Had the transfer of the duties of the poor law authorities to the councils of counties and county boroughs been adopted, and ancillary legislation enacted, the public health organization would have at once possessed a medical service for the poor of some 4,000 doctors, in addition to the doctors already engaged in the public health service; it would have had large infirmaries and the other medical institutions of both services; would have been able to make liaison working arrangements with the committees of voluntary hospitals; and there would have been secured a greatly improved medical service, freed from poor-law shackles, which could gradually be extended as needs and policy indicated. _Insurance versus Public Health_ Political circumstances led to the adoption of a course which medically ran directly athwart the course of needed reform. The National Insurance Act of 1911 was passed, giving sickness and invalidity benefits to all employed manual workers and to others below an income limit of £160 (recently increased to £250), who could contribute a weekly sum which was considerably less than half of the estimated cost of the benefits to be received; and a new medical service was created, further complicating administratively the already existing medical services of the poor law, public health, and educational authorities, and converting the majority of general practitioners into part-time civil servants. The case is an illustration of the moral contagiousness under modern conditions of life, of a new course adopted in any country. Bismarck’s attempt to counteract socialism by insurance has been responsible for state and official experimentation in insurance in many countries, which at least in England was not actuarially, financially, or medically sound, and which has involved expenditure in administration entirely incommensurate with the benefits received. Insurance against sickness and disability is a praiseworthy and valuable provision against future contingencies. I am not concerned here to point out inequalities to the insured in the English Insurance Act inherent in the apportionment of a flat rate for all ages, districts and occupations, and for both sexes, irrespective of known or suspected incidence of sickness, nor the difficulties created by continuing the nonlocalized work of friendly societies and other private organizations, and at the same time creating local insurance committees, who furthermore were not organically related to local health authorities, and had no opportunity, therefore, to develop the conceivable potentialities of insurance experience as an aid to public health work. The act in its present form is now generally condemned; and it is significant that the need for its radical reorganization appears to be universally accepted.[10]