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PARAGRAPH 650-SURGICAL INSTRUMENTS, ETC.

should this be the case, we then think, with this marked reduction of almost 50 per cent, that there is less excuse than there ever has been for class legislation.

Seventh. In view of the fact that practically 50 per cent of the hospitals in this country are run for profit (and profit only) all of whom would be eligible, under the proposed change, to import free of duty by the mere maintenance of a single free bed or the subscriptions of a few friends, however small, to the work of any particular private institution, there would be an opportunity for one of the worst problems the customs officials have ever had to deal with. In view of the proposed reduction, which is liberal indeed, and the fact that American institutions are maintained by direct taxation as well as by American contributed money, we do not believe your honorable body will countenance class legislation.

And if I have time I should like to cite two or three instances. The CHAIRMAN. Your time is just up, but you may have a few minutes.

Mr. THOMAS. The petitioner referred to salvarsan, and the layman should not be ignorant about this. A false modesty has been urged in this matter. This is a specific for syphilis. As a matter of fact probably not 1 per cent of the institutions of this country, of the hospitals, except a few private hospitals, will accept these syphilitic cases for treatment. In Boston I know of only one outside of those of a public nature, and that is really a private hospital, but it can be conceded that we are willing to give every advantage of the doubt in this case. It has not been long ago that a gentleman, now present in this room, told me that an agreement had been made between doctors whereby they would only administer this treatment at a price of $25. If it is a fact that the worst menace this world has can not be treated in the hospitals, as they are at present organized, then there is some excuse, perhaps, for our contention that there would be abuses if they are not open to do the greatest work that hospitals have ever had to do; then we feel there is some reason for contending that perhaps they are not entitled to this great privilege, this class legislation.

There is another item, and that is blood-pressure apparatus, which has been absolutely promoted in this country by the dealer, and for that reason doctors have now come to recognize that blood pressure is as important as the clinical thermometer, and the promotion of blood-pressure apparatus has been done absolutely by the dealers. I do not say that the intelligence of the doctors has not approved that, but, as a matter of fact, we would have been 10 years coming to blood pressure, while through the efforts of the dealers we have come there in a matter of 12 or 15 months, and I could repeat endless instances of that sort.

We have nothing against charity; we have nothing against the hospital; we believe it is a great institution, and nothing should be done to hamper it, but if the granting of this privilege will hamper the industries built up around it to the extent that it will give inefficiency for the great mass of people who employ us for preventive measures, and also handicap the hospitals themselves, because they can not get the supplies, and 80 per cent, I venture to say, of the hospitals will not be able to import anyhow. They can not antici

PARAGRAPH 650-SURGICAL INSTRUMENTS, ETC.

pate their needs. It is the rich institutions, like St. Luke's, who can buy $25,000 worth of scientific apparatus, who can avail themselves of this privilege, but the rank and file, even the municipal hospitals, can not, to a great extent, avail themselves of this privilege.

TESTIMONY OF DR. GEORGE F. CLOVER, NEW YORK, N. Y.

The witness was duly sworn by the chairman.

Dr. CLOVER. Mr. Chairman and gentlemen of the committee, I appear in behalf of a subcommittee of the American Hospital Association, a body comprising 1,100 members, representing 600 of the leading hospitals of the country.

We petition that section 650 of the tariff act be so amended as to include among the institutions authorized to import instruments and utensils and medical preparations, including Roentgen or X-ray plates, free of duty hospitals rendering medical and surgical aid free of charge. In the list of institutions now permitted to import their instruments free of duty are those established for educational and scientific purposes. I submit, gentlemen, that the hospitals which we represent are educational, are scientific, and are also charitable institutions.

They are educational because they maintain training schools for the training of nurses, who are taught to become nurses of the country. These training schools are recognized by the departments of education of their respective States, and are brought under the rules and regulations of those departments. They are educational because they receive medical students from the various medical colleges for educational work, and it is in these hospitals that the medical students receive the practical part of their education. Medical schools of the country are now taking the ground that they will not graduate their medical students unless they have a certain term of service in our hospitals. It is within the walls of our hospitals that physicians and surgeons get their knowledge, their expert knowledge, which make them the prominent physicians and surgeons of the country.

Our hospitals are scientific because within the wards of the hospitals observations are made and classified which make up the medical and surgical data and knowledge of the country. They are scientific because within their laboratories diseases are investigated, and the prevention and cure for disease is often found. Our Government has encouraged science, it has encouraged education, it has encouraged art, it has encouraged literature; but to the greatest of these charityis given no such consideration.

We ask that instruments be placed on the free list, for the reason that a great many of the instruments used in hospital surgery are not made at all here. Other instruments are not made so good as those which we get from abroad. Other instruments are of very good quality, those made of the softer metals, which we do use and which we shall continue to use. are not made here at all. are not nearly as perfect.

Of the scientific apparatus, a great many
Others, such as lenses for our microscopes,
The surgeons, appreciating the need of the

PARAGRAPH 650-SURGICAL INSTRUMENTS, ETC.

best instruments and the best scientific apparatus where life and death is concerned, refuse to use many of the instruments made in this country.

As an evidence of the scientific work of our institution, I submit a volume of surgical and medical reports of the hospital which I represent, in New York-St. Luke's Hospital. Such reports add a great deal to the scientific knowledge of the country.

Mr. JAMES. What effect would this have on the revenue?

Dr. CLOVER. I think very small, sir. The surgical instruments manufactured in this country are below $1,000,000-somewhat over $500,000. The scientific instruments and the surgical instruments combined, I understand, amount to less than $6,000,000.

Mr. JAMES. How would he distinguish between

Mr. HILL. Will you, for the benefit of the committee, try and distinguish between the classes of hospitals and educational institutions that now have the privilege of free admission, and those that do not have? Is it not practically down to the point where those doing business for profit do not have the privilege, and those which are purely educational do have it?

Dr. CLOVER. I am making my plea sir, here for charity; not for institutions that exist for the purpose of making profit. There are in this country about 6,000 hospitals; 3,000 of that number may be classified as public or semipublic hospitals. The best work done in the country is not done in what we may style public hospitals, but the voluntary hospital sometimes called the private hospital, which is of a very high order of institution. That does the educational and scientific work, and a large proportion of its work is free work. Medicine and surgery could not have reached the state of perfection they have reached without these hospitals, and we could not hope for very much progress in the future if these institutions did not exist and were not encouraged. Our hospitals are becoming more educational and more and more scientific.

We make our plea, Mr. Chairman, not in our own interest, or even in the interests of our hospitals, but we make it in the name of charity, for the benefit of the poor people of the country.

Mr. HILL. Doesn't St. Luke's now have this free?

Dr. CLOVER. No, sir.

Mr. HILL. Why shouldn't it?

Dr. CLOVER. I think possibly by a subterfuge we could get our implements in free of duty. We receive, for instance, a certain number of students from Columbia University for educational purposes, and I might make the plea that we were attached to Columbia University. We have no corporate connection with Columbia University. I do not believe in subterfuges, and I do not believe most of the hospitals believe in subterfuges. I know of no hospitals except those that are identified with educational institutions, such possibly as Johns Hopkins, at Baltimore, that do get their implements and instruments in free of duty.

Mr. JAMES. You want this right for hospitals that make no charge for services?

Dr. CLOVER. We make this plea for hospitals that render free care and treatment to the public. Hospitals do these volunteer hospitals do-make some charge to people who can afford to pay. In New York

PARAGRAPH 650-SURGICAL INSTRUMENTS, ETC.

the average free work done by the hospitals is 65 to 75 per cent. That does not include the great work done in the dispensary, which we call ambulatory patients. That work is very large, and is entirely free work, with the exception of an insignificant charge for medicine, if the patient can afford to pay even that charge; otherwise that work is entirely free.

We ask this privilege for surgical instruments, for scientific implements, for X-ray plates. Most of the X-ray plates used here are very excellent plates, but we are obliged to get a very highly sensitized plate from England, that can not yet be obtained in this country, for tissue work-work involving the stomach and the chest. We do not have so many of those plates, but they are extremely expensive, and we are obliged to use them to some degree.

Then, in medicines, medical preparations, there are constantly being discovered in the laboratories of Germany such preparations as Salvarsan, "606," Prof. Ehrlich's discovery. That medicine is administered in our dispensaries and in our hospitals, although it has cost these institutions from $2.50 to $3.50 for a single dose. The men and women of this country have been wonderfully benefitednot only the men and women, but the children, the innocent children. The child unborn has been saved from hereditary syphilis by this remedy.

It is not unlikely that within a year or two a specific for tuberculosis will be discovered, and it is of tremendous importance to the health and welfare of the poor citizens of this country that if these discoveries are made, we be able to administer them to such people as quickly as possible and as cheaply as possible.

Mr. HILL. You recognize the difficulties in the administration of the law, do you not? No one would insinuate for a moment that St. Luke's Hospital would no anything that was not right and proper, and the purpose has been to have such an administration, but the difficulty is to know where to draw the line, so that the Government will not be exploited for purposes of private profit.

Dr. CLOVER. I think the charter should be withdrawn from any institution that exploits its instruments or its medicinal preparations that have been admitted free of duty. I do not believe, sir, that any reputable institution would do that.

Mr. HILL. Disreputable ones might.

Dr. CLOVER. Well, they ought to be put out of existence.

Mr. JAMES. Some of the hospitals that do charitable work, and yet do work for charge or pay, would make considerable profit. If you provide, as you suggest, without limiting it or safeguarding it in some way, these hospitals that really make profit would be permitted to get these instruments free.

Dr. CLOVER. No, there are sanitariums and privately owned hospitals that are in the business for profit. The volunteer hospitals are not in it for profit, although they may have connected with them a department for private patients, or for pay patients. The proportion of patients treated in such departments is very small. Moreover, the hospitals in this country are not sufficiently numerous to meet the needs of the country. We are woefully behind Europe, we are woefully behind Great Britain, in our number of hospitals, and

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PARAGRAPH 650-SURGICAL INSTRUMENTS, ETC.

any surplus after paying the expenses of the pay departments, is turned right over to charitable work. I know of no institution that is not running with an annual deficit, and I know of no institution which ought not to be enlarged. Every cent of money saved, should our request be granted, will be used for the enlargement and betterment of the work among the poor. That is what we primarily exist for.

Mr. JAMES. What percentage of the importation of these instruments and medicines are used by hospitals that are what you might term charitable hospitals?

Dr. CLOVER. That question is very difficult to answer, sir. I haven't data covering that field.

Mr. HARRISON. You stated that about half of the institutions in the country were charitable institutions.

Dr. CLOVER. Yes; that is true.

Mr. HARRISON. They are probably, on the whole, a good deal larger than the others?

Dr. CLOVER. They will be probably 75 to 80 per cent of the insti

tutions.

Mr. HARRISON. Are there any further questions, gentlemen? Before you leave the stand, Dr. Clover, I would like to ask you a question that occurred to me when you mentioned that you represented St. Luke's Hospital. It is on an entirely different subject from that about which you have testified. We had here last week a very lively controversy before the committee between witnesses for and against revising the duty on lemons, and one of the subjects that received a great deal of attention was the statement of one of the witnesses that lemons were very largely used in hospitals, and that the duty had increased the cost of those used medicinally, and another witness appeared and stated that a canvass had been made of the five leading hospitals in New York, in which he asserted it was discovered that these hospitals used only one-tenth of a lemon per patient a year. Now, what is your experience as to corroborating or discrediting that testimony?

Dr. CLOVER. Why, I would say, sir, that was either a misstatement or that the man compiling those figures included ambulatory or out patients, patients who come to the dispensaries and get their treatment. Lemons are a very necessary element in the treatment of certain diseases; in the treatment of fever cases chiefly. What is known as Lanhart's Diet is made up very largely of lemons. I simply can tell you of my own experience at St. Luke's. We use something like 35,000 lemons a year, and in order to economize I have to decline to honor the requests of physicians there occasionally. We ought to use 60,000, but lemons have been very high the last two or three years, and we have to economize. But in fever cases the use of lemons is increasing constantly, and I think will continue to increase.

BRIEF SUBMITTED BY DR. G. F. CLOVER.

As a committee appearing in behalf of the American Hospital Association, a body having a membership of some 1,100 individuals and representing over 600 of the leading hospitals of the country, we respectfully petition that paragraph 650 of the present tariff act be amended in such wise that it may include hospitals rendering medical

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