Part 36

The Agency is carried on by a governing board consisting of delegates from sixteen different associations of women in Chicago, and it has taken its stand by the side of the poor and oppressed and demanded and obtained justice for them in the courts. In its third annual report it publishes the following extracts from a letter of John P. Altgelt, Judge of Superior Court of Cook County: “... I wish to express my high appreciation of the work the Agency is doing.... You have rendered a double service to the courts and have materially aided in the administration of justice.” In Peoria, Ill., there is also such an Agency, and a National Association has been formed “for the purpose of establishing, or helping to establish, similar societies in different parts of the country.”

Another important woman’s society is the “Illinois Woman’s Alliance,” which declares its objects to be: “1. To agitate for the enforcement of all existing laws and ordinances that have been enacted for the protection of women and children, as the factory ordinances and the compulsory education law. 2. To secure the enactment of such laws as shall be found necessary. 3. To investigate all business establishments and factories where women and children are employed, and public institutions where women and children are maintained. 4. To procure the appointment of women as inspectors and as members of boards of education and to serve on boards of management of public institutions.”

The Woman’s Alliance has already been “largely instrumental in procuring the passage of a compulsory education law, and has secured the appointment of women factory inspectors.”

Another branch of work taken up by women in some of our cities is the 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.