CONSUMPTION AND SELF-HELP.
ELSEWHERE we publish a review of a very important J study of the disease of consumption by Dr. Arthur Latham and Mr. Charles Garland, and we are glad to see that the latter is actively engaged in trying to rouse public opinion upon this subject. In a lecture recently delivered at St. Pancras, Mr. Garland specially dealt with the possibility of utilising a system of industrial insurance as a means of combating consumption. At the present time all the great Friendly Societies, which have been built up by the self-help of our English working men, are heavily burdened by the cost of this one disease of consumption. According. to Mr. Garland, no less than 28 per cent. of the sickness benefit paid by the Ancient Order of Foresters and the Hearts of Oak Society was paid on account of con- sumption. It has also been calculated that the average cost of a consumptive patient to these Friendly Societies is three times as great as the average cost of other invalids. Yet hitherto the English Friendly Societies have made practically no attempt to prevent the disease which is so costly to them, and so cruel to their members.
In Germany, on the other hand, an enormous amount of work has already been done of which the British public has but little cognisance. At the very early stages of the working of the German insurance system its authors realised that it was more economical to try to cure sick- ness than to subsidise the sick man and his family. In the case of the particular disease of consumption the banks which are entrusted with the working of the sickness insurance have power to remove patients to sanatoria, where they are maintained out of the insurance funds, while an allowance is made to their families. A good deal of elasticity appears to be permitted in the working of the institution so as to enable the managers, where circum- stances demand it, to give to the patient treatment in excess of that to which he would be entitled under the terms of his insurance. This is done on the broad prin- ciple that in the long run it would be cheaper for the insurance agency to cure the man thoroughly than to send him back patched up, probably to come upon the funds again a few months later. Still more is this the case with the institutions which manage the invalidity insur- ance. As many of our readers are aware, there are in Germany three sets of industrial insurance,—the insurance against accidents, which is paid for entirely by the employers ; the sickness insurance, of which two-thirds of the cost falls upon the workman and one-third on the employer ; and the invalidity and old-age insurance, which is born in equal proportions by employer and employed, a fixed contribution being subsequently added by the Empire and charged to the taxpayer. The invalidity insurance institutions are bound to maintain a man for life if at any age he, through illness, falls into such condition as to be unable to earn more than a third of the normal wage in his trade. It is therefore obvious that these institutions have a very great pecuniary motive for trying to cure every patient who has a reasonable chance of recovery. With this object in view, large sums have been expended by the invalidity insurance institutions in constructing sanatoria and special hospitals, and the results of this expenditure have been most satisfactory. A very interest- ing Report of what has been done in this direction was published by the Medical Officer of the Local Government Beard, and incorporated in the Board's annual Report for the year 1905-6. This Report gives, among other things, figures showing the extent to which the German popula- tion has availed itself of these methods of treatment. In the year 1897, 2,600 males were treated ; in the year 1904, nearly 17,000. The corresponding figures for females were 736 and 6,520. The duration of treatment appears to average about seventy or eighty days. The in- surance institutions are not content, however, with merely trying to cure their members in these special hospitals or sanatoria. Experience has shown that it is highly dangerous for a partially cured tuberculous workman to return at once to a former occupation which has perhaps been the cause of his illness. " Consequently the Committees of the insurance institutions endeavour to procure from the employers special consideration for the discharged patients, and by way of furthering this object a commencement has been made in certain sanatoria in providing light work for the patients towards the termination of their treatment." This method of dealing with the disease has already been tried in England, and its success has been proved by the zeal of the patients themselves to do even more work than is offered to them. At an establishment in Surrey—the Frimley Sanatorium of the Brompton Consumption Hospital—the patients recently completed a large reser- voir by their own labour, and then petitioned to be allowed to build a chapel for themselves. The point, how- ever, with which we are here concerned is that the whole of this scientific treatment of consumption in Germany binges upon the system of industrial insurance. In the words of Herr Bielefeldt, who has taken a leading part in the German campaign against consumption, the organisa- tions of the invalidity insurance have become since 1895 the centre of the anti-tuberculosis movement in Germany. Many millions have already been spent out of the insurance funds in constructing sanatoria, special hospitals, and convalescent homes.
All this has been done in Germany by the direct action of the State, for though much voluntary work is enlisted in the administration of the insurance funds, the direction comes from the State itself. In 'England there is no necessity for this State centralisation, and it would be in many ways a very great evil to introduce it. Happily, we have in this country voluntary organisations which are capable of undertaking the work done in Germany by the State. Already indeed they do, and have for many years done, a large portion of the work performed by the German State insurance system. The benefits drawn by English working men from the Foresters, the Oddfellows, the Hearts of Oak, are considerably larger than those obtaining under the German compulsory insurance. Needless to say, the contributions are also larger, but they are voluntary. The question then arises whether it is not possible to utilise these existing institu- tions, which already serve such a large portion of the English working classes, so as to make them cover practically the whole ground which ought to be covered. We believe that this can be done by imposing by statute upon all English wage-earners the obligation to insure themselves which a very large portion of them have voluntarily recognised. If, however, this is done, it must be done in such a way as to strengthen the existing voluntary organisations instead of weakening them. The proposals so far made by Mr. Lloyd George and Mr. Winston Churchill simply contemplate the erection of a vast system of State insurance on the German model, and this would necessarily sweep away the Friendly Societies altogether. Instead of proceeding on these lines, the course of statesmanship would be to make the Friendly Societies the agents of the State. This can be done by requiring every workman to insure in some Friendly Society or other voluntary institution of his own choice. The system could be worked by means of insurance-cards as in Germany, to which the employer would each week affix the necessary value in stamps. At the end of the quarter or half-year the wage-earner would take his card filled with stamps to his own Friendly Society, and the secretary of the Society would recover the value of the stamps from the Post Office. This would enormously facilitate the working of the Societies, and enable them very largely to extend their operations.
We come back, however, to the point that the insurance institution, whatever it may be, must not be content merely to subsidise the sick man ; it must try to cure him ; and if once we can obtain a universal system of insurance against sickness and invalidity, it will then be economically sound, as well as humanly merciful, to spend freely out of the insurance funds in trying to destroy one of the greatest curses of humanity.
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