natural immunisation seems to have 

 had at least as much to do with the decline of 

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tuberculosis as improvements in environment and 

 food-supply. The object of these remarks is to 

 point out that, while we should not belittle the 

 achievements of the past, there is distinct danger of 

 attributing too much to our efforts and of survey- 

 ing our labours with unmerited complacency. Cer- 

 tainly at the present day there is much in our public 

 health administration which calls for censure rather 

 than for praise. 



In these circumstances the proposal to form a 

 Ministry of Health is highly satisfactory, and if 

 Dr. Addison, Lord Rhondda, and others concerned 

 with or interested in the Bill take full advantage 

 of their opportunities they can produce a measure 

 of great social value. The important thing is to 

 see that we are not satisfied with mere names or 

 with a simple rearrangement of existing authori- 

 ties, but that the scope of public health admini- 

 stration is widened, and that we get to grips with 

 the bedrock causes of disease and with the means 

 of their prevention and cure. So far as is gene- 

 rally known at present, the main object of the Bill 

 is to unite or co-ordinate existing authorities, and 

 we have heard of prolonged negotiations as to 

 whether the Insurance Commissioners, the Local 

 Government Board, or an entirely new body is to 

 form the Ministry. Increased co-operation between 

 the central administrative authorities will be all to 

 the good, for there is no doubt that their present 

 relative isolation leads to much delay, confusion, 

 and unnecessary expense ; but we must not suppose 

 that departmental reorganisation, desirable though 

 it is, will have much effect by itself in improving 

 public health. The history of public health legis- 

 lation in this country shows that two important 

 principles should be observed if the mistakes of the 

 past are to be avoided. 



The first principle is to maintain and extend 

 I scientific research in all branches of medicine and 

 I public health. This at once raises the question of 

 what is to be the position of the Research Com- 

 mittee in regard to the new Ministry. It is not 

 yet known whether the Committee is to form part 

 of the Ministry, but it is generally understood that 

 the Bill immediately to be introduced is of com- 

 paratively limited scope and provides for the grad- 

 ual absorption of various departments as may be 

 found expedient. We would earnestly plead that 

 the Research Committee should be left either 

 entirely outside the Ministry, or, if united to it, 

 should be practically independent and uncon- 

 trolled by any administrative branch of the Minis- 

 try. Scientific research, to be of any value, must 

 be unfettered. Moreover, the Research Committee 

 must have the right to investigate the results of 

 measures taken by any branch of the Ministry and 



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