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PARAGRAPH 650—SURGICAL INSTRUMENTS, ETC.

(Inclosure.) Present paragraph 650 is already too broad, but if must be changed should read:

"Philosophical and scientific apparatus, utensils, instruments, and preparations, including bottles and boxes containing the same, specially imported in good faith for the use and by the order of any society or institution incorporated or established solely for religious, philosophical, educational, scientific, or literary purposes, or for the encouragement of the fine arts, or for the use or by the order of any college, academy, school, or seminary of learning in the United States, or any State or public library, and not for sale. And also if not obtainable in United States of America, all medical and surgical instruments, appliances, apparatus (including Røntgen ray plates), utensils, and chemical and pharmaceutical preparations, including bottles and boxes containing the same, specially imported in good faith for the use and by order of any hospital, or other institution, rendering all medical or surgical aid to the public free of all charge, and whose expenses are borne wholly by public funds, private subscription, or endowments. Such articles, preparations, and instruments to remain the permanent property of such hospital or other institution and not for sale and to be used only for free treatment, subject to such regulations as the Secretary of the Treasury shall prescribe.”

HOSPITAL STATISTICS.

Number in United States, nearly.

8,000 Ninety-four per cent of above have private wards. Private-ward patients pay large prices for rooms (per week).... $25 to $150 Private patients pay extra for nurses, operating rooms, etherizer, resi

dent physician, etc. Private patients pay large fees for operations.....

50 to 5,000 These large fees are allowed by the hospitals to go to the surgeon. One so-called charity hospital (paying no taxes) has an annex in another part of city 400 to 500 rooms at from (per week)......

30 to 100

BRIEF PRESENTED BY MESSRS. SEABURY & JOHNSON, OF

EAST ORANGE, N. J.

Protest against H. R. 23, introduced April 4, 1911, by Mr. Cline, for reduction of customs duties on pharmaceutical and bacteriological products, surgical instruments,

and such instruments and apparatus as are used by eleemosynary institutions. The COMMITTEE ON WAYS AND MEANS,

House of Representatives, Washington, D. C. GENTLEMEN: We are manufacturers of pharmaceutical products and surgical apparatus as are used by eleemosynary institutions, supplying our wares to hospitals and kindred institutions, who consume a very large percentage of the output of our factory.

The great majority of these institutions are private or semiprivate institutions, charging fees for treatment given, though some have departments wherein free treatment is accorded. It is only a very minor portion who give treatment without pay, but this latter class usually represents municipal or State institutions, supported by the city or State from funds derived from the American taxpayer. Even in some of these municipal hospitals commonly supposed to be free a charge is exacted from every patient unless he be a pauper.

We prepare for and sell to these interests millions of yards of aseptic and antiseptic gauze, vast quantities of absorbent cotton and medicated cottons, splints and other dressings, appliances, and pharmaceutical products. The prices at which these goods are sold by us to hospitals and kindred institutions return only an exceedingly sınall profit, as competition amongst the various American manufacturers is very keen and prices to these hospitals are made with the knowledge that considerable of their work is done on a philanthropic basis, which therefore demands the very closest possible prices.

We therefore respectfully protest against the reduction to 15 per cent of the duty of 25 per cent now existing in the present tariff law, our protest being furthermore based as follows:

First. That a reduction of the duty to 15 per cent offers a serious menace to our industry and is a rate inadequate for our protection as manufacturers of the stated PARAGRAPH 650_SURGICAL INSTRUMENTS, ETC. class of products as against the English, German, French, and other foreign producer of similar products.

Second. The American labor cost in the production of these goods varies between 22 and 25 per cent of the factory cost of the finished goods. Foreign labor being only 40 to 50 per cent of the cost of American labor, a protection of not less than 12 per cent is required to equalize the American scale on the item of labor alone, and not less than an additional 124 per cent to cover the increased cost of merchandise in America above that of the progressive foreign countries. These percentages do not take into consideration the higher selling expenses and other charges incidental to the conduct and maintenance of the industry in America as against that in foreign countries.

Third. That with only a 15 per cent tariff on this class of goods, we are of the opinion that an American manufacturer could establish a factory abroad, and with the foreign lower ruling rates of both merchandise and labor could pay that 15 per cent duty and very successfully enter the American market to the great detriment and loss to to the American manufacturers producing similar products at home. In that event benefits from investments of such capital at home will be entirely lost to home labor as well as local, State, and Federal taxes.

It is absolutely necessary therefore to at least partially equalize if not to adequately protect home industry, as against foreign, that a rate of duty of not less than 25 per cent shall be maintained, and we protest most urgently against H. R. 23 as being unfair, unwarranted and damaging to the American manufacturer. Respectfully submitted.

SEABURY & Johnson,

HENRY C. Louis, President. New York, January 29, 1913. BRIEF OF JOSEPH A. BLAKE, NEW YORK, N. Y.

COLUMBIA UNIVERSITY,

New York, January 30, 1913. Hon. Oscar UNDERWOOD, Chairman of the Committee on Ways and Means,

House of Representatives, Washington, D. C. My Dear Sir: I am informed that a movement is on foot to promote legislation in regard to the admission of instruments and apparatus, for the use of hospitals, free of duty.

Inasmuch as already many articles are now admitted free of duty, which are to be used in educational institutions for educational purposes, I strongly urge the extension of this privilege to all hospitals which are afliliated with recognized educational institutions for the instruction of students in medicine. There are many obvious reasons for so doing, chief among which is the fact that such hospitals require many instruments and apparatus of precision which are not manufactured in this country and can only be duplicated here at great expense. Another perhaps not less cogent reason is that the education of students for the degree of doctor of medicine is extremely expensive, costing in properly equipped institutions from $500 to $750 per capita. per year; and a large part of this expense is inculcated in providing instruments and apparatus at the hospitals for the use of the students. Although it might be said with truth that all instruments are used in such hospitals for educational purposes, they are not used solely for educational purposes, being also used for the treatment of patients; and therefore are not exempt under the present statutes. It therefore would mean an elastic interpretation of the present statutes for them to be admitted free of duty and it would be well to clear the atmosphere as to their admissibility. Yours, respectfully,

Jos. A. BLAKE, Professor of Surgery in Columbia University, New York.

PETITION OF GEORGE F. CLOVER, REPRESENTING THE

AMERICAN HOSPITAL ASSOCIATION.

To the Honorable Members of the Ways and Means Committee, House of Representatives,

Washington, D. C.

GENTLEMEN: With no wish to consume unnecessarily any of your valuable time, it would appear to be imperative that in justice to the hospitals represented by the American Hospital Association and to the plea made before you by me, as chairman of 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 MANU

FACTURERS 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 an 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,

were:

Free..

205.0 Pay ward..

48. O Private room.

42.0 Visitors (friends of patients).

2.7 or stated in days of treatment: Free...

74, 901 Pay ward.

17, 423 Private rooms.

15, 603 Visitors (friends of patients).

1,570 Total........

109, 497 or stated in percentages: Free days....

68. 41 Pay ward days..

15.91 Private room days..

14. 25 Visitors (friends of patients).

1.43 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

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 SURGEON8.

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, nswer 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.

Geo. F. CLOVER. WASHINGTON, District of Columbia: Subscribed and sworn to before me this 5th day of February, 1913. (SEAL.]

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,

J. BISHOP & Co. PLATINUM WORKS,

By Chas. H. KERK, Secretary. MALVERN, Pa., January 30, 1913.

78959°-VOL 6-13- -15

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