Hospitals in Towns in England, with Medical Schools attached Hospitals in Dublin, Belfast, Cork, and Galway ESSAY. THE number of Medical Practitioners in the published Medical Register for 1878 was 22,841. Churchill's Medical Directory for the same year contains a much larger number. According to our reckoning, which may be regarded as approximatively correct, the members of the profession were thus distributed : Practising within the London Postal Districts 3,749 11,091 Resident abroad Medical Officers of the Army, Navy, Indian Total · 1.968 2,421 - 2,479 - 23,790 The difference between the numbers of practitioners whose names appear in the Medical Register and Medical Directory respectively, is an excess of about 950 in favour of the Medical Directory. This excess must include some deceased practitioners whose names have not been removed from the Directory, some no longer practising, and those who remain unregistered. The following table gives the number of physicians and surgeons returned at the three censuses of 1851, 1861, and 1871, the population, and the proportion of physicians and surgeons to the population in the three divisions of the kingdom: The average number of persons to one medical man was as The comparison of 1851 with 1871 is vitiated by the circumstance that in 1851 the Medical Act was not in existence, and any one called himself physician or surgeon. In 1861 there was an "ugly rush for qualifications," and there were many foreign graduates. The increase of "physicians" and "surgeons" in the United Kingdom during the 10 years from 1861 to 1871 is, on the face of the figures, only 242—an increase of 269 in England and Wales, and of 63 in Ireland-and a decrease of 90 in Scotland. Dr. Farr considers that the medical attendance for the people was extremely defective in 1851, and more defective in 1876, and that there is an imminent danger that it may become quite inaccessible to vast numbers of people. He calls attention to the increase of chemists and druggists pari passu with the decrease in the supply of medical men, and intimates that they do not live by mere retail or the sale of drugs. In 1841 the chemists and druggists were 7,816; and in 1871, 15,540-an increase of 7,724 in 30 years, or 257 annually. The proportion of chemists and druggists to 10,000 of the population was 4.9 in 1841, 6·0 in 1851, 6-3 in 1861, and 6-8 in 1871. The number of assistants and medical students aged Proportion of Medical Men to Population. 20 and upwards was, in 1851, 2,228; in 1861, 2,276; and in 1871, 3,116. It is difficult to arrive at any trustworthy determination of the proper proportion of medical men to the population. In the army there is a surgeon to every 204 men, or 49 to 10,000. The civil population have not one-sixth part of this number. It is impossible to accept the army as affording any fair basis for even an approximate conclusion. The analogy of the army is fallacious, because the supply in the army is based on a calculation of extraordinary contingencies, which are not taken into account in civil life. Nor can we lay down any hard-and-fast line for the United Kingdom which would be applicable for each of its divisions, nor a hard-andfast line for any of the divisions which would be applicable to all the counties, or for the counties which would be applicable to the towns and villages and country districts, or for any large town which would be applicable to more than a few of the other large towns. The subject is of a decidedly complex character. In order even to arrive at the actual facts of the case as it stands at present, more information is required. We must add to the number of medical men the number of practising unqualified assistants and counter-prescribing chemists, and these two classes are an unknown. quantity, whose absence from the calculation would vitiate the conclusion which we wish to draw. We want to ascertain, at least approximatively, what proportion of medical men is an adequate proportion for supplying the wants of the population under ordinary circumstances, and it is doubtful whether we are at present in a position to settle the question. All that can be done with the data before us consists in calculating the actual proportion of qualified medical men to the population in each division of the kingdom. It is sufficient here to state that the alterations in the proportions existing in 1871 have been comparatively unimportant, and for all practical purposes the figures contained in the table above given may be still used. If we turn to the various towns, and villages, and districts in the different divisions of the kingdom, we find the greatest anomalies prevailing in the distribution of medical men, and in their proportion to the population-the differences ranging, in examples taken more or less at random, from 1 medical man to 210 persons at Buxton, Derbyshire, to 1 to 6,295 at Aberdare. The conclusion at which we have arrived is that no safe general statement can be made until the circumstances of each individual |