owning and hiring of tenement houses, for the purpose of improving the
houses and thereby serving the tenants and the public. This is done both
by individuals, who undertake the oversight of the houses and the
collecting of rents themselves (following the example of Miss Octavia
Hill in London), and by associations such as the Co-operative Building
Association of Boston, which is a joint stock company of men and women,
who buy and build houses and oversee their property by means of
committees of their own number. The object is to raise the standard of
the houses for working people in any given locality, and also to show
that such houses, when managed for the benefit of the tenants, may be
made to pay a fair return to the owners. This work seems peculiarly
fitting for women, who carry sympathy and conscience into their business
relations.
Indeed, the work of women seems to be unending, and it is impossible to
compute its value. The only feeling evoked by the study of the reports
of what is going on all over the country is that of deep gratitude, and
of regret that the whole cannot be spread out for the encouragement and
inspiration of others, and that so meager an account as this must
suffice.
It is strange to remember that all this activity has had its rise in
less than a hundred years. The simple story of the first organized
charitable work ever done, so far as we know, by women in this country
is thus told in an account of the “Female Society of Philadelphia for
the Relief and Employment of the Poor:”
“It will be remembered that in the year 1793, the yellow fever made an
awful and depopulating visitation to our city, and those who were spared
its ravages were left in much distress. Anne Parish, and some other
young women, having devoted considerable time and strength in relieving
the sufferers, felt called upon to continue their labors when the deadly
scourge had passed, as the following minutes, the first on the books,
will show:
“‘A number of young women, having been induced to believe from
observations they have made that they could afford some assistance to
their suffering fellow-creatures, particularly _widows_ and _orphans_,
by entering into a subscription for their relief, visiting them in their
solitary dwellings without distinction of nation or color, sympathizing
in their afflictions, and, as far as their ability extends, alleviating
them, have for this purpose associated together. Their views being
humble and funds inconsiderable, yet seeking neither honor nor applause,
they only ask a blessing on their feeble efforts, sensible of the
obligations they are under to an Almighty Giver for the comforts they
enjoy, are desirous of making a grateful acknowledgment by endeavoring
to adopt the precept He taught, to visit the sick, feed the hungry, and
clothe the naked. They propose to nominate a treasurer, to appoint a
committee to visit the poor, and discover their necessities either for
immediate relief, or to give them employment.’”
This was in 1795, and it was this same young Quaker woman, Anne Parish,
who, in that, or the following year, believing that “ignorance was one
great cause of vice and the calamities attendant thereon, and that a
guarded education would tend greatly to the future usefulness and
respectability of the rising youth,” with two friends, opened the first
charity school for girls in the United States, teaching them “some of
the most useful branches of learning, viz.: spelling, reading, writing,
arithmetic, and sewing.”
These two little societies, both founded by one young woman, were the
pioneers in the work for the desolate and oppressed now being carried on
by hundreds of associations and by thousands of women all over our
country, and we can only thank God that so many are seeking “to comfort
and help the weak-hearted, to raise up those who fall, and to strengthen
such as do stand.”
XIII.
CARE OF THE SICK.
HOSPITALS AND TRAINING SCHOOLS FOR NURSES MANAGED WHOLLY OR IN PART BY
WOMEN.
BY
EDNAH DOW CHENEY.
So soon as the human being emerged from barbarism, and life became
precious, the restoration of the sick to health must have engaged
attention. The original idea of the hospital was wholly charitable, as
it was an obvious duty to take care of the sick, who were unable to help
themselves, and under many circumstances this work could be better done
in an establishment for that special purpose than in a private home.
Such establishments have existed in very early times and in various
countries, and women have always borne their part in the work as nurses,
if not as physicians or managers.
Although the hospital, in some form, was not unknown before the
establishment of the Christian church, yet that church certainly took
the care of the sick as a special province, and found in its orders of
monks and nuns very convenient instruments for carrying it on. It was an
important adjunct of religion, for the mind and heart, during sickness
and convalescence, are open to religious and moral influences, and the
grateful patient often became a zealous convert to the church which had
given him help in the hour of suffering. The old proverb recognized
this:
When the Devil was sick, the Devil a monk would be;
When the Devil was well, the devil a monk was he.
The earliest known hospital for the sick was founded in the latter part
of the fourth century at Cæsarea; St. Chrysostom built one at his own
expense at Constantinople, and Fabiola, the friend of St. Jerome,
founded one at Rome.
Many of the present great European hospitals, as the “Hôtel Dieu” of
Paris, “St. Bartholomew” of London, etc., owe their existence to
religious foundations, and the sisters of various orders made it their
especial work to labor in them.
Women assisted in these good works. In the old hospital of the Savoy in
London, thirteen sisters are on the pay roll. “Queen Mary tried to
restore this hospital, and the ladies of the court and maidens of honor
stored the same with two beds, bedding, and furniture in very ample
manner.” The work of the sisters of charity is familiar to all, and
Protestants have imitated it by establishing orders of women who devote
themselves to the care of the sick.
In addition to the ordinary needs of human life, war brought its large
increase of wounds and sickness, which made military hospitals a
necessity, and women did not hesitate to follow men to the camp and
field to minister to their fellow-beings in distress. In these scenes of
war Florence Nightingale began her great work, which has raised nursing
to the rank of a skillful profession. Private charity also extended help
to the sick, and King James’s favorite goldsmith, George Heriot, secured
an honorable remembrance in Edinburgh by founding the large hospital
which bears his name. Neither has the State forgotten its duty to the
sick, not only in providing infirmaries, almshouses, and other
institutions, but certainly, in later times, in furnishing hospitals for
the poor at the public expense.
In time of war, or when great epidemics devastated cities, the hospitals
often became excessively crowded, and offered scenes of misery and
horror which justified the dread and disgust felt for them in the
popular mind, so that to “die in a hospital” was an expression for the
extreme of human misery.
Through all these years women took an active part in hospital work as
nurses, and, in the case of infirmaries connected with female convents,
must have had charge of the administration; but it is not until our own
day that hospitals have been established especially for the benefit of
women, and mainly under their own control. As the science of medicine
advanced, and physicians were not solitary students but became a body of
educated men united in their work and deeply interested in the
advancement of their science, the hospital came to be regarded not
exclusively as a charity, but also as a school in which the student of
medicine could gain experience and knowledge by intimate acquaintance
with various forms of disease and the means employed to remove it. This
created a vulgar prejudice that the sick were considered only subjects
of experiment, without regard to their own good. But, in fact, the
constant presence of bodies of intelligent students in hospitals has
done much to raise their character and to reform abuses. As Dr. Finlay
says, “Clinical teaching benefits the patient, secures careful
investigation of his case, and has a bracing effect on the work done in
the hospital.”
It is in this relation that hospitals have become especially important
to women during the last thirty years.
The woman physician was not wholly unknown in America before this time.
Anne Hutchinson, of Boston, was doctor as well as preacher. Ruth Barnaby
practiced the profession of midwifery forty years, and this branch of
practice was fully recognized as belonging to women.[197] But while the
standard of education for women was very low, these were only
individuals carrying out the impulses of their genius or their hearts,
having no relation to each other and no thorough systematic education.
When Elizabeth Blackwell took her stand for thorough medical education
for women, she felt the imperative need of clinical instruction for
them. No hospital in America would give to women students of medicine
any opportunity to see the work done in it.
The other hospitals, which have been established since these pioneers,
have followed their plans so nearly that but few exceptions need be made
to the general account. While I cannot be sure that my list is complete,
I give the following names of hospitals known to me, similar in
character and methods:
New York Infirmary, 1857.[198]
Women’s Hospital of Philadelphia, 1860.
New England Hospital for Women and Children, 1862.[198]
Chicago Hospital for Women and Children, 1865.
Pacific Dispensary and Hospital for Women and Children.
Ohio Hospital.
Northwestern Hospital, Minneapolis.
The hospital in Chicago, like other promising children of the East
transplanted to the West, has outgrown its parents, and is now the
largest institution of its kind in this country, and probably in the
world. It has eighty beds.
The Massachusetts Homœopathic Hospital was not established for the
special benefit of women, but in connection with the medical school of
Boston University, but it received the funds of the old Female Medical
School, and it has women professors and students, and admits women to
the hospital as _internes_.
The hospitals have dispensaries connected with them which are very
important aids to the work, both of charity and education. These
dispensaries afford the students a wider range of observation and
experience than they could gain in the hospitals, since the patients are
numbered by thousands, and they bring the poor sick women to the
acquaintance of women physicians, to whom they can often confide their
troubles more freely than to men. Cases which need the treatment of the
hospital are secured admittance to it. In all this hospital work, and
especially in that of the dispensary, as indeed in all charitable work,
it has been found necessary to guard against the danger of pauperizing
those who should be helped. For this reason a small charge is made to
dispensary patients, except in cases of known destitution. The patients
willingly pay it, feeling their own self-respect increased thereby, and
the dispensary may be thus made nearly or quite self-supporting.
The surgical department of hospitals is of special importance to the
poor, as it is almost impossible for them to have the conditions in
their homes necessary to insure a fair chance of success and recovery in
cases of operations. Remarkable success has been attained in this
department in some of the hospitals I have named, where the greatest of
abdominal operations are performed by surgeons connected with the
hospital, with a percentage of recovery equal to that of other good
hospitals here or in Europe. This branch of work is of absolute
importance to the _internes_, and of the greatest value to the nurses.
Not less interesting or successful is the maternity work of these
hospitals. A great deal of the chronic trouble from which working women
suffer so severely comes from want of proper care while they are
exercising the functions of childbearing. The poor applicant to the
maternity department is seen by the woman physician, who gives her
advice as to previous care of herself, and she has in the hospital that
thorough rest and care which are indispensable to full restoration to
health.
A great moral question forces itself on the consideration of the
managers of these hospitals. The applicants to the maternity are very
often unmarried girls. Does true humanity require us to refuse help to
such women? It is evident that care must be exercised to give no
encouragement to immorality, while we must not refuse the aid which is
so often absolutely necessary to save life. The problem is a difficult
one, but the managers have tried to meet it. They usually make a
distinction between the first offense—which is often rather due to
weakness and folly than to depravity—and confirmed habits of immorality,
and do not receive unmarried women a second time. In one hospital, at
least, the directors find the greatest assistance from a committee of
ladies who look after the maternity patients, both before they enter and
after they leave the hospital. They endeavor to procure work for the
mother, and watch over her welfare and that of the child. But they make
it their invariable rule to give aid only on condition that the mother
makes every effort to fulfill her maternal duties; for they believe
there is a regenerating power in motherhood, and that care for her child
is the surest safeguard against a mother’s committing a second fault.
To many women of good position the maternity is a great blessing, if
they have not comfortable homes and friends to care for them. The
expense in the hospital is much less than the price for which good
medical attendance and nursing can be secured at home.
I need only say of the medical care of women by their own sex in
hospitals that its value has been fully proved. Women of all classes
seek this aid eagerly, and show full confidence in their physicians and
obey them quite as implicitly as they do those of the other sex. Women
often say that they have suffered for years without medical or surgical
assistance, that might have relieved them, from unwillingness to reveal
their troubles to men. The greater freedom of the relation between
patients and physicians of the same sex, enables the doctors to exercise
much influence over their patients, who learn many good sanitary lessons
in housekeeping. A physician was surprised to find the sick room of a
poor patient carefully aired: “Why, you know they always do so at the
hospital,” was the explanation given.
These hospitals have also done much to dispel among the poor the fear of
going to hospitals.[199] Finding their friends kindly ministered to by
their own sex, they come to regard the hospital as a kindly refuge in
sickness, not as the last resort of a homeless and deserted sufferer who
will die unfriended and alone.
Besides these hospitals, especially adapted to assist in the medical
education of women, are others established by women mainly in the
interests of charity. I have, for instance, the twelfth annual report of
“The Home of Mercy,” in Pittsfield, Mass. It contains about thirteen
beds, and the number of patients in a year was one hundred. It was
established by a small body of women who felt the need of a place for
the victims of accident or disease. Sixty-eight per cent. of the
patients are women, and all the officers but the physicians. This
institution seems to present a good model for smaller cities and towns
where, especially among a manufacturing population, hospital
accommodations are often much needed. A training school for nurses is
added to its work.
Another step has been taken in the medical education of women in the
employment of women physicians, (made obligatory by the Legislature in
some States) in State institutions, thus giving them management of the
women’s infirmary. At the Reformatory prison at Sherburne, Mass., the
resident physician has charge of the health of two hundred prisoners.
The good care and treatment given them is apparent in the improvement of
the health of prisoners during their stay, and in the small number of
deaths.
The employment of women physicians in insane asylums is a very valuable
measure from which we may hope great good in the future. At present, the
most interesting instance of such work that has come to my notice is in
the State Hospital for the Insane at Norristown, Pa., where Dr. Alice
Bennett, with two women assistants, has charge of over eight hundred
patients. Her carefully tabulated statistics throw much light on
important questions regarding the causes of insanity and the probability
of restoration. Dr. Bennett has introduced beneficial improvements in
the treatment of patients in the direction of more freedom and more
social life and opportunity of employment. She says in her last report,
“No mechanical restraint (by which is meant enforced limitation of free
movements of the body by means of jackets, muffs, straps, etc.) is at
any time made use of in this department.... There are times in the
history of many cases, when temporary separation from external cause of
irritation is beneficial and necessary.... Brush making, basket making,
sewing and mending, kindergarten occupations for the feebler-minded and
melancholy, and the ever-present “housework,” in all its forms, engage
about half the whole number of patients at one time or another. The
officers and patients have also organized a ‘Lend a Hand Club.’ Dr.
Bennett has arranged for a large number of patients to take their meals
together, and finds the arrangement very beneficial.”
Some of those who are working for the sick have preferred the name of
“Hospital Association.” Such is the St. Luke’s hospital in Jacksonville,
Fla., said to be the first one in the State. The officers are women, but
the physicians and a board of trustees are men. The main purpose of this
association seems to be to relieve the wants of strangers, who so often
go to Florida seeking health, but sometimes in vain.
The Women’s Homœopathic Association of Pennsylvania was formed for a
distinctively reformatory purpose. Its government is composed of women,
with the exception of an advisory board of men. The medical faculty is
composed of both men and women. This account is given of its origin:
“The motive of starting a women’s association was, largely, to correct
the abuses that grow out of institutions managed by men. It is here now
and has been for many years the custom for hospital or other charitable
institutions to have an auxiliary board of women managers, whose duties
are to look after the housekeeping department and raise money either by
giving entertainments or begging—the expenditure of the money so raised,
and general management of hospital work, is considered beyond a woman’s
ability. This prevents a voice in the higher administration. Some of the
women, whose names appear as incorporators of the hospital of this
association, desired to open an institution where women could, when in
sickness and sorrow, be in the care of women. Out of 213 patients cared
for during 1888, 153 were charity cases, 45 partial pay, and 15 cases
full pay.”
The “Philadelphia Home for Incurables” was established by women, but its
bounty is not confined to them; it admits men as patients. With the
exception of a superintendent of the men’s department, the management is
entirely in the hands of women. This is an effort to meet the crying
need of a home for chronic sufferers. Each patient pays one hundred
dollars and is kept during her life.
Much other work of the same nature as that I have described is,
doubtless, doing in our vast country, of which no account has reached
us. One of the many “Women’s Clubs” has taken the subject of hospitals
into serious consideration. While rejoicing in every such effort, I
would like to add a word of caution that every enterprise should be most
carefully considered, and the work never allowed to fall below the
recognized standard of merit.
When the pioneer hospitals were opened, no other clinical advantages
were free to women; now the hospitals are beginning to open their doors
to them. The report of the city hospital of Boston says, “The propriety
of women practicing as physicians or surgeons, and their comparative
ability and fitness to pursue this profession, are not questions for the
trustees to consider in the official management of the hospital; they
must recognize the fact that women are becoming practitioners in all the
schools of medicine; that they are admitted to the Massachusetts Medical
and other State societies, and are recognized as practitioners by the
community at large; and that they are admitted in common with male
students to other leading hospitals of the country. The trustees
therefore feel that there is no sufficient reason why women should not
be admitted to the public instruction in the amphitheater on the same
terms as men, except as to certain operations from which a reasonable
sense or regard for propriety may exclude them.” This advance in public
opinion is most gratifying; but, even when all hospitals are open to
women students, the value of those of which I have spoken will not be
lost; they will still have special work to do, both in education and
charity.
This movement for the clinical education of women in hospitals begun in
America, has extended to Great Britain, Switzerland, and Germany, and is
now being rapidly introduced into India, where the Women’s Hospital is
found to be a most important agent in educating and elevating the women
of India.
The lamented Dr. Amandibai Joshee, who was the pioneer of medical
education for Hindoo women, was a student at the Philadelphia college
and an _interne_ at the New England Hospital.
An excellent hospital in Burlington, Vt., was planned and endowed by a
woman (Miss Mary Fletcher), who gave it her personal supervision. It had
no direct bearing on women’s education, but was open to all classes of
patients. Since Miss Fletcher’s death it is called by her name. It is
mainly intended for residents of the State, although other patients are
received if it is not full. It has no women physicians, but a board of
women visitors. It has an amphitheater for clinical instruction, and its
buildings are large and convenient.
All these hospitals maintain the principle that those who are treated in
them should pay for the care they receive according to their ability.
The price of board and treatment varies from five to forty dollars per
week, according to the service required and other circumstances; but in
all the institutions are free beds, endowed or supported by charity.
Out of this hospital work has grown another very important branch of
service in the training schools for nurses. While estimating this new
departure at its full value, I wish to pause a moment to pay a deserved
tribute to the “old-fashioned nurse.” In New England, especially in our
country towns, and I presume no less in other parts of the country, the
nurse was an important and honored member of society. Although not
regularly trained according to the modern demands, she was generally a
woman deeply read in the great school of life; often a widowed mother,
who earned her bread by giving to others the fruits of her own blighted
family life; sometimes a maiden, who, losing the hope of a home of her
own, found a wide and useful sphere for her energies and affections in
care of the sick; sometimes the girl who had wrecked her life by
youthful indiscretion (like Mrs. Gaskell’s “Ruth”), in the ministry of
help to others found a life which soothed her own sorrows and restored
her to the respect of society. The nurse then gathered her knowledge as
she could, watching through long winter nights with sick friends, and
visiting among the poor when disease came upon them. Dickens has drawn
cruel portraits of the nurse of olden time, true, perhaps, to flagrant
instances, but forming a pitiful caricature of the whole class. The old
nurse was more often the true friend of the family, summoned in every
time of trouble, and loving the children whose birth she had watched,
almost as if they were her own.