5089 AUG 11 1899 MARYLAND MEDICAL JOURNAL A Weekly Journal of Medicine and Surgery. VOL. XXXVII.-No. 1. BALTIMORE, APRIL 17, 1897. Original Articles. DISPENSARY ABUSE WHOLE NO. 838 AND THE EFFORT FOR ITS PREVENTION AT THE PRESBYTERIAN EYE, EAR AND THROAT CHARITY HOSPITAL. By Herbert Harlan, A. M., M. D., Baltimore. READ BEFORE THE CLINICAL SOCIETY OF MARYLAND AND THE MEDICAL AND SURGICAL SOCIETY THIS subject is, in my opinion, of vital importance to our profession in every town large enough to have dispensaries. The writer was a chief of clinic at the outdoor department of the Maryland University Hospital for three years, was one of the physicians at the Baltimore General Dispensary for three years and has been on the staff of the above hospital for sixteen years. During this time he has read every article on this subject which he has seen in any medical journal. A few of these articles have been well considered and well written. Most of these have been faultfinding complaints about an evil which is unquestionably very real. "The One of the very best is on Abuse of Medical Charities," by Frank Van Fleet, M. D., of New York, and appeared in the New York Medical Record of August 31, 1895. 'In his introduction he says: "This abuse is an evil which we cannot continue to observe with indifference, for not only does it take away from the members of the medical profession what should be a legitimate source of income and deprive the worthy poor for whom these institutions are intended, of the time and at tention necessary for their proper treatment, but it also begets, in the unworthy and undeserving recipients, habits which tend to degrade them, the influence of which may extend far into the future, affecting not only themselves, but generations yet unborn." There has, however, been a great dearth of articles suggesting any practicable remedy. Let me read part of what the above article says under the head of remedies: "I would say that the first step should be an effort to raise the moral tone of society. Teach the people first that it is more blessed to give than to receive; second, that to accept charity under a misrepresentation of facts does not differ morally from taking that which is the property of some other person and, third, that these thieving actions tend not only to belittle themselves, but beget habits in succeeding generations, which will dull that spirit of independence that should be our natural heritage and leaving them degraded, will contribute to the development of a nation of paupers," and then he rather naively adds: strides toward that millennium, when people, seeing the right, will do it, must "These of necessity be slow." Personally, I do not think any member of this society present or future will ever see that millennium. At the Presbyterian Eye, Ear and Throat Charity Hospital a number of expedients have been resorted to from time to time. Time forbids going into details about all but the last and it is to that method and its practical results that your attention is called this evening. It is the result of the combined efforts and many consultations of the surgeons and their assistants at that institution and has been in operation about three months. This is briefly the plan: All new patients on entering the waiting room have for a long time received their cards and rotation number from a woman clerk, who enters the names and addresses in a book kept for that purpose. Now, all those persons who present a well-to-do appearance are handed the following blank. This they are required to fill out, or in the case of children not accompanied by older per.sons and whose cases are not urgent, the blanks are taken home and returned filled out the next day. The next step is to have judgment passed as to the worthiness or unworthiness of the would-be patient. This is done by one of the three senior surgeons, Dr. Hiram Woods, Dr. F. M. Chisolm, or the writer, and requires about ten minutes' time before the opening of the daily clinic. Those evidently able to pay are kindly but positively refused treatment. The doubtful ones are asked some additional questions. Quite a number state that they are able to pay something, but not a specialist's fee. These are advised to ask their family physician as to whom they shall consult and then state their circumstances, or take a note from the doctor to the specialist he names, with the assurance that they will be treated for what they can really really pay. pay. Those turned away are not given cards or advised to go to the private offices of any of the staff. These blanks are kept and may be referred to, and the Charity Organization Society will inquire into and report on any cases which it may seem desirable to have investigated more fully. As yet this aid has not been called in. course many blanks are filled out irregu Of PRESBYTERIAN EYE, EAR AND THROAT larly, but this is easily remedied by a CHARITY HOSPITAL DISPENSARY. 1007 E. BALTIMORE ST. This Dispensary is a charity supported in whole and conducted by private individuals, and not by State or City. The Surgeons of the Staff receive no compensation for their work. It is for the poor only. All persons unable to pay for professional services are welcome. Those whose circumstances are such that they can pay moderate fees will be refused treatment and are cautioned against applying. This blank must be filled out, and if the answers are satisfactory, the individual whose name it bears will receive free treatment at this Dispensary. 1. Full Name and Address. 2. Age...... 3. Employment of self or person upon whom you are dependent... 4. By whom employed.. 5. What is the name of physician who attends you in ordinary cases of sickness?..... 6. Give reason why you should receive free medical advice and treatment in this Dispensary. The object of this card is to protect the Dispensary from imposition. Information obtained from these answers goes no further than the physician in charge. few questions at the time they are inspected. Some are filled out apparently with a view to evade giving the desired information. So far this number has been very small. In modeling the blank, special effort was made to avoid wounding the feelings of deserving, but sensitive, people. I think we have succeeded in this. There has been no trouble in getting A certain people to fill up the blanks. number, after receiving them, read them over and withdraw, and are seen no more. Some others remark that there are a good many people ahead of them and they will come another day. They, too, are seen no more. There is no account of the number in these two classes who thus tactily admit that the dispensary is not the place for them. Their names were not entered in the books. Nor is there any way of estimating the number kept away entirely by the knowledge which has become spread |