Remarks on State Medicine in Great Britain
Authors: H. W. Rumsey
Journal: BMJ (1867)

NOT many years ago, State NIedicine in England was treated, even by I wvell informed persons, as a mere idea, a speculative theory, or, at best, a German innovation.Any formal view of the subject was liable to be met by taunt and ridicule.Able critics told us that "wwe might as well have a state astronomy or a state chemistry.As those sciences live by their own wits, why (said they) should not medicine ?"It is scarcely necessary for me to reply to objections which had more of sound than sense in them, and which have been virtually set aside by the progress of public and medical opinion.At that time, State Medicine was a novelty in England.Its objects were not understood.Even the very meaning of the word was dark.The fact was barely recognised, if not wholly ignored, that there already existed afragwentary sort of State Medicine ln the country; that is to say, medical practitioners were frequently employed by Government, or by commissioners, or by local authorities, or in courts of lav, for public duties of some kind or other-employed indeed without methodl or rule, .andtherefore not only inefficiently but expensively.Yet these ill-contrived and irregular arrangements have called into action another class of oh.jectors members of our own profession among them-stout defenders of vested interests and established tusaes, raising the old conservative cry, " Great is Diana of the Ephesians.Now, in the face of this active and passive opposition, certain great questions involved in the public action of the profession-chiefly in its preventive and legal departments-have advanced so rapidly; the de- mand for the aid of physicians and surgeons in various departments of civil and legal duty has so greatly increased-theforce of circumstances, in fact, hasS beens so irresistible-that the public, as well as. the Govern- mnent and the medical profession itself, are now compelled to inquire into the principles and the methods on which this growing department of medicine is to be most effectively worked for the benefit and safety of society.And thus it is that, following the lead so admirably taken by Dr. Symonds in I865, I have the honour, by invitation, to treat this day concerning its further development andi better organisation.The proximate cause of my being named for an undertaking which should have fallen into more competent hands, I suppose to have been a request which was made to me some months past by our able and energetic associate, Mir.Arthur Ransome; viz., that I would propose a resolution, at this meeting, in support of certain improvements recom- mended by Dr. Farr (Registrar.General's 27th Annual Report), with the object, in the first place, of verifying the fact of death, identifying the person of the deceased, and, as accurately as possible, investigrating and recording the cause of death.The principal feature of the plan, however, was the appointment of a specially qualified Regitration Mlledicalr 9icer in every registration dis- trict of the kingdom, who would perform certain duties, without superseding either the certificate of the medical attendant of the deceased or legal inquiry by the coroner.Dr. Farr's important suggestion forms the primary and most charac.teristic feature of a larger project which had been published at least ten years before.Then, as now, this measure was proposed as the basis of an organisation, not only for the public registration of all sickness at- tended at the public expense andl in public institutions (which is the ob- ject of Mr. Ransome's Committee), but also, and mainly, to secure a more accurate and trustworthy determination of the causes of death, a more satisfactory performance of medico-legal investigations, a supply of more reliable medical evidence in coroners inquests and courts of law, and to provide generally for scientific advice and aid to local authorities in matters of public health.These objeets arecomprehended in, and con- stitute the main elemtents of, what wue call State AMedicime.Historically and practically, most of these duties arise out of public arrangements for the medical relief of the poor.It was in this department of public medicine, and in the hospitals and dispcnsaries of the kingdom, that medical men became acquainted with the extent and depth of the physical misery and degradation of our common humanity.Here was learnt, here is to be learnt, the condition of the masses-of m Read at the Annual Meeting of the Association in Dublin, August 1867.the living and dying, the healthy and (liseased.Here are trined the men who might afterwards become the most useful Physicians of the State, the 'AaxloAr.soawo'ruost of Plato-"ao&s wACWTous pv 6riwo6s, rAeievous 8& ~o68.,ottrXs&pia1eGo."And thus it is that, from the Stygian realms of destitution and dissoluteness and disease, uprises the corrective agency, empowered to vindicate the primal laws of public order andl public health.In no country, I may here observe, does this elevation of object, this transition from the merely palliative to the really preventive, appear to be so easy of execution and so promising of success as in Ireland, the