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Wasteful Public Charities

Creator: n/a
Date: September 28, 1877
Publication: Springfield Republican
Source: Available at selected libraries

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The most striking and central error in our hospital management is the need of a board of managing physicians. There is absolutely no medical man in authority, no one to pronounce upon the patient's fitness to be admitted or discharged. Each patient employs and pays his own doctor. There is no safeguard against any quackery or any interference with personal fancies. This is an unheard of thing in a well-ordered hospital, which should have its own board, visiting in turn by the month or quarter, supreme in authority as to sanitary matters, admissions and discharges. A board of four physicians to serve quarterly would meet the requirements of our hospital. They should be men of reputation, especially in surgery, and so chosen as to work harmoniously together and to command the confidence of the public. All charlatanism should be excluded, and when we are taxed to pay for the care of the sick we should be insured that their recovery is as speedy as is possible. It is customary for hospital physicians to treat five patients without pay. It is the rule in all public hospitals to require all patients to be attended by the hospital doctors, who are usually the most eminent men in their own town. An examination into the rules and regulations of our leading city hospitals will prove this. We therefore urge the appointment of a board of four prominent and skillful physicians, and the commitments to them of the responsibility of admitting and discharging patients, the exclusion of all chronic, infirm, incurable, insane, idiotic persons, and all persons who have or can have a domicile in the city, only excepting among the latter such few and rare cases as the house surgeons may desire to admit the admission of all true hospital cases, viz.: Acute diseases and surgical cases and chronic patients who require hospital care, or who cannot procure for themselves the necessary nursing elsewhere; the exclusion of lying-in cases which can be cared for invariably elsewhere and at less expense. And this last fact your committee know to be true. A sick hospital is not a suitable place, but an unwholesome one, for lying-in cases.

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The annual appropriation of $6000 is not large for our city to make for hospital use. For a population of 31,000 it is rather small, but it will so almost all we need under proper management. The average number of patients at a given time we find to be only 48. It would cost comparatively little now to have the house generally full. About 12 persons at a time, on a pinch 14 or 16, could be cared for with the help only of one more nurse, or if the sickness was severe of two more. This we base upon the number employed elsewhere. The large general expenses, salaries, heat, etc., would be the same and the increase not very large in provisions. We recommend the uniforms treatment of patients so far as is necessary to cure. No free wards, but rooms appropriated as is convenient to sick and poor. But a patient who can pay should pay according to his or her ability; $4.50 to $5 per week is the charge in the Massachusetts general hospital. We actually know that the city has been giving more than half the cost of their keeping to many people who need no help, while refusing all expense and care to dozens of poor sick, or sending cases to the alms-house which must suffer for wants of hospital care. As this mismanagement is owing to having no home surgeons, and to imperfect knowledge of the regulations of well-ordered hospitals; partly, also, to a spirit of indifference and easy-going wastefulness too common in irresponsible hands.

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We earnestly entreat our city fathers never to think for an instant of giving up the city hospital; rather to appropriate a little more, say $5000, to its maintenance, and to reform its outside management. Inside there appears to be no fault on the part of the persons in charge. Free beds should be established by some of our rich and benevolent citizens. No expenditure of money would be more useful. The owner of a free hospital bed in the Massachusetts general hospital can place any occupant in it that he designates, subject always to the choice of the board of surgeons, who allow no incurable or unsuitable case to come in, or to remain if there The cost of a free patient in the Massachusetts general hospital, we learn from the treasurer, is $500. The contribution of $100 gives the donor the right to nominate the occupant of a bed, under the rules, which exclude chronic and incurable patients. The rate of board at the Carney hospital, Old Harbor street, South Boston, under the charge of Catholic Sisters of Charity, is $5 to $6 per week. This hospitals largely supported by charity and endowments. The character of the Pittsfield house of Mercy states that it is for the benefit of sick persons, "Whether in indigent circumstances or not." On this humane plan the poor are nurses in charity, the rich pay according to their ability. All are equally well cared for, and the good done is inestimable. It is managed wholly by women, with great economy and efficiency; the funds supplied by private charity.

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