One vital factor in Poor Law Reform remains to be considered--the Poor Law Medical service. The 740 Dispensary districts of Ireland are now administered by a little more than 800 Medical Officers. The salaries of these doctors, amounting in all to nearly L100,000 per annum, are paid as to one half by the Poor Law Guardians, and as to the other half out of the Local Taxation (Ireland) account. Most of the doctors, in addition to their public duties as servants of the poor, engage in private practice, of which, in most of the rural areas, their official position gives them a monopoly. A large--perhaps, a surprisingly large--number of the Dispensary doctors are earnest and self-sacrificing men; but the system is corrupted by one radical defect. Owing to the security of private practice involved, there is a fierceness of competition for these appointments out of all proportion to their financial value. The elections are made by the Guardians, and it is a fact so notorious as even to be acknowledged by Mr. Birrell that flagrant canvassing and bribery are a common feature of these elections. Candidates have been known to distribute sums of L400 or L500 to Guardians, in order to secure appointments of L150 or L160 a year. Another serious and extending feature of the present system is the boycotting by the Guardians of all candidates who have not graduated at the new Roman Catholic University. The most highly qualified men from the University of Dublin have now practically abandoned competition for these Dispensary offices outside the Protestant counties of Ulster. Moreover, throughout the whole country local candidates are consistently preferred to superior men from outside. Both the Viceregal and Royal Commissions recognise the necessity of radical reform in this system, but they suggest different remedies. The Royal Commission proposes that the election and control of all the Dispensary Medical Officers of a County shall be vested in the Public Assistance Authority for that County; and that little or no change be made in the present financial basis of the payment of salaries. The Viceregal Commission suggests a bolder and more drastic remedy. It advocates the establishment of a State Medical service on the lines of the existing services in Egypt and India. This would require the payment by the State of the whole, instead of half, of the salaries of Medical Officers. The Commission regards it as proper and equitable that such a service should be, in the beginning, at any rate, restricted to candidates educated in Ireland. A representative Medical Council should elect the candidates by competitive examination, and deal with all important questions of promotion, removal and superannuation. The Commission maintains that the creation of a State Medical service in Ireland would mean a very small increase in the Parliamentary grant in comparison with the benefits involved. This I believe to be the ideal system, but one must recognise