does not end here; unhappily it permeates into the higher social ranks, to the degradation of scientific therapeutics. In respect of the out-patients, hospital abuse, by persons able to pay for advice, is perhaps exaggerated; still, by direct provision or by means of provident dispensaries, some of them might be induced to obtain the more individual and discriminating aid of physicians living among them, conversant with them and their ways, and with the external causes and conditions of their maladies. Thus, by treatment of a more comprehensive kind on physiological lines, vulgar notions of the laws of life and disease would be enlarged, and some health would be compassed not for the body only but also for mind and character.
Hitherto I have been considering the out-patients of Great Britain as hordes; but at the same time I am not forgetful of the precious gifts of diagnosis, and even of treatment, which thus fall to the lot of many of them, as to persons overtaken by acute or vexatious diseases, but who, even if fully aware of the nature of the case, are unable or unprepared to pay for medical aid. Many sufferers are thus consigned to the wards, and on discharge are kept still under supervision; others are benefited by topical remedies, specific drugs, or elaborate technical methods, such as massage, electricity, x rays, or medicated baths, which in general practice are out of reach. Again in respect of diagnosis, there are poor patients as well as rich whose maladies are obscure in nature or difficult to manage; patients who may have made, and be making, payments to a medical man, but are quite unable to add the fees of a consultant, or the charges of costly methods of cure. Even in the poorer families of the middle classes serious illness is a grievous or even a crippling expense, especially in these days of elaborate and costly therapeutics, against which some more orderly provision is sadly needed. And as things are, these important cases are more or less swamped by the horde.
How, then, is the out-patient department to be organised for efficiency, and with respect to the physician in general practice, who in these days has become far too competent a man to be ignored? Time permits me to consider one part only of the problem. It has been proposed that access to an out-patient department shall be only by the introduction of a medical man in the district. This is too narrow a proposal.
