very general terms. 
Wal ORF 
THURSDAY, JUNE 22, 1871 


STATE MEDICINE 
eons the duties which the State owes to Science, 
none are of more practical and vital importance, 
and none are more urgent, than those which concern the 
care exercised, or that should be exercised, over the public 
health by properly appointed State Medical Officers. 
The essays of Dr. H. W. Ramsay have so fully ex- 
plained the term “ State Medicine” that we do not feel it 
necessary here to do more than allude to the subject in 
It will readily be acknowledged that 
some sort of a medical polity is a necessity for a State ; 
but while in this country certain laws and regulations 
exist for the improvement of the public health, still there 
has been but little or no effort made to establish these 
-laws on a scientific basis. 
In the recently issued Second Report of the Royal 
Sanitary Commission, the truerelations of the State towards 
the public in these matters are thus admirably enforced :— 
“Every person should be entitled to such reasonable 
public protection in respect of his health as he is in 
respect of his liberty and his property. For instance, he 
should no more be liable to have the water of his well 
poisoned by the neglect of his neighbour, than to be 
robbed with impunity. And he should be under this 
protection, as far as it is reasonably attainable, every- 
where and at alltimes. The first principle, therefore, of 
sanitary administration is, that no member of the com- 
munity shall wilfully or for profit damage another man’s 
supply of the three absolute essentials of life, food, water, 
and air ; and therefore that it is the duty of the State to 
secure, as far as possible, that these essentials shall be 
supplied in sufficient quantity and the greatest attainable 
purity in all circumstances in which these objects cannot 
be attained by individual care and resources. In this 
‘point of view it may appear a question whether the State 
should allow that any man, even by prescription, shall 
be held to have acquired the right to pollute, for his 
own advantage, another man’s food, water, or air, or in 
any manner poison him. At any rate care should be 
taken that no one shall acquire such right in future.” 
The second requirement is laid down with equal clear- 
ness, viz. :—‘‘ Universality, through constant supervision 
by public health officers in every part of the country. 
The efficiency of the agents in sanitary administration is 
as important as their ubiquity. They must be well in- 
structed and capable, without the pedantry or officious- 
ness of sciolists. Ignorance, pretentiousness, or over- 
meddling on the part of the agents, would bring into dis- 
repute any sanitary system. In a free country disrepute 
would bring about failure. Fitness in the agents is the 
third requisite in sanitary legislation.” 
When, however, the Commission comes to apply these 
principles to the existing state of things, the only prac- 
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tical suggestion offered is that the supervision of the public 
health be entrusted to the Poor Law Medical Officers, of 
whom there are in England alone about 4,000, The 
Commissioners have evidently a suspicion that this sug- 
gestion will not be favourably received by the country. 
And we have no hesitation in saying that it is miserably 
VOL, Iv, 


inadequate. When we look at the value of the examina- 
tions to which alone medical students are compelled to 
submit themselves before they obtain a license to practise, 
or when we look (must we say it ?) at the life of the average 
medical student attached to any of our great hospitals, no 
two conclusions are possible on this subject. It is no- 
torious that, as a rule, it is not the most competent of the 
London students who ultimately arrive at the position of 
general practitioner in a country village ; and the Poor 
Law authorities, however discriminative their choice, can 
only select from the material to their hand. To effect 
the objects arrived at by the Sanitary Commission, a far 
more highly educated class of men is required. 
That medical men should be educated in a knowledge 
of State medicine will probably not be denied, and 
that the State for its own good should encourage such 
knowledge will probably also be granted; but it is not 
easy to persuade a State to adopt even approved of prin- 
ciples, if these principles require a wholly new machinery 
for the effectual carrying of them into practice. The 
Universities are, however, engaged in the work of educa- 
tion, and upon them, we think, devolves the duty not only 
of keeping up the standard of education, but of endea- 
vouring to push this standard ever a little advance of the 
day. 
The training necessary for the medical profession is 
very different from that required to qualify one to be an 
authority on State medicine ; it most certainly assists in 
this qualification, but a man might be a most excellent 
surgeon or a most skilled physician, and yet not be able 
to pronounce an opinion on many of those subjects on 
which his advice would be required by the State. 
In a medical school belonging toa college which holds 
out considerable rewards to those students who distinguish 
themselves as classical or science scholars, there is always 
a probability that some of the students in medicine will 
have also been distinguished students in arts. Experi- 
ence has proved that this is the case in Trinity College, 
Dublin ; and experience has proved the incalculable ad- 
vantage of a high training in art-subjects to the future 
medical man. What better combination of knowledge, 
indeed, could there be to form a model officer of State 
medicine than that of a thorough knowledge of science 
(using the term as it is generally understood at the Uni- 
versities) and of an equally thorough knowledge of medi- 
cine? Weare glad, therefore, to find that, acting on the 
suggestion of Dr. Stokes, their Regius professor of physics, 
the University of Dublin has determined to hold a yearly 
examination for a diploma on State medicine, the first 
of which was held on the 12th inst. This examination 
was open to all doctors of medicine of the Universities of 
Oxford, Cambridge, and Dublin. 
The course is a long but a highly interesting one. It 
resolves itself into the following among other subjects :— 
1. Law: The legislation relative to sanitary measures, to 
the conduct and duties of medical men, to vaccination, 
inoculation, lunatic asylums, &c. 2. Engineering : This 
chiefly in connection with the construction of hospitals, bar- 
racks, troop ships, prisons, and the sewerage and waterworks 
of cities. 3. Vital and Sanitary Statistics, including the 
science of statistics as applied to man, and the practical 
application of statistics to medicine. 4. Meteorology, 
including a knowledge of climates, &c. In addition the 
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