A Tabular Statement of Persons receiving Gratuitous Medical Attendance at Public Hospitals and Dispensaries, in Philadelphia, who are in good if not wealthy circumstances; obtained by the Committee from what they deemed reliable sources of information.

1 Lady

2 Family (5) Vine

6 Gentleman Broad

822

PLACE WHERE ATTENDED.
University (U).
Jefferson (J).
Penna. Hosp. (P).
Dispensaries (D).

Not definitely known (I).

Ample

64

44

Good
Ample

44

Good

46

10

"6 (4)

Mt. Vernon

0.

8000

11

Ample
Good

66

Those marked Good as to ability to pay are able to pay readily $200 per annum. Those marked Ample are able to pay greatly more than those marked "Good." The above list was collected, and the "assessed value or rent" ascertained from OFFICIAL

sources.

There are many other examples under observation, but not determined accurately enough to go into this Report.

The Committee present the following extract from a "Plan for Co-operation of the MEDICAL CHARITIES of the City, with the Ward Associations of the PHILADELPHIA SOCIETY FOR ORGANIZING CHARITY, having for its objects an avoidance of the pauperizing effect of indiscriminate Medical relief, and the protection of the Medical Charities from imposition."

Both in Europe and in this country very active measures have been established to protect communities from the pauperizing and enervating influences of undue and indiscriminate relief, and to give a better direction of the funds of contributors in reaching the worthy poor. Foremost in this question are the Medical Charities.

London' is said to give Medical Charity to one out of every three or four of her population; New York2 in about the same proportion; Boston3 to one in four and a fraction; Philadelphia to one in five and a fraction."

Overlapping and duplication in the registration of beneficiaries at the different services, and other conditions, must account for a large exaggeration in this stated ratio; but the evidence of a very large imposition upon the services rendered. at the offices of our Medical Charities is justly complained of by our Medical Staffs and by the general profession. The numerous and rapidly increasing attendance of patients at many of the out services of our hospitals and dispensaries, overtaxes the energies of the medical officers, and is a disadvantage to the patient in

1 Dr. Joseph Rogers, British Medical Journal for May 27, 1871, and Reports of five Sub-committees of Physicians.

First Report of the Committee on the Abuses of Medical Charities to the State Board of Charities of New York.

3 Proceedings of Norfolk District Medical Society of Massachusetts, 1877. • Reports of Investigating Committees.

the limited time that can be allowed for diagnosis and treatment. But it is because of the lowering effect upon the self-respect and independence of our people that this indiscriminate medical relief is chiefly to be deplored. In London the medical profession have been taking the subject into very thorough consideration for the last nine years, and through a system of Provident Dispensaries, as well as through investigation by the visitors of the Charity Organization Society, they are doing much to restrain the evil.

The subject has been for the last few years under active discussion in New York,' Boston, Philadelphia, and our Western cities.

While Provident Dispensaries are under favorable consideration it is realized that the first step towards remedy must be a complete system of investigation.

In this city the PHILADELPHIA SOCIETY FOR ORGANIZING CHARITY AND SUPPRESSING MENDICANCY affords, through its Ward Association, the means of investigation that would appear requisite.

To facilitate this end, the following dispositions are recom mended:

1st. That the seven GENERAL DISPENSARIES of Philadelphia, to wit: The Southern, The Philadelphia, The Northern, The Philadelphia Society for the Employment and Instruction of the Poor, The Howard Hospital and Infirmary for Incurables, the Charity Hospital, and the Church Dispensary of Southwark, divide the city of Philadelphia east of the Schuylkill River into districts, composed of groups of wards, and that their services be confined to applicants residing within their several districts, as far as their charters will permit.2

A convenient division it is found could be made of the city in accommodation with the limits already practically adopted by these dispensaries.

It is stated in the last report (for the year 1878) of the New York Dispensary, that a charging system of ten cents per visit as part payment for medicines has been introduced, and with very satisfactory effects. Only six per cent. were found unable to pay the fee, and were placed on the free list. These payments added between $3000 and $4000 to the revenue of the dispensary for the year. The report also states that the system of charges is in operation with the other general dispensaries with possibly one exception.

2 The seven General Dispensaries of New York have divided the city between them, each confining relief to its own district.

This Territorial Distribution would secure

1st. Convenience in co-operation with the Ward Association. 2d. A due apportionment of their services.

3d. An avoidance of overlapping in the registration and treatment of Beneficiaries, and the checking of the so-called Rounders on Medical Charities.

It is considered very desirable, and is strongly recommended that the services of the Visiting Physicians at the houses where patients are unable to attend the office of the Dispensary should be so extended as to cover the whole city. Visiting Physicians are now provided by the Philadelphia Northern Dispensaries, and the great value and importance of this provision as a true and needed charity is respectfully urged upon the attention of the management of the Southern, of the Phila. Society for the Employment and Instruction of the Poor, of the Howard, of the Charity Hospital and of the Church Dispensary of Southwark, inviting the addition of these services to the relief already afforded by these institutions. The service, attempted by the Physicians of the Guardians of the Poor, is found to be insufficient in force to cover adequately their districts. It is not deemed practicable or desirable to confine the Out door (Dispensary) relief of Hospitals or of any of the Special Dispensaries to given Districts. The foregoing propositions relate to territorial distribution, and are therefore necessarily restricted to the General Dispensaries.

All the Medical Charities, whether general or special, are urged to co-operate in having investigation made of applicants for Out-door (Dispensary) relief, where discrimination may be required, as proposed through the Ward Associations of the PHILA. SOCIETY FOR ORGANIZING CHARITY AND SUPPRESSING MENDICANCY. A charge of ten cents per visit, or for medicine, may be made, unless specially exempted after investigation, and provided their charters do not prevent. Out-door patients, however, who may offer and shall be required as subjects for clinical instruction should be admitted for treatment without investigation or payment of fee. Applicants for admission to the Hospital Wards may be referred for investigation at the discretion of the admitting officers.

It is suggested that the conditions for medical relief differ from other forms of relief

1st. In that physical suffering cannot be passed by; and

2d. In that the relief, not being exchangeable, is not liable to abuse.

The question of investigation, therefore, should be as to the ability to pay, and not upon the moral standing of the patient, as the general rule.

The payment of a small fee would tend to preserve the selfrespect of the applicant and, at the same time, aid in the support of the services, and would, in a measure, check an undue recourse to the Medical Charities.

The very salutary effects that have resulted from this system of fees in New York would commend strongly its adoption by all the Medical Charities of Philadelphia, unless prohibited specifically by the terms of their charters.

It is believed that these provisions are sufficiently simple to be put in immediate operation without difficulty, and that the general ability to pay the fee, as evinced in New York, will give comparatively few cases for investigation. It will be observed that the investigation will only be required (1) when the applicant is believed to be above the class for medical charity, and that the reference to the Society for investigation will be exercised at the discretion of the medical staff; and (2) where the beneficiary pleads an inability to pay the fee. It is believed, from experience in New York and elsewhere, that over 90 per per cent. are able to make this small contribution to the funds of the institution, and that, if the practice is generally adopted, in a very short time the requirements will become understood by the patients, and but few cases will ask for the exemption. These cases would in most instances, it is presumed, apply to the Ward Offices for the Certificate of the Superintendent before appearing at the Medical Charity. If not, the medical officers, unless in cases of special distress or urgency, will refer the applicant to the Ward Office for the Certificate, before treatment. When ignorance of the Ward Office is claimed, the applicant should be referred to the Office of the Ward Association in which the Medical Charity is situated, for the needed information.

Diagrams showing the location of the several Ward Offices would also be furnished to each Medical Charity from the Office of the SOCIETY FOR ORGANIZING CHARITY.