The Use of Digitals in Disease of the Aortic Valves
Authors: J. M. Fothergill
Journal: BMJ (1877)

aid.In this town alone, there are some fourteen medical charities: in i876, there were 7,786 in-patients; 69,876 out-patients; i8,872 visited at home; 3,525 accidents, etc.; total, 101,579 separate indi- viduals, or about one-fifth of the entire population.This mass of gratuitous medical relief would doubtless be largely added to were it not for the fact that the Salford and Pendleton Royal Hospital, with its staff of twenty physicians, surgeons, assistant-surgeons, and apothecaries, make no report of the good work they are supposed to do.In confirmation of the opinion I have advanced, that the imperfect system of district medical relief lays at the root of out-patient hospital abuse, I will quote from a return, moved for by the then President of the Poor-law Board, Mr. C. Villiers : it refers to sick cases in metro- politan districts, i866-the year before the Metropolitan Poor-law Act, i867, was passed.This return gives the number of cases of fever and zymotic disease, acute disorders, and chronic disorders, which were under treatment on January 7th and July 17th of that year.Having been at that time the medical officer of the Strand Union Workhouse, the population of which union was then 42,000, I had a personal knowledge of this union.On January ist, Mr. H.Jones, district medical officer, had 2 cases of zymotic disease; 3 of acute disorders, and i8 chronic.On July 7th, no zymotic cases; 3 acute, and 14 chronic disorders.On January 7th, Mr. Brookes had 4 zymotic cases; on July 7th, none; on January 7th, I acute case; July 7th, none; on January 7th, 4 chronic cases; on July 7th, I. Now, it will be asked, where were the sick poor of this union?Why, with the exception of those in the workhouse infirmary, they were under treatment at the dispensaries and out-patient departments of the various medical charities which abound in that union.That I may not be supposed to deal unfairly with this return, I may state that in the Paddington Union, Mr. R. Harper only had one patient on July 7th, and none at all on January 7th; similarly, Dr.Cook of Hampstead had only four.Now, there is no error in this re- turn, for it was made by the medical officers themselves.Passing from the general consideration of medical relief in the coun- ties I have above referred to, let me contrast the population, number of district medical officers and apothecaries, of workhouse medical offi- cers and apothecaries, the total cost of medical relief, the gross amount of poor relief, and the relation between the expenditure on medical re- lief and gross relief in the four Irish unions-viz., the North Dublin, South Dublin, Belfast, and Cork-and the three unions of Chorlton, Salford, and Manchester for the year i871.Thus, Chorlton, with a population of 21I,357, had 9 district medical officers, 2 workhouse medical officers; the cost of medical relief was /I,391 ; the cost of gross relief, /40,760; and the proportion of medical to gross relief, 30.Salford: population, 128,894; district medical officers, 4; workhouse medical officers, 2; cost of medical relief, /952; cost of gross relief, /30,308; proportion of medical to gross relief, 31 M. Manchester population, 173,965; district medical officers, 5; workhouse medical officers, 4; cost of medical relief, /2,587; cost of gross relief, /73,457; proportion of medical to gross relief, 28yz.Contrasted with North Dublin population, 135,146; district medical officers, io, and 3 apo- thecaries; workhouse medical officers, 4, and 7 apothecaries; cost of medical relief, /4,360, of which /987 is cost of medicine; cost of gross relief, /30,762 ; proportion of medical to gross relief, 7. South * Read before the Thames Valley Branch.