To deny ready relief to the sick and needy who have no physician, may know none, or in any case are unable to pay for his intervention in cases, for instance, of incipient acute disease, of infections, or more insidious maladies would not be, and ought not to be, tolerated by the public, whether in the name of charity or of civil order. Moreover, the delicate question must arise, How fairly the general practitioner would play the game? As things are, the ill-paid "club doctor" often, and not unnaturally, declines to add to his bounden duties; nay, the physician who resents a hint at "further advice," or sniffs at it when obtained, is not quite extinct. Again, what about the time, the trouble, the miscarriage, and the comparative ineffectiveness of brief notes or messages?
The proposal as it stands, then, is narrow and impracticable; yet it touches an important principle, especially as regards cases of difficult diagnosis, those again which need costly methods of cure, and afflicted persons who have paid fees but can pay no longer. To encourage family physicians to refer patients of these two classes to the hospital is then the duty of the managers; and for the cases of difficult diagnosis or treatment I suggest that the need would be met by the appointment at every hospital, and in each department, of an invariable hour when the outside physician and his patient could rely upon a consultation with one or other of the honorary staff in his respective department These hours should be fairly frequent and invariable; the busy practitioner cannot be counting days and hours, he must be able to say offhand when John or Mary shall meet him at the hospital gates. There he would probably encounter others of his brethren on similar errands; and, if all could join in each consultation, they would derive as much of interest and experience for themselves as of advantage for their patients. Such a system would surely extend itself in many incalculable ways; it would offer a fertile field for the younger consultants, raise the value of medical methods in the eyes of the public, and tend by example to reduce the burden of hangers-on and of routine prescribing among them, and even, perhaps, the vague discontent and quack-hankering among the well-to-do. I will only add that on the medical side provision should be made for consultations in mental diseases.