The great and fundamental mistake made in the initiation of the English Insurance Act was that in effect it ignored the entire history of the relation of preventive and curative medicine to the State. This history cannot be detailed now: but, briefly, for long years the destitute had been entitled to domiciliary and institutional treatment at the public expense. This medical aid was given by Poor Law Authorities, and their method of doing this work had rendered the benefaction commonly unacceptable. Then Public Health Authorities on a steadily increasing scale found it necessary to treat disease in order the more effectively to prevent it. And so fevers and smallpox, and chronic infective diseases like tuberculosis and syphilis came under treatment, practically for all comers, at the public expense. As already mentioned the fundamental importance of maternity and childhood has also been realised, and the State is now taking an increasing share in ensuring health at these periods of life. And while Public Health Authorities were increasing their activities, Education Authorities began to subject school children to medical inspection, and to treat them for the detected defects, the treatment of which they could not otherwise secure. And so, not to make this sketch too complex, three great central government departments or sub-departments and three sets of local authorities were engaged in medically treating the people at the public expense. This sketch does not include the smaller (nevertheless enormous) amount of treatment of disease by voluntary hospitals. It is safe to state that at any one time one-half of the total treatment of disease is being carried out at the public expense. If the domiciliary treatment of insured persons is worthy to come into the same category as the skilled services mentioned above, the proportion of disease already treated at the public expense greatly exceeds 50 per cent. (Note.—Less than four-ninths of the cost of medical treatment of insured persons comes from the contributions of the insured.) The complexity of local authorities concerned in the treatment of disease was wilfully increased under the National (Health) Insurance Act; and, contrary to the advice of public health workers and of the Royal Commission on the Poor Laws a golden opportunity for securing the merging of poor law into public health work and for initiating a unified system of State Medicine for all who need it was lost. Poverty to a preponderant extent is due to sickness. Two statements have recently been made by the Medical Society of the State of New York, viz., that “evidence is against the fact that any considerable amount of impoverishment is caused by illness,” and that they can find no “available evidence that ... in the main, medical attendance in this State is grossly deficient in quantity or grossly defective in quality.” (_Monthly Labor Review_, January, 1920, p. 256.)