It is true, there are grave scandals in the public medical service.  The public doctor may be also a private practitioner eking out his earnings by giving a little time to public work for a mean payment.  There are cases in which the position is one which no successful practitioner will accept, and where, therefore, incapables or drunkards get automatically selected for the post, faute de mieux; but even in these cases the doctor is less disastrous in his public capacity than in his private one:  besides, the conditions which produce these bad cases are doomed, as the evil is now recognized and understood.  A popular but unstable remedy is to enable local authorities, when they are too small to require the undivided time of such men as the Medical Officers of our great municipalities, to combine for public health purposes so that each may share the services of a highly paid official of the best class; but the right remedy is a larger area as the sanitary unit.

MEDICAL ORGANIZATION

Another advantage of public medical work is that it admits of organization, and consequently of the distribution of the work in such a manner as to avoid wasting the time of highly qualified experts on trivial jobs.  The individualism of private practice leads to an appalling waste of time on trifles.  Men whose dexterity as operators or almost divinatory skill in diagnosis are constantly needed for difficult cases, are poulticing whitlows, vaccinating, changing unimportant dressings, prescribing ether drams for ladies with timid leanings towards dipsomania, and generally wasting their time in the pursuit of private fees.  In no other profession is the practitioner expected to do all the work involved in it from the first day of his professional career to the last as the doctor is.  The judge passes sentence of death; but he is not expected to hang the criminal with his own hands, as he would be if the legal profession were as unorganized as the medical.  The bishop is not expected to blow the organ or wash the baby he baptizes.  The general is not asked to plan a campaign or conduct a battle at half-past twelve and to play the drum at half-past two.  Even if they were, things would still not be as bad as in the medical profession; for in it not only is the first-class man set to do third-class work, but, what is much more terrifying, the third-class man is expected to do first-class work.  Every general practitioner is supposed to be capable of the whole range of medical and surgical work at a moment’s notice; and the country doctor, who has not a specialist nor a crack consultant at the end of his telephone, often has to tackle without hesitation cases which no sane practitioner in a town would take in hand without assistance.  No doubt this develops the resourcefulness of the country doctor, and makes him a more capable man than his suburban colleague; but it cannot develop the second-class man