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The Official ()rgan of the Charity Organization Society of the City of New York.


JULY 7, 1900.

No. 6.


6 8 8







from the patient's point of view, not

necessarily that which may seem most The Care of Families in Illness ..

important to the visitor. For inThe Housing Problem in London.

stance if the visitor finds windows The Economic Utility of a State Board... closed, air bad and stifling, and on Private Charity in India

the bed with the sick mother one or Social COURSES IN THE UNIVERSITY OF

two small children whom she, forPENNSYLVANIA...

getful of herself, is trying to minister MODERN CHARITY

to, it may seem that the first thing THE LONDON C. (). S


open a window.

Do not, however, Tuberculosis Hospitals ...

begin thus. Take all the bad air, dirt, and confusion for granted, and

pay no attention to them. Ask if THE CARE OF FAMILIES IN WHICH THERE IS there has been a doctor, and if so ILLNESS.

what he has ordered, and whether

the patient is getting what he preBy Miss L. L. Dock,

scribed. If you find that the doctor Resident in the Nurses' Settlement. has ordered something which the

patient has not been able to get for We will suppose that the visitor herself, on account of the expense, has been called to a home where and which you are able to procure for there is illness, and that she is mak- her, such as an ice-bag or some other ing her first visit. We will not now appliance; or if there is a prescripsuppose an emergency case, in the tion waiting to be filled because hospital use of the term, requiring they have not yet succeeded in instantaneous action, but a simple borrowing the money to pay for it, case of illness, let us say, of the get it, and thus relieve the anxiety mother of a family.

of the moment. Next inquire On entering the home of the fam whether the patient has the proper ily and meeting the sick person nourishment, supplementing the insome little practical service rendered quiry with your own eyes; and if will often do much to establish not, send out and get a quart or two confidence and an unconstrained of milk, or a jar of beef extract, or a feeling. Whatever the most urgent fresh egg, and give her a cup of immediate necessity may be it should nourishment. After this the window be learned as promptly and with as may be opened and the children little questioning as possible, and taken away from the bed.

If a should be relieved without delay flock of curious neighbors has come without stopping for further investi in ask all to go out save, perhaps, gations. By immediate necessity I one, who should be chosen with mean that which is most important reference to her appearance of hav


ing common sense and kindness.

some cases not at all, yet sensible You can now sit down and get ac suggestions are often to be had quainted; and if the patient is too from them. They are not to be weak to talk, make your inquiries learned by having a crowd in the from one of the family, or, if there room all talking at

once, but by is no one else, from the neighbor. conferring individually with those

To be able to plan the best in whom the patient feels special course for the family where there is confidence. illness, all the circumstances of the It does not often happen that the family must be learned. There are, visitor can come to final conclusions, however, some special inquiries re or plan out the whole management lating to the illness. Learn the of a case upon the first visit; nor doctor's name, address, and whether would it always be wise to do so. he is free or pay; how often he However, in illness, more than in comes; what amount of interest he

almost any other situation, should takes in the affairs of the family; the visitor be able to imagine her. whether he has given any advice self in the invalid's place. Do not outside of mere treatment, as to go away without doing something seek hospital care, to call a definite, something which will relieve nurse. When he can be seen in case the anxiety of mind of the sick one, it is desirable to confer with him. and give her confidence. Make Get as much light as possible upon some provision for the next twentythe cost of the illness so far; whether four hours-either by ordering it has been necessary to run into nourishment and stimulant, or by debt, or whether savings have been providing an attendant, or by promencroached upon. Inquire into the ising to send clean clothing or care she has had and how nearly appliances, or perhaps by doing all adequate it has been. Find out these, if they are necessary. especially what the neighbors and When it is a question of hospital relations have done, and how far versus home care, the problem will they may be counted upon to con be easiest in case of a child ; more tinue their aid. Their voluntary difficult in case of a father who services should be encouraged. If is a wage-earner; and most difficult they receive the impression that by in the case of a mother with small the coming of the visitor they are children. Hospital care would be dismissed from all further interest, advisable under such circumstances as and that everything will be done by the following, speaking generally, but the charitable society, they will drop not now with reference to whether away and leave to the visitor com the patient is a child or an adult: plexities with which she, if inexpe 11. When the illness is of such a rienced, may be quite unable to cope nature that some definite treatment alone, but which, under friendly co is required which can not be had at operation, resolve themselves into home, or some condition necessary manageable details.

for recovery can not be complied The advisory powers of the neigh with. Examples: a fractured leg bors are not to be despised. They which needs to be suspended, and know all one another's affairs, and a case of brain trouble where the often see homely, practical expe- surroundings are inevitably noisy. dients and ways out of trouble In this case

one should not be which the visitor would not think influenced by the fact that the home of. While, of course, their views might be fairly comfortable, and the should not be accepted blindly, and in family intelligent and kind.

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b. When the expenses of illness most the whole cost of the case are likely to constitute a drain which comes upon charity, or when crowdmight involve the family in debt ing is so close that the invalid can beyond their power of recovery.

not have the necessary privacy. In such a case, although the illness To consider individuals as such it itself might be of such a character may be said, generally, that one that it could be taken care of at should hesitate to advise hospital in home quite satisfactorily, this fact the case of a nursing infant unless should not be held important. It the mother could go with it; only would seem unnecessary to make in very exceptional circumstances this statement, yet actual experience would it be best to remove it, and shows that it is often extremely such a decision should be made only . difficult for the family of a sick by a responsible physician. person to foresee the financial dis With older children one need not aster which we know often comes hesitate to advise the hospital. upon them as the result of a long Children are happy in the hospital, illness.

and do well. The parents are often Warnings as to the expense are loth to part with them, believing often given in vain, to be regretted they will be homesick and fret. later. It is a pity that physicians This, however, is a mistake. often do not realize this side of the A sick man--husband or fatherfamily's position. Even although may also be freely urged to go to they have no personal interest in hospital. The task of nursing him keeping the patient at home, and will only be an added burden for are treating him free; yet they often, the wife, who may need to take his simply by failing to grasp any but place for the time as a wage-earner; the professional aspect of the case, and money laid out upon medicine, nullify all the visitor's efforts by as medical attendance, etc., for him in suring the family that hospital is the home might be better applied to not necessary, that the patient will the support of the family during recover just as well at home. This his absence. may be quite true, but at the end In the case of the sick mother the of the illness the family is ruined, circumstances are very different. If and becomes a burden on charity. her removal to hospital does not in. I have known of illnesses in tene volve breaking up the family, then ment-house families which have cost she may be advised purely froin the $60, $75, and $100, and even some medical standpoint, as is best for times $200 or $300.

herself. If daughters or a sister can c. When the presence of the patient keep the home together, well and in the home or the attendant over good. If, however, the home dework and care is likely to break down pends on her, she will be unwilling or definitely injure the health of to go, and the question of what is another member of the family. This, best for her solely from a professional too, is often overlooked. It can never point of view cannot come first. be anything but a mistake to make All the circumstances must be one person ill while trying to make carefully balanced. The nature and another one well. Such conditions severity of her disease and its probmight be caused by various conta able duration; her chances for regious diseases, although I do not covery at home; her chances in hosrefer to them exclusively.

pital; the costs involved in her care d. Hospital is of course advisable at home, and in the care of the when poverty is so extreme that al- family in case of her removal ;

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whether the life and comfort of the intelligent, and industrious. It is so family will be likely to suffer de hard to find her, however, for such a moralization if she remains, as some position, at least in large cities, and times happens; what the prob- her wages would be so considerable, able effect on their moral and mate that this is practically out of the rial well-being would be if the home question. were broken up; what would become It is, perhaps, not necessary to of the husband, the children, and the mention the necessity of being furniture; and how they could again thoroughly familiar with the special. be re-united.

ization and limitations of hospitals. Speaking generally, one may say incurable and chronic homes, and that the home should be broken up other institutions, in order to know only as a last resort. One would in just where to apply in certain cases. every way try to manage so that this Some hospitals, for instance, will shall be avoided. It should, how not admit patients with puerperal ever, be noted that if the husband is sepsis; others will not admit phthisis. obliged for any length of time to One needs to be become experienced cease wage-earning in order to per in the classification of cases, in order form the duties of nurse and house not to lose prestige with the hoskeeper, no good object is gained. pitals by asking them to take the The patient is at a disadvantage, wrong ones—a procedure that wastes and all the disorganization which time and causes

annoyance and you aim to avoid will fall upon the trouble. family sooner or later, so that this When the patient, for proper arrangement is never anything but a reasons, does not go to hospital, mistake or a misfortune. Rather she should be well and generously than adopt it, the mother should be cared for at home. We do not find persuaded to go to hospital.

that it pauperizes people to supply Breaking up the home need not their needs quite freely during illof necessity mean final break up. ness, or, if they can themselves proThe little children should be placed vide the needs, to bestow various out with the most conscientious little luxuries upon them. Well-torelatives, or in a suitable institution. do people receive many gifts, in As a nurse, I would say that the illness, of food, conveniences, and care of good relatives or friends comforts. Why not the poor also? would be better for them than any Nor do I think that it is improper but really ideal institutions, but that for several charitable agencies to fairly good institutions are better contribute at the same time toward than bad relatives. The older chil. one sick case, if one alone can not dren and father can look after them well take the whole cost, provided selves in the rooms; if there are no that they agree together and work older children, the father could sleep co-operatively. They may each be in his rooms and get meals outside; specialized to give one kind of thing, or, is able to pay the rent, he can and their united gifts will supply lock up his rooms and live elsewhere. all the patient's needs. One society, If there is no father, all the children for instance, will give milk daily; will have to be provided for, and the another will agree to pay a month's furniture stored away. To engage rent; another has wine, jelly, or and pay a woman to come in and fruit to distribute ; another keeps tale charge of rooms and children bed linen and appliances. Of course, might be a good plan, if the ideal there may be places where all these woman could be had-trustworthy, functions are united in one society.


cities pro


Adequately to care for the sick and chicken-pox still less. Severe poor in their own homes the follow cases of scarlet fever should, if posing conditions should be complied sible, be sent to the hospital. All with:

cases of diphtheria had better be 1. The patient should have a bed sent there ; although with the use of alone. If necessary a cot may be anti-toxin, which some loaned.

vide free for the poor through 2. She should have a daily bath boards of health, this contagion is and enough changes of bed linen to no longer so terrifying. We feel, in keep her clean.

our work, that typhoid is more of a 3. She should have sufficient nour menace than a mild scarlet fever or ishment of the proper kind furnished even a mild diphtheria. Under the continuously. As a general state circumstances existing in ment one might say, at least one crowded tenements, we have rarely quart of milk daily—often more, known of a case, left at home, where one or two fresh eggs, and one or a second case did not develop, and two cups of beef tea or soup.

in some instances six and seven 4. She should have the appliances members of the family, in periods of requisite for comfort and treatment; time which showed successive infecbed-pan or douche-pan, or ice-cap, tions from the first case; whereas we or hot water bag, or surgical dress have innumerable times watched ings, etc., etc.

scarlet and diphtheria where no 5. There should be some one to second case developed. give her food and medicine by day, There is also, practically, no such and, if the illness is critical, by night thing as isolation of tuberculosis. also.

And in the case of a gonorrheal or 6. Beside her own laundry the syphilitic member of a family not family laundry must be seen to. If only would such a thing as isolation there is no one else some one must be unheard of, but also medical be paid to do the washing and care does not always extend to occasional scrubbing.

cautioning and instructing the Beside the nursing, there will be patient against infectious contact watching and friendly advice needed with others. Yet the former infor the rest of the family, the chil fection, conveyed by towel or handdren encouraged to keep tidy and kerchief, may cause the most viruhelp in the house, and the comfort of lent inflammation of the eyes, the husband, if the wife is sick, with not infrequent loss of sight arranged for in little ways.

while the latter may poison a second The management of contagion is person through even a slight cut of a difficult subject. Speaking aca the finger. demically, all contagions ought to be About all that a visitor, or even a isolated. Practically this is impos nurse,can do in regard to contagions, sible in the homes of the poor. is to instruct people in the mode of In working with such cases you transmission of different diseases, will not find it possible to rise and so enlist their intelligence in much above the standard set by the specific mode of disinfection; your board of health, whatever that special attention being given to the may be. The towns are few where following points: there is sufficient hospital provision That the germs of phthisis are in for scarlet sever, owing to its pro the sputa, and that these should be tracted convalescent period. Mea. burned, and dishes used by the pasles is hardly even considered, tient boiled.

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