Woman's work in municipalities. Mary Ritter Beard
of vigor and in the hardships they bring into the lives of the workers and thousands of families. The activity of the Women’s Municipal League of Boston affords us an example of the way in which women are awakening to their own and the public responsibility for such occupational diseases. In their study of these dread enemies of working people, they have begun with lead-poisoning and, perhaps wisely, since painters come into their homes and they themselves often share directly in the responsibility for the infection through their failure to provide hot water and other cleansing materials at the close of the painter’s day of work. This League has become interested in the physical troubles of telephone operators also, such as the loss of voice and hearing.
Family Visitation
As in other branches of social endeavor, we see public health work tending more and more toward prevention. The ideal now is not merely to provide more ambulances, but rather to reduce the necessity for so many ambulances. This need early became apparent as hospitals discharged patients only to find them soon fallen into sickness again.
In all varieties of hospitals where the poor are admitted as patients, the follow-up treatment is often as vital as the immediate prescription and nursing. This involves family visitation and advice and is called by Miss Katherine Tucker, president of the New York Association of Hospital Social Service Workers, “a new profession.” Miss Ida M. Cannon, headworker of the Social Service Department of the Massachusetts General Hospital, puts these pertinent questions about the social work of hospitals:
OF WHAT USE IS IT—
If a patient for whom the surgeon orders a back brace starves herself to pay the bill?
If a workman, cured of rheumatism, goes back to his job in the damp cellar which caused it?
If a clerk, fitted to glasses, returns to the dim desk which crippled her sight?
If an unmarried girl, delivered of her child, goes from the maternity ward back to the neighborhood that ruined her?
Medicine and surgery, supplemented by social service, not only cure disease but restore to full health and working capacity.
The theory and practice of this youngest handmaiden of medical science are fully, simply and interestingly told in the latest Russell Sage Foundation Publication.
Dr. Richard Cabot, of Boston, was one of the first physicians to emphasize the social background of health; but it is admitted on all sides that women are proper persons to treat the family and discover its needs. They are social physicians in a very real sense and their knowledge must be industrial, economic, psychological, as well as medical.
At the fifteenth annual convention of the American Hospital Association held in Boston last summer (1914), Dr. Frederick Washburn, president of the association, insisted that the function of the hospital is not merely to treat patients acutely sick, but to aid in the prevention of disease, and to undertake social service and coöperation with community agencies. Other speakers dwelt on the necessity of better care of the “out-patient,” the social service side of health work. The Survey had this to say: “A new note was struck by Elizabeth V. H. Richards, headworker of the social service department of the Boston Dispensary, who showed that the social service department is not only of assistance to individual patients, but that the medical social worker can be of value to the managing authorities of the institution as a whole, in studying the efficiency of its clinical work, and in planning the broader relations which its work may bear to other welfare resources in the community.”
The home situation clearly has to be considered as well as the physical ailment in almost every case requiring medical care. Thus the task is a coöperative one between the social worker and the medical scientist. Every attempt to improve labor and living conditions is a similar aid to medical science if not to the medical profession, so that any proper study of health or physical well-being must lead us on to an examination of efforts for better housing, a living wage, for social insurance, for workmen’s compensation, and the many other devices that make a decent standard of living possible.
After-care is especially imperative in cases of mental disorder. Patients may be discharged from insane hospitals in some cases if the physician can trust in the home environment. The social worker is his aid in these cases and thus helps to keep families together. The prevention of insanity and the after-care of patients is the object of the National Committee for Mental Hygiene which numbers Julia Lathrop, Jane Addams, Mrs. Philip Moore and several other women among its members. Dr. Thomas Salmon, a leader in this work, writes: “Women are active in this committee and I can say that we rely very much upon the wise counsel of these members of the committee.”
District Nursing
Care of the sick in hospitals, as everyone knows, depends almost as much upon efficient nursing as upon the skill of the physician—in many cases, far more. Of the labors of nurses for humanity, it is not necessary to speak here. But in our present public health campaign, a new type of nurse has appeared, “the visiting nurse,” who watches homes to guard against disease as well as to cure, and she is now regarded by competent observers as the strategic point in the battle for improved health in our cities and towns.
Ysabella Waters in her examination into the system of visiting nursing in the United States shows that in 1913 “50 health departments employed 867 visiting nurses, including 345 school nurses, 350 tuberculosis nurses, 107 infant hygiene nurses and 65 employed in other fields of sanitary work. At the same time 64 departments of education reported the employment of 200 visiting nurses in their work and Miss Waters obtained records of 2,367 nurses taking part in public health work under other auspices, most of them being engaged in the campaign against tuberculosis.”
An excellent system of district nursing is that developed by Miss Lillian Wald from her Nurses Settlement in New York City, and, according to Professor Winslow, it was due to her far-sightedness and organizing ability that the application of the educational force of district nursing was made to the problem of tuberculosis. Miss Wald’s belief that the hospitals can never cope with disease and that home treatment is better and more practicable is borne out by the figures given for the total number of patients treated last year by the district nurses which indicates that the number visited and cared for was larger than the number treated by three large city hospitals in the same space of time. Ten per cent. is the proportion usually cited as the ratio of the sick taken to hospitals. Miss Wald contends that the treatment of patients in their homes, especially where children are concerned, is preferable to hospital care in most cases, and can be carried on in a way that compares favorably with the treatment accorded in hospitals and by the private nurse in the homes of the well-to-do.
Miss Wald began her work for public nursing twenty-four years ago and has steadily pushed its importance into public recognition and changed the official attitude, as well as the attitude of doctors and laymen, from that of indifference or contempt to that of sympathy and understanding and public support.
In other cities, the idea has been taken up and developed in many ways. The Visiting Nurses’ Society of Philadelphia wants to increase its force to enter industrial nursing and here as elsewhere in the various aspects of nursing, the demand for training far exceeds the equipment. Here, too, just as the hospital nurse soon sees the necessity of economic backgrounds for cure and prevention of disease, so the industrial nurse is seeing and writing on the causes and prevention of ills among working men and women. They are greatly aided in this study by that splendid contribution by Miss Goldmark on “Fatigue and Efficiency.”
Los Angeles was the first city to municipalize the district nurse, and this bold step was taken at the instigation of Mrs. Maude Foster Weston and the College Settlement workers who furnished statistics and reports, which they themselves had gleaned from their own observations with private district nursing, to prove that such a step was municipally advantageous. The first school nurse was also secured in that city through