The use and abuse of medical charities in late nineteenth century America

Philanthropia - the love of man - has a long and honorable tradition in the history of medicine. Medical charity has always been one facet of the humanitarian character of the medical profession. It is medicine, said Alexander Stevens in the first presidential address to the newly formed American Medical Association in 1848, that is the link uniting science and philanthropy. Yet when the charitable impulse runs afoul of the medical market place, economics have usually dominated philanthropy. One such encounter between the needs of patients and the needs of their physicians at the end of the nineteenth century was particularly interesting, and engendered the controversy that became known as the dispensary abuse. In discussing the use and the alleged abuse of medical charity in the late nineteenth century, a whole series of medical and social problems must be considered. Income, of both patients and doctors, the supply of physicians, medical education, changing patterns of medical care, especially specialization, regulation of medical practice, and by no means least noteworthy, the quality of medical care are all important facets of the intense arguments over the abuse of medical charities. As discussed by physicians and social workers in the years between the Civil War and World War I, medical charity usually referred to hospitals and their outpatient departments and to free standing dispensaries. The historical development of both these institutions has already been very well described by George Rosen in 'The Impact of the Hospital on the Physician, the Patient and the Community', that appeared in Hospital Administration in the Fall of 1964, and more recently in an article by Charles Rosenberg in the January, 1974 issue of the Journal of the History of Medicine, entitled 'Social Class and Medical Care in Nineteenth Century America: The Rise and Fall of the Dispensary'.