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We identify two approaches to financial crises in the history of political economy, namely, the exogenous approach whereby financial crises are sudden events, and the endogenous approach whereby they arise from a long process. In focusing on the endogenous approach, we study the contributions by Thomas Tooke, Ralph Hawtrey, Hyman Minsky and Charles Kindleberger to the lender-of-last-resort theory, especially in international contexts, under the gold standard and the dollar system. The function of the lender of last resort broadens institutionally (depending on the type of securities and on the institutions issuing or holding them) and internationally (depending on jurisdiction and on the type of institutions ultimately requiring international liquidity).

AbstractBen Bernanke first referred to Walter Bagehot’s Lombard Street when he was in the chair of the Board of Governors, and when the Federal Reserve responded to the global financial crisis that began in August 2007. While the literature has dealt with the practice of the Federal Reserve and its compliance or otherwise with Bagehot’s rules, it has not detailed Bernanke’s theory of lending in last resort and the underlying interpretation of Bagehot’s rules. Thus, our approach is not empirical but theoretical. We first recall Bagehot’s arguments especially regarding the respective levels of interest rates. Then we show how Bernanke met Bagehot and how he revisited Bagehot’s rules. We find that Bernanke’s approach can be sustained under theoretical conditions—notably working on the assumption that the fundamental value of financial assets can be identified. We conclude by emphasising that the debate can be either restricted to the question of moral hazard, or broadened to the question of the financial cycle. [ABSTRACT FROM AUTHOR]

Our paper shows how Charles P. Kindleberger examined the function of the international lender of last resort and anticipated the rules governing the dollar swap line program (with unlimited amounts and at a fixed price) implemented by the Federal Reserve in the aftermath of the failure of Lehman Brothers in September 2008. We systematically explore Kindleberger's works on the central bank swap agreement in order to discern the theoretical foundations of the international lender of last resort rules he proposed. In this respect, two of his arguments that appear concomitantly must be distinguished. The first concerns the burden that the leadership partly or mostly should shoulder because of the problem of free riding—this is the traditional argument of benevolent leadership. The second argument concerns the efficiency with which the leadership operates as the stabilizer given the international monetary and financial context—this argument of the efficient stabilizer has been far less studied in the literature. We find that the Federal Reserve was not a benevolent monetary institution, but the global financial stabilizer instead—meaning that Kindleberger's second argument finally prevailed. We conclude by emphasizing how central bankers rediscovered Kindleberger's contribution to the international lender of last resort function. [ABSTRACT FROM AUTHOR]

Ben Bernanke and Charles Kindleberger both studied financial crises. One interpretation in monetary macroeconomics associates them over their endorsement of the credit view as opposed to the money view. We suggest another interpretation and compare their contributions on financial crises more closely. This comparison makes all the more sense as the two authors were engaged in a discussion that the literature has not studied in depth, but that forms the Ariadne's thread of our investigation. We show that the difference did not so much concern the distinction between rationality and irrationality hypothesis, or between policy and market failure, as the distinction between exogeneity and endogeneity of financial crises. Bernanke rested on the assumption of any kind of exogenous shocks and studied their effects on credit intermediation, whereas Kindleberger analysed credit intermediation throughout the financial cycle and pointed out the causes of financial crises as the culmination of the endogenous process. [ABSTRACT FROM AUTHOR]

Background: Although the Pneumonia Severity Index (PSI) has been extensively validated, little is known of the impact of its routine use as an aid to site-of-treatment decisions for patients with pneumonia who present to emergency departments (EDs)., Methods: A prospective, observational, controlled cohort study of patients with pneumonia was conducted in 8 EDs that used the PSI (PSI-user EDs) and 8 EDs that did not use the PSI (PSI-nonuser EDs) in France. The outcomes examined included the proportion of "low-risk" patients (PSI risk classes I-III) treated as outpatients, all-cause 28-day mortality, admission of inpatients to the intensive care unit, and subsequent hospitalization of outpatients., Results: Of the 925 patients enrolled in the study, 472 (51.0%) were treated at PSI-user EDs, and 453 (49.0%) were treated at PSI-nonuser EDs; 449 (48.5%) of all patients were considered to be at low risk. In PSI-user EDs, 92 (42.8%) of 215 patients at low risk were treated as outpatients, compared with 56 (23.9%) of 234 patients at low risk in PSI-nonuser EDs. The adjusted odds ratios for outpatient treatment were higher for patients in PSI risk classes I and II who were treated in PSI-user EDs, compared with PSI-nonuser EDs (adjusted odds ratio, 7.0 [95% confidence interval, 2.0-25.0] and 4.6 [95% confidence interval, 1.3-16.2], respectively), whereas the adjusted odds ratio did not differ by PSI-user status among patients in risk class III or among patients at high risk. After adjusting for pneumonia severity, mortality was lower in patients who were treated in PSI-user EDs; other safety outcomes did not differ between patients treated in PSI-user and PSI-nonuser EDs., Conclusions: The routine use of the PSI was associated with a larger proportion of patients in PSI risk classes I and II who had pneumonia and who were treated in the outpatient environment without compromising their safety.

Objective: The number of visits to emergency units in public hospital settings in France increases every year. The adequation between admission to an SAU--Service d'accueil d'urgence (emergency unit) and the clinical status of the patient must be checked to improve handling upstream of the SAU., Method: A prospective study was conducted in the SAU of the University Hospital in Nantes to assess the proportion of patients who would benefit from direct hospitalisation, scheduled in a department of specialised or polyvalent medicine., Results: This proportion was of 10%. Seventy-three percent of the patients were aged over 60. They were referred in 77% of cases by their treating physician and in 10.4% of cases by the physician on duty. Thirty-three percent of cases were non-specified organ diseases, 20% were dermatological affections, 12% broncho-pulmonary infections and in the same proportion rheumatological pathologies; other affections were rare., Comments: The results of this study must be confirmed in a pilot study in which the general practitioner would refer any patient, that he would have sent to an SAU, directly to a medical department without passing through the SAU. To do so, using a cell phone, the practitioner would contact the hospital physician who would find a hospital bed. The impact of this new modality of hospitalisation on the SAU could be assessed in terms of the number of admissions avoided to the SAU.