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that not one of them knew who he was, though they had
intrusted him with $60,000 a year of their taxes. Little by
little I learned from charity work that the trail of politics
is over us all and that courts are clogged and institutions
crowded from misfits in government, from public indiffer-
ence and economic greed. Thereafter politics and industry
became my chief concern. In trying to make women in-
telligent, conscientious citizens, I feel the League of Women
Voters is doing constructive work for progress, and the
Consumers' League, by its unbiased research, is on the road
to justice for more people.

When the Community Chest was organized and a
citizen's generosity was rated by the size of his contribution,
far from realizing my childish dream of being a philan-
thropist, I was among the smallest givers. Although a be-
liever in central financing, so few are ready to give for
prevention instead of relief that I have always wanted my
bit to go toward education of the public on preventive
measures. When daily accidents used to occur at the corner
where I lived and passersby saw the bleeding victims, the
majority stopped and wanted to do something for them ;
but when the voters were asked to appropriate money for
traffic-signals to prevent accidents, there was little public
interest. For lack of imagination to visualize the trouble
they do not see, many good people have accident hearts
and not traffic-signal generosity.

Of course some of the societies included in the Chest do
preventive work, and I realize there must still be relief
work, but I sometimes think that if the members would
work as hard for prevention they could, in the coming years,
do away with the need for some of the organizations.
Moreover I cannot grasp how it can be really a community
chest when over 80 per cent of the citizens have no voice in
its management. As women have done charity work
throughout the ages, it would seem that they might still be
trusted to work with men for the common good. The
charities themselves must have some slight idea of their
own field, but they too are denied a word in the distribution
of the money, and the laboring people, the largest group in
any city, who are urged to give as true Americans, have no
way of expressing how they would like the money appor-
tioned. This decision is left to successful business men of
recognized integrity. Though some of these men are my
friends and I know well their earnest intentions and busi-



ness sagacity, might it not be wise to add men and women
with a knowledge of the basic causes of poverty? To en-
sure permanence and general good-will, I believe that the
Community Chest should have a better balanced board, not
by adding one woman, or one laboring man, but by having
a fair representation from different groups of citizens and
the included organizations.

Yearly I hand out golden nuggets of wisdom to the
enthusiastic solicitors who come for my quota. They have
so fine a spirit of civic enterprise that I am always torn
between a regret in crushing their budding hope and a sense
of duty to testify to the light as 1 see it. They bear with
me with invincible courtesy and then, undoubtedly cheering
themselves with remembered slogans for knockers, they go
back to the noon singing about all pulling together. How-
ever, there was once a young man who said : "Why I never
thought of that, I guess your're right." But he was evidently
not a good salesman and his place was filled.

To find the cause of misfortune, should we not go deeper
and learn from those who have suffered most from the
mistakes of our civilization what we did not do in our ig-
norance, or in our negligence, or alas, in our selfishness,
that they could not keep abreast of community life ?
Philanthropy has developed here from the old-fashioned
"God bless you" to the newer conception of justice which
would give more people opportunity to develop physically,
mentally and spiritually. The prevention of unemployment,
social insurance, betters wages and shorter hours, birth
control, playgrounds, better housing and a more liberal edu-
cation for adult and child these with the growing sense
of personal, industrial and community responsibility would
lessen the demands for charity. But a renewed faith in
democracy with a discernment of the value of beauty and
the things of the spirit, would also undoubtedly make for
the well-being of the whole nation. The late Ambassador
Walter Page summed it all up in this way:

The only acceptable measure of any civilization is the ex-
tent to which it improves the condition of the common people.
A few cultured and university-trained men at the top, a few
ancient families living in luxury, a few painters and poets and
statesmen and generals these things do not constitute a satis-
factory state of society: the real test is the extent to which
the masses participate in education, in the necessities and com-
forts of existence, in the right of self-evolution and self-
expression, in that equality of opportunity which is the basis
of social progress.

MY adventures in philanthropy are over. I believe now
that the truth alone can make us free, that more
people must have ways of hearing it, that permanent prog-
ress can come only by a recognition of the common brother-
hood of all. At times it seems that the world is not quite
ready for my way of saving it, and that Atlas does not want
women to help bear the weight of it, or to show him how
to make ballast out of a burden. Then again it may be that
Providence working with, or perhaps against, Congress can
eventually bring about the necessary changes. Hence I am
a candidate now only for membership in that most promising
society of the future, The Leave It to Evolution League,
and I shall be busy enough learning to obey the most diffi-
cult of all our laws, that of love, and content if I have
the privilege of working with the small group of self-
less men and women, usually obscure but occasionally
of passing prominence, on the age-long task of making an
ideal real.



Though Doctors Disagree

Cooperative Clinics are Open to One out of Three People in Berlin



By MICHAEL M. DAVIS




XCKPT for the absence of steins one might
have thought that this big waiting room
in Berlin was a cafe. There was an at-
mosphere of quiet sociability among the hun-
dred people seated in fours or fives around
little tables. There was subdued talking;
some persons were rending; others simply waiting. Every
few moments a young white-gowned attendant appeared
from the inner regions and called a name as a page calls
in a club, only less loudly, and having found the patient
named, escorted him to the doctor.

The courteous madchen at the admission desk asked me
to wait until the chief physician was disengaged. Standing
to one side I watched the new arrivals that followed me.
They showed a ticket of membership at the desk ; no ques-
tions were asked unless something on their ticket was not
clear; they paid no fees, for they or the breadwinners of
families were already contributors in weekly payments to
the insurance society which, federated with others of its
kind in Berlin, has set up this and thirty-seven other clinics
to furnish medical service to a million and a half persons
out of the four million inhabitants of the greater city.

When you have visited the average large clinic in
America, where most patients must wait and hope ; when
you have seen the herded men, women and children in the
teaching clinics of the German universities or the throngs
of persons in the great out-patient departments of London,
well advertised as recipients of charity in the hospitals' an-
nual reports you are prepared, as I was, to appreciate the
dignity and individuality which accompany organized med-
ical service under self-support. German insurance societies,



members represent the insured persons, one-third, the em-
ployers. This body elects a managing committee which,
inturn, chooses the executive officers.

Some nineteen million Germans are insured in about seven
thousand such societies united in a network of federations:
federation according to the kind of society, federations for
cities and districts, with a federation of federations for the
whole of Germany. Thus it is the federation of the sick-
ness insurance societies of Berlin under whose auspices the
thirty-eight clinics for furnishing medical care to members
and their families are now maintained.

While I had heard rumors about these clinics before
leaving America and had been given a brief account of them
at the office of the Health Section of the League of Na-
tions in Geneva, the extent of their organization and the
completeness of their equipment and service came as a
surprise.

It was hard to believe that the system had grown up
within two and a half years. I talked with Doctor Walter
Pryll, their effective organizer and medical supervisor and
now medical advisor of the corresponding federation of ^ so-
cieties for all Germany. He is an executive with a vision,
as well as a medical man. He said to me:

We are giving our members and their families better treat-
ment than they have ever had before. They have free choice
among all the clinics and physicians in our system,
each clinic on its mettle to hold a patient by developing mutt
interest between him and the clinic doctor. We give our phy-
sicians equipment and assistants to work with, laboratory fi
ities and opportunities for consultation which doctors cannot
possibly have in private practice among working pec
are giving them adequate salaries; t n e same schedul >ro-



physicians' widows in case of death. In Germany these gov-
ernment salaries have proved sufficient to attract and retain



bodies but are mutually self-governing organizations of in-
sured persons and their employers. Like our commercial

life insurance societies, though these German organizations a V ery satisfactory type of man.
are not commercial in our sense, they are under state super- We are doing
vision. These societies may be small organizations composed



centers of



clinic" are examples. And



of the employes of a single establishment. The larger and ' .. emp h a sis also to those chronic illnesses which

partially disable the adult worker, endeavoring to dimm,
incidence or severity when they cannot



writes



D/^/c room
Davis,



Convenient to the waitmg-
the Oranien-Strasse



tf * . t I

thirds of the cost is paid by j oes so \ ar g e a system of organized med-
the insured person, one-third by
his employer. Payment of half



n



more significant societies are formed on a district basis. All pYrtfaTly "disable the adult worker, endeavoring to .

employed persons where wages do not exceed a specified ~!J ..,.r; f u when thev cannot I
amount must belong to some
sickness insurance society. Two- / n no other City,

r. s *L~ fifteen departments

. service exist under one management. ^.^ ovef fo fhe chief spec i a i t ies
_ grew out of the physician's strike of Q{ medic j ne an d surgery; a well-
to two-thirds of wages during &nd ^ fhe l argest 3ca \ e experiment equ j pped x . ray room, a small
illness and medical care during .* ^ ^^ ^ , (h( , econom les laboratory ( a central laboratory
sickness are the two chief ben- orqanization to the treatment of sick- for a ll Berlin is utilized for
The society must provide / J . j {{ -^ ^ major work ), a clinic for the ex-
these and ,t may also, at it. d,s- n5. 11 exec itive sec- amination and advice of expectant
cretion, furnish medical care ^for Kgiouna vj 31, ic* J~)' fiensarv mothers (prenatal clinic) and the
members of the families of the retary of the Committee on ^^ l . cnn , fc _ a(1v ; sorv c ij n i c j n which
insured. On the governing body Development of the Unitea
of the society two-thirds of the Fund of New York

155



young people of high-school age



156



THOUGH DOCTORS DISAGREE



are examined as to their ability to undertake various forms
of athletics and counseled in building themselves up.

The clinic in the Oranien-Strasse receives about seven
hundred persons a day, nearly twice the number attending
the Cornell Clinic in New York. It is open six hours daily,
the afternoon period running until half-past six for the con-
venience of day workers. On Sunday it is open for one hour,
at least in some departments. Each doctor has a private
room where he receives patients individually, with nurse or
clerk in attendance. Each patient, when told to return for
further treatment, has a definite appointment by day and
hour.

The thirty-eight clinics which, under the supervision of
the city federation, cover Greater Berlin, range in size from
the one just described to small clinics in the outlying sec-
tions with only one department, one or two physicians, caring
for adults and children, and receiving fifty to seventy-five
patients a day. In 1925 the whole system received an aver-
age of more than 6,000 visits daily, or more than 1,600,000
a year. There is probably no other community in the world
with so large a system of organized medical service under
one management. In Berlin the people served are nearly
all workmen and their families. The middle and profes-
sional classes are hardly represented.

A \veek spent in visiting several of these clinics, talking
with physicians on their staffs, with officials at the office of
the central federation, and with outside doctors and other
critics, is much too short a time for a thorough study. The
medical societies and most medical educators expressed a
profound and unremitting antagonism to the centralized
organization of medical service which this Berlin system
represents. "Cheap hireling doctors," said one university
professor of medicine. "One more effort of the sickness
insurance societies to establish medical slavery," said the
president of a physician's association. The issues were too
live, the sentiment too keen, to expect balanced judgments
on either side. The anticipated report on Health Insurance
by the Health Section of the League of Nations may give
a detached and scientific view.

On the vital question of the quality of medical personnel
and of service rendered patients, a visitor, even if a doctor,
could not apply any conclusive test. One can report only
impressions of -favorable working conditions, an interested
and active-minded type of physician, and records which,
while not full as in the best teaching clinics, are systemat-
ically and definitely written out. The basis of comparison
for any such system as this must of course be with the gen-
eral medical practice of the community, not with the service
in the office of expensive specialists or in selected clinics de-
voted to teaching and research.

PATIENTS who need a doctor's care at home are also
served by physicians on the staff. It is, however, the
rule that should the treatment of a patient be begun by a
physician at the clinic and the patient need attention at
home, the same physician must continue to carry the case.

Hospital service is not included, for although a few so-
cieties have small institutions, hospitals in Berlin and else-
where in Germany are in the main under public control.
The sickness insurance societies pay these public hospitals
a per capita rate for members or their dependents. A num-
ber of societies, however, have their own sanatoria for tuber-
culosis and convalescent homes.

Early in 1926 a central record system was started, which



was being gradually put into effect in the clinics during the
period of my visit, and which summarized upon a Health
Card (Gesundhfits-Ktirte) all the essential points of the
patient's condition and treatment. This card will serve as
a guide to his entire medical history in whatever clinics he
may be treated during the course of years. A full-blown
statistical scheme for recording administrative data of at-
tendance and medical data as to kinds of diseases treated,
classified by age, sex, and in other ways, was also in course
of introduction. The central office was transferring the in-
formation to punch cards which were in turn to be put
through tabulating machines for systematic analysis and
study.

A large central laboratory, or diagnostic institute, serves
the whole system, its staff consisting of eight doctors, twenty
technicians, and three consultants, (described as university
professors) who are paid retaining fees for an hour's daily
service.

THERE is a long history behind these clinics, Doctor
Pryll told me, but they were forced into a sudden
organized growth by the doctors' strike of 1923.

As you know, he said, German health insurance has, since
its inception over forty years ago, involved continual adjust-
ment between the bodies of physicians and the insurance so-
cieties as to the conditions of medical service. The war. the
inflation of the currency and its subsequent stabilization nat-
urally upset things. Negotiations as to the amount and man-
ner of payment led, unfortunately, to an impasse in 1923 when
the doctors, under the leadership of the National Association
of the Physicians of Germany, actually went on strike.

Imagine what it meant in Berlin to have doctors refuse to
provide medical service for our hundreds of thousands of in-
sured members and their families! The hospitals, of course,
remained in action and not a few doctors worked for us de-
spite their organization. The terms laid down by the doctors'
organization seemed to us both financially impossible and in-
trinsically undesirable. We took the bit in our teeth. There
had been local doctors' strikes before in Germany at various
times and places, but nothing so serious or extensive as this
of 1923. A number of insurance societies had started specialty
clinics for their members and there were a few general ones.
In Berlin, for example, we already had our central diagnostic
laboratory, and prenatal and dental clinics under the auspices
of some of the district societies of our Berlin federation. Fac-
ing the crisis three years ago, we decided to set up a system
of medical service through clinics.

By the beginning of 1924 we had sixteen such clinics; by
the end of 1924 the number had doubled; during 1925 and in
1926 the number increased to thirty-eight, although more re-
cently our chief effort has been toward their improvement in
equipment, organization and interrelationships.

The acuteness of the contest is difficult to exaggerate. It
is hardly possible to believe that a body of professional men
would go to such lengths in trade-union warfare against an
organized effort on the part of a large number of persons to
provide medical service under conditions which are satisfac-
tory to them and are within their means. I can only suggest
the bitterness of the struggle by telling you that I had let-
ters threatening my life and that my wife was visited by wives
of physicians we had known socially, who sought to frighten
her into calling me off. The physicians coming on our staff
practically wiped themselves out of the official German med-
ical organizations, and that is one reason why we have thought
it fair to permit our men, particularly the older ones, to re-
tain a little time for private practice so that all their bridges
shall not be burnt behind them.

\Ve have come to believe that our system of providing med-
ical service through well-organized clinics, with a staff of doc-
tors able to treat patients in their homes when needed, is funda-
mentally sound in principle and in line with the trend of scien-
tific modern medicine. The project has been thought of by
some as a stroke of economy. It (Continued on page 192)



Ramsay MacDonald Today



By S. K. RATCLIFFE



AMSAY MACDONALD was prime minis-
ter of Britain from January to November,
1924. He was so violently repudiated in
the general election of that year (an election
won by the miserable trick of the Zinovieff
letter), that some millions of English people
iwere convinced that the present leader of the Labor Party
I could never again be the head of a government. Let us
(see what two and a half years of Tory rule, under a prime
j minister driven by his die-hards, have done for British
(Labor. How does Ramsay MacDonald stand today?

He is the leader, the only visible leader, of a party which
1 contains certain elements that are hostile to him. Mac-
! Donald is a parliamentarian, a constitutionalist. Properly
speaking, he belongs to the political left centre. There are
sections of the labor unions which are to the right of him,
and others, of course, which are far to his left. There are
groups, both Labor and Liberal, which, especially in im-
perial policy, would take a much more radical stand than he
has been able to do witness his surrender when in office
to the big-navy men and his sanctioning of coercive action in
India ; or note the caution during the China crisis of his
statements as to the expeditionary force. As prime minister,
he is aware, he would have been compelled to take action in
the Far East not materially different from that of the Bald-
I win government ; and the knowledge of this throws into
plain relief the opposition between the political leader of the
| Labor Party and certain large bodies of the rank and file.

THEY have been calling for withdrawal from China,
thereby greatly embarrassing the Labor front bench in
Parliament. In foreign and imperial policy Ramsay Mac-
Donald stands midway between the frank imperialism of
J. H. Thomas and the radical internationalism of such con-
trasted types as John Wheatley of the Clyde and H. N.
Brailsford, until recently editor of the New Leader.

Mention of Brailsford, who is by far the most power-
ful journalist in the Labor movement, is a reminder of the
very interesting fact that Ramsay MacDonald, whom the
outside world regards as a fine representative of intellectual-
ist labor, has lost the support of many men and women
naturally belonging to his own division of the party. They
indict him in varying terms. Some assert that he is out
of touch with the dominant industrial section; others, that
as party leader he displays a characteristic which Americans
associate with Woodrow Wilson the habit of playing a
lone hand and keeping his own counsel. Brailsford's assault
was comprehensive and extraordinarily fierce, and it includ-
ed the very serious accusation that, under MacDonald, the
Labor Party had been committed to a barren course of oppo-
sition and was neglecting the essential business of thinking
out and proclaiming new positive policies on coal, Indus-



trial contro , agriculture, the standard wage, and what not.
Nevertheless, the position of Ramsay MacDonald is
secure. He remains the unchallenged leader of the Labor
There is no alternative leader in sight. There is,
at present, no rival who need cause him an hour's uneasiness.
Certain districts-in Wales, in Scotland, in the north of
England are assumed to be antagonistic to him; but if,
with them as with any others, there is need of a star speaker
for a mass meeting, the first choice is Mac and the second
is not worth bothering about. His place, so far as the
country is concerned, is unaltered. As for the House of
Commons, one has merely to name the few men who, in
the anti-Labor press, are from time to time suggested as
possible leaders John Wheatley, J. H. Thomas, Oswald
Mosley. They sound like echoes.

IT may perhaps be thought that after the great strikes of
1926 Ramsay MacDonald's personal standing in the labor
movement could not fail to be gravely impaired. During
a great industrial conflict, for example, a parliamentary
leader is necessarily of little account, and MacDonald was
a party to the humiliating submission which ended the
general strike of May, while he was conspicuously out of
things from beginning to end of the half-year's coal stoppage.
True; but here is the main result of those unprecedented
experiences: Labor is admittedly far stronger by reason of
last year's crushing defeats than it was in 1924; its coming
successes at the polls are taken for granted by Conservatives
and Liberals alike, and no one is found seriously to dispute
the inference made by the party headquarters that political
Labor is certain of advancing at the expense of the direct-
actionists. The Baldwin government in 1926 set out to
destroy the menace of the general strike (Labor's biggest
weapon in the economic field). Needless to say, it did
not intend to restore and enlarge the political power of
Labor. But that is what it did.

I RETURN to the personal position of Ramsay Mac-
Donald. He is the leader, says an influential opponent, of



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