New-York tribune., 1907-10-08
DISPENSARY EVILS.
THEIR WORK CRITICISED.
Or. GOMrater Would Haze Mann
Reforms Made.

Dr s s Goldwater. superintendent of Mount
sinai Hospital. secretary Of the Hospital Confer
rnce and president of the American Hospital As
tociation has written article 'Dispensary
Reform" in which he strongly denounces dispen-
tarv practice and says swindling and certain
evils are bound up with the work as il Is now
commonly conducted throughout the city The
physician says he has plan for the regulation of
lispsnsary work, based the principle of umita-
ZION OF attendance in proportion to facilities fer
adequate treatment In his article he says:
believe that the essential features of this plan
might be adopted with advantages in Philadelphia
Of poverty in England or in the Thited States Sie
where me pfeHai,lhg N cor conditions in dispensary
shall endeayor 10 show that in the opinion of
The New YORK state Board Of Charities the care
ready accomplished almost all that can he eX-
pect5d Of it in checking dispensarv abusee and
that notwithstanding this the evil of overcroWding
and an ne oo3ec{onable practices associated with
MANY dlspensary physicians recognize the need
q d reIorina Iion IN the methods of dispensary
Etathenl, ana advocate the extension Of the work
a The dispensary TO the home. wherever it ap-
pears neessaTy 16 10 strike at The causes of disease
by melloos more crasuc than the use of drugs
ElrgqSes 81 furthfeTmore to inquire whether it is
HSBer dispe7saT1 9SS6Y psuents to adopt the
ssans II anV 6isnsTssriieea a-o 10 70 ask by what
bccepJ these ideals.
I hold that in dispensary work. no less than in
hospital work. there certain standards oS
method and achievement TO ian below which js 10
LsL While . hospitals. as evidence of their efi-
pentage Of their patients who are discharEed as
Z the out-patent department here the subject of
.oast IS Co[liASnly mere growth in attendance and
ne sttelsllt NiAleNer Is made 10 judge the work
q the department by any real standard Of eIi-
roFe oI the problem, Is not how many arc treated.
but now Wei they are treated. and we must en-
make ior efficiency. or be content 10 have dis
pensaFles STAMPED as failures.
The literature of dispensary is volur1inous II
EhoEs II the main that the advantage offered by
freedom Of access 10 dispensaries is seized bv per
n consequence Of this, and partly because Of the
riIenteIe dispensares are o1ercToWdedp that the
gasiy q the work done in dspensaries is low. and
critics great variety of opinion naturally
ing upon the purpose of this article. all peculiar
ena lolosyneI2ti views and omittng also replies
Sce disBsny abuse Sf Ras R5sSe Shown S to gTouP
ltSeI IN three main divisions;
physicians second abuse on the part OF the pro-
fession, careless and Intellectual treatment Third
the sbuse ca the part of the dispensaries; en-
Iary Services lthis in turn fostering the abuse Of
olsPensares by patients and physicIans).
GERS time, which IS reckoned by seconds rather
Of hygienie treatment no provision for nourish-
being due 10 iEJemperance insufficient clothing.
bad habits bad food and poverty. is not suscept-
r tresre5 ~ home II is obvious that such med-
= - et,cae - aJ5tt 10 -sf,e}scIo-T, 70 tbe Too+
shall not enlarge uEon the subiect OF dspensary
and the Indictment against them is only too ia
niliar Nowhere else IN all the wide field Of vol
afflicted q our great cities Is the gap between
en- s9 aho a. sc-e. eI!lel W. V,tn IN t ~ az z
where du New York State) more than 10000 on
every year, with net. social gain so small that that
tne conteInp!aflon GI II claiIellSes me siucG-'
faith IN the so-callcd philanthropy concerned IN
With the facilities at present existing. that any
EidusI case can result frcm even the most rigid
@ a y2ss gssa l sl + @2i IL af 5f9PSa 6a
- OF oiSpeseFleS ~ pattt1L7 d L'e 20 teE ~
trstion ard investigation % az cases. the general
Iba5 ieSls 81 5r5 m "C@ cr - l s Of orcEEodng
superficial eXarlna alton arc careless and Intellectual
The dispersary law q the stase Of New York
5 a conservative measure. drawn oy men tu!ly
C0sntzart OF the facts in regard 70 The abuse Of
oispensaries by socially undssarl12g class; "a
sliliar- apparently with the fraudulent pfGctlces
Of sC-Called dispensarie conducted for private
gain under the cloak Of charity, and informed as
% the tendency Of not few disnensaTy managers
= be careless about certain details OF hygiene and
tie grouping ot The sexes and IN the examination
But the framers Of the law, while seeking to
SertI,- daefra! ~ irteferjn as little as POSSIBLE
p=sII ~ ~ ~ ~ i-i5 eo iDI5ar
rom the terms Of the law there was no thought
IN the minds OF its trainers, Of compelling dis
pensaries 70 limit their work 10 dimensions con-
Eistent with their facilities; no idea that a system
plcaUtS for olsUeuSaTy relief would be compelled
81 every 10 prove their right 10 the relief
offered them. And yet i is plain that there is a
fort Of sWindIe. unconscious perhaps, but none the
less real. in the attempt 10 make relatively
small dispenssVy organization meet the needs OF
unlimited number Of patients; and the lesson
Of the for and tie value Of routine inVestiga
modern schools of philanthropy. is to-day recog
n!zed feature Of all kinds Of relief work except
that n hospitals and dispensaries.
There in New York City to-day fourteen dis
penssries having outdoor visiting physicians and
nUrEeE. Years the lower part of Manhattan
Island. then city CT New York. was subdivded
into districts six dispensareS. each of which ap
Pointed district physicians. The duty
a. these physicians TO visit patients who were
reported bv their friends At the dispensaTY as be-
ing too sick 10 call there for treatment The Good
Samaritan (then the Eastern DispensaTy) under
tooK look the district east of First avenue
and south OF l4th street; the Northeastern Dis
pensaTy district included between Sixth avenue
The West Side similarly sUbdivided, the
soufhernmost portion henP assigned 10 the New
York DisDensary the central portion 70 tho North
western Dispensarv and the northern extremity OF
ne city that time extending TO Ssth street, 70
the Northern DispenFsTy. The system then es-
tablished t8s been continued 20 this day with
cut chang, Of district assignment. regardless Of
the fact that the Nurses Settlement and other
agencies too numerous TO mention have since en-
teTed the field ready 70 share the burden. Indeed
bui Tor the birth and growth Of these new orRanl-
1etons the diEpensaries mentioned would have
neen overwhelmed by the increasing demands of q
tapidlv multiplying population.