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This far-reaching but on the whole simple scheme of reform emerged, during the three years' investigation of the Poor Law Commission, from two streams of facts in the survey of the whole country that was made by the Commissioners. In town after town it was discovered that the old idea of the sphere of a Public Health Service-namely, that it confined itself to measures of general provision, and did not treat the individual patientmwas no longer correct. The recent developments of the Public Health Service-its 7oo municipal hospitals crowded with patients, opening their wards to one disease after another, and even adding out-patients' departments and dispensaries ; the growing staffs of " health visitors " (who are occasionally qualified medical practitioners), giving " hygienic advice"; the organization, here and there, of domiciliary nursing ; the active supervision of midwives ; the "milk clinics"; the medical inspection and treatment of school children; the official acceptance of the specifically pauperizing disease of phthisis as part of the sphere of the Public Health Authority-were rapidly encroaching on the domain of the Poor Law doctor and the Poor Law infirmary, and were bringing about a hopeless confusion of principle as to what was the public and what the personal responsibility for sickness. Secondly, it had to be admitted that these developments of the Public Health Service were not to be ascribed merely to the over-zeal of local authorities or to the muddleheadedness of Parliament, but that they were the necessary" outcome of a half-conscious realization that the principles of the Public-*Read l~efore ihe-Soci~yoi-Medical 0iiicersof Heat~, jan. I4~i9-ro~ Health Department afforded a better basis for State medicine than those of the Poor Law Medical Service. This, as the Commission fully recognized, was not the fault of the Poor Law doctor himself. What appeared to the Commis-* Report of Consultative Committee upon children below five, Cd 4,959 of I9o8, p. x~ 7. * "TEe Poor Law Commissioner and the Medical Profession." By a MedicalPractitioner, (London : A. C. Fifield, I9o9.) * Presidential Address read before the Southern Branch of tile Society of Medical Officers of Health) December 3rd, x9o9.

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