Page images
PDF
EPUB

WHEN SICKNESS COURTS POVERTY.

To us, fortunate proprietors of small holdings in the banks, happy in the knowledge that we have friends who are able, besides being willing, to help us, sickness is no amiable visitor. To those who live from one week-end to another with many wants that no economy seems able to supply she is the very sister of despair. It is not true, as some would have us believe, that sickness and poverty together form a "vicious circle". A circle can be broken. This malignant commixtion of ills would better be termed a “vicious vortex from which the best rescue apparatus so far devised can save but a fraction of the victims.

But have we exhausted the possibilities of mutual aid? Can no better apparatus be invented? It is to this question that Mr Gerald Morgan has recently addressed himself in an instructive and quite readable little book (1). He first shows the inadequacy of voluntary health insurance. In doing so he is greatly helped by the valuable report issued in 1919 by the Health Insurance Commission of the State of Illinois. A careful study of 3,000 families, representative of various industries in Chicago, showed that 20.9 per cent of all wage-earners lost wages on account of sickness but that only 13.4 per cent of those sick received insurance payments. A more detailed analysis proved that those who most needed insurance, because most often sick, poorest and nearest dependency, were insured least often and least adequately. This general conclusion can be taken as true of other places than Chicago where voluntary insurance is relied on; it is indeed the justification of those nation-wide schemes which have been formulated to co-ordinate and to support the work of the voluntary insurance societies. Whether or not these national schemes are along right lines, the reader must judge for himself. Mr Morgan compares and contrasts the state-aided system of Denmark and the compulsory systems of Germany and Great Britain. He describes

(1) Public Relief of Sickness, by Gerald Morgan. New York: The Macmillan Company, 1922.

also the Davenport Health Insurance Bill, introduced into the New York State legislature on March 11th, 1920, though not yet passed into law. Criticism is shrewdly confined to important features and is nearly always just.

From the point of view of preventive medecine the most important feature of this book is its castigation of medical benefits, that is the provision to the sick man, in part return for premium payments, of what is technically known as "adequate medical attendance and treatment". Here are some of the charges brought against them :

a) They are expensive; so expensive that in order to supply even inadequate medical attendance, the cash benefit has to be reduced to a quite insufficient level.

[ocr errors]

b) Since new methods of diagnosis and of treatment are always being introduced, the cost of 'adequate attendance and treatment" goes on increasing and cannot be accurately foretold. This is a serious actuarial difficulty.

c) Doctors are obliged to make strict contracts for their services. The commercial side of medical practice is unfortunately emphasized, and indeed the practitioner receives a direct pecuniary inducement to scamp his work.

d) The system of medical benefits provides what is in effect a public medical service at public expense (since wage-earners, employers and Government all contribute), yet available to only onethird of the population (medical attendance and treatment is not afforded to the families of insured persons).

Mr Morgan's remedy is like the Red Queen's : "Off with their heads ", he says. It is a simple solution and has much to commend it. Of course these beheaded benefits will have to be replaced. Mr Morgan is ready with their successors: the title of his last chapter reads Reasons for public medical relief by health centres in America. They are good reasons and apply equally well to other countries. Most of them have been already set down in these columns (1). The Robinson-Moore

1) See The World's Health, vol. 3, p. 129.

Health Centre Bill provides the author with a convenient model of Health Centre legislation. This bill is designed for the State of New York and was introduced on February 28th, 1921. Its prospects of passing, unamended, into law are at present none too bright, but, if it should succeed in spite of its enemies, we shall all profit from the interesting experience of a community in which adequate medical treatment is really available at all times, to all in need of it, irrespective of their means; and where there are appropriate institutions for the care of every ailment and beds for all who come.

Can such a Utopian measure have enemies? Alas for human waywardness, it can. First there is the Economist. Of course it is always a mistaken (economic) policy to attempt to save money on the necessary safeguarding of health, but the mistake just now is a common one. There is also the Doctor. On page 179 Mr Morgan gives a whole paragraph of reasons why the average doctor should be pleased about the Health Centre, but he knows quite well that the doctors will in fact be very far from pleased. Anything suggestive of a State Medical Service is anathema. Who would exchange a remunerative country practice, won by years of unselfish service, for the post of a hireling, set to fill up endless forms by a stupid and meddlesome bureaucracy? And then, supposing that some pushing young graduate, fresh from school, should be given the post over your head --and half your practice gone!

Perhaps, as Mr Morgan thinks, the doctors' fears are exaggerated, but we must look at the problem from their point of view and do all in our power to mitigate the evils and discomforts which the socialization of medicine involves. We commend at the same time, to all opponents of the bill these words from an essay by Sir Arthur Newsholme (1):

"We scarcely realize how far we have gone in the socialization of medicine. It is impossible to go back, or to stand still. The services of the medical profession are needed, not only to provide the necessary service, but in helping to determine

(1) The increasing socialization of medicine in "Public Health and Insurance", Baltimore: The Johns Hopkins Press. 1920.

[merged small][ocr errors][merged small][merged small][merged small][merged small][merged small]

Those who are employed either professionally or as volunteers in the fight against disease for a greater abundance of life may, with advantage, abandon for a few moments the smoke and turmoil of the fighting line to study in the more tranquil atmosphere of their army's headquarters those maps and diagrams which reveal the broad strategy of the whole campaign. Time so spent is not wasted. They return, refreshed with hope for the final issue and more dangerous to the enemy by their knowledge of his armament and of its disposition. It is for this reason that the busiest public health worker should take time to read a series of addresses by the professor of vital statistics in the new School of Hygiene at Johns Hopkins University. These addresses were recently delivered before the Lowell Institute at Boston and are now published in book form as one of a number of monographs on experimental biology.

In The Biology of Death (1) Dr. Pearl has found a striking and appropriate title. In his book we read what Life has to tell us about Death. We learn that for long ages Life was untroubled by this youthful cousin and we are a little surprised to find that even now she regards him without terror, not even as an enemy, but rather as a

(1) The Biology of Death, by Raymond Pearl. J. B. Lippincott Co. Philadelphia & London, 1922, pp. 275. Price $2.50.

useful scavenger of her worn out clothes. For if the amoeba is immortal, so too, and in the same sense, is man, linked to his most distant progenitor by one unbroken protoplasmic chain. We see in their true proportion the little bodies which for a brief while have grown, as it were excrescent from each human link, and crumbled, and been dutifully dusted off by the active hand of Death. Having thus adjusted our perspective, and still not wholly indifferent to this flickering temporal body of ours, we examine it more closely. It is built of cells, each derived from the union of two immortal germ cells which form a true link in the chain of Life. These body or « somatic » cells are of many varieties, specialized to perform the diverse duties of muscle, nerve and blood. But though they are so unlike the parent cells yet it is true that they too are born of the immortals. Wherefore should they die?

Biologists, searching an answer to this question, have at last shown that these somatic cells too, if they are given the right environment, will go on living, certainly longer than the species from which they are derived, almost certainly for ever. Listen to this:

<< By the method of transfer to fresh nutrient media, Carrel has been able to keep cultures of tissue from the heart of the chick embryo alive for a long period of years. In a letter, recently received, he says: The strain of connective tissue obtained from a piece of chick heart is still alive and will be nine years old the seventeenth of January, 1921 ".

[ocr errors]

Now the average age of a hen is from 2 to 4 years. Moreover this existence in vitro does not involve the loss of functional specialization seen in the cancer cell, which Leo Loeb showed, twenty years

"Burrows was ago, to be potentially immortal. able to demonstrate that the isolated heart muscle cells of the chick embryo can divide as well as differentiate, and beat rhythmically in the culture medium".

Still is man born to trouble as the sparks fly upward. The trouble resides not in the essence of his body but in the complexity of its organization. He is fearfully and wonderfully made, to the end that he may accomplish many remarkable things. But the years of his life are three score years and ten, or thereabouts. That they are on the average more than they used to be, even in the prosperity of Roman civilization, two thousand years ago, is about the most encouraging evidence which statistical study affords of the success of modern methods in combating disease.

Anyone who feels that social medicine has not been worth while should consult Dr. Pearl's comparative life tables. He will assuredly agree that While the tired waves vainly breaking Seem here no painful inch to gain Far back through creeks and inlets making Comes silent, flooding in, the main.

On the other hand, the too rash enthusiast who is willing to ascribe to preventive medicine all triumphs past and to come will find himself gradually driven by mathematical logic to agree with this proposition « that inherited constitution fundamentally and primarily determines how long an individual will live ».

There is nothing so technical in this book that it will pass the comprehension of any educated reader and to all such we can promise that they will find in its pages the very quintessence of

romance.

J.R.E.

Le Gérant: LYMAN BRYSON.

[merged small][merged small][merged small][merged small][merged small][merged small][merged small][ocr errors][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small]

A MONTHLY REVIEW PUBLISHED
BY THE LEAGUE OF RED CROSS SOCIETIES

7, Rue Quentin-Bauchart, 7

THE LEAGUE OF RED CROSS SOCIETIES AND ITS PROGRAMME

The Red Cross is the symbol of human compassion. It was their pity for the suffering and unaided victims of the battle of Solferino (June 24th, 1859) that moved Henry Dunant and his friends to take the first steps which led to the formation of the International Red Cross Committee in 1863, and to the signature in 1864 of the Geneva Convention, under which the rights of the wounded in wartime were officially recognized. Red Cross Societies have since been formed in nearly every country.

In 1919 on the initiative of Mr. Henry P. Davison, Chairman of the War Council of the American Red Cross, the Red Cross Societies of America, France, Great Britain, Italy and Japan founded the League of Red Cross Societies, with the object of applying the spirit and organization of the Red Cross, in peacetime, to the improvement of public health throughout the world. The permanent Secretariat of the League, established in Geneva in 1919 and transferred to Paris in 1922, is a central office equipped to collect and distribute information bearing on the peacetime work of Red Cross Societies, and to assist them in planning and carrying out their programmes. The Secretariat also acts as the collective representative of the national Societies

belonging to the League, and in this capacity maintains close co-operative relations with the Health Section of the League of Nations, the Office International d'Hygiène Publique, the International Labour Office, and the more important non-official international health organizations.

The General Council, which is the supreme authority of the League, meets at least once every two years, It comprises delegates from all Red Cross Societies, members of the League. At its second meeting, in 1922, the Council recommended to all Red Cross Societies the adoption of peacetime programmes aimed especially at the development in their several countries of popular health instruction, public health nursing and Junior Red Cross organization. This is the basis upon which Red Cross Societies throughout the world are working to-day.

The Board of Governors of the League meets annually. It consists of representatives of each of the five founder societies, ten nominees of societies designated by the General Council, and the Director-General and Secretary-General. The Board of Governors directs the policy of the League in pursuance of the resolutions of the General Council.

LES PRESSES UNIVERSITAIRES

DE FRANCE

CO-OPERATIVE COMPANY OF PRINTERS, PUBLISHERS AND BOOKSELLERS

49, boulevard Saint-Michel. PARIS (V)

under the patronage of la Confédération des Sociétés Scientifiques françaises

Telephone : Gobelins 59-56

STUDENTS,

JOIN the Presses Universitaires de France.

BUY your books and stationery at the Presses Universitaires de France.

Postal Cheque 392-33

HAVE YOUR THESES PRINTED and published at the Presses Universitaires de

France.

ASK FOR THE list of the tECHNICAL COMMITTEES of the Presses Universitaires. You will find in it the names of all your professors.

APPLY to 49, Boulevard Saint-Michel, for further information.

« PreviousContinue »