and amounted during the past year, after crediting all legacies, to $58,504.88. The receipts of the hospital from donations. and legacies were as follows: Donations, $46,003.83; legacies, $32,730.14. This continued deficit would indicate an apparent lack of appreciation of the large amount of charitable work done by the hospital, and unless the hospital receives increased support it will inevitably be forced to curtail its work and diminish its usefulness, and that curtailment will be out of proportion to any saving in expenses actually made, for many expenses of the hospital are constant without regard to the number of patients, and the cost of treatment per capita increases as that number is diminished. This situation cannot be too strongly emphasized. It is not as if there were city hospitals in New York to which the needy poor could resort if the doors of the Presbyterian Hospital could not be opened more widely or had to be half closed. The city hospital accommodation in New York is entirely inadequate to meet the needs of its population. The free hospital treatment given in many cities by public hospitals is in New York supplied by the Presbyterian and other private hospitals. Unless these private hospitals be adequately supported, the poor must suffer while city hospitals are being built, and city hospitals must be built at whatever increase in city taxation.' From report of the New York Skin and Cancer Hospital for the year ending September, 1902: "Total deficiency in general expense account September 30, 1902, $12,511.89." The following further personal opinions have been received by the Editor of CHARITIES: John E. Parsons-I am, and for many years have been, the president of the Woman's Hospital. I am also, and from the beginning I have been, president of the General Memorial (formerly the New York Cancer) Hospital. The financial problem is always before those who are interested in hospital administration. Expenses are inevitable. So far as my knowledge goes, there is a conscientious effort on the part of those concerned in the management of all hospitals in the city to reduce expenses to a minimum and to practise all reasonable economy. None the less, there is the apprehension that at any time there may be a deficiency of receipts to meet expenses, and a necessity of determining what shall be done. I am not sure that it is the interest of hospitals that they shall be possessed of endowments so large as to save the necessity of appeals for public assistance. It is desirable that the philanthropic public shall be kept informed about hospital management, and one way to accomplished this is by appeals for financial aid, to point to the fact that without such assistance the work is endangered. The darkest period of the night is just before the dawn. In the case of hospitals it not infrequently happens that when the situation seems to be the most discouraging, relief comes from some unexpected source. One result is that hospitals continue to live under circumstances which seem to threaten their continued existence. I am opposed to state or city aid in the case of private hospitals. Assistance should come from board money received from patients, from the income of endowments, legacies, and donations from individuals. The help from legacies is necessarily uncertain, and yet about so uncertain a matter as that, the law of average in a very vague and indefinite way does apply. The same is true about money to be received from patients. The public is beginning to recognize the advantages of hospital treatment, and in many of the hospitals there are private rooms which patients are glad to occupy, and at varying charges, in some cases the charge being sufficient, or nearly sufficient, to meet the expense. The subject with which it is perhaps most difficult to deal is that which is referred to in Mr. Tucker's article. The Hospital Saturday and Sunday Association was established for the reason, among others, that it furnished a subject, in aid of which Protestant, and Romanist, Jews, Christians, and persons of all other religious belief, or of no belief, might join in common effort. Pleasant as is the sentiment which is concerned, my judgment and observation are that from a mere money standpoint. hospitals lose rather Hospital Work Menaced in New York than gain from the association. It is an easy thing to contribute a small amount to a church collection for a general cause. I think that a larger contribution could be obtained from the same individual in answer to a direct appeal for a particular and specific cause. I do not believe that hospitals will be suffered to die. However great may be the discouragement, the work justifies itself, and I think that it is reasonable to hope that the support will be forthcoming. Charities have not received their fair share of the enormous accumulations of recent years. While the generosity of many persons who have recently acquired wealth is marked, it seems to me that larger sums are to be hoped for if the cause is suitably represented and its needs made known. A very well-known gentleman, possessed of considerable means, said to me some years ago, "I do not give because I do not know how to give." Giving requires an education. That the means exist, and that it will be forthcoming, however serious the discouragement. I firmly believe. E. S. Hopkins, Jr.-In connection with the questions raised in Mr. Tucker's article on the condition of the hospitals. in New York, the following suggestions may be of some value: That all patients be charged some sum of money and that this charge be based upon three considerations: The amount of attention received, the actual cost of such attention to the hospital, and the financial resources of the patient. A fourth consideration might be the natural profit on illness which the medical profession have a right to expect in return for the time which they expend in preparing themselves to combat it. The question of medical attention in New York for the millions of people in moderate circumstances is one of acute importance, and the present costly system of private practitioners must in time give way to some more equitable condition, both in respect to patient and practi tioner. Treatment in private hospitals or at home is alike costly, and treatment in public hospitals is repugnant to reasonable pride. A surrender of this pride or financial ruin are the alternatives which face the man who has in prospect a long 69 illness or a slow recovery from some accident; if not financial ruin at least a great and unjust sacrifice, or if not that then the acceptance of inferior medical assistance from some physician whose practice is limited by the prices which it is necessary for him to charge to meet the demands made on doctors living in New York. As the great majority of patients must. always continue to be persons of limited means and of very limited means-it would seem that by charging them a reasonable price for illness the demoralization of charity would be removed and the interests of the medical profession conserved. This might be accomplished by the means suggested and by the growth in size and number of hospitals which would follow. It would be easy to ascertain the cost per patient per hour to each particular hospital, for each particular complaint and for each stage of the complaint. Thus a man with a broken leg might be charged twenty-five cents an hour for the first day of his treatment, five cents per hour for some weeks subsequent, and two cents per hour until discharged. If such a man had a good position, say as a clerk or as a mechanic, and had no one dependent upon him, this charge might be doubled, while in case of an unemployed man with a dependent family it might be done away with entirely. The initial cost per hour would represent the actual expense to the hospital and the additional charge could be credited to profits, and while furnishing just profits would at the same time secure that very desirable discrimination between persons of varying financial resources, a discrimination which is exercised constantly by almost all physicians, even under present conditions. Twenty or thirty classes of persons could be designated, basing the classification on the salary received by the patient, the number of those dependent upon him, or upon the resources of those upon whom he is dependent. Such a system as this would doubtless have the effect of working a hardship upon general practitioners if suddenly and successfully introduced, as the sick would be able to be attended by a fewer number of physicians, but ultimately the number of medical students would be decreased, the medical bill of the entire city would be vastly reduced, the general medical practitioners would entirely disappear, and in every way the modern beneficial tendency toward consolidation and specialization would be furthered. Dr. W. E. Dreyfus, Chemist, Bellevue and Allied Hospitals.—In the article published January 2 in CHARITIES, regarding the financial problem of city hospitals, I see that Dr. J. W. Brannan has laid great stress on the economy which might be secured in the use of surgical and medical supplies. I think that in this respect Dr. Brannan has touched a vital, and at the same time, a very sore point in the management of the majority of hospitals. You probably know that fourteen charitable institutions of the city of New York are supplied with medicines, drugs, surgical ligatures, druggist's sundries, liquors, and operating furniture from this department, and the amount of money spent for this purpose is very much Magazines of the Week CHARITY. Christmas Dinners for Many. (Co-operation January 2.) Work of the Associated Charities in Cities. Charles A. Allen. Report of Committee on Extension of Organized Charities. C. N. Pond. Why Is There Any Need of Proper Charity Organization in Our Smaller Cities and Towns? L. J. Bonar. The Extension of Oryanized Charity as Promoting a Wise Management of Municipal Relief. W. S. Eagleson. (Ohio Bulletin of Charities and Correction for the quarter ending December 31.) CHILDREN. The Medical Care of Children in Elementary Schools. (Hospital- December 26.) State Care of Indigent Crippled and Deformed Children. Arthur J. Gillette. Clinical Dmonstration and Remarks on Crippled Children. C. E. Sawyer. Girls' Indu trial Home. George B. Christian, Jr. Self-Gorerning Ros. J. A. Gunckel. Child Problems and Their Treatment. Amos W. Butler. Cleveland Boys' Home. A. G. Lohmann. (Ohio Bulletin of Charities and Correction for the quarter ending December 31.) DOMESTIC ECONOMY. A New Solution of the Dome tic Problem. Caroline Stone Atherton. (Federation Bulletin January.) EDUCATION. Progress in Education. Edward Lyttleton. (National Review-December.) Education and Religion. Arthur S. Hadley. (Independent- December 31.) HOSPITALS, General Hospitals. A. C. McCabe. (Ohi Bulletin of Charities and Correction for the quarter ending December 31.) INSTITUTIONS. Evils in County Institutions. (Co-operation January 2.) LABOR. Colorado: The Ba'tle Ground of Labor and Capital. Arthur Chapman, (World To-Day-January.) (Labour Gazette, Dominion of Canada December.) The Abolition of Strikes and Lockouts. Frank Parsons. (Arena-January.) NURSING. Nurses and the National Physique. (Hespital-December.) Suggestions Regarding Training Schools for Nurses. Florence F. Rice. (Trained Nurse and Hospital Review - January.) SETTLEMENTS. Chicago Commons, Eugene Parsons. (World To-Day-January.) TUBERCULOSIS. Minneapolis in Line. (Co-operationJanuary 2. A Plea for Justice to the Consumptive. S. A. Knopf. (Medical Record-January 2. Ameri below the average amount spent for such purposes by private institutions. This is not due to the fact that the institutions in question are not provided as well as private institutions. On the contrary, we have been very liberal to them. It is, on the other hand, due to our system, and mostly to the fact that we manufacture everything we possibly can, at a saving. You know that all the chartered charitable institutions are entitled to tax-free alcohol, but very few take advantage of it, in the sense that they use this tax-free alcohol to manufacture their high-priced fluid extracts, tinctures, etc. The saving for our city institutions on tax-free alcohol during 1903 amounted to about $21,000, the indirect benefit therefrom being about $9,000 more. To give you a specific instance: Before the Kings County hospitals were supplied from this department they spent the sum of $17,771.12 for drugs, liquors, etc. Afterthey were consolidated with this department we furnished them the same amount at a saving of nearly $4,000 per annum. can and International Congresses on Tuberculosis and Tuberculosis Exhibits for the Years 190, and 1905. (Southern California Practitioner-December.) Department of Tuberculosis. F. M. Potterger. Southern California Practitioner - December. Come Investigations of a Bacterial Treatment of Tuberculosis. Stephen J. Maher. A Gospel of Hope Against Tuberculosis. Editorial. (New York Medical Journal and Philadelphia Medical Journal-January 2.) WOMEN'S CLUBS. The Work of Women's Clubs. Martha D. White. (Federation Bulletin January.) From the Twenty-first Annual Report, Cambridge Associated Charities, 1903."Each year our work naturally affiliates with that of other activities that seemed a few years since quite apart from our duties. If one look, for example, at CHARITIES one finds it filled now with articles on the new hopes of curing that appalling scourge tuberculosis. The new story of this horror comes out, indeed, in New York under the auspices of the Charity Organization Society.1 As if they were making a plea for the Consumers' League, we are told what the sweat-shop means as a means of disseminating disease. At least 20,000 inmates of these New York tenements are afflicted with this contagion, Dr. Pryor thinking the estimate far too small. Our local burden from the disease is, by comparison, small. 1 The Plague in Its Stronghold, 1903 A Weekly Review of Local and General Philanthropy. Publication Office: 105 East 22d Street, New York portant branch of the university was No less striking was Dean Wayland's contribution to the cause of organized the Hotel Chelsea, Atlantic City, Febru- ary 18 and 20, inclusive. An instructive and interesting program is being arranged and it is hoped there will be a large at- tendance. The two previous sessions were held in the assembly chamber at Trenton, and were attended by a large number of people. In going this year to the south- ern part of the state, the officers wish to indicate that the conference is truly a state organization, and not a sectional or local one. A representative committee has been appointed in Atlantic City, with Comp- troller A. M. Heston as chairman. The conference will open Thursday evening at eight o'clock with two addresses of general interest. E. C. Stokes is to speak on "The State's Duty Toward Its Dependents," and Jeffrey R. Brackett, president of the National Conference, on "The Worker in Charity and Correction." Defectives, E. R. Johnstone, chairman; Friday morning. (2) County and Municipal Charities, C. F. Currie, chairman; Friday afternoon. (3) Treatinent of the Criminal, Miss Mary S. Lewis, chairman; Friday evening. (4) Private Charities, the Rev. F. A. Foy, chairman; Saturday morning. on Two excellent articles have Dr. Bernstein been contributed to recent Institutionalism. numbers of The American Hebrew by Dr. L. B. Bernstein, superintendent of the Hebrew Sheltering Guardian Society. In the first there is a definition of institutionalism, and in the second a consideration of the methods by which it may be counteracted. It is not the suggestions themselvesalthough these are pertinent and of a practical character that are of the greatest significance, but the fact that so impor tant an institution as that which has called Dr. Bernstein to be its executive, is giving serious consideration to the problems discussed in these papers. That there are valid objections to the congregate or barrack system is realized by the writer, as shown by his closing declaration that "however sincere one's efforts may be to realize truly human individualization and a natural family tone in a congregate institution, the irresistible drift of modern institutional policy points to the real remedy; to the cottage or pavilion system." Unanimous Tenement-law Decisions. Unanimous decisions were handed down last week by the Appellate Division on the sanitary provisions of the New York tenement-house law, which give unquestioned legal foundation to the policy of making tenement-house owners alter their property from time to time in harmony with advancing standards of sanitation and decency. Line for line, the new law has been subject to the most searching litigation and the readers of CHARITIES are already familiar with the details of the Moeschen case, one of two involving the same point, coming before. differently constituted courts. Both decisions in favor of the Tenement-house Department were unanimous, so that all seven judges of the Appellate Division joined in sustaining the law, as did every lower tribunal before which the cases were brought. No appeal lies from the findings of the Appellate Division without special permission from that court, and even if granted, there is little likelihood of a reversal. to Public Opinion. Public opinion has brought Quick Response about a stay in the decision to shut down the evening schools, recreation centers, and playgrounds in New York. As result of the agitation of the friends of these more progressive educational activities, there is now no likelihood that they will be discontinued. And, as brought out at the meeting of the Council for Civic Cooperation-a report of which will be found on another page of this issue the time is opportune to press for an enlargement of these activities and a more intelligent administration of those al ready carried on. At a meeting of the Board of Education Thursday evening, action was taken rescinding the earlier resolution to close. the special activities February 1, and a committee of five was appointed to assist Comptroller Grout in determining whether the cut in the appropriations at the hands of the Board of Estimate and Apportionment may be met by economies in other branches of the school department where waste and extravagance have been alleged to exist. Mavor McClellan is quoted as saying that, if the investigation does not make this apparent within six weeks, money will be forthcoming, probably through the issue of special revenue bonds. 1 Admission to each series, $3; to single lectures, 50 cent. |