i. Will the position of the profession, socially and financially, be improved as a whole ? I think that it will. If I thought that provident dispensaries were for the advantage of a portion, and not the whole profession, I would cease to support them. Provident dispensaries are intended for the classes above pauperism and beZow competency to pay for medical advice at the usual charges; i. c., they include as members the class at present drawing on the gratuitous medical aid of the hospitals, and the class which is attended by private practitioners for very small fees. Now every one will recognise that, if the large numbers which I gave of those who are in receipt of gratuitous medical aid be approximately correct, a small payment from each would make a large addition to the income of the profession as a whole. And then, as to those who pay very small fees, it has often surprised me to hear from general practitioners working amongst the poor how much they lose by bad debts. It is no unusual thing to meet with gentlemen who calmly submit to an annual loss of 25 per cent. of booked accounts; and this loss is greatly caused by those who should belonc to provident dispensaries. In proof of this I can refer to two practitioners near the Haverstock Hill Dispensary, who tell me that their percentage of bad debts has been diminished from 20 to I2 per cent. since the dispensary commenced. They can now advise their poor patients to join the dispensary. The work of visiting the poor who pay, or rather who pretend to pay, must be done at a great waste of strength to the practitioner, whereas in the provident dispensary the patients are subject to fixed rules. They can be made to attend on certain days ; and, if visits at home be made, they are applied for early in the day. In addition to this, the practitioner, instead of having the trouble of making out bills which may never be paid, obtains a certain fixed remuneration in pro. portion to the work done. To give two instances: medical officers generally attend twice a veek for an hour ; and, in addition, they see patients at their homes if necessary. Thus, at Haverstock Hill, the average daily number of visits for each medical officer is four, and the average annual remuneration is /90. At Northampton, the average daily number of visits varies from twenty-six to thirty, and the remuneration is /500 and so on. These visits are easily made in the usual rounds of practice. At some dispensaries, it is complained that the medical officers entrust the seeing of their patients to assistants ; and that they thus keep up a monopoly which is unfair to the other medical practitioners of the town. It is with the view of preventing this, and of including as many of the practitioners of each district as possible, that the Medical Committee of the Charitable Organisation Society have proposed that about I, 500 members should be allowed to each doctor ; and they even hope that, when these institutions become self-supporting-i. e., when the -eal liability of members can be ascertained and paid for-it will be possible to include all the resident practitioners who are willing to do the work. The rule for preventing unsuitable admissions is wvorthy of note. The patient, if he be in good health, enters his name, but does not become a member for a molnth, during which inquiries can be made. Still abuses creep into these, as into every other institution. Thus patients ente-, pi e'ending to be healtlhy, and at the end of their month of probation they declare a chronic malady. These, however, are the exceptions. I prefer rather to think of the many who pay on month after month and year after year without requiring aid ; and I like to quote the experience of myself and others, who have almost invariably found the provident dispensary patient less exacting of his doctor, and more thoughtful and grateful for attention, than the charitable dispensary patient. 2. What advantages have the patients ? They may be shortly enumerated thus. They make their payments in time of health, and are attended by men whose interest it is to keep them well. Their medical antecedents are known, as they are always attached to the same institution, and attended by the same medical officer. There is no delay in obtaining letters; and thus the patient is saved the danger of no treatment, and of counter-practice, which is worse. I heard it lately given as an objection to provident dispensaries by a working man at a public meeting, that the physicians and surgeons who attend in hospital out-patient rooms do not attend at provident dispensaries. There is some force in this ; and it was with the view of obtaining the services of that class of the profession, as well as providing a substitute for out-patient departments, that the Charity Organisation Society specially recommended the affiliation of the provident dispensaries to the hospitals. 3. The third and last point on which I shall say a few words is, To vhat extent might the science of medicine be advanced ? First, by increased facilities for medical teaching. This provident system might replace the apprenticeships of the past, in giving the student practical tact. He might thus see disease at its commencement in the dispensary, and follow it through its course in the hospital to its termination, under suitable guidance. Secondly, as a machinery for registering disease, nothing could be better than the provident system. Diseases are seen early, and can be easily followed up. Thus both timely warning would be given of epidemics by weekly returns, and yearly reports could be based upon these. Forms with this view have been drawn up by the Medical Subcommittee of the Charity Organisation Society, and approved by Dr. Farr ; and I would respectfully suggest that that scheme for the registration of sickness be considered, and, if it be worthv of the honour, endorsed by some body of position, such as the Council of this Branch. And now, gentlemen, I have finished the slhort summary to which I am limited. In any case, I should consider it unnecessary to enter into fuller details, as I explained the working of provident dispensaries in a paper read before this Branich two years ago. Since that time, the profession has been coMing round to approve of provident dispensaries and the most recent action taken was the conference of December in these rooms, called by the Charity Organisation Societv for the consideration of its report and rules for provident dispensaries. Kinowing as I do h0ow carefully those rules were propared, modified as they are by the advice of the best authorities on this subject, I have every confi. dence in recommending them as a groundwork at least to all whl> think of commencing provident dispensaries.
British Medical Journal