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Account ledger detailing the payments made by the union's Dispensary Districts. Payments are recorded under columns headed; date, name of officer, for, no. of paying order, medicine and medical appliances, rent of dispensary buildings, books, forms, stationery, printing and advertising, Medical Officers salaries and payments for temporary services, Dispensary Caretakers salaries for payments of temporary services, Midwives for payments of temporary services, vaccination expenses and other expenses.

Accounts from September 1916 to September 1925 are arranged by a monthly account of the payments of the Dispensary Districts of Banagher; Ferbane; Frankford; Birr and Killyon; Kinnitty; Riverstown.

Following the abolishment of the Union in 1925, and the transfer to the county councils' Board of Health, this ledger appears to have been repurposed to include payment accounts broadly across the county, and includes the accounts of Blueball/Killoughey; Daignean/Geashill; Tullamore; Cloneygowan and Portarlington; Kilcormac; Edenderry; Rhode; Rathangan; Roscrea; Shinrone; Moneygall, Tullamore County Hospital; Birr District Hospital; Edenderry District Hospital; Clara.