[Interim report...[and] Final report.... Volume I.Report. Volume II. Appendix].

  • Great Britain. Departmental Committee on Tuberculosis.
Date:
1912-1913
Catalogue details

Licence: In copyright

Credit: [Interim report...[and] Final report.... Volume I.Report. Volume II. Appendix]. Source: Wellcome Collection.

Provider: This material has been provided by London School of Hygiene & Tropical Medicine Library & Archives Service. The original may be consulted at London School of Hygiene & Tropical Medicine Library & Archives Service.

    214/266 (page 160)
    Depai-tment 4 sliould manage the publishing busi- ness—whicli I assume will be very considerable. I d(j not know whether the research department will be engaged in publishing leaflets for the propagandism of tlie insvirance scheme, but if so. such publications ought to be in the hands of this department. I think also that the scheme should bring out a monthly tuber- ciilosis bulletin, something on the lines of the Tropical Diseases Bulletin isstied under the auspices of the Colonial Office—a publication which will be of the greatest utility to all the workers under the scheme. Possibly also a monthly journal of reports of all work done might also be contemplated; and an expert biblio- grapher must, of course, be employed, and, perhaps, a librai-y collected. Department 5 will be the directorate and head office. It is outside this memorandum to enter into further details on these branches, though this could easily be done. Other schemes of division or subdivision might be suggested, and I have merely given the one which appears to myself to be perhaps the best. 10. Organisation of each Department. I would recommend that each department should consist of workers under Headings 5, 6, 7, and 8, under a genei-al director of the department and, if this be found advisable, with local sub-directors. Thus each department will possess a head who will be, I sxippose, one of the most distinguished men in the countiy on the special line of work under consideration. Under him there may possibly be sub-directors at some of the principal local centres—though this question of the employment of sub-directors will require considera- tion. I presume, also, that the Director of Departments 1, 2, and 3 will each have a small office, and that he will receive the reports of the workers, and will be free to visit them when necessary. Department 3 should, I think, possess, besides the statisticians en- gaged upon their proper woi-k, men who can be called upon to visit various areas for the collection of epide- miological material; and here, again, as already stated, a highly expert director will be required. The Bulletin and Journal will require to have a full- time editor. I do not think it will be possible to place each department under a separate committee. The work of each is sure to cover an extremely large field, requiring a large and very detailed correspondence; and if any committee were appointed to deal with this business, it would have to meet once a week, or more often. On general grounds, moreover, I doubt whether any com- mittee will possess as much initiative as should be possessed by a well selected director. 11. The Directorate. This must obviously manage the whole of the scheme. That is to say, it vrill be called upon to select the workers and to give a general approval of the lines of work being followed in each department. It will also be concerned with the payments and the general disposal of a large sum of money. I presume, therefore, that it will require secretarial and accountant branches. The question arises whether the Directorate had better be placed in the hands of a single person or in the hands of a committee. Personally I think that if each department of the research is imder a Director, as just described, the genei-al Directorate had better be placed in the hands of a committee of two branches, one branch to be specially concerned with the scientific work, and another branch to be specially concei'ned with the finances, the two branches together constituting the whole committee. If the Directorate were to consist of a single director he would still have to be made subordinate to some kind of committee, so that the organisation would ultimately result in precisely the same scheme as I have just given, with the addition of a high pay- ment for a chief official. This will scarcely be necessary ; but on the other hand the managing committee must be veiy carefxiUy selected. The branch of the committee concerned with finances should contain a proper proportion of businesg men; hnt this work will not dilfer in any important particulars from that of many other similar committees. On the other hand the scientific committee must be constituted very carefully. I m\ist here di-aw attention to the fact that siich committees are frequently con- stituted veiy improperly in this country. In fact they often consist of men who have not done very great work in science and who, whatever may be their abilities in other directions, often possess little scientific initiative, or even knowledge in the special department concerned, and are not personally acquainted with the great difficidties of such work. I wo\ild therefore strongly xivge that the scientific committee shoiild con- sist only of a few of the very best scientific workers in the country—principally of the best workers in the patho- logical line, associated with a few of the best workers in some other lines of science, including chemistiy, physics, statistics, and physiology, with one or two clinicians. I think that the general selection of lines of study, the choice of the men vinder Headings 5 and 6 and the management of details should be left to the directors of the departments, but that the scientific committee should chose the whole-time workers and exercise a general supervision over the lines of research and meet, say, only once a month. The directors of each depart- ment should at least attend the meetings of the committees and should jierhaps be members of it. Possibly also the director of one of the branches may be made chief director of the whole scheme imder the committee, if a chief director is ultimately found to be necessaiy, and the director of the Epidemiological Department would prima facia be the one most suitable for this post—but I would postpone making such, an appointment until experience has been gained upon the general working of the scheme. 12. Advisability of pooling or breaking up the Ftind. It has been asked whether the administration of the fund should be kept centralised or whether it should be divided amongst the four different Insurance Com- missions in proportion to the number of insured persons in dilferent parts of the United Kingdom. I think that it would be highly imdesirable to break it up at first, but that if experience shows the advis- ability of devolution, suitable aiTangements can easily be made later. Conversely, if the four Insm-ance Commissions are entrusted with research from the beginning, it will be very difficult to get them to give it up later, in the event of the devoliited scheme not being found to be working j^roperly. Moreover, I may remark that under the scheme as drawn up above, the woo'lc will be entirely decentralised and will be spread all over the country, whereas the direction will be centralised. This will tend to combine the advantages both of decentralisation and centralisation, and will also tend to get rid of the defects of both. I am con- vinced that for large-scale scientific work the direction should be centralised and the researches shoiild be decentralised—just as siiggested. Now, if each Insur- ance Commission were to become absolute master of its own researches, there would be no general direction, the work would frequently clash, there would be dis- putes and jealousies, and certainly a very considerable waste of funds over the brain power of the organised body. I think that medical practice shoiild certainly be placed under each Instu-ance Commission, but it is another thing entirely with research—which corresponds to the intelligence department of an army, and must by its very nature be centralised in its higher branches. It might be possible, if it is strongly desired to give the four Commissions some say in the matter, to form a general (as distinct from an executive) committee, which win consist of members taken from all the Commissions, and which will sit once a year to consider the general report of the research scheme. This is a point upon which I am not competent to speak at present, as I am not fully acquainted with various details of the insm-ance scheme. 13. Prizes. I believe that since the time of Jenner, the British nation has never once paid for pubhc sei-vices rendered to it by private researches, although these services have sometimes been of the very greatest value to the