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"intervals of a month or thereabouts, 'renewal' orders from the Relieving
"Officers and of the entries of such ' renewal' orders in the Medical Officers'
"books precisely as in the case of original orders. This fact, however, by no
"means accounts for more than a proportion of the apparent diminution in
"the number of separate cases, and other causes must be sought for the
"extraordinary comparative figures which your tabular returns contain.
"But here a difficulty presents itself, from the impossibility of assigning the
"diminution with any positiveness to a given cause. Having conferred
"upon the subject with Medical Officers and Relieving Officers I am led to
"the conclusion that various causes have contributed to the very satisfactory
"results indicated by your Returns. In the first place there is reason to
"believe that there has been an actual diminution of sickness to a moderate
"extent. Next the continuous improvements, under your own direction,
"which have been effected in the sanitary condition of the District must
"necessarily have been conducive to a greater degree of health among
"the poorer classes. This opinion appears to be confirmed on persual
"of the column headed 'Fever' in Table VI., the number of such cases
"having been greatly reduced during the last three years; the number in
"1868 being 586, while in 1871 they were only 201. And lastly, to the
"improvements which have been effected in the administration of Poor Law
"medical relief within the Union must be attributed to a large extent the
"favourable returns now comparatively presented. "Whilst reasonable, and
"indeed, increased facilities are afforded to the necessitous poor to obtain
"medical and other relief, there is now, as regards the official staff, a greater
"sub-division of labour than formerly, and this without division of responsibility.
There is also a stricter discrimination exercised in the grant of
"medical relief and a closer investigation of the circumstances of persons
"who may apply for medical relief than was possible under the old regime.
"You have recollection of the time when each of the two Relieving Officers
"of the Union was compelled to ventilate their crowds of morning applicants
"by disposing first of the large number who came for ' doctor's orders,' and
"having ' given such orders—many upon trifling pretexts - that it was
"absolutely impossible for the Relieving Officers promptly to visit and closely
"to investigate such cases. Now, however, a salutary change has been
"effected. In lieu of two Relieving Officers and two Assistants there are
"five Relieving Officers (without Assistants), the Relief Districts being con"terminous
with the five Medical Districts. There is now but one Dispensary
"for the entire Union, and at this Dispensary (which adjoins the Relief
"Office and communicates with it by means of a speaking tube) the Medical
"Officers attend each morning to see patients and prescribe medicines. The
"Relieving Officers being in attendance during corresponding hours in the
"adjoining office, the immense advantage of the Relieving Officer and
"Medical Officer of a District being enabled to confer upon cases which
"present themselves is apparent. Prom these two departments an applicant
"may, when the circumstances justify, obtain medical order, medical advice