tion of the body corporate; and, in our dependencies, malaria, cholera and plague must be added.

It is hoped that these figures will set men thinking. The art of citizen-making is far from advanced if this is the result of our training and equipment. Fitness in health, brain and moral force, which mean sound health, intelligence and will power are not obtained under such conditions, and the time is come for its realization and the attention of us all. The practical application of the stores of medical and scientific knowledge is the remedy which must be entrusted to a Medical Minister, with the full consent and approbation of the nation, and perhaps by his personal intercourse and communication a new era of health will be entered upon. He would have to contend, not merely with the forces of disease, but with those of apathy and ignorance.

VITAL STATISTICS.

Those skilled in vital statistics claim that one-third of the deaths annually registered are dependent on causes which proper administration of sanitary measures could remove.

FICTITIOUS ARGUMENTS AGAINST THE APPOINTMENT OF A MINISTER.

There are objections that arise, more especially in that constitution of mind known as conservative, that dislikes any alteration of existing affairs, to the appointment. The world to them must stop still in its course. It is said that the appointment of another Minister would lesson the individual weight of those that exist. The Public Health Department is, in many countries a subordinate portion of another one, and no loss of prestige to its overworked head could ensue from the withdrawal of such specialized duties as those of the care of the public health. The onerous duties of local government, of agriculture, etc., afford ample scope and to spare to one man, however wise and capable. No loss of status would ensue, nor is it possible for one man, however brilliantly endowed, to undertake the superintendence and charge of the health of millions, and yet have time or strength for the performance of other exhaustive duties. I do not think the argument holds good, that prestige would be lost.

Again, it is said that the effective discharge of public health regulations must eventually devolve on local authorities. The truth of this I allow at once, but it does not weaken the plea for a Minister. In the future local gover.iment will grow, in sani

tary and other matters, it is sincerely hoped. Over-centralization is justly to be condemned, and the central authority that would attempt to interpose and enforce unduly even the wisest of rules on the community would not be tolerated. But no greater spur or incentive to the proper sanitary progress of local authorities could be devised; nothing could be better calculated to promote the best interests of all departments than a trained chief with adequate powers. It is true that the fulfilment of our expectations would depend partly on the personality of the Minister, but in the long run our hopes would be realized.

In the recent debate on the appointment of a Minister of Commerce in the House of Commons at Westminster it was brought forward as opposing arguments that we have four times as many Ministers as other countries, that our Cabinet is three times as large as any other Cabinet, and that our number of paid Ministers was about five times as numerous as the paid Ministers of other people. I am unable to criticize the accuracy of all these statements, but I cannot accept them as proving generally the inadvisability of further appointments. Seriously speaking, that such a number of Ministers has been found requisite and necessary in the order of things is to my mind an argument in favor of the appointment I advocate. If the appointment of a Minister of Commerce is described as of vital importance, the functions of a Minister of Health, on whom life may be said to depend, are yet more truly of vital importance.

Again, I am asked if existing arrangements are really insufficient? To this I would answer by another question, "Are the infectious and preventable diseases, the filth diseases, the industrial diseases, the infant mortality, etc., diminishing universally and in proportion to our knowledge of the potentiality for decrease? Are investigations as to the causes and prevention of lunacy and cancer being duly promoted by state means? the annual reports clearly set forth to the country the need for further measures of personal inquiry and direct medical supervision?" In fact, are state arrangements commensurate with the proper share of the efforts which should be made to prevent wastage" of life? The success of nations or individuals is a hollow one, if the penalty is exacted in disease of body and mind, with the poverty, misery and suffering entailed in it.

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Then the objection is raised that such an official would entail increased taxation; and perhaps, on the surface, the matter of cost may appear of some, even of great, antagonistic weight.

The yearly expenditure of English departments is certainly

large, judging from the published figures. In 1902-03, the administrative expenses of the Local Government Board were estimated at £220,323, of the Home Office £152,356, of the General Register Office £54,524, of the Privy Council Office at £23.390, and a grant of £15,300 was made to the Meteorological Office; or nearly half a million yearly; and this is only a portion of the Civil Service Estimates.

Such disbursement has grown naturally in the evolution of state affairs, and has long ago been recognized as wise. It cannot be denied, even closely studying economy by the redistribution of the duties of the departments, with due regard to their best interests, that the creation of such an official and staff would entail considerable further expenditure of public money. A Minister of Public Health would receive a salary of three to five thousand a year, and from a business point of view would deserve and earn it well, and the necessary and adequate expansion of his staff would undoubtedly call for many thousands more. must be remembered, however, that such a Ministry would consist largely of already existing officers, who would be now attached to the Health Department. One cannot but be impressed with the annual payment of a grant of £15.300 to the Meteorological Office, and one feels that a country which can afford this can pay also for an improved health service.

The Imperial Vaccination League made the remarkable statement that in London, in the recent epidemic of smallpox, the cost of attempting to isolate the sufferers had been £500,000. Indeed, we may legitimately claim that this half-million of money might never have been expended with a Minister at the head of affairs with proper powers, and in any case it would have been far better utilized in the support of an enlarged Department of Preventive Medicine.

Many years ago Dr. Farr calculated that the average value for all ages of a life was £150. The sum of £150 is too low an estimate of the value of each person restored to working. capacity from disablement or death from phthisis. In England deaths from phthisis amount to 60,000 per annum. Lower this mortality by one per cent. per annum only, as a minimum result of increased efficiency, and £90,000, or the cost of your department, is paid for by one small economic gain from the diminution of a single disease. But are not pounds, shillings and pence after all a fictitious estimate of an improved national or even individual standard of health.

To my medical confrères it is unnecessary to dilate further on the sum total of benefaction that might ensue from State (in addition to voluntary) measures directed systematically and ceaselessly against alcoholism, lunacy, syphilis, tuberculosis, infant mortality and other visitations, or by assisting the scientific research of cancer and other diseases from State as well as private resources.

Lastly, it has been said that nothing has been brought forward to prove that it is desirable to detach sanitary administration from other departments of local government.

It must not be concluded that because a separate central Office of Health is established, that local sanitary administration would therefore be disconnected from other local work. It is to be remarked that a Sanitary Authority has nevertheless a complete title and existence, such as are not to be found apparently in the central Sanitary Authority of the Empire; that, speaking in a relative sense only, urban and rural sanitary authorities possess more marked identity than the State Medical Department.

The Appointment of a British Minister of Education has been coincident with the handing over of local administration. of education to the local governing bodies; at a time, therefore, when correlation was taking the place of previous separation. No jot of evidence can be brought forward from this undoubted advance in education to prove that there should not be such a Minister, and that the appointment was not entirely for the best.

It may be fairly be claimed that the real effect of the appointment of a Minister on local sanitary authorities would be to add weight to the recommendations of these bodies if in accordance with sanitary requirements, and would render them more generally effective; the Minister would initiate and promote their sanitary progress, if necessary; would lend assistance to those in need of help; would stimulate those who were apathetic or indifferent to the public duties which they had assumed and the legislative trusts they were responsible for: would remove such shackles as unduly bound them; and would be compelling to those who wilfully neglect their duty. The central authority would not needlessly interfere with local matters in any way; for in our system of local government the principle is assumed that what ought to be done for local interests should be done by local bodies, with certain limitations. But it is not to be assumed that local authority extends to the omission of advantages gained by science and civilization-which may

mean an attack by default on the health and even life of the governed, for there are sins of omission as well as commission. Each local sanitary authority has for its legal existence to lessen to its utmost the incidence of disease within its district, and, where preventable disease is not prevented, it would be the bounden duty of the central authority to intervene. Happily, there is always a beacon in view to guide the Government bark between the rocks of interference and neglect, and it is "the medical requirements of the public health."

The Minister would at once be the friend of all, the teacher of sanitary law, and director of the public health administration. Here I would submit to you a recognition of the enormous value of the work done by voluntary efforts. In England it has been said, with a large amount of justice, that every great sanitary improvement has been initiated by voluntary or local action. Such a truth is very suggestive and its significance worthy of consideration. If it were not for these associations and individuals in my country, movements for the better housing of the working classes, the prevention of tuberculosis, smallpox, alcoholism, or cancer research might not as yet have been initiated.

It is now my duty to place briefly before you the existing basis in England on which a Ministry of Health would be properly laid and an outline of its functions. It would undoubtedly be the Medical Department of the Local Government Board, which consists of a medical officer, two assistants and some thirteen medical inspectors, of whose talents and labors no praise is too high.

THE LOCAL GOVERNMENT BOARD AND ITS ORIGIN.

The Board was established in 1871 to concentrate in one department of the Government the supervision of the laws relating to public health and the relief or the poor and local government. It consists of a President appointed by the Crown, of the Lord President of the Privy Council, the principal Secretaries of State, the Lord Privy Seal, and the Chancellor of the Exchequer. The latter are all ar-officio. The President sits in Parliament and is a member of the Cabinet as a rule, and receives a salary of £2,000 a year. The work is carried out in reality by the President and permanent staff of Secretary and four assistant secretaries, and inspectors, general, engineering and medical. A brief history of the origin of the Board is interesting in the light of its present development.

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