PARAGRAPH 650-SURGICAL INSTRUMENTS, ETC.

a committee appointed for the purpose of petitioning that hospital instruments, apparatus, etc., be placed on the free list, some of the statements made by Mr. F. H. Thomas and Mr. Charles J. Pilling, of the American Surgical Trade Association, be answered.

ARGUMENT AS TO HARM THAT WOULD ENSUE TO SURGICAL INSTRUMENT MANUFACTURERS SEEMS TO BE OVERRATED AND OVERSTATED.

Mr. Thomas asserts that a large portion of the work done by the instrument manufacturers in this country is for the making of the newer instruments and orthopedic apparatus used in the treatment of chronic cases. The United States is the mother of orthopedic surgery, this line of surgery having been inaugurated by the late Dr. Sayre, of New York. Instruments for this service are as well made here, if not better, than abroad. They must be fitted by the surgeon to the patient and, therefore, there is no probability whatever that they will be imported. As stated by me at the hearing, the soft-metal instruments, as made in the United States, are excellent and for that reason there will be no inclination to import them.

Mr. Thomas argues that at least 60 per cent of the surgical instuments and allied articles are at the present time imported. The brief submitted by me states that 80 per cent are so imported. The discrepancy in his figures and mine is doubtless caused by the fact that I did not include orthopedic apparatus and instruments for the treatment of chronic cases in my estimate; but, accepting Mr. Thomas's figures as correct, I have little or no doubt that, including the orthopedic appliances and soft-metal instruments, the instrument manufacturers of this country would continue to supply 40 per cent of the instruments purchased for use here even with the duty eliminated altogether. There will be no desire to purchase abroad instruments that are made here and that are satisfactory to the surgeons.

THE PROPORTION OF HOSPITALS OPERATED FOR PROFIT TO THOSE MAINTAINED FOR CHARITABLE PURPOSES.

That 50 per cent of the hospitals in this country are run for profit (and profit only), as stated by Mr. Thomas, is apparently true; but, if considered from the point of services rendered and patients treated rather than from a numerical viewpoint, the ratio would be greatly altered. It would show that at least 80 per cent of these hospitals are charitable institutions. The private hospitals are, for the most part, very small affairs. Moreover, my brief for hospitals was for those only which render medical or surgical aid to the public or a portion thereof free of charge, in which instruction in medicine and nursing is given and whose expenses are borne wholly or in part by public funds, private subscription, or endowment. This excludes nstitutions which are maintained and run for profit.

THE USE OF SALVARSAN.

Mr. Thomas's statement that not 1 per cent of the hospitals in this country will accept syphilitic cases for salvarsan treatment is erroneous. I do not know of any hospital in the city of New York that is not purchasing salvarsan for treatment of syphilis. Had Mr. Thomas asserted that but few hospitals receive cases of syphilis to their wards in the primary or contagious state, because such cases would be dangerous to their patients, his statement would have been correct. Such cases are treated in the dispensaries of the hospitals and cases of the remoter effects of syphilis (and the number of such cases is legion) and inherited syphilis are treated with salvarsan in the wards thereof. Mr. Thomas's assertion that there is an agreement between doctors that they would only administer this treatment at a price of $25 would make it appear all the more necessary that the hospitals be placed in a position to obtain salvarsan as cheaply as possible in order to administer it to the poor.

STATEMENTS AS TO ST. LUKE'S HOSPITAL.

As to statements regarding St. Luke's Hospital, my appearance before you was in behalf of hospitals generally and their charitable work and not to exploit St. Luke's Hospital; but as our opponent illustrated his contentions with much detail regarding this institution it is necessary that I respond by referring to it and to its acts and work specifically.

Some of the assertions made by Mr. Pilling are erroneous, while others, as they were stated, are misleading. St. Lukes is not a wealthy institution in proportion to the services it renders. It publishes for distribution to the public each year, in its

PARAGRAPH 650-SURGICAL INSTRUMENTS, ETC.

annual report, a copy of which is filed herewith (not printed), its income and its expenditure account, page 23; its balance sheet, page 24; detailed list of its assets, pages 25 and 26; statistics as to classification of patients, etc., pages 39 and 40; and a detailed expense and revenue statement, pages 43 and 44. These tabulations show that the average of the patients per day for the fiscal year ending September 30, 1912,

Besides the charitable work done in the wards, as stated above, the statistics of work in the dispensary, or out-patient department, shows that 47,298 visits were made, or an average of 216.6 visits each day, while in the visiting or home nursing department, the total visits made was 3,488, making the average patients per day, in all departments, 526. For many years several of the wards of the hospital were closed, because its revenue was insufficient to maintain them. One ward is still closed for the same reason. It has spent each year more than its income in its efforts to meet the demands made upon it for charitable, medical, and surgical relief. At the end of the last fiscal year its deficit was $22,000. Moreover, as shown by the plan of buildings published in the report, it purposes to extend its charitable work by erecting new buildings as rapidly as its finances will permit.

PRIVATE-ROOM SERVICE.

The private-room service of the hospital does not in the least degree detract from its charitable work, but, on the contrary, it distinctly adds to it, since all revenue over and above its expenses is used for the maintenance and extension of its free work, and therefore the institution, in maintaining a private-room service, is no less charitable in character, but rather more so than one that does not maintain such service.

SPECIAL NURSING.

Mr. Pilling's statement as to extra charges made to private patients for special nurses and anesthetists implies that the hospital derives a revenue from this service. When the private graduated nurse, at the request of the patient or family of the patient, is called in from outside, she herself receives all the money collected for her services, less 50 cents per day for her board while nursing the patient in the hospital. The fee referred to as charged by the anesthetists for private patients is not charged by the hospital, but by an expert anesthetist called in for the purpose.

AS TO ALLEGED FEES CHARGED BY RESIDENT PHYSICIANS.

The entire statement on this subject is erroneous. There are no fees charged by the resident physicians and surgeons for their services.

PARAGRAPH 653-PLATINUM.

FEES OF VISITING PHYSICIANS AND SURGEONS.

While such physicians and surgeons do, for their own protection, charge a fee to their well-to-do private patients, they invariably consider the financial condition of the patient, reducing their fees when necessary, and in many instances remitting altogether.

The replies, as above made, to the assertions regarding St. Lukes will, in a general way, answer those made as to other charitable institutions. An arthopedic hospital or dispensary, for instance, that maintains its own instrument-making shop does not do so for profit, but in order to give braces and instruments to its poor patients at a nominal charge and where necessary without any charge, and in other ways to further its charitable work.

Respectfully submitted.

WASHINGTON, District of Columbia:

Subscribed and sworn to before me this 5th day of February, 1913.

[SEAL.]

GEO. F. CLOver.

EDWIN D. FLATHER,

Notary Public.

PARAGRAPH 651.

Phosphates, crude.

PARAGRAPH 652.

Plants, trees, shrubs, roots, seed cane, and seeds, imported by the Department of Agriculture or the United States Botanic Garden.

PARAGRAPH 653.

Platinum, unmanufactured or in ingots, bars, plates, sheets, wire, sponge, or scrap, and vases, retorts, and other apparatus, vessels, and parts thereof, composed of platinum, for chemical uses.

PLATINUM.

THE WAYS AND MEANS COMMITTEE,

United States House of Representatives, Washington, D. C.

GENTLEMEN: In preparing the new revenue act permit us to call to your attention paragraph 653 on the free list of the existing law.

This paragraph reads: "Platinum, unmanufactured or in ingots, bars, plates, sheets, wire, sponge, or scrap, and vases, retorts, and other apparatus, vessels, and parts thereof, composed of platinum, for chemical uses."

On account of the extreme high price of platinum, which has more than doubled in price within the past five years, we respectfully request that no duty be imposed on unmanufactured platinum, ingots, bars, plates, sheets, wire, sponge, or scrap.

The domestic source of supply amounts to not more than 300 to 500 ounces annually, nearly the entire quantity imported being of Russian origin.

In reference to platinum for chemical purposes, if it is the intention of the committee to make this dutiable, we would suggest that not over 5 per cent or 10 per cent be fixed as the rate, on account of the high value of platinum.

Furthermore, several constructions can be placed on the wording of the existing law. While "platinum for chemical purposes" was intended only to apply to articles for analytical work or the manufacture of chemicals, we call to your attention that there are a number of articles and appliances made of platinum for attachment to machines and mechanical devices designed to be brought in contact with or convey chemicals, but their application or use is only incidental to the manufacture and treatment of materials that could not in any way be classified as chemicals. Therefore, these articles should not be exempt from duty under this paragraph.

We request also, for the reasons above stated, that no duty be placed on the items covered by paragraph 595, which are known as the platinum group of metals.

Very respectfully,

MALVERN, PA., January 30, 1913.

78959°- -VOL 6-13-15

J. BISHOP & Co. PLATINUM WORKS, BY CHAS. H. KERK, Secretary.

PARAGRAPH 654.

Plumbago.

PARAGRAPH 655.

PARAGRAPH 655-CAUSTIC POTASH.

Potash, crude, or "black salts"; carbonate of potash, crude or refined; hydrate of, or caustic potash, not including refined in sticks or rolls; nitrate of potash or saltpeter, crude; sulphate of potash, crude or refined, and muriate of potash.

See also W. H. Bower, p. 5873.

CAUSTIC POTASH.

TESTIMONY OF MR. C. C. SPEIDEN.

The witness was duly sworn by Mr. Harrison.

Mr. SPEIDEN. Mr. Chairman and gentlemen of the committee, you will permit me to say that my first rough statement on this subject was made as the result of a casual conversation. At that time I had no idea or intention of appearing before your committee. Some of the facts stated, however, came to the attention of several consumers of the goods in question, who suggested that I put before you further facts pertaining to the subject.

Mr. HARRISON. Now, Mr. Speiden, before you leave that subject, if you will allow me to interrogate you. You are to testify as to paragraph 655 of the present bill?

Mr. SPEIDEN. Yes.

Mr. HARRISON. As to the articles, hydrate of potash

Mr. SPEIDEN. Yes, and carbonate of potash.

Mr. HARRISON. Not including refined, in sticks or rolls. Is that correct?

Mr. SPEIDEN. Yes, sir; that is correct.

Mr. HARRISON. Well, now, are you a member of the firm of Innis & Speiden?

Mr. SPEIDEN. Innis, Speiden & Co.; yes, sir.

Mr. HARRISON. And you are the author of a letter to the New York Evening Post concerning the imposition of a duty upon this article, a couple of weeks ago, are you not?

Mr. SPEIDEN. I plead guilty to that; yes, sir.

Mr. HARRISON. I understood that. I wish to elaborate a little on that. And in that letter you suggested that for years this article had been on the free list and had remained so until this Congress, yielding to the persuasions of a single American manufacturer of this article, had placed the duty upon it and intended to protect the manufacturer. Is that correct?

Mr. SPEIDEN. That was an inadvertent form of a part of statement. Mr. HARRISON. Now, I understand you now that you wish to say that you were misinformed, and that you retract that statement? Mr. SPEIDEN. I certainly will, so far as it applies in that way. Mr. HARRISON. Now please proceed.

Mr. SPEIDEN. One of the members of your committee also suggested that you would like to hear further facts concerning the subject.

Just how the real facts of any situation may be obscured by those seeking tariff favors was probably never better illustrated than in the

PARAGRAPH 655-CAUSTIC POTASH.

recent hearing before the Ways and Means Committee when the one and only manufacturer of caustic potash in America sought to have a duty placed upon this article. All the arguments against a duty on caustic potash apply with equal or greater force to any duty on carbonate of potash, which is also largely used by the woolen, soap, and glass industries; also in some tobacco fertilizers potash is required in the form of carbonate.)

For over 20 years, under all tariffs. Republican and Democratic alike, caustic potash (also carbonate of potash) has been on the free list. It is used extensively in soap and woolen goods making (also in electroplating and fine chemical industries). It is made chiefly by electrolysis of the muriate of potash from the Stassfurt mineral potash deposits in Germany.

A few years ago an enthusiastic inventor, thinking he had discovered a process that would produce caustic potash economically, induced a large chemical firm to allow him to work out his theory in their laboratory, where it was clearly demonstrated that the process was neither practical nor economical, and the experienced chemical firm promptly dropped it. The persuasive inventor, however, had better success with some Wall Street promoters, who were induced to go into it on a manufacturing scale and in due course of time a small factory was installed at Niagara Falls.

This factory demonstrated in a larger and more conclusive way the unprofitableness of the undertaking, but the investment had been made and, as was only natural, the undertaking was kept alive in the hope that something might be done to extricate the unfortunate investors. Something was done, namely, debts were incurred-a very substantial one being that owed to the producer of the muriate of potash in Germany, who, to save himself, took over a controlling interest in the reorganized business, only to find that the advantage of ownership of raw material 4,000 miles away was not sufficient to offset other disadvantages inherent in the project itself.

It now became the turn of the new German owner to devise some method of extrication, and obviously that offered by a protective tariff appealed most strongly to him, since with sufficient protection he could make a profit on both his muriate of potash refined from the crude potash salts in Germany, and the caustic potash converted from this muriate here. Accordingly, at the recent hearing before the Ways and Means Committee specious arguments were advanced by the representatives of this foreign owner as to why a duty of $20 per ton should be imposed on this article, which is essentially raw material in the soap making and woolen manufacturers' industries. Many irrelevant and misleading statements were made, to which, according to the record, no refuting testimony was offered, and on its face it would seem that the committee were allowed to remain in ignorance as to the real facts. It would appear that the German's representatives bald assertion that the price need not be raised more than 25 per cent to afford him his desired protection was somewhat at variance with the policy of a downward revision of the tariff, or free raw materials.

We believe it will only be necessary to have the pertinent facts fully understood by your committee to have them realize the injustice