being to examine and pass into the profession men who are qualified to practise. In the halls of these colleges lectures are delivered which occasionally touch on public health, and fundamental principles concerning it are buried in the archives of these colleges or current medical journals. The General Medical Council has functions of a disciplinary nature. None of these bodies can speak to the nation with the tremendous authority on questions of public health with which the Lord Chancellor can speak on questions of law, so the fact remains that the public has never heard any pronouncement made upon its health from a medical man with the whole weight of the medical profession behind him, and therefore he and his profession are dumb creatures. The only position from which such a man could make his profession speak is that of Minister of Health in the Parliament of the day. The public would listen to him knowing full well that his words would have the weight of authority and that his opinion would be well considered.

It would be no sound argument to assert that the Lord Chancellor is a political factor as well as a Government official. There is no doubt that he is always a great political factor. I am sure it is unnecessary to point out that, great as the political claims of a Lord Chancellor are, he would never dare to interfere with the administration of justice to suit a political issue. I believe it is on account of his membership in the profession he represents that his duty to law is uninfluenced by the claims of political issues, and he would not, in any circumstances whatever, allow a political issue to interfere with his administration of law. This is such an obvious fact that I believe, if the public and the medical profession were once to realise their truth, both would at once clamour for a doctor of equal position in his profession to be of necessity Minister of Health.

Take the position of a Prime Minister, who in this matter would be only one of the public. To whom should he apply for help and advice, or how should he ascertain the opinion of the medical profession on the great questions of public health which are of ever increasing difficulty? In law he would go to the Lord Chancellor. In medicine would he go to Sir Alfred Mond or to Sir Arthur Griffith-Boscawen ? For his own sake he ought to see that he has a member of the medical profession responsible in Parliament to him, to the Government and to the public for the opinion and advice he gives. I heard Sir Alfred Mond say he found it impossible to get a united opinion of the medical profession. He seemed almost merry about this deplorable fact. He would have the same difficulty in obtaining it in law in the absence of the Lord Chancellor or the Attorney-General or Solicitor-General. The public would find a united profession behind a medical man who VOL. XCIII-No. 551

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spoke from the high and dignified position of Minister of Health. The unimportance of the post as it now stands is well illustrated by the complete apathy of the medical profession as to who should hold this appointment. It has no interest in the astute successful politicians who occupy the position. The public has the same apathy, and takes no notice of what they think or say on a medical question.

2. The Medical Profession.-In early times the medical profession considered their only function to be attendance upon the sick and all their endeavours were focused upon the treatment of the individual and his ailment. It was only during recent and contemporary history that the profession began to orientalise its functions from an additional standpoint. It now realises that the ailment of an individual may have desperately important relations to people with whom he comes in contact, the whole population of his country, and the populations of all countries outside it. Thus the profession now regards its functions as threefold (1) its effectiveness as applied to the individual ; (2) as applied to the nation; and (3) as applied to all other nations. That statement represents an obvious, true, and great conception of its functions. Further, it realises that all these functions are so correlated that one cannot be performed badly without adversely affecting, either immediately or remotely, all the other functions. In spite of having arrived at this clear perception of its duties, the medical profession, as a corporate body, remains dumb. I believe its dumbness is due to the fact that, having realised its functions, it has not realised how it can make them properly effective, and so it comes about that measures for the prevention of disease are in the hands of a layman at the head of the Ministry of Health who knows nothing about the questions on which he is consulted.

Turning to other important matters, I referred just now to Sir Alfred Mond's rather chaffing allusion to the want of unity on medical opinions. The cure for this deplorable state of things lies directly in the hands of the public and the medical profession. They should demand that a member of the medical profession, with responsible and special knowledge of his subject, should always be appointed as Minister of Health.

The great consequences that must follow neither the public nor the medical profession yet seems to see. One would be that not only would a Prime Minister desire the advice and guidance of the medical man he placed there, but also he would not dare to implant in the problems of public health any scheme that would be considered by his Minister as being directly opposed to the national welfare.

With the concurrence of his Minister of Health his plans might

fail to carry Parliament with him, but a Prime Minister would lose his Minister of Health if he attempted to carry through Parliament a plan which the Minister judged subversive to public health. The resignation of the Minister on a question of public health would be a menace he dare not face. The menace might only delay an unfortunate measure, but at least the public would have a chance of appreciating the question at issue between the profession and the Prime Minister As things are, there is nothing to stop retrogressive measures.

However estimable the intentions of a Prime Minister may be, his blind uncertain measures may ignorantly plunge the whole country in chaotic and inefficient legislation on questions of public health. The waste of money is prodigious, but what is of more importance is that public health is thrown into the cockpit of political strife, where its problems can never be helped nor improved except by lucky accident.

It is quite true that individuals occasionally find some relief while being attended by an unqualified practitioner, but there is no one to tell them how many eventually consult the qualified, efficient man after they have been hopelessly knocked about by the unqualified practitioner. I quite understand; it is almost a natural sporting idea that the public should like to go to unqualified practitioners, if it were only because they are unqualified and therefore probably objects of jealousy on the part of those who are qualified. All those ideas are natural and easily understood. I do not blame the public; if it is contented, the matter concerns it alone. As Mr. Bonar Law pointed out, every country has the Government it deserves, and in the circumstances I have mentioned the public has the unqualified practitioners it deserves. It may sound naïve on my part to say it is more important for a country to have its public health efficiently guarded by a continuity of efficient medical men than it is for a country merely to possess the Government it deserves. The country, after years of political strife, understands the wiles of political officials. It has never yet heard nor realised what great power for good can grow from advice given by the corporate opinion of the medical profession.

It will be said: 'Yes, that is all very well; but there has been a doctor as Minister of Health, and he is considered by many to have been a failure in that position.' I do not intend to enter into a discussion on an individual; I merely want to point out that a Minister of Health should deal with questions of public health, and not have foisted upon him the conduct of political affairs that have no concern with public health, or if they have, the question of his success or failure should not be visited upon him as Minister of Health. A man can be a good Minister of Health and a bad

political tub-thumper. He may be a great doctor and a bad Minister of Health; in the same way a man may be a great lawyer and a bad Lord Chancellor. The housing of the population is no more a question for the Minister of Health than the building of the Law Courts is a question for the Lord Chancellor. I can quite see that the Minister of Health should advise the Government to build more houses, and that he should be consulted as to whether the houses provided are sanitary and fit to live in; other than that function, I cannot see how the policy involved can possibly be a question for a Minister of Health. It is a great Government problem, and if any department were more involved in it than another it would surely be the Home Office.

If it were considered desirable that questions of public health should first be discussed in the Commons and that therefore it would be an advantage for the Minister of Health to control the debates from a seat in that House, it might be said then that the members of the medical profession in the House of Commons available for such a great post are very limited in number, and there may come times when the kind of man wanted for the post would have no seat. The same question has before now arisen in connection with such appointments as those of Attorney-General and Solicitor-General on the legal side of the question. What has happened has been that a certain man has been approached and told that if he is given a safe seat and returned to Parliament he will be made Solicitor-General.

The same procedure ought to apply in the medical appointment.

Should it be considered desirable that the occupant of the post should be a member of the House of Lords, the remedy is obvious.

There are other matters connected with this part of the question.

There is no incentive for the correct type of medical man for the post of Minister of Health to enter Parliament; if he be there, he is there by accident. There is no incentive at the present moment, because every man in the medical profession knows that the post is open to any man of any profession who may happen to be in Parliament and who has done fairly well by his party. All lawyers who enter Parliament know that the legal appointments are open to them by right, and to them alone, so as a rule the right lawyers for these posts are induced to become members of Parliament.

The following question may be urged against my contention Is it necessary to have a professional man to represent the opinions of his own profession in the Government when the Chancellor of the Exchequer, the Secretary of State for Foreign

Affairs, the President of the Board of Trade, the Secretary of State for War, and the First Lord of the Admiralty may be unprofessional men representing professional matters of which they know nothing until they enter these respective offices? Should any controversy arise upon this question, I shall be quite prepared to argue the matter. For the present moment I will content myself by asking why, if these professional offices are so successfully held by unprofessional men, is it considered essential to appoint a lawyer in the position of Lord Chancellor? It cannot be because the public think law is more important than health; nor is it only because in the past legal luminaries have been able in the passage of time and by the acquisition of great power to secure for themselves and their profession great worldly positions and princely emoluments. I give them the credit of possessing higher ideals than these.

There is another argument with which I may be met. It is this: Some of the greatest discoveries which have influenced medical procedure have been made by men like Pasteur, who are not members of the medical profession; and would I exclude a man like Pasteur from the position of Minister of Health? My answer to that argument would be: Yes, I would; because the permanent rule of the appointment of a medical man as Minister of Health would be for the greatest ultimate benefit to the health of the public. There is nothing to prevent a man who is not a lawyer suggesting to the legal profession an alteration of law that would benefit its administration. That would be considered, as things are at present, by the Lord Chancellor and acted upon accordingly. It would not delay epoch-making alterations of law: neither would the exclusion of a Pasteur from the office exclude from the processes of medicine epoch-making changes in the public health; on the contrary, it would probably hasten them.

One of the present evils due to the absence of a high dignified exponent of medical opinion is this: A poisonous seed which may lead to the utmost danger to public health is at the present moment germinating in the mind of the public, which scarcely realises to what extremities the growth may lead. It is the recognition of unqualified practice. The term is used in its widest sense.

There is a vast amount of unqualified practice permitted to men who possess no medical qualification at all. The danger can never be stopped so long as the public sees the control of its health in the hands of a man who is not a member of the profession he represents. It is such a menace that people are beginning to think twice before investing money and time in attaining medical qualifications when they see large practices and general appreciation meted out to men who possess no medical training or