HEALTH
About one-fourth of all the poverty that has come within the scope of
charitable investigation is directly caused by sickness. "In both
American and English experience," writes Warner, "the percentage
attributable to this cause sinks but once slightly below fifteen and
never quite reaches thirty. The average is between twenty and
twenty-five. This is one of the most significant facts brought out by
these tables [of the statistical causes of poverty]. It is not one
which the author anticipated when the collection of statistics began;
and yet it has been confirmed and reconfirmed in so many ways that the
conclusion seems inevitable that the figures set forth real and
important facts. Personal acquaintance with the destitute classes has
further convinced him that most of the {96} causes of poverty result
from or result in a weakened physical and mental constitution, often
merging into actual disease." [1]
This fact gives added importance to all the efforts of modern charity
to secure improved dwellings, open spaces, cheap baths, and better
municipal sanitation for the poor. But improvement in these matters
cannot come entirely from without; "the model tenement implies a model
tenant." As a London authority puts it: "The condition of the house
may degrade its occupants. The careless life and habits of the
occupants will spoil the house, and make it filthy and unhealthy." The
friendly visitor should try to make the family healthily discontented
with unsanitary surroundings, and so prepare them for better quarters.
Removing families from unfit tenements is not enough, however, if these
tenements are almost immediately reoccupied. Their condition should be
reported to the Board of Health, and, if condemned, we should see that
no one else is permitted to move into them.
I have often noticed that charity agents, {97} who work habitually in
poor neighborhoods, get so accustomed to bad sanitary conditions that
they hardly notice them. Volunteer workers are not so likely to fall
into this error, though it is possible for volunteers to be very
unobservant. They often feel that things are all wrong, without being
able to state the specific difficulties. An observant visitor will
learn the condition of the cellar, walls, yard, plumbing, and
outhouses; will learn to take the cubic contents of a room in order to
find out the air space for each sleeper; will learn the family method
of garbage disposal; will see how the rooms are ventilated; and will
learn all these things without asking many questions. Dampness is a
very common cause of sickness; when the children cough it is a very
simple matter to ask about the cellar, and even get permission to see
it.
The prejudice against fresh air, especially night air, is a difficult
one to overcome. One mother, who kept her children scrupulously clean,
could never understand the value of fresh air until a visitor explained
to her how air was polluted by the soiled air that we {98} breathed
out, just as water was polluted when we washed our hands in it. When
the children breathed this soiled air in again it made them "dirty
inside"; and this homely statement left such an unpleasant picture in
the mother's mind that her rooms were always well ventilated afterward.
It is difficult to ventilate a small room without making a draft, but,
next to the chimney, the upper sash is the simplest ventilator, and
should not be immovable, as it is in many small houses. A board about
five inches wide under the lower sash will make a current of air
between the upper and lower sashes, and, better still, two pieces of
elbow pipe with dampers, fixed in the board, will throw a good current
of air upward into the room. Another ventilator can be made by tacking
a strip of loosely woven material to the upper sash and to the top of
the window-frame. When the upper sash is dropped, the stuff is drawn
taut over the opening, and, while permitting air to pass through,
breaks the current.
Equal in importance with fresh air inside the house is exercise out of
doors. I was {99} shocked some years ago to find that, of six
Sunday-school boys who went with me on a little trip to our largest
city park, five had never been there before. This had not been due to
lack of time or money, though they had very little of either; but its
sole cause had been lack of enterprise.
There is an impatient and popular saying that soap and water are cheap;
like many other popular sayings, it is only half true. Personal
cleanliness is rather expensive when one takes into account the time,
energy, and frequent changes of clothing required to keep the body
daintily clean. Visitors should realize this in any effort to
introduce a higher standard of personal neatness, and should not be
impatient when they do not immediately succeed. Cleanliness and health
are so nearly related, however, that the effort is very well worth
making. A visitor who hesitated to complain to a mother about her
little girl's neglected condition, borrowed the child to spend the day,
and brought her home at night sweet, clean, and rosy, with her hair
well brushed and curled. The hint was taken.
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It would be very unfortunate for the visitor to be an alarmist, for
there are imaginary invalids among the poor as well as elsewhere, but
more frequently the poor neglect the earlier symptoms of sickness
altogether, or else dose themselves with patent medicines. The quack
doctors who advertise in the daily papers draw much of their custom
from the very poor, who are also large consumers of cure-alls and
proprietary medicines. We have seen how children's physical defects
can pass unnoticed at home, and this is the case in a less degree with
the defects and ailments of adults. The very cheap grade of medical
service that is sometimes given by regular practitioners in poor
neighborhoods has a tendency to discourage the poor from taking
sickness in time. The visitor can help them to procure better medical
service at reasonable charges or, when necessary, without charge. The
grade of service in dispensaries varies greatly, but the medical advice
and directions given there with the medicines can be made far more
useful if the visitor will go with the patient and see that the
directions are understood and carried {101} out. Often no adult in the
family can spare the time to go with a sick child to the dispensary.
Here, too, the visitor's service will be helpful. In cases of
contagious disease, see that the Board of Health is notified promptly.
Other things being equal, an acute case of illness can usually be
better and more economically cared for in a hospital than in a poor
home. In fact, although hospitals were intended originally for the
destitute sick, the practice of sending well-to-do patients there is
rapidly spreading. The prejudice against hospitals, still so general
among the poor, is a survival from a time when hospital care was far
less humane than now. If the visitor has ever been a patient in a
hospital, and can tell his own experience or the experiences of
friends, or if he happens to know some of the doctors or nurses, and
promises to see them about his poor friend, the prejudice can often be
overcome. The dread of the untried and the unknown is natural enough,
and yet it will happen now and then that hospital care is so clearly
the best thing that nothing can take the place {102} of it, and
suffering and loss will be entailed upon the family by their refusal to
let the sick member go. In such cases charitable people may be
justified in helping the family to a right decision by withholding all
relief.
The prejudice against hospitals is strong in the negro race. In the
first family I ever visited the mother, a colored woman, had been
bedridden for thirteen months. According to her own account she had
been "conjured," and at first the mention of a hospital made her
hysterical. She consented to let a doctor, who was a friend of mine,
see her, and he pronounced her disease sciatic rheumatism. He said she
could never get well at home with four small, noisy children, and,
besides, the walls of her house were damp. After two months of
persuading, I got the mother into a hospital and the family moved into
a dry house. Among the arguments that won her were my own acquaintance
with the hospital nurses, and my promise to visit her frequently while
there; and my further promise to see that the children were well cared
for while she was away. But the argument that tipped the scale was the
{103} promise to take her away to the hospital in a carriage with two
horses.
Among the cases in which hospital care is not practicable are those of
chronic invalids, of patients too sick to be moved, and of patients
able to be treated as "out-patients" in the dispensaries. Confinement
cases, where there are children in the family who must be placed
temporarily in institutions if the mother leaves home, are best treated
in the home. There are societies that provide a nurse and baby-linen
at such times. Some families are so degraded that they look forward to
times of confinement as times of plenty (see family cited on p. 55),
and in these cases nothing but hospital care should be offered, while
we place the children temporarily in institutions or with neighbors.
For the destitute sick outside of hospitals, district nurses are now
provided in many cities. When these nurses are careful to instruct
well members of the household in the care of the sick, their influence
is especially helpful, and they are often able not only to relieve
suffering, but to raise the standard of living in the home. Diet
kitchens, supplying food specially {104} prepared for the sick either
free or at a nominal cost, are also found in many of our cities.
With all the charities provided for the sick, there is still need of
better provision in this country for convalescents, who are sent from
the hospitals too weak to resume work, and still needing rest, good
food, and pure air to effect a complete cure.
Two classes of invalids remain to be mentioned in this condensed
summary. First, accident cases, in which the visitor must be careful
to see that legal redress is obtained when the case is one for damages,
and must, at the same time, protect the victim from lawyers who are
glad to take a sure case for "half the proceeds." Second, incurables,
for whom homes are provided requiring an entrance fee, or for whom,
more often, nothing remains but the almshouse. The visitor can
sometimes secure the coöperation of friends and charities interested,
and so raise enough money to provide the fee for such an invalid, when,
without coöperation, as much money and more would be spent and the
patient remain in the end unprovided for. Charitable people often
{105} get tired; they will do a great deal for a while, and will then
get interested elsewhere, and grudge the help that is still needed. In
view of this failing, it is much better, in making plans for
incurables, to secure a lump sum that will make adequate provision,
than to depend upon the continued interest of a number of people.
The migration of invalids is the last point upon which I shall attempt
to touch under this head. Any one who has visited California, Florida,
Colorado, or any other part of our country where climatic conditions
are supposed to be favorable for invalids, will realize the
irresponsible way in which charitable people are accustomed to send the
sick where they do not belong. The worst of it is that the sudden
change of climate and the impossibility of securing proper care, so far
from effecting a cure, in many cases hasten death. "The saddest thing
about the life of a Denver minister," writes Rev. Samuel A. Eliot, "is
the number of lonely funerals that he is called upon to attend. Often
I have been hastily summoned to say a prayer over some poor body at the
undertaker's {106} shop, where there would be present just the
undertaker and the minister, with perhaps the keeper of the
boarding-house where the lad died or an officer of the Charity
Organization Society. I look at the youthful victim of ignorant
good-will borne to his neglected grave, I imagine the mother and
sisters in the farmhouse on the New England hillside, whose tenderness
might have soothed his last hours, and I think with bitterness of the
well-meant but misdirected charity which condemned him to a miserable
exile and a forlorn death." [2]
It must be remembered that change of climate is helpful only in the
earlier stages of disease, and only then when the patient is able to
live in comparative comfort, free from worry and anxiety. To send
invalids to a strange place in the name of charity, without providing
them with the means of subsistence, is the refinement of cruelty.
Collateral Readings: Publications of local Board of Health.
Proceedings of International Congress of Charities, Chicago, 1893,
volume on "Hospitals, Dispensaries, {107} and Nursing." "Instructive
District Nursing," M. K. Sedgewick in "Forum," Vol. XXII, pp. 297 _sq_.
"The Feeble-minded," Dr. George H. Knight in Proceedings of
Twenty-second National Conference of Charities, pp. 150 _sq_. See also
discussion in same volume, pp. 460 _sq_. "The Care of Epileptics,"
William P. Letchworth in Proceedings of Twenty-third National
Conference of Charities, pp. 199 _sq_. "Industrial Education of
Epileptics," Dr. William P. Spratling in Proceedings of Twenty-fourth
National Conference of Charities, pp. 69 _sq_. "Destitute
Convalescents: After Care of the Insane," Dr. Richard Dewey in the
same, pp. 76 _sq_. See also discussion on pp. 464 _sq_.
[1] "American Charities," p. 40.
[2] Proceedings of the Nineteenth Conference of Charities, Denver,
1892, pp. 91 _sq_.
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