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3. In considering the means whereby these principles can be put into effect there must be allowance for wide variations to meet the differences in conditions and facilities of different countries. Generally, it will be necessary for schemes for the improvement of environment, such as water-supply and drainage schemes, to be carried out by the Government, municipality, or other local authority, at the expense of the taxpayer. But in some countries, especially on plantations and mines, much can be and has been done in the way of housing and sanitation by the employer. 4. Schemes for ante-natal care, midwifery services, child welfare, and the provision of supplementary food for expectant mothers and young children should be the responsibility of the Government or local authority in many places. But this is a direction in which much can be done by an employer, or by a co-operative scheme organized by the employer and workers. We would emphasize that in our opinion such provision is not less important than medical care, hospital treatment, and sick-pay. 5. In rural areas medical treatment, by the agency of permanent or mobile dispensaries, district hospitals, and health centres, is likely to be practicable only if the cost is met by Government or by the local administration, although those who benefit might be required to pay a small part of the cost, if only to induce them to attach greater value to the service rendered. It has to be remembered, however, that all such payments open the door to abuse, and once the people have been trained to appreciate them the services should be free for all those patients who are living near the subsistence line. These rural treatment centres should be linked with a central hospital for specialized treatment wherever geographical conditions make this practicable. 6. In some rural areas there are hospitals and other medical services maintained by plantations or industrial undertakings. Where these are proved to be efficient and adequate, arrangements should be made whereby they can serve the needs of the local population, in addition to the employees of the industry or plantation. Appropriate financial arrangements should be made by the local authority. Conversely, where the medical service of a local authority can serve adequately the needs of a plantation or industry, arrangements should be made to facilitate this, and the industry should pay the cost. In all such arrangements and also in the medical services of plantations and industries alone, full importance should be given to environmental hygiene. The local authority should be empowered to make regulations to maintain high standards of treatment and to ensure co-ordination and the prevention of wastage of medical skill. In all these rural schemes the doctor will have to serve a wide area. He should be assisted by well-trained hospital assistants, dressers or compounders, and nurses and midwives wherever they are obtainable. 7. For centres serving large populations, urban and rural, specialized hospitals are essential, and in such places the responsibility for providing and maintaining them must rest on the Government or local authority. Those who benefit from them and who are able should pay a part of the cost, either by direct payment of award charges, or, if the patients are participants in any social insurance scheme, from the funds of that scheme. A large proportion of patients will not be able to pay, and it may be expected that the expenditure will always greatly exceed the direct revenue. The difference will have to be made up from general or local revenue. In such a hospital scheme for urban areas maternity hospital provision is of special importance. 8. Private Hospitals for Factories and Industries. —These are likely to fulfil a useful function for dealing with illness which does not require specialized treatment and diagnosis. They could very well be financed by a contributory or insurance scheme, and could qualify for a government subsidy if the standard of treatment was found to be satisfactory. The management of such a hospital should have workers as well as employers on the governing board. Such a hospital, though in no way able to provide a complete medical service, could meet the greater part of the need of the workers if it

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