The Layman's View of Hospital Work Among the Poor
By MISS JANE ADDAMS, Hull House, Chicago
I COME with a great deal of diffidence before an audience composed, I imagine, of hospital superintendents, doctors and nurses, because the layman is never very popular when he expresses his views to the expert and anyone who represents the poor, who have their full share as we all know of prejudices and difficulties, is not apt to be very popular; but I take it I would not have been asked to come unless you expected me to speak quite freely. When I say some of the things I am planning to say, I trust you will understand that I am trying to give quite carefully the opinions which I have gathered from sympathetic interest in the recitals of many poor people during the eighteen years that I have been in Hull House, from patients in the various hospitals.
In the first place it seems to some of us who hear the recitals of poor people before they go and after they come back as if the patient were not the chief concern of the hospital, as though really and truly the chief concern -- and when I say this I realize that it has certain educational sides -- that the chief concern is the education of the [intern], shall I say? That the next concern is in some way the visiting staff, and that the third concern is the training of the nurse, and, shall I say, the fourth concern is the comfort of the patient? Now, when I put it in this way, I realize that this is not true; I realize that, broadly speaking, the hospital is founded for the patient; but as you look at it, as these patients come and go, it more or less formulates itself in this order in your mind. For instance, one patient whom I knew said to me, "It broke my heart all the time I was in the hospital when the nurse folded sheets." She meant she was lying in her bed very anxious for some little attention from the nurse which seemed to her very important, and that the nurse, instead of giving this little attention, was taking sheets which had been folded in one kind of way by the laundry and was folding them in another kind of way in accordance with the rules of the hospital and smoothing them out on the shelves of the linen closet.
Now I suppose it is very important to have sheets folded in a certain kind of way and put in the linen closet in a certain kind of way, and it certainly presents a better appearance to the visiting staff and to outside visitors to open the door of the linen closet and see the sheets carefully folded; but it does seem as if some laundry might be induced to fold the sheets in the first place exactly as the hospital wishes to have them folded, so that they do not need to be refolded before they are put in the linen closet; but the patient lying there is quite conscious of what the nurse is doing and is all the while wishing that the nurse should be doing something for her. I give this a mere incident, and I am sure some of you recognize its truth.
It is true, perhaps, that some things in hospital wards, things which are very valuable and useful in themselves, have been exalted into a sort of [fetish], into a kind of institutional test. If the linen closet is perfectly kept, then in the eye of the casual visiting staff the hospital is running well; if it is not, the hospital is not running well, and no one stops to inquire whether it has been made tidy by [someone] who has been engaged for that purpose and that the patient has not suffered because the sheets were not properly folded.
I hear complaints from some of my neighbors of certain nationalities which I shall not mention and who, I must confess, are not very fond of being bathed every day -- I admit that, so that they may not be brought up to me again, -- but they do dislike to feel that the bath is such an institution in the morning that when the patient has not slept well at night, and let us assume that at four or five o'clock in the morning he has fallen into a sort of troubled sleep, and along [page 2] about six or seven or eight o'clock he has fallen into a comfortable sleep. (I think the physicians here will hear me out that such cases occur), and then the call of the doctor is coming between nine and ten, or between half past eight and half past nine, and because it is a rule of the hospital that the patient must be bathed and properly in order and the bed properly made, he therefore is roused out of his first comfortable sleep he has had for the last twenty-four hours in order to be in proper trim for the doctor to look at, that patient who cares for his own sleep a great deal and cares for the doctor very little, that patient feels that his comfort is being sacrificed to the hospital looks, to the general hospitalization, shall I say, of the situation. I have known of one case where the nurse carefully folded the hands of a patient who had just had a bath across the clean sheets and said, "Now, I do wish you would stay like that until the doctor comes, and if you will just keep still and not stir, you would be all right." Now, that may have been a very worthy nurse and the doctor may have been very much edified by the spectacle of a clean pair of hands folded on a smooth pair of sheets, but then it is hard for us to get up the same kind of reverence for these young [interns] and the head nurse that the people of the hospital seem to feel. After all, it is very nice to have the ward looking well when these young [interns] come there to pay their visit, but those of us who have known [interns] under various conditions in life, these young men in search of a career, like many other young men, we cannot quite see why his impression should seem so important to the hospital managers, should see so much more important than, shall we say, the impression of the patient himself, for, after all, the hospital, I suppose, in the last analysis is concerned with the comfort of the patients themselves.
I am also aware of another thing to which I shall plead guilty at once, and that is that among the very poor people there is a deep-seated prejudice against hospitals as such. I have heard and you have all heard the absurd stories they tell, that if you go to a hospital they will cut you up; if you go there they will find out what is the matter with you in all sorts of queer ways. That prejudice is something that any visitor or any charity organization, or that [anyone] who knows anything about the poor is perfectly familiar with. But I do think this, I think the hospitals might do more than they do to counteract that prejudice; they might do more than they are doing to substitute for that the real mission and object of the hospital, more than the hospitals as such do do. For instance, I am going to tell one or two rather grisly stories, and when I am telling these stories I am scattering them quite liberally over various hospitals in Chicago, and most of them occurred several years ago, so that none of the present management of any hospital in Chicago needs to feel concerned.
I am thinking of one woman in our neighborhood who was taken very suddenly one Sunday about noon to a hospital because her appendix had ruptured, and it seemed to her attending physician that she must be operated on immediately, so she was taken to this hospital just about noon. The physician was not ready to swear that that was what had happened, but he was reasonably sure. It took two hours to get a diagnosis from the hospital physician, and then they said, "Yes, that was the matter," and the patient was transferred to the surgical ward. The physician by that time was quite frantic, his two hours had been lost, and that operation should be performed at once. I will not tell the difficulties which intervened; it was a Sunday afternoon, the visiting surgeon could not be found, the next surgeon was out in the suburbs, and there was a series of excellent reasons which at one time were written down, but I could not find them this morning; they were excellent reasons why the operation was not performed until six o'clock. In the intervening time, when the patient was technically in collapse, the nurse insisted of course on the usual bath. The nurse also insisted on combing the patient's hair and braiding it out into two nice braids, all the time the patient being in collapse. The nurse also insisted on various other things which you are all familiar with, and the operation was finally performed, and the patient died a very few hours after. Now, to some of us who were interested in the patient she seemed to us a valuable woman, she seemed to us a valuable member of society, performing her duty day by day, who was certainly dear to a great many people; it seemed to some of us that she did not have a square deal. Of course, those things may happen in the best regulated institutions, but somehow or other the machinery goes on a little reluctantly, it lacks adaption, it lacks power of readjustment, it does not quite rise to an unusual occasion; and if one could avoid taking a patient to a hospital at noon on Sunday, if one could be consulted in the matter one would avoid it, but it cannot be avoided, and that is one of the things that has to be taken into consideration.
Then I think of other stories which I have heard, which perhaps are not worth repeating, [page 3] but they do go to prove to some of us that if it is the business of the hospital -- perhaps it is not the business of the hospital but if the business of the hospital is to take people who have become [maimed] in life because of some accident, because of some fearful calamity, if it is their business to take them in and cure them and set them back again in the paths of life, so that they shall proceed either to be an economic factor in the support of the family, or that equally valuable function, the mother of the family, and to go on with some spirit and health in her duties, then the hospital does not quite live up to its character. I am sure your consciences are all bad in regard to the convalescent patients. I am sure you know that the hospitals are so crowded that you push people out at the first possible moment that your consciences will allow, and perhaps even a little sooner in some cases. Perhaps this matter is being taken care of by some hospitals, as has been mentioned in regard to Bellevue Hospital, but I am not aware that there is anything of that kind in Chicago; they are pushed out while they are still weak, and sometimes a collapse comes because of the premature hospital dismissal, or dismissal into the wide world without any intermediary stage. Now if that is not the business of the hospital, then I beg your pardon. If it is to treat diseases, to treat them so that [interns] may be educated, to treat them so that hospitals will have a splendid record and put down so many cases as cured, if it is to do all those other things which do not appear altogether so clear to the layman, then this indictment is quite unfair, and I apologize for it, but if perchance it should be the more humane aim to care for those members of society who cannot be cared for in their own home and to send them back so that they may take up the work of life again, then it seems to me they are open to some measure of indictment. Of course I am not speaking of patients who are able to go into private rooms. I am not speaking of patients who are able to pay for special nurses, because, you know, usually those patients get some measure of care, not such good care as they do at the hospital, but they get some measure of care in their own homes. I am speaking of people whose one chance for recovery, whose one chance for restoration to society lies in the hospital, and those people, as you know, are apt to come in large numbers.
Then there is still another class. A lady from Hull House some time ago went to a hospital and asked for a woman in whom she was much interested who was in one of those wards which every city hospital is obliged to have where the wrecks of womanhood are cared for -- at least they are sheltered and given a minimum of care, because, as she went to ask for this one, as she gave the name of the patient that she was looking for, she looked up the patient that was in this "disreputable" ward, if I may call it such, because character ought not to count in a hospital, where all may be reduced by suffering to the same state of wretchedness -- when she asked for this patient she was treated in a way that I hardly think discourtesy would define, but insult would be much nearer. It was assumed because she was asking to see a woman of that sort, that she herself must be a woman of that sort, that nobody could be coming on an errand of humanitarianism [page 4] to see this woman because she needed somebody to hold her to a purpose, such reason did not seem to enter into the thoughts of this man that officially met her. Things of that kind are constantly encountered. You come with a sick child and of course you are asked quite candidly and quite rightly and you are treated as the mother or aunt of that child; you come to any hospital in an ambulance at night, perhaps with a patient pinned up in blankets and you wake up these rather sleepy people whose business it is to let you in and you are treated quite as the mother or aunt of that child, quite unofficially; you get these hospitals, not from the point of view of the visitor being taken about, not from the point of view of the visiting physician, but you see it from the point of view of the recipient of charity, and I suppose the point of view of the recipient of charity is never a pleasant point of view. I suppose we cannot help that. It seems to be left over from the English poor laws, from the old statutes which confused poverty and crime, there is something like that that has been left over and that makes us hard, that makes us a little less human and a little less courteous to the recipient of charity.
I would like to say one thing more in regard to that class, that is, I believe that the people who come to the defense of the hospitals; the nurses defend themselves, the doctors defend themselves by saying the treatment is impersonal. I do not know just what they mean by that. I know I have been very ill once or twice and nothing drove me so near to black despair as to have the nurse pat me on the head; that I could not stand for a moment, and to be called "My dear." That is not what sick people want; they want to have the treatment impersonal, because they do not care for the personal relations of life at such a time, but what they do want to have is the thing that they need and they want to have them when they want them, as the little girl said, and it is because they do not get them when they want them that they find the hospital so hard to bear. It is not that they want to be patted and sung to and cajoled, that is not really what a desperately sick person wants, but they want to feel that they are getting the very best attention that their situation demands. That if they are in the surgical ward and are having a very bad "mouth," as it is called, if they are having a very bad case of indigestion and asked for something that will relieve them and the young surgeon says, "That is natural in these cases," and passes on without suggesting any alleviation, because this care happens to be a surgical case and the patient is not in the medical ward, I believe it is natural that the patient who feels the need of something that he does not get should complain of those things and they come home and they tell their neighbors and friends that "It was horrid at the hospital. I waited three hours to get a drink of water. I asked the nurse for an ice bag five times while she was folding those," I won't say the words, "those blank sheets."
It is things of that sort which make one venture to give the layman's views, not because it is pleasant, but because after all it may be of some benefit and I hope very much there will be a discussion. I have asked a friend to come with me, who has had a great deal more experience with hospitals than I have had and if I have not taken all my time, I hope that she may be given an opportunity to speak. I would like to have [someone] help me bear the load of the discussion which I understand will come later. I thank you, gentlemen.