Committee stage and re-cast it with fresh actuarial calculations based on the new census.

Note on the position of hospitals under the Insurance Bill.

On July 25 last the Chancellor of the Exchequer replied to the joint deputations representing the various Voluntary Hospital Managers as follows:

'He thought they were labouring under apprehensions which they would find would not be justified by the results. They feared that, as a result of the Act, the subscriptions would be considerably diminished. He did not think that there was reasonable ground to apprehend that consequence. There were many hospitals which depended upon substantial working-class contributions; but in future the working-class would put less in, as far as members of Friendly Societies were concerned, than they had hitherto paid towards the Friendly Societies. The Bill would relieve them of anything between sixpence and a shilling a month. He did not believe that men would neglect their duty towards the hospitals because they were calling upon them to make contributions towards sickness amongst their employees . . . There might be a momentary irritation, but that appeared whenever they produced a Bill which called upon people to pay money. He was told three years ago that no more money would come to the hospitals. That happened with every Bill ever introduced which made people pay. People said that there was an end of all hospitals and charities; but human nature was much better than it liked to represent itself. After the momentary agitation had passed, people would do their duty to those institutions in the same sort of way as hitherto.'

This view is unfortunately not held by those responsible for the management of the voluntary hospitals, whose opinions, owing to their intimate connexion with the work of the hospitals, are at least worthy of consideration; and I will endeavour to point out some of the reasons why they do not share Mr Lloyd George's opinion.

The chief sources of income of the voluntary hospitals are (1) interest on invested funds, (2) legacies and donations, (3) subscriptions.

The interest on invested funds, amounting to about

500,000l.* per annum, will, of course, not be affected; but in regard to legacies the case is likely to be different. It is well known that hospitals have been able to carry on their work, including general maintenance, building, etc., only by making frequent inroads upon their invested funds, and trusting to the legacies of the charitable to make good the sums so expended. The sum of 501,5362 was received from this source alone in 1909. It is to be feared that in the future, if the State Insurance Bill passes into law in its present form, the charitably disposed will no longer feel the same call to contribute as in the past. They will believe that the work of healing the sick is being undertaken by the State; and it will be difficult to make it generally understood that the medical benefits under the Bill do not cover such illnesses as can only be treated inside the walls of the hospitals. If this anticipation proves true, it will be impossible to carry on the work of the hospitals without trenching on the invested funds, the income from which will thus be seriously diminished, if it does not entirely disappear.

Donations, which in 1909 amounted to 750,000l., will possibly suffer less than other sources of income, because the majority of them generally come from those who, either personally or through some relation or friend, have come actually in touch with some hospital, and are acquainted with the nature of the work carried on there. If everyone could be induced to visit some one hospital and see for himself what the daily life and work of a hospital is, there would be little likelihood of complaints about the want of support; the difficulty is to obtain financial support from that section of the public which is ignorant of what a hospital is, and what it does.

Lastly, there is the question of subscriptions, which amounted in 1909 to 342,4981., or, if to this be added the amounts contributed by the Hospital Sunday and Saturday Funds and the contributions of working people, a total of 622,000l. This source of income, the backbone of the financial support received by the hospitals, is that which is likely to suffer most heavily. Many subscribers

* All the figures quoted are taken from Burdett's Hospitals and Charities' for 1909 (the last year available) and refer to thirty-one hospitals with medical schools, eighty-three general hospitals, and fifty-eight special hospitals.

will fail to understand why they should be asked to continue their subscriptions to the voluntary hospitals when weekly contributions are being made towards the State Insurance Fund; others will say they cannot afford to pay to the hospitals as well as to the State. It will not be generally understood that the hospitals will be required in the future just as much as, if not more than, in the past; and that the State Insurance Bill only makes provision for the minor ailments of life.

At present a very large sum is annually distributed to the hospitals from working-men's collections of one penny a week; in Newcastle this amounts to some 17,0001. a year, in Leicester to 9000l., in Leeds to 17,000l., in London to about 64,000l. a year. How many working-men will be able to maintain this contribution if they also have to pay their share of the State Insurance? From actual experience one knows how difficult it is to make it clear to a man who applies to a hospital for the treatment of some minor ailment that he is not eligible for free treatment if he is in a position to pay for such treatment as may be necessary, even though he is a contributor to the Hospital Saturday Fund. How much more difficult will this be when he has to pay to a State Sickness Fund! Moreover, the large firms who are now among the best supporters of the hospitals will have to make very large contributions to the State for their employees, and can hardly fail to reduce their charities accordingly.

The only really practical experience that the hospitals have to go upon is that which was gained when the Employers' Liability Act and the Workmen's and Servants' Compensation Acts came into force. Every hospital, without exception, I should say, suffered heavily. Mr Howard Collins, Superintendent of the General Hospital, Birmingham, gives the figures as they affected that hospital. According to him, there was a drop of 1200l. a year in the one case and of 8007. in the other, which could be traced directly to the effect of these Acts. Many hospitals have already received notice of withdrawals of subscriptions if the State Insurance Bill comes into force.

Finally, the public should be made aware how small a margin there is at present-taking the General and Special Hospitals and the hospitals with Medical Schools

all together-between their income and expenditure accounts. In 1909 the total income was 2,626,9781., while the total expenditure was 2,358,8781.; and these figures do not include the existing debts of the hospitals. It is clear, therefore, that the margin at present existing is very narrow; and this, of course, makes no allowance for such an important provision as that of sinking funds for rebuilding or refurnishing, or for any large capital expenditure such as from time to time becomes imperative.

The unanimous apprehension of hospital managers that the voluntary system, as we have known it in the past, is doomed if the State Insurance Bill becomes law, is therefore, in my opinion, founded on solid grounds. All those who believe that the voluntary system is the best will be only too glad if the future should prove the Chancellor's optimism to be justified; but the probabilities all point the other way. There are many other aspects of this question to be considered if the Insurance Bill is passed, but I have not attempted to touch them, my object being solely to show some of the grounds for the contention of the hospitals in regard to the continuance of the voluntary system upon financial grounds alone.

A. WILLIAM WEST,

Treasurer and Chairman, St George's Hospital; Chairman of the Central Hospital Council for London and the British Hospitals Association; Treasurer of the National Association for Sanatoria for Workers, etc.

*The total expenditure in the United Kingdom upon hospitals is estimated at £4,000,000.

Art. 13.-THE RECENT STRIKES.

1. Psychologie du Socialisme.

By Gustave le Bon.

Paris Félix Alcan, 1898. 2. Le Collectivisme. By P. Leroy-Beaulieu. Second (enlarged) edition. Paris: Alcan, 1909. English translation (abridged). By Sir Arthur Clay. London: Murray, 1908.

3. Le Syndicalisme contre le Socialisme. By 'Mermeix.' Paris: Ollendorff, 1910.

4. Psychologie politique et la Défense sociale. By Gustave le Bon. Paris: Flammarion, 1910.

5. Syndicalism and Labour. By Sir Arthur Clay. London: Murray, 1911.

THE year 1911 will always be memorable in our history. It will be memorable for the Coronation, the Imperial Conference, and the Canadian elections. But it will be remembered for events even more important than these. The Parliament Act has effected the greatest change in our political system since 1832; but it may be doubted whether the great industrial revolt is not symptomatic of a revolution at least equally great in the social order. For many years Trade Unions have been an essential part of our social organisation; the public was familiar with them, and had learnt to regard strikes with sympathetic toleration as unavoidable incidents of industrial life, and even with a comfortable conviction born of experience that trade would not be seriously injured by their occurrence, and that, after a more or less prolonged conflict, masters and men would settle their differences and business would go on as before. Until recently events have justified this faith. Strikes have been usually restricted to the trade and locality in which they originated and have not directly affected the convenience or the pockets of the general public. Even when, as in 1910, the disturbance affected important branches of industry and was widely spread, the effect upon the general trade of the country was almost insignificant; and the Stock Exchange, that sensitive index of capitalistic opinion, gave no evidence of the existence of serious alarm.