122 



NATURE 



[April 



1918 



to indicate where these measures have failed to 

 achieve their object. At the present time there is 

 more than a tendency in many of the reports issued 

 by Government departments responsible for public 

 health administration to give an unduly favourable 

 picture of the results of their work. 



Another function of the research department 

 of the Ministry should be to examine criti- 

 cally all proposed public health legislation. 

 Too often have purely popular views of the 

 causation and prevention of disease formed 

 the basis of public health Acts, and often these 

 views have had little scientific foundation, with the 

 result that much time has been wasted and money 

 uselessly spent. It is too much to hope that the 

 Minister of Public Health will always be a member 

 of the medical profession, but at least we may 

 hope that the political Minister will be assisted by 

 a professional director at the head of the admini- 

 stration, with an expert committee of the highest 

 standing, and that future public health Bills will 

 be presented to Parliament only after they have 

 been thoroughly examined and criticised by this 

 committee. Thus only shall we avoid repeating the 

 failures which have been so conspicuous in recent 

 public health legislation. 



The second principle is concerned with the rela- 

 tion of the Ministry to local public health authori- 

 ties. Here we may be anticipating, for no hint has 

 yet been given that the local authorities are to be 

 touched by the Bill. Yet the limitation of reform to 

 the central authorities (if it is to be so) must be 

 quite temporary, for without reorganisation of the 

 local bodies which are administering public health 

 measures the value of the Bill will be very small. 

 It is, indeed, arguable that the start should have 

 been made with the local authorities, leaving the re- 

 organisation of the central departments for later 

 consideration. A complete and really effective 

 scheme, however, demands the co-ordination of 

 the local sanitary authority, the insurance com- 

 mittee, the board of guardians, the pensions com- 

 mittee, and other authorities which are engaged in 

 some form or other with public health and medical 

 services. At present the overlapping and indepen- 

 dent working of these bodies is productive <A more 

 confusion and delay and constitutes a greater evil 

 than the lack of co-ordination among the central 

 authorities. Probably the best plan would be to 

 replace or unite all these bodies in one local au- 

 thority, which in county boroughs would be the 

 borough council, and in counties the coanty coun- 

 cil, exercising some of its powers through the 

 urban and rural district councils. The creation of 

 entirely new local public health authorities has also 

 been advocated. 



NO. 2529, VOL. lOl] 



Closely associated with this question is the 

 proper division of power between the central and 

 local authorities. Here, as in so many other 

 social activities, two schools of opinion exist : one 

 which advocates increased central control, mainly 

 for the reason that it considers local control un- 

 satisfactory and desires to subject the authorities 

 tt) a process of "gingering up "; while the other 

 is in favour of a large measure of decentralisation 

 which would give local authorities increased powers 

 at the expense of the central departments. The 

 holding of the balance fairly between these views 

 demands nice judgment, but in our opinion a great 

 deal is to be said for decentralisation. In the 

 first place, the larger local authorities, as, for 

 instance, the councils of the great towns, now 

 display a sense of responsibility for their duties 

 and a keenness in providing healthy conditions 

 within their area which fully justify confidence 

 being placed in them. Indeed, the complaint is 

 often heard that the obligation local authorities 

 may be under to submit their proposals to a central 

 body for approval is a serious cause of delay and 

 inefficiency. Secondly, the local incidence of dis- 

 ease and the causes of disease vary so widely from 

 place to place that a large element of elasticity in 

 the preventive measures is necessary if appropriate 

 remedial steps are to be taken. Centralisation of 

 authority tends towards an undesirable uniformity 

 over the whole country. If, on the other hand, 

 local authorities can act on their own initiative they 

 are in a position to establish just those systems of 

 prevention and forms of treatment which the local 

 circumstances demand. 



The proposal tO' form a Ministry of Health was 

 first made many years ago, but it has required the 

 stimulus of a great war to bring it into being. The 

 difficulties before the Ministry — at any time great 

 — are now all the greater in the circumstances in 

 which it begins its task. The supreme fact is that 

 the introduction of this Bill definitely marks the 

 assumption of responsibility by Government for the 

 health of the people, and as such it will be wel- 

 comed by all who have the nation's well-being at 

 heart. 



ALCOHOL, ITS USE AND ABUSE. 

 Alcohol: Its Action on the Human Organism: 

 Pp. xii+ 133 + Appendix and Index x. (London : 

 H.M.S.O.,\9i8.) Price 25. 6d. net. 



THE form of this little volume is a welcome 

 innovation in Government reports, attract- 

 ing, instead of repelling, the reader. Its object 

 is to present the conclusions arrived at by a com- 

 mittee of the Liquor Control Board after a cold 

 and dispassionate examination of the effects of 

 alcohol. No statements are made without exact 



