The first White House wedding on record was that of Lucy Payne Washington, sister of "Dolley" Madison, wife of the fourth President of the United States.
WhiteHouse Weddings
President Jackson's grandniece, Mary Eastin (left), and Mary Lewis, motherless daughter of an old Presidentialfriend, both had White House weddings in 1832.
FOR THE world at large, the White House is the nerve centre of the United States Government. For Americans there is, in addition, a close personal involvement with the historic Presidential mansion and its occupants. At few times is interest so high as on the rare occasions when there is a wedding in the White House. Currently holding the nation's attention is the June 12 marriage of President Richard M. Nixon's daughter Tricia to Edward Finch Cox (seen above on the occasion of their engagement). The unpublicized story of their romance dates back to a first meeting seven years ago. The Presidential home has been the setting for 16 previous weddings, some of them shown in the other pictures on these pages.
SPAN Srirangam: The Past Recaptured by Elizabeth
Of all the weddings in the White House, the most historic was that of Grover Cleveland, 22nd President, to Frances Folsom. Never before or since has a U.S. President been married in the executive mansion.
6
Wahl
The Multinational Corporation by Neil H. Jacoby
A New Approach to Family Planning
28
by Jean M. Immerwahr
A Race Against the Clock
32
by Lawrence Galton
The Ropeway
40
by A.K. Ganguly
A wedding that almost didn't come off was that of Francis Bowes Sayre to President Wilson's daughter Jessie. A guard refused to believe Sayre was the bridegroom and nearly barred him from the White House! Front cover
Back cover
A cosmopolitan luxury hotel was, till recently, almost the only imaginable setting for this spacious cocktaillounge. This one, however, is miles aloft in one of the new Air-India 747s, featured on pp. 2-5. Photograph by Jehangir Gazdar.
In the tropics, summer means blazing, searing heat-something to run away from. In more temperate climes, the word evokes a mood like that 0 f this young American couple, all set for an exciting sand-and-surf holiday. Photograph by Carl Purcell.
CATHERINE
SCOTT, Editor;
DANIEL
P. OLEKSIW, Publisher.
Editorial Staff: Carmen Kagal, Avinash Pasricha, Nirmal K. Sharma, Krishan G. Gabrani, Austen Nazareth. Art Staff:B.Roy Choudhury, Nand K. Katyal, Kanti Roy, Kuldip Singh Jus, Gopi Gajwani. ProductionStaff: Awtar S. Marwaha, Mammen Philip. PhotographicServices: USIS Photo Lab. Published by the United States Information Service, Bahawalpur House, Sikandra Road, New Delhi, on behalf of the American Embassy, New Delhi. Printed by Arun K. Mehta at Vakil & Sons Private Limited, Vakils House, Sprott Road, 18 Ballard Estate, Bombay-I.
President Lyndon B. Johnson's daughter Lynda married Marine Captain Charles S. Robb in December 1967. The couple is seen using a sword to cut the cake at their wedding reception held in the White House.
Manuscripts and photographs sent for publication must be accompanied by stamped, self-addressed envelope for return. SPAN is not responsible for any loss in transit. Use of SPAN articles in other publications is encouraged except when they are copyrighted. For details, write to the Editor, SPAN. Subscription: One year, rupees five; single copy, fifty paise. Inasmuch as we are currently oversubscribed for SPAN, we regret that it will not be possible to accept any more subscriptions for the time being. For change of address, send old address from a recent SPAN envelope along with new address to A.K. Mitra, Circulation Manager. AllolV six weeks for change of address to become effective.
JUMBO- ~\ JETTING. v. . WITH ~'''·'111'''~
Latest of a long line of aircraft developed by the Boeing Company, the 747-B is the world's largest and fastest commercial plane. Now in service with Air-India, it offers a safety and economy matching its sizfi and speed. Emperor Ashoka, first of the fleet, makes use of traditional Indian decoration, as seen in this view (below, left) of First Class. Below: One of the charming hostesses who add so much to the attraction of Air-India's Boeing 747 flights is seen in her specially-designed new uniform.
Window panels depicting love legends of Indian mythology; intriguing tray-tables that pull out of the seat hand-rests; a comfortable, spacious Economy Class-these are some features of Air-India's new jumbo jets.
SRIRANGAM: .THE PAST RECAPTURED
A famous temple in Tamil Nadu is rel;'aininc its ancient splendour through a major, UNESCO-aided restoration project.
OVER THE CENTURIES the temple of Sri Ranganathaswami on the island of Srirangam in Tamil Nadu has been richly endowed. Ivory chests, gold and silver ornaments, garments made of pearls, and precious jewels were heaped at the feet of the Deity. Inscriptions on the temple walls record the names of illustrious donors and their gifts of cattle and fields. Other devotees built structures to house the God, laying out vast walls, pillared halls and pleasure gardens. The temple was favoured by kings. A Pandya monarch offered an elephant's weight of gold and jewels. The Hoysalas are said to have built the Venugopala, a channing sanctuary adorned with sculptured ladies at their leisure. The Vijayanagar kings helped to restore the temple after the Muslim conquest of the fourteenth century, and the Nayaks of Thanjavur lavished gifts including statues of themselves in devotional attitudes. Even England gave to the temple. When the Prince of Wales, the future King Edward VII, visited Srirangam in 1875, he contributed a large gold cup, which still lies in the temple treasury. continued Left, bound in scaffolding, the 150-foot Vellai gopuram is the tallest in the temple complex. As workmen toil, they uncover figures like the graceful musician at right.
he restorers are preserving a beritace that belongs to all people, regardless of nationality Qrreligion.
T Today the great kings are gone, and Sri Ranganathaswami's artistic and historical legacy passes to ordinary men. To protect this inheritance, modern devotees are contributing time, money and effort in a major temple restoration project. The gift of preservation may not appear to be as spectacular as the munificent gifts of ancient kings, but it is no less valuable. Without it, much of the beauty created in the past would have been lost to the future. Before restoration began a year ago, many of the temple's art treasures were concealed under layers of dirt and chipping paint accumulated over hundreds of years. The stucco figures adorning the gopurams wore mottled coats of black and grey grime. Whitewash and paint so encased surfaces in many of the mandapas, or pillared halls, that men had forgotten what decoration, if any, had been carved on the stone underneath. The curling roots of plants had seeped into crevices in walls and roofs threatening the structure of some buildings, and unnecessary embellishments of paint and cement defaced portions of the temple's magnificent stone masonry. The restorers' task was enormous, in part because of the generosity of their ancestors, for the temple's ancient wealth is reflected in its vast size. Said to be the largest temple in area in India, Sri Ranganathaswami sprawls across roughly 155 acres and is the only temple in the country to have seven concentric walls, or prakaras, enclosing the central sanctuary. Twentyone gopurams tower above countless mandapas and shrines, ar:d the major portion of a municipality of 42,000 people with their homes, shops and places of work is sheltered within the temple's three outer walls. Despite the large outlay of money and years of labour that restoration would require, temple authorities felt an obligation to meet the challenge. To Hindus the temple of Sri Ranganathaswami has been an
important centre of the Vaishnava tradition since ancient times, and today pilgrims from every state in India visit its shrine. Non-Hindus, particularly visitors from' abroad, could find at the temple a variety of South Indian art and architecture and an outstanding opportunity to observe the area's living religious heritage. Restoration, the authorities felt, would not only preserve the temple, but would also enhance its attraction to pilgrims and tourists from all over the world. Before they began, however, the restorers sought expert advice. The United Nations Educational, Scientific and Cultural Organization contributed the services of two architects, Mr. Patrick Faulkner and Mr. George Wright, and of art historian Miss Jeannine Auboyer. Mr. Faulkner made an exploratory study of the huge religious complex in 1966. Two years later, Mr. Wright outlined a suggested restoration plan, while Miss Auboyer, who is director of the Musee Guimet in Paris, wrote a detailed description of the modern temple and its history. The Wright report became the restoration textbook, for it combined a discussion of guiding principles for the project with technical advice. Since only Hindus may enter the temple's third prakara, the architect restricted his recommendations almost entirely to the outer areas. He suggested that the initial effort focus on the eastern section of the fourth prakara, an area both accessible to non-Hindus and, according to Miss Auboyer, rich with 15th and 16th-century stone carving. Except for minor damage from vandalism, the structures and carving remained intact, but, as elsewhere in the temple, the art lay hidden. The UNESCO adviser's suggestions were accepted, and work began under the supervision of Mr. S.G.S. Avudaiappan, an engineer from the Madras Public Works Department. Labourers recruited from
local villages took up the tedious task of chipping away thick coats of whitewash from the 957 columns in the Hall of a Thousand Pillars. Others cleaned the fewer but more elaborately carved pillars in the Sesharayar mandapa across the courtyard. A huge wooden scaffold was constructed around the Vellai gopuram, the tallest in the temple-I 50 feet high-and an army of nimble scrubbers began to bathe each of its silent figures. Aware that restoration efforts have sometimes damaged structures they were intended to improve, Mr. Avudaiappan relies heavily on the housewife's soap, water and brushes. Coil' brushes were chosen over wire ones to avoid scratching the delicate carvings, and special hardwood chisels are used instead of metal tools to strip away the outer coats of whitewash. Only the best workers are allowed to use stronger materials. Hydrochloric acid, lightly applied and swiftly removed, cleans away lime that lodges in tiny pockets in the stone after the chisels have done their work. The acid also helps remove grime from the Vellai gopuram, before it is treated with a water resistant compound. Other chemicals are used to kill the roots of vegetation. Patience and perseverance are, however, the workers' most important tools. One pillar can take four men three days to clean and the task of scrubbing and rinsing the Vellai gopuram has occupied rougWy 60 men for almost a year. Work in the fourth prakara is a little more than half completed, but the results are readily apparent. Stone flowers bloom in the Hall of a Thousand Pillars from columns which were smooth painted surfaces in 1969. In the Sesharayar mandapa, dirt and traces of whitewash have been cleaned away, revealing a population of charming maidens, gallant heroes, wandering shepherds and wise old men. Musicians and dancers seem to celebrate continued
E
merging from the dust and grime of centuries are a host of figures: charminc maidens, wandering shepherds and gallant heroes astride prancing horses.
the loss of their dull shrouds, and the famous horsemen on the facade are as fresh as they were on the first morning of their chase. Though still bound in scaffolding, the Vellai gopuram gleams a golden colour in the South Indian sun, and throughout the courtyard, one senses anew the vitality and soaring ambitions of the famed dynasties of the past. The fourth prakara still resounds with the clatter of chisels, buckets and brushes. A few yards away from a recently reborn shepherd, workmen excavate pillars buried in a wall of brick and paint, while their colleagues strip unnecessary cement from the base of the Vellai gopuram. When the cleanup is completed, temple authorities plan a special tourist entrance to guide
Workman uses a coir brush, above, to scrub a stucco sculpture on the Vellai gopuram. Opposite page: The intricately-carved horseman facade of the Sesharayar mandapa. visitors through the eastern gopurams directly to the artistic showcase in the fourth prakara. In deference to religious beliefs, they also hope to repair broken figures on the Vellai gopuram. Eventually large areas of the temple will be restored, a project that is expected to take more than 20 years and cost more than Rs. 40 lakhs. Sections in good conditions will, of course, be left untouched but the cleaning of the other gopurams and numerous whitewashed surfaces is high on the priority list. In fitting tribute to their an-
cestors, the restorers also hope to catalogue the temple's treasure and exhibit some jewels and art objects in new showcases, a UNESCO gift, in the temple museum. With its emphasis on cleaning structures of recent embellishments rather than redecorating them, the Srirangam project differs from renovation activity in most living temples in South India. So far, however, it has met with wide acclaim, according to Mr. K. Srinivasan, vice chairman of the Sri Ranganathaswami Devasthanam Thiruppani Committee, which oversees the restoration work. Extreme care has been taken not to offend religious sensibilities and those who prefer repainting usually change their minds when they visit the fourth prakara and see the high quality of art that had once been obscured. "Anyone who wants a modern gopuram should build a modern gopuram," Mr. Srinivasan said. "Our object is to present the ancient things in the ancient way and prevent them from decaying." Other temples in South India have recently inquired about the approach and techniques used in the Srirangam restoration. Among the factors that appeal to temple managements is the low cost of future maintenance, for a simple cleaning every few years is much less expensive than periodic redecoration. For years to come, the temple of Sri Ranganathaswami will enrich the lives of both Hindus and non-Hindus, devotees of the Deity and students of India's culture. As men of faith, the restorers have not interfered with the temple's religious function so worshippers continue their devotions in surroundings they know and love. But as modern men, they are restoring and preserving a heritage that belongs to all people, regardless of nationality or religion. Though they lack the wealth of kings, the restorers' gift is great, for at Srirangam, the past is coming alive again. END
to use its patents or know-how, employ THE EMERGENCE of the multinational private corporation as a powerful agent of foreign nationals, have foreign stockholders, borrow money from foreign bankers world social and economic change has and may even have a foreigner on its been a signal development of the postwar board of directors. None of these circumera. This evolution has been regarded with stances, however, would make an entermixed opinions by public officials of the prise "multinational," because none would investing and the host countries, as well require a substantial direct investment in as by observers of international affairs. The multinational corporation is, among foreign countries' assets nor entail a reother things, a private "government," ofsponsibility for managing organizations of people in alien societies. Only when an ten richer in assets and more, populous in stockholders and employees than are some enterprise confronts the problems of deof the national states in which it carries on signing, producing, marketing and financing its products within foreign nations does its business. It is simultaneously a "citizen" of several nation-states, owing obedience . it become a true multinational. to their laws and paying them taxes, yet having its own objectives and being responsive to a management located in a foreign nation. Small wonder that some critics see in it an irresponsible instrument of private economic power or of economic"imperialism" by its home country. Others view it as an international carrier of advanced management science and technology, an agent for the global transmission of cultures, bringing closer the day when a common set of ideals will unite mankind. What motives have thrust this corporate institution into a position of world prominence'? How is it characteristically , managed? What effects does it produce on investing and host nations, and on international relationships and institutions? Above all, how can the policies of multinational companies and of the nations in which they operate minimize international conflicts and advance the cause of human welfare and world order? A multinational corporation owns and manages businesses in two or more countries. It is an agency of direct, as opposed Although we define the multinational corporation by ownership and manageto stock-portfolio, investment in foreign countries, holding and managing the unment of businesses in several nations, in reality this is generally only one stage in a derlying physical assets rather than securities based upon those assets. process of multinationalization. CharacterAlmost every large enterprise has foristically, the expanding corporation traeign involvements of some kind. Whatever verses the following stages: its home, it will probably send agents to I. Exports its products to foreign other nations, establish representative ofcountries. 2. Establishes sales organizations fices abroad, import foreign materials, export some products, license foreign firms abroad. 3. Licenses use of its patents and know-how to foreign firms About the Author: Mr. Jacoby is Professor of that make and sell its products. Business Economics and Policy and former Dean, 4. Establishes foreign manufacturing Graduate School of Business Administration facilities. of the University of California at Los Angeles.
multinational corporation is a 'citizen' of several nations simultaneously.
5. Multinationalizes management from top to bottom. 6. Multinationalizes ownership of corporate stock. Upward of 100,000 U.S. business enterprises are stage-one exporters; many fewer have reached stages two or three; only about 4,500 firms are stage-four multinationals. A mere handful of giant firms are approaching stages five and six. Legally, a domestic corporation may mul.tinationalize by establishing foreign branches, by operating wholly- or partiallyowned subsidiaries in other countries, or by entering into joint ventures with entrepreneurs in other countries. Whatever the legal format, it becomes a working corporate citizen within many nations. This makes the word "multinational" accurately descriptive of its character.
Rise of Corporate Multinationalism Multinational operations by private business corporations are comparatively recent in man's history. The earliest substantial multinational corporate investment came in the mining and petroleum industries during the initial years of the 20th century. Nature decreed a wide geographical separation of great mineral deposits in less-developed' regions from important markets in the' United States and Western Europe. Hence, large oil companies like British Petroleum and Standard Oil Company were among the first true multinationals, and hard-mineral corporations, such as International Nickel, Anaconda Copper and Kennecott Copper, were other early entrants. Singer, Coca-Cola and Woolworth were early American manufacturing and merchandising multinationals; Unilever, Philips and Imperial Chemical entered the foreign arena from Britain and The Netherlands. Chemical and drug companies went abroad from Germany. After the Second World War, the multinational corporation flowered as American firms heavily invested abroad in a wide variety of manufacturing and merchandising operations. But American corporations are by no means the only multinationals. Direct foreign corporate investment in the United States stood at nearly $11 billion at the end of 1968, having risen by 25 per cent during the preceding three years as continued
more foreign businesses gained the financial means and the managerial confidence to enter the huge American market. The foreign operations of multinational enterprises have generated many misunderstandings and tensions with the governments and peoples of host countries as well as with the governments of their home countries. As corporate citizens of many nations engaged in transnational business, they daily confront conflicts between national policies and divergent economic and social systems and values. As agents of technological and cultural change, they naturally provoke critical reactions from businessmen and governments, both domestic and foreign. Foreign criticisms of U.S. corporate operations abroad have focused upon six kinds of problems: (I) "exploitation" of local manpower or natural resources, (2) conflict between U.S. national policies and the national interests of the foreign country, (3) overcentralization of managerial decision-making in American headquarters, (4) the locating of all advanced research. and technical tasks in the United States, (5) insensitivity to local laws and customs, and (6) behaviour that de-stabilizes foreign economies. All these charges should be looked at closely. ÂŤExploitation"
only when monopoly prevails. As long as world markets for natural resources are effectively competitive, the terms on which a foreign company enters a country to explore for and produce its natural resources reflect a careful balancing of estimated risks and rewards. Today, any country possessing natural resources finds that exploration and development rights are eagerly sought by firms from many foreign nations. It can charge substantial bonuses for limited concessions, and heavy taxes and royalties on the production from successful concessions.
verall, the return on U.S. foreign investment has not been . exceSSIve.
The charge of "exploitation" by foreignowned enterprises is often made against U.S. firms producing minerals or other basic products. It is based upon the idea that the foreign company "takes away" irreplaceable natural resources without providing a quid pro quo. What critics The terms of entry into the foreign oil commonly Qverlook or underestimate are business have become so onerous that the the heavy risks assumed by the foreign oil-producing country typically makes company in searching for and developing about three times as much money per local resources, the large losses incurred barrel of oil produced (from successful in unsuccessful ventures, and the great concessions) as does the oil company, contribution made to their own country's although it invests no capital and incurs material welfare by the foreign company no expense. that succeeds. After the fact, it is easy to Natural-resource agreements under curpoint to "extravagant" profits being real- . rent conditions are non-exploitative, whatized from a successful foreign operation ever may have been true in the past. The and to forget the many unsuccessful ven- host country profits from the public intures, uncertainties and delays experienced come generated- by royalties and taxes, from the private income derived from in creating a profitable enterprise. "Exploitation" of a country's natural wage payments and other expenses in the resources, in the economic sense of ob- local economy, and, above all, by the taining them at distress prices, is possible acquisition of modern technology and
management skills. Taking the good ventures with the bad, the overall return on American foreign investment has not been excessive. Disparities Between National Policies
More serious is the allegation that the foreign affiliates of U.S. companies, being under the policy directives of their home offices, are obliged to pursue policies that serve U.S. interests rather than those of the host country. Although conflicts do arise when there are disparities between national policies, there is no conflict between the multinational company's goal of maximizing profits in each country and overall profit maximization when national policies are harmonized. The multinational company will serve its own interests best by investing in its subsidiaries in each country up to the point where the marginal return on capital is the same in all countries, and by allowing each of its subsidiaries freedom to enter the parent company's home market, as well as the markets of third countries, to the extent that its competitive strength permits. In a rationally managed multinational corporation, comparative costs will dictate the amount of the exports of its foreign subsidiary, just as they do in a locally owned company. Nearly all differences between multinational corporations and host governments can be resolved by effectively harmonizing and rationalizing national policies, and by wider use of international organizations to determine policies on a global basis. Multinational business has not created disparities between national policies; it has merely thrown old disparities into bolder relief, and made urgent the task of removing them. Overcentralized Management A third genre of complaints against the
multinational corporation is that it overcentralizes management decisions in its head office, leaving only routine administration to foreign officers. An allied indictment is that it uses little foreign managerial talent in its foreign operations. In a 1965 study of this matter among the French affiliates of U.S. firms, Allan Johnstone concluded that the American multinational firms did indeed drive with a
tight rein; home offices often made policy decisions without consideration of their local consequences' in France. However, in his book Foreign Ownership of Canadian Industry, A.E. Safarian's conclusion in . respect to the Canadian subsidiaries of American firms was different: wide delegations of authority were made to the managers of Canadian subsidiaries by their American parents, which were generally less involved in their Canadian operations than in their American subsidiaries. Delegated authority to the management of a foreign subsidiary usually widens through time as confidence is gained from successful experience. It would be inconsistent to, argue for full autonomy 'of a foreign subsidiary, because it would preclude a transfer of management expertise. Foreign owners cannot reasonably be .expected to surrender their right to approve major decisions of the enterprise. . The record of American companies in developing foreign management personnel is good. American multinational businesses have a strong economic reason for employing local personnel to the maximum extent.¡The cost of a local manager is less. While the personnel policies of American companies doubtless will continue to be a source of international friction, the evidence shows that lime tends to bring wider authority to the management of foreign affiliates and a greater use of native managers. Overcentralized Research
A fourth criticism of American multinational companies is that they centralize scientific research and engineering activities in the United States, while relegating foreign operations to "hewing wood and drawing water." No doubt this stricture applies to some multinational companies, but it is generally refuted by the evidence. Safarian found that most of the spending on industrial research and development was concentrated in the foreign-owned sector of Canadian industry, and John H. Dunning, in his paper The ROle of American Investment
in the British
Economy,
found that British subsidiaries of U.S. firms spent larger parts of their sales .dollars than did British firms in the same industries. . As in th~ case of .management skills,
have made concessions to French customs by moving less rapidly. De-stabilizing
Effects
It is charged that foreign subsidiaries of the U.S. corporation often frustrate stabilization policies of the host country. Canadians complain that the fluctuations in inflows of U.S. capital into their country complicate their problems of attaining stable economic growth without inflation. They also feel vulnerable to shifts in U.S. policies governing investment outflows, such as' foreign investment controls. The Canadian complaint about uneven investment inflows is simply the other side of the U.S. problem of uneven foreign investment outflows. The efforts of private investors to profit from changing opportunities and international inequalities in investment returns lead to instability .of international capital flows that poses a problem (or both countries. When recognized as a mutual problem arising from natural economic forces, and not as an international transfer of technology is an extraterritorial imposition of American important gain from foreign investment for laws, this problem can be resolved by a host country. A multinational corpora- consultation and harmonizing actions by . tion entering a foreign nation is likely in the two g.overnments. Although the multinationaI':corporathe first stage to import its technical knowl- ' edge from its home country. Later, as tion magnified jntetnation~l flows of' local personnel are trained and local prob- capital and internal stabilization problems are id~ntified, it usually establishes lems, it ctidnot create those pf.oblems. local research facilities. Normally, it has a strong incentive to do so, because foreign Effects on International and Transnational Institutions research costs are much lower. Multinational corporations have helped to create transnational financial instituInsensitivity to Local Business Practices tions, because the large scale of their American managers of foreign subsidiaries are said to be insensitive to local operations generated financial needs bebusiness customs. Oft-cited examples are yond the capabilities of national instituthe laying off of factory workers from a tions. Notable examples are the Eurodollar Parisian refrigerator plant by General market, the Eurobond market, and the Motors in 1963, Remington Rand's simi- multinational banking syndicate. The lar action with a Lyons typewriter plant mat;ly billions of U.S. dollars held in that same year, and the computer plant Europe are actively traded, borrowed and closed by General Electric. These episodes lent by banks and businesses in the Europrovoked angry comment by the French dollar market for both short- and longpress, even though the American c()rpo-, term purposes. Multinational businesses rations justified their actions as a quest frequently borrow funds by selling Eurofor efficiency in the face of shifts in market bonds-debt securities dominated in one demand.' French consternation was due to European currency but sold and held by the French' tradition that the employer, investots in many countries. Transnational rather th.an the employee? bears the man- finance has become commonplace, as power adjustment costs of shifts in market syndicates composed of British, European demands~ The American companies should anf! ,At11eri<:an investment bankers under"
11ereiS
strong- economic reason¡ for maXImum, employment of local personnel.
continued
write large corporate issues and distribute them throughout the world. The multinationalization of manufacturing and trading enterprises has been followed by the multi nationalization of banking, as American and British bankers have established overseas branches and affiliates. Huge amounts offunds are transferred from one country or currency to another in the course of each business day. All these developments show that the world's business has long since outgrown national boundaries. The concepts of national currencies and exchange rates have become anachronistic in the age of multinational business.
such an ocean regime be established, one sphere of its action would be the formation and monitoring of agreements with business enterprises for the exploration and exploitation of the incalculable riches in the oceans and seabeds.
Policies to Expand Multinational Business
haviour of American managements abroad or for intergovernmental consultative machinery. The overriding conclusion, however, is that there are no irremediable conflicts of national interest. On the contrary, private international capita"l flows create . rising pressures to lower national barriers to a wo~ld economy, and to harmonize Ot unify national systems of money, taxation, transportation, commerce and law.
An important problem of multinational business concerns the political relationFuture of the Multinational ships between foreign affiliates and the Corporation governments of their parent corporations. Critics charge that the multinational corThe multinational corporation is only poration is an instrument of "imperialat the beginning of its ultimate developism," collaborating with its home government, and its impact upon nations and ment to enhance its national power in the the world order. Today, a few corporaworld. Conversely, it is alleged that multitions are multinational in all dimensions. national companies use the economic, dipMost are national corporations that have lomatic and military power of their home gone abroad to do business, but retain the government to gain profits. ownership, management, and world-view Manifestly, the U.S. Government-as of their country of origin. does every other national governmentWhile one may foresee a further expanacts in many ways to support American sion of U.S. direct corporate investment private enterprise abroad. The Departabroad, it is likely that the reverse flow of ments of Commerce and State negotiate foreign corporate investment into the treaties of commerce and friendship with United States may expand even faster. foreign countries, maintain consular serRates of return on investment in the United vices, promote American exports, insure States have risen and converged with against some risks of investment in lessthose available abroad. The growing mandeveloped countries, and support interagerial and technical competence of Euronational trade fairs. U.S. governmental pean and Japanese entrepreneurs will lead policies encourage private foreign investmany of them to enter the American marment as a means of strengthening forket. Such a development would enhance eign economies and reducing political domestic competition, reduce the outflow instabilities. of capital, and improve the U.S. balance The de-politicalization of American of payments. In the long run, multinabusiness' investment abroad is desirable tional business may prove far more effecbecause it reduces the risk of military contive than international trade in equalizing flict growing out of economic intercourse interest rates, real wages, and living standbetween nations. Private economic inards throughout the world. terests in profit are separated from national The rise of multinational business has The multinational corporation is, benot yet brought much tangible change in political interests in power and security. yond doubt, the most powerful agency for Although the risks and costs of foreign ininternational institutions. Although the regional and global economic unity that vestment are higher for private entreprescale of operations of the World Bank and our century _has produced. It is fundathe International Monetary Fund has ex- neurs, the more important risks and costs mentally an instrument of peace. Its transof war are lower for citizens. Moreover, the actions are transnational in nature and panded, the United Nations and its other purpose. Its interest is to emphasize the affiiiated bodies so far have not been in- knowledge that private foreign investment stands on its own feet is likely to make timately involved in multinational entercommon goals of peoples, to reconcile or remove differences between them. It canprise. Nevertheless, a new era of such in- the behaviour of both investors and host not thrive in a regime of international tenvolvement may be dawning. Resolutions . countries more responsible in the future. Some foreign complaints about U.S. sion and conflict. Is it too much to hope have been introduced into the General corporate investment reflect a misunderthat, through the instrumentality of multiAssembly of the United Nations for the standing of the benefits received by the national business, the imperatives of world establishment of an international governhost country. Other complaints have , economic progress will ultimately help to ment over the oceans and seabeds of the merit, and call for adjustments in the bebring unity to mankind? world beyond national jurisdiction. Should END
orld business has long since outgrown national boundaries.
AMERI It WIRE RVI S
Round the clock, seven days a week, two highly competitive, privately-owned organizations provide word and picture coverage of news happening all over the globe to newspapers, periodicals, and broadcasting stations in the United States and many other countries.
IN THE EARLY 1930s American writer Stephen Vincent Benet observed: "As the world shrinks and nations jostle one another, far neighbours become important. Correct and rapid information about them is at a premium." Today, with the world considerably smaller, it is even more vital that neighbours know one another better. Helping in that process, concomitant with their primary role, are two American news organizations whose logotypes, (AP) and (UPI), are by far the most ubiquitous in the history of journalism. The symbols identify the Associated Press and United Press International, the world's largest news-gathering agencies. Called wire services, news services or' press associations, these privately-owned and highly competitive organizations provide round-the-clock, seven-day-a-week word and picture coverage of news happenings all over the globe. Their products are distributed by telegraph and other means to newspapers, periodicals and radio-television stations throughout the United States and in many other countries. Both wire services, headquartered in New York City, place major emphasis in their daily coverage on speed, accuracy and brevity. However, in recent years there has been a corollary trend towards development of longer, more timeless "enterprise" articles that rely heavily on analysis and interpretation. The Associated Press is a non-profit, cooperative association operated by its member newspapers and broadcasters for their mutual benefit under a cost-sharing plan. United Press International is organized as a business firm and sells its news on a contract fee basis. Some newspapers and radioTV stations subscribe to both services. Like all U.S. news media, the AP and UPI take pride in their editorial independence and zealously guard their constitutionally-protected right to report and interpret the news as they see fit, circumscribed only by laws of libel and sedition and self-imposed standards of good taste. The Associated Press is the older and larger of the two services. It grew out of a loose federation of regional press associations which operated in the United States in the second half of the 19th century. Six New York City newspapers organized the first of these associations, called the New York Associated Press, in 1848 to secure in one telegraphic transmission the foreign. news gathered from ships arriving in Boston, Massachusetts. The papers were the
Sun, Herald, Tribune, Express, Courier and Enquirer, and Journal of Commerce. Soon the same group began sharing the expenses of "news boats" which met incoming ships in New York, and expanded its membership by one in 1851 when the Times was founded. At first the association was informal, but by 1856 a more definite organization emerged. It established a general news office, broadened the scope of its coverage, and started selling its news to "outside" papers in Boston, Philadelphia, Pennsylvania, and other cities. Other regional associations-the Western Associated Press, the New England Associated Press and the Southern Associated Press-arose and affiliated with the New York group, which through agreements with the Western Union Telegraph Company gained a virtual monopoly on wire news in the country. In 1885 the Western AP, charging that the flow of news was being restricted in favour of New York City papers, withdrew from the federation and became a vigorous competitor. After a reorganization, the Western AP was incorporated in Illinois in 1893 as the Associated Press. This is generally considered to mark the beginning of the modern Associated Press. The New York AP was dissolved that same year after vainly contesting against the new association. Towards the end of the decade the AP suspended a Chicago newspaper from membership because of an infraction of association rules. The paper obtained ajudgment from the Supreme Court of Illinois that the AP must sell its news to all buyers without exception. This was contrary to the whole co-operative structure of the association; a quick and effective legal move was deemed necessary. The Associated Press in Illinois was dissolved, and the agency was reorganized again in New York in 1900. More than 600 newspapers in the United States were AP members at the time, and the service continued to grow in the next several years. Co-operative agreements were arranged with European press agencies-Reuters of London, Havas of Paris, W olffs of Berlin. It remained for two giants of American journalism, publishers Edward W. Scripps and William Randolph Hearst, to challenge successfully the AP and establish major competing wire services which furnished their news on an unrestricted contract basis rather than under the mutual (or membership) arrangement of the AP.
The Scripps-McRae Press Association had been organized in 1897 to serve all newspapers of the Scripps-McRae (now Scripps-Howard) chain except those on the West Coast, for which another report called the Scripps News Service was designed. Meanwhile, an eastern Publisher's Press Association had grown up, and Scripps devised a plan by which his two agencies and the Publisher's Press divided news coverage. Finally, however, Scripps bought out the eastern association and merged all three groups into a new United Press Associations in 1907. Later, the name was changed simply to United Press. Hearst founded the International News Service in 1909 as a report designed for sale to morning papers and at the same time the National Press Association for evening papers, supplanting similar earlier services set up for his own newspaper chain. These two agencies were merged in 1911, with the International News Service (INS) as the surviving name. All three agencies grew dramatically in the ensuing years as newspapers, themselves growing in number, devoted increas-
Twenty-four hours a day, news "copy" in an unendingstream from around the worldflows in over the wires to America's press services. ingly larger amounts of space to national and international affairs. A new and important market for wire news opened with the arrival of radio broadcasting in the 1920s. The press associations at first were reluctant to allow radio the use of their news, reflecting newspapers' fears that it would cause circulation declines. But this attitude changed as it became evident the fears were groundless-that, in fact, newscasts in many cases actually served to boost newspaper sales. The AP, UP and INS agreed in 1928 to give radio stations two daily newscasts between them. This concession was broadened the next year to permit a fairly free flow of news to radio, and before long all three services were avidly competing to sign up subscribers. The advent of commercial television in the late 1940s served similarly to stimulate expansion of the wire services. The year 1945 saw the resolution of a bothersome legal question involving an
The AP employs about 3,300 persons fulltime; UPI some 2,500. In the early days, before 1915, all wire news was sent and received in Morse code by telegraph operators. They and their clicking instruments gave way gradually but completely in the next 20 years to teletypewriters (teletype machines). Another method of telegraphic transmission, involving devices capable of automatic typesetting (teletypesetters), came into widespread news service use in the 1950s. This method is especially favoured by small and medium-sized papers. Telephotography, the transmission of pictures by electrical signals, is also used by the wire services. The AP inaugurated its Wirephoto system in 1935, and competitors soon began operating similar systems. In 1939 the AP sent the first colour telephoto, and since then further technological refinements have been made in photo transmission techniques. In addition to spot news and pictures, both the AP and UPI furnish subscribers with a wide variety of feature material, by wire and mail. Supplementing the basic, all-inclusive coverage of the two major wire services in the United States are scores of smaller, more specialized news and feature services and newspaper syndicates that distribute everything from political columns to comic Associated Press rule that permitted a strips. Among them: The North American member newspaper to "blackball" applicaNewspaper Alliance, the New York Times News Service, King Features Syndicate, tions from competing papers in the same Copley News Service, the Bell-McClure area. By a five-to-three decision, the U.S. Syndicate, Los Angeles Times-Washington Supreme Court outlawed the practice as Syndiunconstitutional, and the AP amended its Post News Service, Publishers-Hall cate, Newspaper Enterprise Association, bylaws to conform. The majority opinion, written by Justice Hugo L. Black, asserted McNaught Syndicate, and the Chicago that "freedom of the press from govern- - Tribune-New York News Syndicate. All the services and syndicates enjoy the mental interference does not sanction resame guarantees of press freedom as other pression ... by private interests .... " Another highlight in the evolution of news media in the United States. These guarantees are contained in the Federal and U.S. wire services-and the last major state constitutions and have been further organizational change-came in 1958 when defined in innumerable court decisions. International News Service and United Freedom of the press in America means Press merged to become United Press freedom to criticize the government, its International. The amalgamation greatly officials in their conduct of the governstrengthened United Press. Today, UPI ment, and all other persons and organizaserves 6,400 clients in the United States tions whose activities affect the public weland abroad. The AP's world-wide outlets fare. It also means freedom to report and total 10,500, including 5,500 newspaper publish news and opinion about public afand broadcast members in the U.S. fairs, without the requirement of a governBoth services maintain large editorial ment permit, free from censorship, exempt staffs which gather and process the daily from arbitrary and excessive taxation, and news for direct transmission from strategiunregulated in the publication of facts and cally located bureaus to the offices of subcriticism related to public affairs. END scribers. Wire circuits link all the bureaus.
Photo at right-Mrs. Nixon's favourite-shows the President with David Lupi. model for a 1970 poster soliciting public support for children with speech and hearing disabilities. Photographers' choice was this picture at left of President Nixon, working late and alone in his executive office.
WHATISIT LIKE-the daily life of the President of the United States? This is the theme of a photographic exhibit recently shown at the Smithsonian Institution in Washington and now touring other major American cities. Titled "The First Two Years: A Photographic Impression of the Presidency," it is the first official display of pictures of an incumbent President. The fifty photographs, selected from among thousands taken by White House cameramen since President Richard Nixon took office in 1969, provide candid glimpses of the Presidency, of the time, and of the man. "We tried to cover all aspects of the Presidency," said Byron Schumaker, director of the exhibit. "We wanted to show the loneliness of the job as well as the excitement, the moments of peace and the great stress." Presented here is an eight-page portfolio of photographs from the exhibit.
The Presidency is laws, crises, rituals, speeches -but most certainly it is discussions: they are held even on plane trips.
Mr. Nixon meets the fight.'ng men, above, while on a visit to South Vietnam in July 1969. The President is Commander-in-Chief of all U.S. armed services. At right, Mr. Nixon confers with Secretary of State William Rogers and other aides aboard the Presidential helicopter. Photo, right above, shows sequence from speech delivered by Mr. Nixon.
With commitments for peace around the globe, the Chief Executive often confers with world leaders to strengthen ties and resolve differences.
President Nixon converses with Chancellor Willy Brandt of West Germany, above, in the Green Room at the White House. Right, during a visit to the Vatican, the President calls on Pope Paul. Far right, Mr. Nixon confers with aide John Ehrlichman as they stroll across the east lawn of the Presidential mansion.
The aweSOlne burden of the Presidency is sometimes lifted-lighter moments include playing the piano, choosing a tie.
Mr. Nixon, taking a turn at the piano, right, strikes up "Happy Birthday" for Duke Ellington (extreme left) during a White House party for the famed musician. Far right, President and Mrs. Nixon and daughter Tricia are cheered by guests at the Inaugural Ball in 1969. Below, President Nixon stops along roadside to watch horsemen work out during a visit to Ireland.
One of the greatest moments of Mr. Nixon's Presidency was the Apollo-ll landing in July 1969. Above, he radiophones the first men on the moon. Right, Mr. Nixon s('eks a sales clerk's opinion in selecting a necktie.
III a village clinic, right, the doctor, auxiliary nurse-midwife, and dai instruct a patient. Children receive special care, below, at the project's many feeding centres.
,
If children live longer, will parents be more ready to accept the idea of family planning? This is the question to which answers are being sought in an unusual experiment in Punjab.
A new approach to familY Planning BEING THE WIFE of a demographer is an education: a population education at least. I won't say it's compulsory, but I am a captive audience whenever the 'population' class meets. This may be at breakfast, lunch, tea, dinner or even bedtime. I've acquired a whole new vocabulary. I can almost look intelligent when we have other demographers visiting us, as long as they don't ask me any questions. Previously when invited to attend population or family planning conferences, I would refuse. But now when I am invited, I go right along. Fecundity, fertility tables, simulations and modelling are words I take in stride. I'm not in the 'baby' class any more. Recently I was invited to attend a family planning conference in the Ludhiana District of the Punjab. I knew there was a Rural Health Research Centre there in a village called Narangwal, and that it was sponsored by the Department of International Health of John Hopkins University, Maryland. But that was all I knew, so on the plane from Bombay to Delhi, I began asking questions. When our boys were young, they discovered that asking their father questions was easier than looking things up in an encyclopaedia, so they would ask him first. Then if they weren't satisfied, they'd go do their own research. I'm guilty of the same procedure.
About the Author: Mrs. Immerwahr is the wife of Dr. George E. lmmerwahr, a demographer from the U.S. Census Bureau, who is serving as adviser at the International Institute of Population Studies, Bombay.
"Please tell me about the research being done in Narangwal, professor," I asked. "I know there's a lot of research going on in demographic and family planning training centres in India. But in a rural district, what could be happening?" "Well, it's a different approach to family planning," he told me. "It's based on the theory that family planning acceptance is contingent on child survival." "Which means?" "If they c~n lower the death rate in infants and children in the¡ first five years of life, they believe the parents will stop thinking they must have at least six children in order to have two or three who will live. They believe the parents will be more ready to accept the idea of family limitation." "But I thought that child mortality had declined so much, with improved health services and better nutrition." "It really has greatly improved," he explained, "particularly in the younger age groups. It's because of the better survival of children and young people that we're having rapid population growth, with the possibility of a billion persons in India in 25 years. But, nevertheless, there are still many villages in India where as many as one-third of the children born die before reaching age five." "What do they do in the Narangwal Research Centre then?" I continued, "Is it mostly concerned with improving the health of small children?" "Yes, but in different ways. They've been testing family planning acceptance alone and in continuation with various
health services for women and children over an extended period of time, to find which combination of services gives the highest increment of acceptance and continued use of family planning. They are aware of many other points which affect acceptance, but as health workers they are primarily concerned with experimenting with health factors." At this point my instructor took some work out of his case, implying that the lesson was over, and if I wanted to know more I would have to do further research. Arriving at Narangwal the next morning, my schooling advanced rapidly as the meetings progressed. As we listened, we learned how, from the modest headquarters with the simple sign, 'Rural Health Research Projects,' invisible threads were woven like a cobweb into the daily life of 20,000 villagers, living in 22 villages within a close radius of the Centre. To my astonishment I learned that the project team includes physicians, social scientists, public health nurses, statisticians, statistical assistants, field investigators, lady health visitors, Auxiliary Nurse Midwives (ANMs); in addition to administrative and secretarial people, about 80 or so more professionals and auxiliary workers; and that all these people have been living in villages for various lengths of time, some for as long as nine years. Different members of the staff told how faithfully births, deaths and other vital statistics were recorded. A census taken in each village reveals demographic and socio-economic information on every occupant. Investigators from the Centre continued
From the headquarters of the research centre, invisible threads are woven like a cobweb into the daily life of 20,000 villagers. collect information regularly on important events and community reactions to them, thus giving valuable insight into community thinking. Housing is mapped and enumerated for ease in locating individual families. Tabulations from these and other records keep a dozen statistical assistants and two computers busy. The population study is only one of four major subjects in the research programme. Others are orientation of doctors to rural work; analysis of functions of health centres, and developing methods for studying how effectively health needs of villages are being met; and a study of interaction of infection and nutrition among children. "In one group of nine villages," we were told by the head of the Child Care Programme, "special child care services are maintained. Mothers are given instruction in how to care for their new babies, and aided with feeding problems from birth to three years of age. Special child Jeeding programmes are operated for malnourished children. "We try to stress keeping baby well and child healthy, rather than just treating the sick child. Routine health care is given to all children under 13. Mothers are helped to keep the children well through understanding child growth and development, and through better food and health habits. Close records are kept and compared with those of the four 'control' villages, which receive no extra services." In another group of four villages, intensive women's health services are given. Auxiliary Nurse Midwives assigned to the project are given two or three months' extra training so that they can give prenatal and post-natal care to expectant moth~~ Every woman in the 15 to 49, or reproductive, age group is visited every two months, to aid in early detection of pregnancy. Routine tests and treatment are given at definite steps in the pregnancy, and complications are referred to the backup team of doctors at the headquarters. According to Sister Delores Laliberte, the ANM works with the village dai, or
I
Doctors, nurses and social scientists meet to review project findings, above, while research team interviews rural housewife, above right. Investigators work informallychatting beside a well, right, or sharing a charpoy with a village grandmother. midwife, in helping the mother prepare for the home delivery, but the ANM does not assist in the delivery unless the dai requests her help. "Women's services are more important than child services," she said, "as help given before the baby comes helps the workers in establishing good relations with the families." "For some reason," Dr. Carl Taylor, founder and director of the project, told us, "our poorest co-operation came from the villages which received comprehensive care (both mother and child services). We can't say that they were stacked against us but the statistics don't show what we would like to see." He was referring to the 'books' each guest had been given, filled with tabulations, thick as a telephone directory, with different coloured pages for each group of villages. We were to meet in discussion groups after lunch to analyze the all-important tables and make suggestions as to the direction and relevancy of the programme. I peeked in mine to see if I could find the results of the effort to reduce child mortality, but gave up quickly, deciding to wait for the experts. At lunch under the big colourful canopy, we had a chance to get acquainted with other guests, and find out what they were doing. There were national and state senior public health and family planning officials, as well as district and block repre-
sentatives. There were persons from WHO, UNICEF, USAID and the Ford Foundation. At one table Dr. Taylor sat with a handsome group of Sikhs in rural dress. These were the village leaders who had been given a special invitation in appreciation of their co-operation. The projects work in close collaboration with the Punjab Government and with very active support from the Government of India, its Directorate General of Health Services and the Indian Council of Medical Research. When our discussion group met, I was all prepared to hear the results of the experiments summarized and analyzed. Had the death rate decreased? Was acceptance rising? But first, the experts plunged into the topic of leading concern. "What can we do to make family planning more acceptable at the village level?"
Health officials pondered what health service component could be added to the field worker's stock-in-trade. Some felt he might make more headway if he could talk on smallpox or nutrition. One suggested that he might carry band-aids or pesticides. One gentleman queried, "Suppose he goes to a village and finds a lot of people with influenza. Should he talk about family planning? He needs to be more than a family planning man!" Having told what was being done in their different states about this problem, the discussion returned to. the reports of the morning session. Was the Narangwal experiment providing the answer to the very question they found so perplexing? Improved training of ANMs to relieve medical manpower shortage . . . mother and child care services of preventive nature ... improved child nutrition programmes
family planning integrated with health services, as a natural part of them? Cost of the experiments made it unlikely that the pattern could be adopted on a national scale. Results were not available for a long enough period of time to be conclusive. Yet it was agreed that the problems encountered in setting up the experiments, and the solutions reached had tremendous value in their applicability to other nations as well as India. The research effort was in itself a whole showcase of ideas, and good methods for any agency to borrow. After the discussions we were taken to visit one of the villages, where we saw for ourselves the nowadays common sight of happy, healthy children, who shyly watched us or followed along with our group. One of my companions told me he could remember how many miserable looking children he formerly saw in a village. We saw the ANM in her own little home in the village, and in the two-room clinic provided by the Panchayat. Instead of one ANM to every 10,000 population, as in the government's rural health services, the project ANMs were each assigned to their own village with a population a quarter of this size. The project has found this is imperative for adequate care, so the ANM can make home visits every morning, and have clinics in the afternoon. In this way they also reach the fearful and superstitious who would not normally avail themselves of their services. We saw one happy young mother whose tiny baby weighed only one kilo at birth. The mother was giving the baby excellent care. Dr. Tom Barns, tbe gynaecologist at
the Centre remarked, "The baby is doing possibly better in the home with her care than if it were in a hospital where there is more chance of infection." We recognized some of the staggering problems in operation which the administration had to solve. Transportation, housing suitable for the urban staff converted from ordinary village houses; communication between workers in villages and headquarters. Dr. Barns is thinking of installing carrier pigeons. He hopes they will beat the stork's arrival. One got the feeling that there was the greatest interest and dedication to the project from everyone on the staff. All felt involved, and hopeful for the success of the experiment. On the plane on the way home, I had a chance to ask one of the experts (my husband) a few unanswered questions. "Tell me, please, about the results in the experiment villages. Did the death rates drop? Did the number of births decrease?" "Yes and no. The death rates dropped as much as 60 per cent in the villages which received the intensive care, as compared with the 'control' villages. But the births have not decreased. In fact in one village they were higher. But that is to be expected. The experiment will continue for four or five more years. Results then will have great value to those who are in charge of health and family planning programmes." "But don't the people realize that their children are surviving?" "Apparently they are stillunconvinced. In one of the surveys the question was asked, 'Do you think more children are living now than lived thirty years ago?' Only 29 per cent felt that they did. The same number thought more children were dying nO\v than then. But 42 per cent either had no thoughts about it or thought it was the same. This shows where the education needs to be directed." The 'professor' took out his papers. The class was over. If I had any more questions I would have to find the answers myself. But where would I find them? How could so many people become educated in time to spare the country from overpopulation? Then I remembered hearing Dr. Taylor say, "There are powerful forces within the society itself. ... " I smiled to myself. There are some questIons which even research can't answer. END
authority in the case. All other hospital and check the results of the tests and exapersonnel provide whatever assistance is mination, and his own physician comes by required at his instruction. to reassure him and to say that he will Beneath attending and staff doctors in participate in his post-operative care. the hospital chain of command come variConsiderable attention is paid to diet. ous nurses and aides. The senior profes- Many hospitals prepare a series of five to sional is the RN, registered nurse, who has eight basic diets which are subject to great passed¡ a state examination after a mini- variation. Combinations of them called for mum of three years of formal training be- by medical and surgical conditions of yond high school. Next comes the LPN, patients run to as many as 50. A patient licensed practical nurse, who typically has with a heart condition may be on a salthad at least one year of formal training free diet; if he also has diabetes, he will after high-school graduation. Nurses' aides, be on a no- or low-starch diet as well. If, who assist both RN and LPN, are non- in addition, he should need surgery, he professionals with on-the-job training. No may be on a liquid diet, but still salt-free AMERICAHASITS world-renowned hospi- member of any of these groups may at- and low in starch. tals, such as Johns Hopkins, Massachu- tempt a task beyond her tested competence. To pay for hospitalization, 80 per cent setts General, Columbia-Presbyterian and For example, most state laws prohibit a of Americans are covered by insurance. many others-all large teaching institu- nurses' aide from administering so much as Health-care policies may be purchased by tions associated with medical schools and an aspirin tablet. individuals; very often, they are provided Finally, there are the volunteer workers. by employers. A good basic hospitalizaserving as centres of research and advanced training as well as patient care. In addi- Teen-age volunteers are commonly called tion insurance policy provides at least 60 tion, however, it has many smaller, yet "candy stripers" and older volunteers to 120 days of care in a semi-private room, modern, community hospitals-more than trained by the Red Cross are known as with generous coverage for other services "Gray Ladies," both names deriving from including laboratory work, X-rays, drugs 7,000 of them across the United Statesthat provide the great bulk of hospital their uniforms. Volunteers make a tre- and the elaborate equipment of a modern health care. On any day these hospitals mendous contribution to patient care and operating room. serve more than 1.4 million patients. For well-being, providing through their unIn addition to insurance policies offered these individuals, time is an essential factor paid services many amenities that other- by commercial companies, there are those in their treatment. But also for the hospi- wise might not be available. They visit provided by Blue Cross and Blue Shield, tals themselves, faced with the growing patients, perform little chores for them, non-profit organizations sponsored by docneeds of a community and the rapid ad- bring them reading material, operate gift tors and hospitals, which cover about onevances in medical science, time is the great- shops, coffee shops and the information third of all Americans. Blue Cross covers est shortage they face in their efforts to desk, and help to orient patients' families. hospitalization and usually pays the hospiprovide the "best" and "most modern" for Every attempt is made to render the tal bill in full for semi-private care. Blue ' admission procedure for a patient simple. Shield plans pay the doctors' bills. those temporarily in their care. Not long ago, for example, a 39-yearThese hospitals are local institutions Except for an emergency, the personal caring for the needs of a particular com- physician makes a reservation. On the old Wisconsin housewife was driving her six children home from a party when her munity or area. The number of beds may pre-arranged day and at the pre-arranged range from 25 or fewer in a small rural hour, he appears at the hospital, signs in car stalled on a level crossing and was community to 500 to 1,000 in a large at the admissions office, and receives his hit by a train. The mother and six children all were badly injured~so badly that it identification bracelet. metropolitan area. In some countries, hospitals historically After that-for example, in the case of a required a total of 308 days of hospital care are looked upon as public utilities to be man who is to have a gall-bladder opera- to put them on their feet again. The bill tightly controlled, staffed entirely by spe- tion-he is taken by a volunteer to the was $36,571-and the father of the family, cialists, with the family doctor "losing" his nursing unit where the head nurse discusses who worked as a fireman in it boiler room, patient at the hospital door and "regain- with him the routine admission procedures didn't earn that much money in half a ing" him only when he is released. In the such as chest X-ray and blood count, in- dozen years. But the father's employer had United States, hospital privileges are¡ troduces him to the nurses' who will be provided his workers with a good insurance granted to most physicians, including caring for him, and to a nurses' aide who policy that covered the dependents for hosgeneral practitioners. The wider extension takes him to his room. After he has un- pital care and covered costs of doctors of hospital privileges is believed to upgrade packed, he goes to the radiological depart- and surgeons. Americans who have no insurance either all doctors, helping them keep abreast of ment and clinical laboratory for X-ray and new developments in medicine. blood testing. When he returns to his by choice or lack of funds receive hospital Except in emergencies, which account room, a staff physician gives him a pre- care right along with everyone else, but for about 10 per cent of all hospitaliza- operative physical examination, a dietitian . their method of payment is different. Some tions, each patient's personal physician may confer with him about his post-opera- are "self-insured," that is, wealthy enough arranges for his admission to a hospitaltive diet, an anaesthesiologist drops in to to pay their bills without undue strain. The and the personal physician, thereafter explain about the anaesthetic to be used, others receive treatment either free or accalled the attending physician, has top the surgeon stops in to review his record cording to their limited ability to pay in
Rushing to the aid of a criticallyill patient, the nurse at left symbolizes the constant battle against time that is waged in American hospitals. In this, as in all other hospital services, everything is geared to the needs of the patient.
continued
"Humanizing" programmes adopted by hospitals include candle-light dinners for parents and explanations by doctors to reassure surgery patients. community hospitals run by public funds which serve both the paying and nonpaying patient. Those with the ability to payor with insurance to compensate the institutions plus support from community taxes offset the expenses of those who pay nothing. In addition, the federal government in co-operation with the states has established a system of financial assistance .called Medicaid for those who need care, either in or out of a hospital, but cannot . afford its costs. Medicaid will also pay: the. small premiums that bring anyone over' 65 the government-sponsored hos1?italinsurance called Medicare. Over the years there h,asbee~ ~u~h agi~ tation in America fOIi.¡.~'socialized"medicine'and, indeed, the 'principle of universal medical service is reflected iIi.the ma~y)nsurance and government plans to be found in the country. But Americans also cling to the principle of the personal physician, chosen by the patient and paid by him, who owes his first allegiance to the individual rather than an organization for which the doctor works. By insurance plans, government programmes and other measures, it is hoped that the benefits of a patient-oriented and free-choice system can be retained while also serving the medical needs of all on an equal basis. Hospital stays have decreased in length. For example, 20 years ago an appendectomy typically required a staypf at least 14 days; now the patient is out in three to five days. At the same time, because the patient receives more intensive, advanced care, often with complex equipment and treatments requiring highly:trained technical personnel, hospital payrolls have shot up sharply-more' than fivefold since World War II. Wages and salaries repre- , sent about two-thirds of a hospital budget. Today, an average of 241 hospital employees care for every 100 patients compared to a>148-to-loo'ratio in 1946. A single complicated operation may involve as many as 45 people. Many patients; it has been discovered, after recovering from an acute phase of illness or within a few days"after surgery'of some types, don't really need crxpensive
round-the-clock services and even recover more quickly without them when they fend for themselves with some supervision. And so, increasingly, they are being transferred to special units in a separate wing of the hospital where they can have low-cost, hotel-like rooms, carry their own tray in a cafeteria, attend to most of their personal needs on their own. In more and more communities, too, there are organized home-care programmes, which make it possible for a convalescent patient to return home earlier than he would otherwise and,.at home, to be cared for by a visiting hospital team. The sterile institutional look of hospitals is disappearing. Wall colours are brighter; some of the new sick-room furnishings ~re like diose at home. This is one part of an effort hospitals 'are making to cancel the natural anxiety of ill patients in strange surroundiJ)gs. In addition, hospitals have adopted other ."J;1U!11anizing"programmes. Many hospitals 110W encourage pre-hospital 'discussion with parents of young patients, pfoviding them with an opportunity to aSKquestions and voice apprehensions. By alleviating parental fears, which a child can sense, and by answering disturbing questions, pre-hospital disc\.lssion and counselling leads to calmer parents and more cooperative young patients. At the' Hospital of St. Anthony de Padua in Chicago, very soon after a patient who is to have surgery signs in, he goes to class. For an hour, before he can begin brooding about his upcoming operation, hospital staff members explain in detail tQ him and other new arrivals what they may expect before, during, and after surgery. Soon the patients become relaxed. Many hospitals encourage children to bring favourite toys as a means of maintaining a feeling of familiarity and continuity. The Montclair, New Jersey, Community Hospital provides wheel-chair guided tours to entertain convalescent patients. Some hospitals invite new parents to a "farewell" dinner-a candle-light gourmet meal for two: with the idea that the new mother and father, with a new-born to care for upon getting home, will have little chance for a quiet meal for several months, In the United States today there is new view of the hospital as not just a place to receive intensive in-patient service, but as a community health centre. 'Thus, for example, the Hunterdon Medical Center, a 121-bed institution in Flemington, New
a
Jersey, serves an entire rural county of 65,000. It offers a screening programme to detect illness in apparently healthy people. It supplies speech therapists for the county's schools, maintains a home-care programme, and 'has an affiliation with a local nursing home for patients who no longer require hospitalization. As a means of assuring first-rate care in community hospitals, these institutions must meet certain standards applicable to large teaching hospitals as well if they are . to be accredited. The Joint Commission on Accreditation is a professional body supported by hospitals and doctors and charged with ipspecting and approving hospitals, making certain that the facilities are safe and professionally managed, and especially that doctors are organized to monitor the quality of care by regular review of diagnosis, treatment and results. Already, more than 400 hospitals have joined in a new computer-based medical audit programme offered by the Commission on Professional and Hospital Ac~ tivities, anon-profit organization sponsored by the American College of Physicians, American College of Surgeons, and American Hospital Association. From each hospital, the medical record librarian submits an abstract of each patient's record. All abstracts are fed into a computer. Regularly, each hospital gets baclc a report. Did a doctor fail to make a blood-sugar study in a patient with possible .diabetes.? Is a doctor using blood transfusions carelessly? The report shows up any such failings, alerting hospitals to poor practices. It helps improve laboratory procedures, use of tests, of blood, of antibiotics and other drugs. Also, in each computer-audited hospital, the doctors get reports allowing them to compare their success rates in medicine and surgery with those of other audited hospitals. One of America's modern hospitals dedicated to the general care of the sick and injured is the Queen's Medical Center in Honolulu, Hawaii. Founded over 100' years ago, long before Hawaii became the 50th 'state of the United States, Queen's has managed to keep pace wl~h the pressing needs of a growing community and at the same time stay abreast of medical advances. The focus of both concerns has always been the patient, not just his ailment >or infirmity, but the total person who finds himself suddenly in an unsure and unfamiliar circumstance-eyen, perhaps, ,as.an, emergency case.
A VERY SPECIAL PATIENT IN HONOLULU Unlike most emergency cases at Queen's Medical Center in Honolulu, the arrival of Victor M. Ashikhmin (left) was fully expected. A 19-year-old Soviet seaman, Victor had been badly burned when an ammonia compressor exploded on his trawler in the Pacific Ocean. With no adequate facilities aboard for such a crisis, he was evacuated by a U.S. Navy helicopter and flown 1,600 kilometres to Honolulu for treatment. For six weeks, Victor was "'-~ hospitalized: specialists were brought in to treat his burns, translators were found, and nurses were assigned to him. Victor was only one of the 18,000 bed patients and 25,000 emergency cases treated annually at Queen's. When illness strikes quickly, a patient is often brought in to Emergency by ambulance. Waiting is a staff of 15, including a fully qualified physician. "We treat everything," says head nurse Barbara Ideta, "from a severed arm to a temperature one degree above normal." The stroke victim below has just had his immediate needs attended to, and is in the process of being handed over to his doctor. Although most cases are uncomplicated, the staff is geared to treat the extraordinary. Emergency staff members are trained to use the "crash cart," a conveyance that holds everything needed to assist a cardiac arrest patient: defibrillator, resuscitator, oxygen, and medicines (see page 32). When a signal sounds in the hospital that a person's heart has stopped, a nurse from Emergency comes running, knowing that every second decides life or death.
SPECIALIZA TION LEADS THE WAY TO THE FUTURE Queen's Medical Center, one of 34 general hospitals in Hawaii, ranks by all odds as the largest and most advanced in the area in terms of specialized equipment and trained personnel. For its 447-bed capacity, the hospital maintains a staff (professional and lay) of approximately 900 persons, a ratio of two employees to one patient. However, more indicative of the care available is the fact that each patient on an average receives four and one-half hours of nursing care a day. Of course, this figure varies according to illness. Specialization in care and treatment is fast becoming a significant factor in tl)e hospital's operation. According to Will J. Henderson, Chief Administrator: "More and more patients are being cared for in facilities specifically designed for a particular illness and employees are being intensively trained to care for special cases." For example, Queen's runs a unit exclusively for patients who (a) have had or are suspected to have had a heart attack or (b) have
experienced life-threatening disturbances in their heartbeat rhythm. Electrical monitors are placed on each patient upon arrival and remain until he leaves. Any change in heartbeat automatically shows on a screen at the central desk and is recorded for later transcription on a graph. One nurse trained in coronary care is assigned for every two patients. Because of this speciality at Queen's, the hospital trains all other doctors and nurses in Hawaii in coronary care. Another hospital in the area has put a similar emphasis on kidney disease and, by mutual agreement between hospitals, patients are referred to the one best equipped to handle their case. Duplication is thus avoided and the patient retains the advantages of excellent care. Although the "inside" of Queen's resembles good hospitals found anywhere, outside it remains unique in its tropical island setting and Hawaiian atmosphere. But the ease of island living does not interfere with the efficiency of a staff dedicated to keeping it on a par with the best in the world.
Queen's is a teaching hospital where young doctors are trained by experienced physicians. At left, a senior doctor (facing camera) has a discussion with three younger doctors. In the paediatrics section, below left, parents' visits are encouraged. The surgery department, below, . includes J 5 operating suites. At right, the enormous two-million-volt X-ray therapy machine, only one of its kind in Hawaii, treats 30 to 40 cancer patients every day.
OUTOF THEDAWN, it bursts across the land. Before its blunt-nosed engine stretches a path of shining rails, old friends to the huge iron wheels that effortlessly churn up the miles. The schedule is precise-Elko, 9 :46; Green River, 11:58; Omaha, 2:02. Those who ride the silver railcars are envied. They sit and watch, while a giant invisible hand winds the endless landscape past their eyes. Those beside the tracks catch only an impression: a white coat, arms folded, at an open door; a flash of red decorating the dining tables; a face peering out through a glass reflection. The names of the trains themselves echoed romance: "Super Chief," "Western Star," "California Zephyr," "Sunset Limited," "Silver Meteor," "Lark," "Twentieth Century." For traveller and onlooker alike, each train has recalled the spirit of a young and growing United States. Like loyal soldiers they have performed their duties without complaint. But changing times have sent many of the long trains over the horizon and into oblivion. A massive national programme of highway-building has helped divert the rush of busy travellers to cars and buses, as well as to planes. In four decades the number of scheduled daily intercity U.S. passenger trains dropped from a peak of about 20,000 to fewer than 400; by late last year the railways were planning to discontinue 100 more. Although American railway companies are private enterprises, they are closely regulated by United States Government As U.S. highways expanded, rail passenger traffic dropped. To help retain basic train ralites (map, below), Amtrak took over on May 1.
agencies. These agencies have been reluctant to permit the railways to drop passenger runs, even when the operations clearly became unprofitable. For many years the regulators took the position that the railways should subsidize passenger service out of the earnings from their profitable goods traffic. But the railways' earnings from freight also have suffered due to increased competition from other modes of transport-particularly trucks operating on the extensive and growing network of high-speed highways. The collapse last year of the Penn Central, the nation's biggest railway, was symbolic of the trend. It came to be widely recognized that the railways could not be expected to carry the burden of unprofit" able passenger operations any longer. To ensure that long-distance rail passenger service will be available and to relieve the railways of the burden of providing it at a loss, the U.S. Government has taken the historic step of assuming responsibility for maintaining a basic network of rail traffic. By upgrading service and equipment and by eliminating passenger runs with insufficient patronage, the Government hopes to make the passenger service selfsupporting. The Rail Passenger Service Act of 1970 provided for a semi-public National Railroad Passenger Corporation (also known as Amtrak), which began operating some 165 daily passenger trains from May 1 this year. Since that date, individual railway companies have been permitted to discontinue their intercity passenger trains by paying Amtrak to take over the responsibility. Amtrak runs trains Oil the privatelyowned railways' tracks. Some of the 23 railways now operating passenger services may supplement Amtrak by continuing to operate those trains that earn a profit. Sources of capital for the new system are the U.S. Government, the payments made by the private railroads, and the sale of securities to the public. Not included in the Amtrak system are goods trains (which will be continued by the individual railways on a private-enterprise basis) or suburban lines. U.S. Secretary of Transportation John Volpe-a director of Amtrak-promises replacement of old railway stations with more comfortable modern ones and laying of tracks adequate to carry the faster passenger trains of the future. The magic of the train whistle in the night may have been muted, but it will not be stilled. The long END trains will return.
pains and gives promise of an era of economic development for the people of its section of the Himalayan foothills. It serves the needs of the community and the region. In addition, it has all the makings of a major tourist attraction. Darjeeling suffers perennially from a shortage of domestic fuel-wood and charcoal. At present charcoal is brought to the area from the plains of Sukna and Siliguri, but it hardly meets 60 per cent of the demand. The same wood which yields charcoal can be fruitfully utilized by the woodbased industries in and around Siliguri. Moreover, the present method of production and transportation is considered economically unsound. Considerable loss has been incurred over the years. In the Rangeet Valley, both in Darjeeling and in the neighbouring areas of Sikkim, this potential resource remains untapped. Hence the need to improve the accessibility of the forests. The Darjeeling-Rangeet Valley
Ropeway is one project which helps do it. The principal object of this Ropeway is the transportation of products of the Goke protected forests near Singla (elevation: 283 metres above sea level) on the Sikkim border in the Rangeet Valley to North Point (elevation: 2,045 metres), five kilometres from Darjeeling. It also serves three tea estates, through intermediate stations en route. Situated at the junction of the Ramam and the Little and Great Rangeet rivers, Singla attracts tourists who like to go fishing or shooting. There one can see myriads of butterflies weave iridescent patterns in the air. Legend has it that Guru Padmasambhava fought pitched battles against demons in these jungles on his way to preach Buddhism in Tibet. On the opposite bank of the Rangeet is Jorethan, the small terminus of Sikkim State Transport, with its neat red-roofed bungalows and blue-grey, hard-topped
roads. There is a proposal to extend the Ropeway up to Jorethan. Undoubtedly it has already opened to tourists places of unusual beauty in the magnificent Rangeet Valley. Tourists are attracted to Darjeeling by the great snows of the Himalayas-the mighty Kanchenjunga and elusive Everest; fine forests of oak, magnolia, and rhododendron; a thousand species of flora and fauna; hundreds of beautiful birds; and numerous game fish. It is, in Mark Twain's apt tribute, "the one land that all men desire to see, and, having seen once-by even a glimpse-would not give. that glimpse for the shows of the rest of the globe combined." Bounded by Sikkim on the north and flanked by Bhutan on the west, Darjeeling's great attraction is a view of Mt. Everest at sunrise from Tiger Hill, about 10 kilometres away. Other things to be seen are Observatory Hill, the Lebong Race Course,
The Ropeway carries six passengers or 750 kilogrammes o.f freight at a time. Left, unloading timber at the topmost station; above, a view of the Ropeway's glass-panelled passenger cabin. Route (shown on map at right) includes three intermediate stations. Ride involves I,8oo-metre descent, lasts 48 minutes.
the Lloyd Botanical Gardens, the Birch Hill Public Park, the Natural History Museum, and the Himalayan Mountaineering Institute. And now, the Ropeway. Jagadish and Mira Guha, like many a young couple, could not resist the lure of Darjeeling and its surroundings. They were up there to steep themselves in the grandeur and the beauty of the mountains. After a pony ride in the morning, they enjoyed a thrilling trip on the Ropeway. "The ride is simply enchanting," was the enthusiastic comment. "Emerald-green tea gardens, romantically landscaped valleys, tumbling hill streams, and above all shimmering Kanchenjunga are fascinating." The 48-minute ride involves a descent of about 1,800 metres. Designed by Riblets Tramways Company of the U.S.A. and erected by Willcox Buckwell India Ltd., the Ropeway is a single track and is divided into four sections; each of which handles intermediate traffic. In other words, the
journey necessitates a change of cabins at the three intermediate stations-Van Tukvar, Barnesbeg, and Singladara. About 8.3 kilometres long and moving at 10.8 kilometres per hour, the Ropeway carries six passengers or 750 kilogrammes of goods at a time. A round trip costs Rs. 16. Traffic is quite heavy during the peak season, when the Ropeway earns up to Rs. 1,000 a day, working on an eight-hour schedule. The upward traffic consists principally of charcoal and timber for the urban population of Darjeeling, but also potatoes and other vegetables grown in the valley. The Ropeway can carry 4,000 tonnes of goods a year. Downward traffic is mostly rations and fertilizers for valley and tea gardens. The carriers are a self-levelling platform type with removable sides. The glasspanelled cabin sits on the freight platform before it moves. Each terminal is equipped with a tele-
phone to facilitate communication between the operators. There is also a device to stabilize the carriers during loading and unloading operations, and safety measures have been taken to guard against accidents. The dollar cost of the project was financed fro111 a U.S.A.J.D. non-project loan and the rupee cost by the state government to cover indigenous equipment, material and services, as well as taxes and duties on imported and local items. From the U.S. non-project loan the Government of India allocated $123,000 (Rs. 9.2Iakhs) for U.s. equipment and engineering services for the Ropeway. U.S. equipment includes components for track rope and hauling rope, four sets of driving units, four carriages, five hydraulic hand-lifts, a construction winch, and driving tools. It seems likely that the project will be a financial success as well as bring the isolated Rangeet Valley and the outside world closer together. END
A staid old museum has acquired a dazzling new reputation as the scene of some of the liveliest and most exciting 'happenings' in Washington, D.C.
MANYAMERICANSstill think of the Smithsonian Institution as "the nation's attic." But that rusty image has been sent to the cleaners. Now, the 125-year-old museum is where the action is-it has become one of the liveliest showplaces in Washington, D.C. As one startled observer remarked: "The change can only be compared to a nice old grandmother suddenly putting on theatrical makeup." Summer visitors strolling along the Mall, where the Smithsonian's main buildings are located, might come across: a jazz concert on the steps of the Natural History Museum; a puppet show; a Swiss fife and drum corps; a passenger-carrying hot-air balloon; or a carousel swinging full tilt in front of the original Smithsonian "castle." When tlle "Summer Festival on the Mal!" began in 1967, the intention was to bring the museum to life for many of the residents who had never been exposed to the mind-challenging mysteries and treasures displayed right in their own backyard. It worked. The summer festivals are so successful that they have become regular attractions in their own right. "We've got a tiger by the tail and can't let go," says Benjamin Lawless, chief of exhibition design at the Smithsonian's Museum of History and Technology. He adds: "We started out with the idea of increasing interest by goi ng out to where the people are. Now we've picked up such momentum that we're on our toes just keeping up the pace." The "happenings" on the Mall were just one stage in the programme. Another stage involved satellite museums-a concept first suggested by the Smithsonian's head man, Secretary S. Dillon Ripley. Ripley's idea was that if some people can't Text continued on page 48 Left, members of a summer theatre group from Iowa perform in costumes of the 1920s. Passenger-carrying hot-air balloon at right demonstrates methods of pioneer aeronatlts.
The Smithsonian has emerged from its buildings to embrace the out-of-doors.
The young audience above displays varied reactions to the sight of a sheep being shorn. These city children also saw a dog herding sheep, and a harness-maker working with awls and gouges. At left, a crowd collects around this resplendent drummer, dressed in the costume of the Seminole Indians. Youngsters scramble to buy souvenirs, right, to commemorate their day at the Smithsonian. In many of the museum's activities, the visitors take an active part in the 'happenings.'
Its light-hearted approach does not undermine the Smithsonian's serious purpose: to increase and diffuse knowledge among men.
go to the Smithsonian, then the Smithsonian should go to them. The first satellite was tested four summers ago in the capital's Anacostia district. Under the. direction of John Kinard, the museum set up shop in an abandoned movie house. The critics had their usual doubts, but the first show-The Negro in America-drew an unexpected 5,087 persons in 15 days. Their curiosity whetted, many of these visitors headed for the main museums on the Mall. Here, the "happenings" gave them even more reason to make repeat visits. Plans call for other satellite museums in the Washington area and beyond. Other living museum projects include summer and after-school programmes, designed to interest young people in museum work. Also in the works are seminars on museum management in answer to the requests for technical help that come from dozens of smaller museums throughout the country. Not to be overlooked, of course, is the fact that through this lighthearted approach shines the fact that the Smithsonian Institution is made up of some of the world's most outstanding historic, natural history, and art museums. A visit to the Smithsonian is for many the higWight of a trip to the capital. The magnificen t Museum of History and Technology, for example, features some of the most exciting display techniques in the world. How else would you describe the Hall of Historic Americans in which 100 live-size mannequins stage an old-time political parade? Contrasting with the modern architecture of these exhibition buildings is the Old Patent Office (only the Capitol and White House are older) which houses the National Portrait Gallery and the National Collection of Fine Art. The National Air Museum has acquired many of the historic aircraft that played a part in American air history, from the Wright Brothers' original Kitty Hawk to Lindbergh's Spirit of St. Louis and John Glenn's space capsule. This collection will some day be housed in a single supermodern structure, designed specifically to hold and display the larger artifactsall parts of the living, growing, swinging Smithsonian. END
Jazz singer at right is a member of the famous Jelly Roll Morton Memorial Band from New Orleans. Visiting youth choir, above left, provides music under the stars. Skilled needlewoman explains quilt-making, left, during American Folk Life Festival.