Volunteer Aid Work in Foreign Territory
Boston Medical and Surgical Journal
very successful. I have no doubt that a considerable number of unfit eases receive treatment each day in our Outpatient Clinics. It is my wish within a week or two to put one of my best and most responsible clerks in charge of a special inquiry room in the Out-patient Department for two hours each day, and to have all eases suspected to be able to pay sent to him for thorough questioning. One thing that 1 especially object to on theoretical grounds is the questioning of the patients by the
... atients by the doctors themselves, especially in the presence of other patients. I am decidedly of the opinion that such practice is wrong, aud liable to misinterpretation. Investigation and questioning should be dune by the executive department through some responsible agent. As I said above, now that our new Infirmary is running successfully I hope within a week or two to make a radical departure in the line suggested. Yours very truly, Fabbak Conn. A l the Boston City Hospital, the out-patients are refused treatment by the physician iu charge of the department at which the patient applies if the physician thinks the case iu question unsuitable for charity. If the patient insists upon being treated after being refused treatment upon the grounds of pecuniary unlilness the question may be referred to the Superintendent for fulher investigation and decision. In the eye department there is a rule tllîit the patient asking for a prescription for gold-rinnned glasses shall be refused (realment on the ground that the ability to afford ibis luxury implies ability to pay a physician. Dr. Howe may be quoted assaying: "I do not believe that abuse can be slopped until all hospitals in all cities agree on some simple rational system and live up to it. " At the Massachusetts General Hospital all new outpatients are seen by the admitting physician and questioned as to their ability to pay for medical treatment, unless their appearance evidently indicates that they are suitable cases lor charily: patients who admit their ability to pay something are refused treatment; those in regard to whom the admitting physician is in doubt are referred to the superintendent for further questioning and final decision. Patients known to have been treated in other hospitals for the trouble for which they come to the Massachusetts (¡encrai Hospital are referred back to the original clinic for treatment unless there seems to be a good reason for retaining them. At the Boston Dispensary all new patients, except such as are evidently charity cases, are questioned as to their ability to pay for treatment. Doubtful cases which it seems best to admit are reported to the physician who is to have charge of tho case for supplementary questioning. In one way or a not her. therefore, the hospital administrations seek to winnow their applicants at the gate. but the winnowing process is one which lacks uniformity and co-opëration and hence fails of the best execution. The use of the term clearing house in this connection is not inadvisedly made, for iu addition to its limited application iu the hanking system as early as the year 1856 in ibis country, a clearing house ill other lines of business has conic to be a central bureau not only for the establishment and maintenance of balances but for such co-operative investigation ¡is may constitute it a bureau of information as well ; and it is readily conceivable that the establishment and maintenance by hospitals in a large city of an officer to whom, or a bureau to which, there could be referred, for more leisurely investigation, pecuniarily doubtful eases, would not only relieve the individual administrator of a part of a most unwelcome task, but would in lime become a channel through which there should flow interchange of ideas, and from which there should emanate to the public instructive information ¡is to the rights as well as the obligations of hospitals. Such an officer or bureau constituting a clearing bouse should be under the direction of a board ol control, said board of control being not as is proposed in the new Dispensary lull of New York, the Stale Board of Charities, or other alien organization to which is given a dominant power, but a board of control made up primarily of the medical superintendents of the hospitals themselves. A board thus formed and backed if possible, by legislative enactment, making fraudulent abuse of medical charity a misdemeanor, would be likely lo be an efficient piece of machinery for the attainment of the desired end. The attention given to this question of the abuse of . medical charities in the meetings of the National Association of Charities and Correction in recent years and the agitation accompanying the framing of the Dispensary Bill in New York are among many evidences that this subject is attracting the thoughtful consideration of the public at huge, and the conclusion that any carefully-considered remedial measure emanating from medical sources is likely to receive cordial support, is based upon the fact that while the abuse is-one which concerns the well-being of the community as a whole, its correction is properly one of the responsibilities of the medical profession. In reBpondiug to the request of your committee to make a few remarks on tlie volunteer aid work of last summer, it Beemed best to restrict such to some of the general cousiderations which would suggest themselves from an opportunity of seeing this work conducted under unusual conditions. From this standpoint the position of bodies of volunteer relief, particularly iu these days of well-equipped facilities for meeting emergencies, is a question of great interest. The work of the Massachusetts Volunteer Aid Association of last summer is so well known to you all,probably the majority of those present were more or less intimately connected with its affairs, -that I do not intend to take your time with the details of any special department. It came into existence with the urgent demand at the time, filled its mission, aud then was over.