We scarcely realize how far we have gone in the socialization of medicine. It is impossible to go back, or to stand still. The services of the medical profession are needed, not only to provide the necessary service, but in helping to determine its conditions. One essential item will be the substitution for fees during sickness of an annual payment to private practitioners by each family for supervising its members in health, for inquiry into their industrial and domestic life, so far as it contains elements inimical to health, and for giving preventive more than curative advice. The second and most urgent element consists in the organization of hospital and consultative expert services for all, which, while greatly increasing each patient’s prospect of prompt recovery, will enable the general practitioner to escape from the soul-destroying inefficiency of unaided medical practice. Of course, any service provided, whether partial or complete, will need to be kept free from “political pull.” This spells inefficiency; and inefficiency means disease and death. “Political pull,” although not in the official list of Causes of Death, is among the potent causes of excessive mortality; and for this, every one of us must bear his individual share of responsibility, insofar as we have abstained from active support of sound and clean government, when we were unable to take an actual share in government. FOOTNOTES: [9] The Wesley M. Carpenter lecture delivered October 2, 1919, before the New York Academy of Medicine. [10] Thus Mr. Bishop Harman, an ophthalmic surgeon, and a member of the Council of the British Medical Association, says: “In my out-patient clinic 60% of the patients are insured persons who attend for treatment that is essential to their industrial efficiency.... A scheme of medical benefit which does not provide for specialist service and for institutional treatment is no scheme, it is poorer in status than the Poor Law provision which does all these things.” (_British Medical Journal_, Mar. 15, 19). Dr. R. Sanderson, of Brighton, writing on behalf of medical practitioners, says: “We are the victims of a half-fledged, inadequate piece of legislation which is founded apparently on the supposition that disease can be dealt with effectually by giving bottles of medicine or liniment to the sick, or that if this fails and the sick get worse, they can be sent to one of the overcrowded voluntary hospitals with which the legislature has nothing whatever to do. Anything more unsatisfactory to the sick, or demoralizing to us as a profession, it is hard to imagine.”