UNITED STATES OF AMERICA
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1363 two other institutions of similar scope-Sir Patrick Dun’s Hospital and the Royal City of Dublin Hos- pital. He pointed out that a hospital unit of 100- 150 beds could not hope to do its work as efficiently as a larger unit, and stated that the governors had been forced to the opinion that better service for the public and better opportunities for education and research would be obtained by the merging of these three hospitals into one. The proposal had been warmly encouraged by the Hospitals Com- mission, and a joint committee was busy working out the details of a scheme. On the evening of Dec. 5th the matron enter- tained a company of some 300 nurses and guests to a dance in the hospital, and on the next day a dinner of past and present students and members of the staff was held at the Royal Hibernian Hotel when a company of over 200 sat down under the chairmanship of Sir John Lumsden, senior member of the staff. THE APPOINTMENTS COMMISSION Since the selection of candidates for appointments under local authorities was committed some eight years ago to a local appointments commission, the working of that body has been closely watched, and its value is now recognised in almost every quarter. Medical candidates are particularly pleased that nowadays they can look with confidence to a fair consideration of their claims and a fair recommenda- tion as a result. The President of the Executive Council, Mr. de Valera, who admitted that he had been at one time prejudiced against the work of the Commission, declared in the Dail a few months ago that he was quite satisfied that it performed its duties efficiently and fairly. In 1928 a Select Com- mittee of the two Houses of the Legislature was set up to study the working of the Commission. It made a report containing several recommendations of importance, none of which have up to the present been acted upon. UNITED STATES OF AMERICA (FROM AN OCCASIONAL CORRESPONDENT) A PHYSICIAN’S FANTASY WHEN President Roosevelt, speaking in Washington on Nov. 15th, expressed doubt as to whether the time had come for any federal legislation on old- age security, he added : " Organisations promoting fantastic schemes have aroused hopes which cannot possibly be fulfilled." His words will generally be understood to refer to the proposal of a California physician, Dr. F. E. Townsend. This doctor, retired from service as public health officer in Long Beach, conceived the idea of using old-age pensions as a complete cure for depression and economic ills in general. He would give to every person over 60 years old in the United States$200 a month on the single condition that the money must all be spent within 30 days. This enormous expenditure would prove such a tonic to industry that everyone would find employment and prosperity would return. The huge sums necessary to make these payments are to be raised by a sales tax. It is not astonishing that Dr. Townsend failed to interest the 1933 Congress in this project. What is remarkable is the success that he met when he appealed for popular support. One meets his ardent disciples in the most remote places, men, and especially women, to whom the Townsend plan has become a veritable religion. Dr. Townsend himself conducts an office in Washington that employs 500 people ; to that extent, at least, he has contributed to re-employment. Some 4,000,000 individuals have signed petitions favouring a trial of his plan. In the same speech that foretold the postponement of old-age pensions Mr. Roosevelt referred to health insurance as due " soon or later." Whether or not a health insurance bill will be introduced in the next Congress, plenty of work on the coming American plan is being done behind the scenes by the President’s committee on economic security. The Journal of the American Medical Association announces that the presidents of the American Medical Association, the American College of Physicians, and the American College of Surgeons have accepted positions on a medical advisory board. Popular interest in the subject will be maintained by a series of 19 radio addresses under the general title Doctors, Dollars, and Disease, which are sponsored by the National Advisory Council on Radio in Education and will be broadcast over a nation wide hook-up weekly from Nov. 19th to Feb. 25th (10.45 P.M., E.S.T.). FALLING DEATH-RATES The Bureau of the Census announces a record low death-rate for the year 1933. There were 1,342,073 deaths from all causes which, on the estimated popula- tion for 1933, gives a death-rate of 10-7 per 1000. This is also the first time that mortality statistics are complete for the whole country, the State of Texas having been admitted last year. Deaths from contagious diseases showed a decrease, due chiefly to decreased mortality from influenza- and from tuberculosis. Maternal mortality also declined. Cancer deaths remained practically the same as for 1932. Mortality from this cause had increased steadily for 15 years prior to 1933. The mortality experience of the Metropolitan Life Insurance Company for the first nine months of 1934 indicates that the tuberculosis death-rate has continued its remarkable decline, though the general death-rate may be slightly higher than last year. An unusual feature of this experience is the appearance of divergent trends for pneumonia and influenza, the former having increased while the latter has again decreased. Suicides and homicides have each decreased, but there has been a sharp rise (9-6 per cent.) in the fatalities from automobile accidents. Panel and Contract Practice Mortgaging of Practices AT the November meeting of the Insurance Acts Committee the question was raised as to the prevalence of this practice in various areas. Many instances have occurred in Lancashire and in the London area. Birmingham, it seems, has had only one case of a practice changing hands with a mortgage on it, although of course there, as elsewhere, practices have been bought with borrowed money. It might be argued that a doctor who owes money for his practice on which he has to pay interest would be more likely to give way to lax certification, canvassing, and other doubtful practices with the idea of attracting patients and paying off his loan the more quickly ; or equally plausibly that under such financial control he would behave as a salaried assistant and be less liable to ethical transgression. Certain it is that financial organisations are increasingly approaching doctors, especially those with big lists, with offers of attractive
Transcript of UNITED STATES OF AMERICA
1363
two other institutions of similar scope-Sir PatrickDun’s Hospital and the Royal City of Dublin Hos-pital. He pointed out that a hospital unit of 100-150 beds could not hope to do its work as efficientlyas a larger unit, and stated that the governors hadbeen forced to the opinion that better service forthe public and better opportunities for educationand research would be obtained by the mergingof these three hospitals into one. The proposal hadbeen warmly encouraged by the Hospitals Com-mission, and a joint committee was busy workingout the details of a scheme.On the evening of Dec. 5th the matron enter-
tained a company of some 300 nurses and gueststo a dance in the hospital, and on the next day adinner of past and present students and membersof the staff was held at the Royal Hibernian Hotelwhen a company of over 200 sat down under the
chairmanship of Sir John Lumsden, senior memberof the staff.
THE APPOINTMENTS COMMISSION
Since the selection of candidates for appointmentsunder local authorities was committed some eightyears ago to a local appointments commission, theworking of that body has been closely watched, andits value is now recognised in almost every quarter.Medical candidates are particularly pleased thatnowadays they can look with confidence to a fairconsideration of their claims and a fair recommenda-tion as a result. The President of the ExecutiveCouncil, Mr. de Valera, who admitted that he hadbeen at one time prejudiced against the work ofthe Commission, declared in the Dail a few monthsago that he was quite satisfied that it performed itsduties efficiently and fairly. In 1928 a Select Com-mittee of the two Houses of the Legislature was setup to study the working of the Commission. It madea report containing several recommendations of
importance, none of which have up to the presentbeen acted upon.
UNITED STATES OF AMERICA
(FROM AN OCCASIONAL CORRESPONDENT)
A PHYSICIAN’S FANTASY
WHEN President Roosevelt, speaking in Washingtonon Nov. 15th, expressed doubt as to whether thetime had come for any federal legislation on old-
age security, he added : " Organisations promotingfantastic schemes have aroused hopes which cannotpossibly be fulfilled." His words will generally beunderstood to refer to the proposal of a Californiaphysician, Dr. F. E. Townsend. This doctor, retiredfrom service as public health officer in Long Beach,conceived the idea of using old-age pensions as a
complete cure for depression and economic ills in
general. He would give to every person over 60 yearsold in the United States$200 a month on the singlecondition that the money must all be spent within30 days. This enormous expenditure would provesuch a tonic to industry that everyone would findemployment and prosperity would return. Thehuge sums necessary to make these payments areto be raised by a sales tax.
It is not astonishing that Dr. Townsend failed tointerest the 1933 Congress in this project. What isremarkable is the success that he met when he appealedfor popular support. One meets his ardent disciplesin the most remote places, men, and especially women,to whom the Townsend plan has become a veritable
religion. Dr. Townsend himself conducts an officein Washington that employs 500 people ; to thatextent, at least, he has contributed to re-employment.Some 4,000,000 individuals have signed petitionsfavouring a trial of his plan.
In the same speech that foretold the postponementof old-age pensions Mr. Roosevelt referred to healthinsurance as due " soon or later." Whether or nota health insurance bill will be introduced in thenext Congress, plenty of work on the coming Americanplan is being done behind the scenes by the President’scommittee on economic security. The Journal of theAmerican Medical Association announces that thepresidents of the American Medical Association, theAmerican College of Physicians, and the AmericanCollege of Surgeons have accepted positions on a
medical advisory board. Popular interest in the
subject will be maintained by a series of 19 radioaddresses under the general title Doctors, Dollars,and Disease, which are sponsored by the NationalAdvisory Council on Radio in Education and will bebroadcast over a nation wide hook-up weekly fromNov. 19th to Feb. 25th (10.45 P.M., E.S.T.).
FALLING DEATH-RATES
The Bureau of the Census announces a record lowdeath-rate for the year 1933. There were 1,342,073deaths from all causes which, on the estimated popula-tion for 1933, gives a death-rate of 10-7 per 1000.This is also the first time that mortality statisticsare complete for the whole country, the State ofTexas having been admitted last year. Deaths from
contagious diseases showed a decrease, due chieflyto decreased mortality from influenza- and fromtuberculosis. Maternal mortality also declined.Cancer deaths remained practically the same as
for 1932. Mortality from this cause had increasedsteadily for 15 years prior to 1933.The mortality experience of the Metropolitan Life
Insurance Company for the first nine months of 1934indicates that the tuberculosis death-rate hascontinued its remarkable decline, though the generaldeath-rate may be slightly higher than last year.An unusual feature of this experience is the appearanceof divergent trends for pneumonia and influenza,the former having increased while the latter has
again decreased. Suicides and homicides have eachdecreased, but there has been a sharp rise (9-6 percent.) in the fatalities from automobile accidents.
Panel and Contract Practice
Mortgaging of PracticesAT the November meeting of the Insurance Acts
Committee the question was raised as to the prevalenceof this practice in various areas. Many instanceshave occurred in Lancashire and in the London area.
Birmingham, it seems, has had only one case of apractice changing hands with a mortgage on it,although of course there, as elsewhere, practices havebeen bought with borrowed money. It might be arguedthat a doctor who owes money for his practice onwhich he has to pay interest would be more likely togive way to lax certification, canvassing, and otherdoubtful practices with the idea of attracting patientsand paying off his loan the more quickly ; or equallyplausibly that under such financial control he wouldbehave as a salaried assistant and be less liableto ethical transgression. Certain it is that financialorganisations are increasingly approaching doctors,especially those with big lists, with offers of attractive
