XIV

THE HOSPITAL

THE hospital is an institution where patients are received whose illness requires that they remain in bed and receive more constant care and supervision than is possible in their homes. For the purpose of this study hospitals may be divided into two kinds:

1. The public-service hospital is a hospital, whether supported by public or private funds, which takes at least some patients as a service to the community and not merely in return for payment.

2. The proprietary hospital is run as a business enterprise. The term "private" should not be applied to hospitals of this second class because it is ambiguous, being used sometimes to mean supported by private as distinguished from public funds, and sometimes to mean maintained for private profit.

Hospitals are unevenly distributed throughout the United States. A disproportionate number are found in the larger cities and in the older communities of the East. The majority of these hospitals are of small size. There are 3,187 hospitals listed in the American Medical Directory of 1918 which, on the basis of information therein contained, have been tentatively classified as general hospitals of the first, or publicservice, class. One thousand two hundred and thirtynine of these, or 39 per cent, had 25 beds or fewer.

There were almost exactly the same number (1,246) with from 26 to 99 beds. Only 702 hospitals had 100 beds or more. The number of private proprietary hospitals is much larger, but the great bulk are small, having 25 beds or less.

In discussing the relation of the hospital to the medical care of the immigrant we are practically limited to the public-service group, chiefly to the institutions of 100 beds or more. The most highly developed examples of hospital service are found in the large hospitals, particularly in those which are affiliated with medical schools and are university or teaching hospitals.

In view of the fact that a large number of northern Europeans have settled in the growing industrial communities of middle size and in the small towns and rural districts, it is significant that the 66 medical schools of the country are nearly all located in large cities, that the number of medical schools is likely to diminish rather than to increase, and that hospitals established and maintained in intimate co-operation with these schools can reach only a very small fraction of the population in each state. These facts are fundamental to a consideration of hospital service for the immigrant.

IMMIGRANT ATTITUDES

The service that hospitals can render the immigrant is in part dependent upon his attitude toward the hospital. This is brought out by interviews with the foreign born, both doctors and laymen.

A Polish doctor says:

Poles are decidedly opposed to going to the hospital under any circumstances or to allowing their children to be taken. To go to the hospital is to die, they think, because in their experience it has always meant the last resort. Aside from this, they lack confidence in hospitals. The strangest stories gain currency among them about practices in the hospitals and the doctors can't reassure them. They actually believe that patients die of neglect or are killed by "black medicine."

A Russian doctor says:

Russians are afraid to go to the hospital; they have known little or nothing of them in the old country, and the experiences of people of their own nationality in the hospitals of this country have not served to give them any faith in them, for they do not understand the treatments. Exaggerated stories easily gain currency. The lack of the language makes them feel strange and helpless.

An Italian doctor says:

The masses of the Italian people have a deep-seated prejudice against hospitals. It would be difficult to find the cause of it. I cannot understand it; it is like many of the superstitions of ignorant people. They say people are abused, or neglected, or killed in hospitals. The younger generation is of course getting away from such notions, but still I have to deal with many cases at home when I know recovery would be much more certain in a hospital.

The immigrant's attitude toward the hospital of course depends partly on his background and partly on his personality and immediate circumstances. If he has come from a district abroad in which hospitals are distant places to which only desperately ill people are sent, naturally he comes to America with a different notion than if he had been brought up in a

large city well provided with hospitals. Once located in an American city, the immigrant and his family may be in continuous good health, but they are almost certain to hear about a neighbor or friend who has been taken to this or that hospital because of accident or illness.

Those who visit a patient report their impressions. The patient himself returns and does likewise. Should the patient die at the hospital, a feeling of fear or repugnance may be strongly confirmed among his acquaintances. Most hospitals give even the sophisticated visitor a sense of being surrounded by very busy, presumably very efficient, doctors, nurses, and employees, who are passing rapidly from one duty to another and have little time for him. When to the intrinsically depressing features of a hospital are added unfamiliarity with the language spoken there, and a sense of isolation and helplessness, the immigrant may be pardoned for sharing what an American visitor to many hospitals described as "a sinking feeling in the chest." It is easy to understand how the impressions of the individual immigrants quoted below were acquired. A Lettish immigrant reports:

Does not trust hospitals or dispensaries, especially city hospitals, which many of the men from the factory had been sent to when different accidents happened. One or two of them had died and the family and neighbors look upon all hospitals as a place where one goes to die.

From two Lithuanians come the following testimonies:

All hospitals are the same to Mr. M. hurt in the factory they are sent there,

"When men are and if the young

doctors do not practice on them they live, but otherwise

they die." Mr. M. had no other occasion to use doctors. When he had a cold and sore throat he told the druggist what the trouble was and he gave him some medicine. "Of course the druggist knows what is good for you."

Had to go to hospital for spinal trouble. Did not like the hospital, as they were not kind to her. They spoke in a foreign tongue which she could not comprehend.

The attitude toward hospitals revealed in one hundred and fifty interviews with doctors, and about an equal number with individual immigrants, could be summarized in the following opinions:

A strange place.

A place in which I cannot understand what people say, nor be understood.

A place where doctors practice on you, especially young doctors.

A place where people die.

A place where I cannot get the food I like or am used to.

A place where either I have to take charity or pay more than I can afford.

These items are listed in about their order of frequency or importance, so far as can be judged from the material at hand. Obviously the degree of strangeness varies with the individual and his previous experience with hospitals. An immigrant who speaks even a little English is far less isolated and unhappy in a hospital than one who may be shut off for weeks with people who cannot speak a word of the only tongue he knows. The education or intelligence of the patient, as well as his previous experience in medical institutions, will determine whether he believes the false stories about doctors "practicing on patients,"