THE ABUSE OF MEDICAL CHARITIES.

[The following Report of "the Committee on the Abuse of Medical Charities," was presented to the Philadelphla County Medical Society on March 24, 1880, adopted by the Society as its Report, and respectfully referred to the American Medical Association.]

REPORT.

The Committee on the Abuse of Medical Charities, consisting of the "Committee on Hygiene and the Relations of the Profession to the Public," with the addition of the following named gentlemen: Drs. S. R. Skillern, R. Burns, W. B. Atkinson, J. G. Stetler, W. T. Taylor, R. J. Dunglison, C. A. McCall, and W. R. D Blackwood, beg leave to present this their final report. The subject, it will be remembered, was referred to the Committee, in the shape of a Memorial from the "West Philadelphia Book Club," at the regular meeting of this Society held May 22, 1878. While, therefore, on the one hand the Committee feel that they are not open to the charge of having acted precipitately or with undue haste in this extremely delicate matter, they trust that the amount of work they have accomplished, and the tangible results at which they have arrived, will be considered a justification of their action in delaying their report until the present time.

The Committee considered that their first duty was to ascertain the facts of the case,-whether such an evil as that represented in the Memorial did really exist, viz.: "A wholesale and indiscriminate, gratuitous, medical attendance in connection with the clinics, dispensaries, and other eleemosynary institutions of this city," constituting "a subject of so vast importance and so difficult to overcome, as to require concerted action by the profession generally." This question divided itself into two heads. First, Was the actual number of cases treated gratuitously during any one specified space of time for which records could be obtained, say the year 1877, disproportionately large

when viewed in relation to the population of the city? and, secondly, Is there direct evidence, apart from this general deduction, that persons abundantly able to pay a physician, are in the habit, in any considerable number, of obtaining gratuitous advice at the dispensaries? Sub-committees were accordingly appointed to investigate these questions; the work of the first being again subdivided into the discovery of (a) the amount of gratuitous service rendered by College Dispensaries, (b) the amount of such service rendered by Religious Dispensaries, and (e) the amount rendered by General and Special Dispensaries. The reports of these sub-committees (which are appended to this report, see appendix) appeared to the Committee fully to sustain the complaint of the Memorial, showing that in the neighborhood of one hundred and twenty thousand persons had been prescribed for at the various dispensaries during the previous year (1877) and that instances without number could be cited of individuals, in the possession of ample means, availing themselves of the opportunities provided by the benevolent for the benefit of the poor alone. Fifty-nine such cases were reported specifically, with their residences and incomes. Thus reassured that they had firm ground to stand upon, the next step taken by the Committee was to endeavor to discover to what extent the managers of such institutions were aware of the impositions which were practised upon them, and to obtain an expression of opinion from them and from their medical staffs, as to the best means of meeting the evil, its existence being acknowledged. This effort took the shape of the following circular, a copy of which was sent to the Secretary of each board of Managers, and to the Secretary of each Medical Staff. In taking this step your Committee availed themselves of the experience of the "Committee on the Abuses of Medical Charities of the New York State Board of Charities."

QUESTION I. Should General Dispensaries confine their operations strictly to certain geographical limits?

QUESTION II. In order to restrict the benefits of your institution to those who are really poor, should inquiries be made in each case as to the ability of the applicant to pay for medical advice?

QUESTION III. Would it be advisable to establish, as a standard of qualification for relief, the amount of income, rent paid, or general circumstances of the individual applying?

QUESTION IV. Would it be well for you to charge at your discretion a fee, either for advice or medicines, or for both?

Replies to this circular were received from fifteen Dispensaries. They are, many of them, full, and contain valuable suggestions. As a rule it was found that they recognized fully the necessity for repressive measures, but confessed themselves to be without the requisite machinery for undertaking them.

The Committee beg leave to quote from a few of the most suggestive of these replies.

DAS DEUTSCHE HOSPITAL DER STADT PHILAD’A. (GERMAN HOSPITAL.)

"The authorities of our institution have long since recognized the importance of reform in the matter which the Philadelphia Medical Society has wisely taken into consideration, and will cheerfully cooperate with said Society, and the medical charities of this city to effect the desired end."-Medical Staff.

MISSION HOSPITAL.

QUESTION III.

"A check of this sort would be an excellent protection against vagrancy could it be attained, but we cannot see how the information could be reached. The statements of patients in such cases we have found to be utterly unreliable, and our information. must be derived from some other source."-Medical Staff.

WOMAN'S HOSPITAL.

QUESTION II.

"After the first relief has been given if there is any doubt as to the poverty of the applicant, or suspicion of imposture, it is suggested that the name and address of the patient be referred to the respective ward bureau of organized charity, for investigation, and upon endorsement by said bureau, the applicant may return for a second visit and for continued relief."-Board of Managers.

CHILDREN'S HOSPITAL.

QUESTION II.

"The plan it is proposed to adopt in this institution is to require applicants, whose cases are doubtful, to bring a certificate of worthiness of relief from some charitable organization of their ward or district as a condition of a second visit."-Board of Managers.

QUESTION II.

"Patients should be required to present a certificate from the visitor of the poor in the district he or she lives in, or from the secretary of any well-known charitable organization, or from a well-known citizen, before being admitted for treatment. This certificate to be taken up and filed, so that it could not be used promiscuously."-Member of Staff of Wills Hospital.

GERMAN HOSPITAL.

QUESTION II.

"Yes. But as it will often be difficult, if not impossible, to obtain reliable information, we would respectfully suggest that some arrangement might be made with the 'Philadelphia Society for Organizing Charitable Relief and Repressing Mendicaney,' by which information in any given case might be obtained through the Ward Associations' of said Society."-Board of Managers.

It thus became evident that, with the means at their command, both the managers and the medical officers of these charities felt themselves powerless to control an evil which they knew to be growing under their hands. There was a missing link in the chain, viz., an adequate investigation, which should leave no doubt as to the worthiness of the applicant.

While these replies were under consideration, overtures were received from the "Committee on Out-door Relief of the Society for Organizing Charity," alluded to in two of the replies above quoted, requesting a conference with your Committee, with the intimation that their Society might possibly, through its ward associations, undertake the labor of investigating cases referred to them by the dispensaries for decision. This proposal appeared to your Committe to meet the want. The matter was brought