and shall put most prominently forward, and discuss at most length, those questions which affect us as medical men, and which have the most direct bearing upon the standing and reputation of the medical profession.
We have put these numerous reports at the head of this article to show (1) the evils of which we have to complain, as they are exhibited on a large scale, and (2) the various forms of the remedy that we venture to urge.
The reports of the several medical charities-free hospitals and dispensaries-show how enormous is the number of persons who annually seek advice and medicine from these institutions. Several writers have computed what is the total number of individuals who annually apply to the medical charities of the metropolis, and they tell us that it is over a million. We have ourselves gone carefully through the figures for the year 1873, and we make the total 1,288,085. This is altogether exclusive of the Poor Law and of a great number of private and semiprivate institutions which publish no reports. Beyond the medical charity which can be estimated in figures there is a large amount which cannot be tabulated. We may, therefore, rest assured that the total at which we arrive by adding together the figures given in the various published reports is not an exaggerated one; but that, on the contrary, it repre sents only a proportion, a very large proportion, no doubt, but still only a proportion of the whole medical charity of the metropolis. And what is true of London is true also, though in a less degree, of the provincial towns and of the country at large. We may, therefore, safely conclude that a very large percentage of the community rely upon medical charity in time of sickness. In the metropolis this proportion amounts to something like a quarter.
This, then, is the first fact to which we call attention-the enormous number of persons who expect to receive their medical attendance and medicine at the expense of their neighbours, as a matter of charity. It needs no argument of ours to prove that this is a very undue number. In exceptional circumstances-for example, when famine devastates a countrya great part of the population may have to rely upon charity in one shape or another for the necessaries of life. But if such a state of things became chronic, we should think that it augured very ill for the prosperity of the people. Soup kitchens are excellent institutions on an emergency, but it would not be beneficial to have them always in operation for the supply of all comers. And the principle is the same with regard to medical charity. Sickness is not one of the necessities of life, and yet it may truly be said to be one of its neces