Boston and for Massachusetts usually are cited as standard for a city and a state, New York's requirements being considered exceptional. Boston has one bed for each 1 10 inhabitants and Massachusetts one for each 165, and these never seem too many indeed, scarcely enough. But the Boston hospitals admittedly draw some patients from other states.
Students of public health and welfare have agreed that any city must have at least one active bed for each 200 of population to meet its obvious obligations and that any state should have one bed for from 200 to 300 depending on the density of the rural population and its proportion to the urban population.
Table II. on the previous page shows conditions in 1921, convalescent and allied institutions and all hospitals for the nervous or insane being excluded.
Classification. Two-thirds of the hospitals in the United States in 1921 were classified as general, one-third as special, i.e. confining their work to tuberculosis, general contagious, mental and nervous diseases, maternity, etc. Nearly all limited their admissions to acute cases, with the result that the lack of pro- vision for chronic cases was the prominent defect.
Finances. The rapid increase in operating costs following the outbreak of the World War was a serious problem to American hospitals. Nearly all hospitals in 1921 admitted three classes of patients: (a) those paying full cost of their care; (6) those paying part of the cost in definite charges; (c) those paying nothing. " Pay " hospitals adjusted themselves to the new condi- tions by increasing their charges; " part pay " hospitals were generally able to obtain larger rates from patients during the war. Until deflation began there were fewer free patients than before the World War. This circumstance, the increase of (and the payment received from the Federal Government for) soldier patients, enabled the hospitals to meet their increased costs.
Answers to a general questionnaire in 1921 showed the actual investment in buildings and original equipment to average $4,714 per bed, no allowance being made for subsequent increases in values of land or buildings. On this basis the first cost of building and equipping the American hospitals had been $3,279,520,372. Annual maintenance cost for 1920 was $791 per bed. This figure, applied to the entire field, shows a total annual operating cost of $550,287,118. The above figures were compiled by the Modern Hospital with the aid of various agencies and organizations.
Equipment. During 1910-20 there was a marked change in the equipment of the average hospital. The previous development in clinical and pathological laboratory facilities and work continued and expanded. An institution in 1921 had little claim to rating as a hospital unless it had a working X-ray equipment and was prepared to carry out any pathological and clinical laboratory work, including serological examinations, at least to the extent of the Wasserman test. To do this many institutions were compelled to make working arrangements with private firms or with other institutions, but the essential aim that of making the service available to the patients in the hospitals was secured. The average mechanical equipment also was much improved.
Medical Education in Hospitals. The Council on Medical Educa- tion and Hospitals of the American Medical Association was in 1921 making a real contribution to the professional work of hospitals, as well as developing the fifth or intern year of medical education, by establishing a routine inspection of the hospitals' facilities and personnel for the instruction of the interns. Lists of approved hospitals were published and were of great service, as there were more positions for interns than new graduates in medicine, and a hospital was forced to comply with the requirements for admission to the approved list in order to obtain interns.
New Hospitals. There was a distinct movement in the decade 1910-20 to make hospital service available to everyone. State legislation enabling rural counties with small populations to com- bine for the support of one hospital, and encouraging average counties without hospitals to erect and support one, was responsible for the larger part of the increase. Such county hospitals have their work supplemented through private endowment or gift and admit the private patients of the physicians in the county. The need for free service in some counties is very small. The hospital is often in type a community institution quite different from the county hospital in a large county having many private hospitals. In these large coun- ties the county hospital provides largely for free or chronic patients and often acts as a department of public service for the poor.
Organization. The American Hospital Association has both in- stitutional members (hospitals) and personnel members, such as hospital trustees, persons on the medical staff, superintendents and department heads. State associations similarly organized were being formed rapidly in 1921 as state sections of the American Hos-
pital Association. There was also a Catholic Hospital Association. There were many National associations of the nurses, social workers and dietitians. These were all united in the American Conference on Hospital Service, formed to deal with questions larger than those of any one of the associations. (A. R. W.)
HOUGHTON, WILLIAM STANLEY (1881-1913), English playwright, was born at Manchester Feb. 1881, and was educated at the Manchester grammar school. He became a cotton-broker, but employed his leisure in dramatic criticism for the Manchester Guardian and in the writing of plays. The Dear Departed was produced by Miss Horniman in Manchester in 1908 and afterwards in London. With Hindle Wakes (1912) he leapt into fame. It had a long run in London and later in the same year The Younger Generation (written and played in Manchester in 1910) was successfully produced at the Haymarket theatre, London, with Trust the People the following year at the Garrick and The Perfect Cure at the Apollo. His early death in Manchester Dec. 10 1913 cut short a career of much promise.
HOURS OF LABOUR. The decade following 1910 witnessed a rapid advance and extension in the already widespread movement in favour of the reduction of the hours of labour. This was mainly due, apart from general trade-union pressure, firstly to the repercussions of the World War and of experience of industry under war conditions, and, secondly, to the international recognition of the principle of the 8-hour day in the Treaty of Peace of Versailles as one of the " principles . . . well fitted to guide the policy of the League of Nations."
Until the outbreak of the World War the movement in favour of the reduction of hours, and particularly in favour of the 8-hour day, had gone forward but only slowly and spasmodically. International conferences of workers passed the ordinary resolu- tions demanding the 8-hour day, as did the International Socialist Conference of 1910, the International Textile Workers' Con- ference in 1911 and the eighth Congress of Trade Union Secre- taries in 1913. In 1912 the International Association for Labour Legislation asked for a 56-hour week for glass-workers, an 8-hour day for the iron and steel trades, for workers in paper and pulp mills and in the manufacture of chemicals. In the following year the Miners' International Congress demanded the day of eight hours " bank to bank." The official delegates of the Berne Con- ference in 1913 contented themselves with a proposal to limit the hours of child workers to 10 daily a proposal which the Inter- national Association for Labour Legislation adopted in 1918, with the suggestion that part of the working day should be devoted to trade education. The Berne Conference further sug- gested a lo-hour day for women workers.
The comparatively moderate nature of the majority of these pre-war proposals and indeed of certain later ones, such as that of the Congress of Inter-Allied Trade Unions at Leeds in 1916, which asked for the lo-hour day, and that of the International Trade Union Congress held at Berne in 1917, which demanded that the daily maximum should be gradually reduced to 8 hours would hardly have prepared the student of these matters for the very striking advances which became operative in the chief industrial countries between the Armistice and 1921. The ad- vance is also to be noted in recent expressions of trade union opinion, in the movement for the 7- and even for the 6-hour day in coal-mining, and in such pronouncements as that of so influential an employer as Lord Leverhulme in England, who in 1918 him- self advocated the 6-hour day on economic grounds.
The outbreak of war had been followed in all the belligerent countries by the suspension of all limitations upon the hours of labour worked in industries of importance in the conduct of the .war, whether these limitations arose from agreements with the trade unions, from legislation or from custom. In all cases the general course of events was the same. After some difficulty, varying in degree with the imminence of the threat to national safety and with the strength of trade unionism, the workers consented, were persuaded by tempting rates of wages, or were coerced to lengthen the working day. In all cases, after the experience of a period of excessively long hours, it was found that the returns from overtaxed labour rapidly diminished, and in all cases limitations were sooner or later re-imposed, not, however, reducing
