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sloves. I can always go to that stock inventory, in card index form, and follow my rubber gloves, as rubber gloves. I can also follow them as charged against the operating room, by following the operating room expenses, so that I do not lumber the bookkeeping system with a stock inventory charge. I do keep my rubber glove account separate in that way, also enter articles such as gauze and cotton, etc. That stock inventory shows not only the receipt of the cases of goods, but in detail the distribution of these goods.

DR. ALICE M. SEABROOKE, Philadelphia: We keep track of anything received. The amount and price is entered, and anything distributed into a department is checked up against that department, and we can in that way find out what each department is costing us.

Dr. FISHER: These remarks indicate that you also have your "Book of Detail” accounts. One of the most important books which we keep is the “For Month and to Date” book, which shows the cost of every department, with every subdivision of it, for each month of the year, and also shows monthly the total cost of each department “to date.” This book is ruled to show the accounts for five years. Thus any increase of expense is shown at once, and the “Books of Detail” show in what items the increase has been and whether in quantity or price. This book is very quickly written up with this system of bookkeeping.

I see that our discussion has taken us rather into detail, and this has been profitable. When, however, it comes to making our annual reports hospitals and other corporations do not present all these details to the public, but aim to group expenditure and receipt items under somewhat comprehensive headings. This broader classification as worked out by the hospitals now using this system is shown in the schedules in the book which you have received and which I have just shown upon the screen. The general plan is an elastic one as shown in the fact that the system is in use by one of the smallest hospitals in New York city, as well as the largest.

I would like at this point to say a word about "Corporate Expenses," which I forgot in the lantern talk. Of course all the expenditures of the hospital may be regarded as for the care of the patients-nevertheless there are a class of expenditures not very directly for the professional care of patients, and which do not fall under the schedules showing expense items by the superintendent. For this class the title “Corporation Expenses" seemed to be the most satisfactory. The schedule will be found on page 4 and the explanation of it on pages 20 and 21 of the book “Hospital Financial Reports and Statistics."

MR. J. Ross ROBERTSON: How do you keep your semi-private ward separate from your general expenses?

Dr. FISHER: We have our private patients served from our one general kitchen, and we have to make an estimate; we have no kitchen for private patients. We known this, however, that the food for private patients costs a great deal more than food for ward patients; we know also that the time spent in the kitchen is a great deal more for private patients relatively than it is for the ward patients. While our private patients show but eight or nine per cent in drug treatment, we estimate the kitchen cost to be fifteen per cent for this class of patients.

Miss MAUD BANFIELD, Philadelphia: Just a question with regard to interest on mortgages: if you raise a mortgage, would you charge that interest to the maintenance account?

DR. FISHER: That goes under the heading of corporation expenses,

MR. J. Ross ROBERTSON: Would you not charge the interest to maintenance account?

Miss BANFIELD: We charge up all our interest due on mortgages to the maintenance account. If I do not have to charge it to that I could make a very much better showing in my report.

MR. J. Ross ROBERTSON: When we had a mortgage for $75,000 or $85,000 on the Toronto Hospital for Sick Children, the interest was about $5,000 a year. We charged that amount to maintenance. It was right that we should. We were getting money from the public, and it was an item in the cost of maintenance that had to be reckoned and accounted for just hte same as expenditures for provisions.

DR. FISHER: In the system presented this would be a corporation expense-a business transaction by the corporation.

Miss BANFIELD: I would like to move a vote of thanks to Dr. Fisher for sending many of us books, and for the immense amount of labor which I know he has put upon this question. I know it has proved of great benefit to many of us.

DR. FISHER: I shall carry these thanks to the real workers in the development of the system of “Hospital Financial Reports and Statistics,” to whom I have already referred, and who, I am sure, will prize the appreciation of this Association.

Vote of thanks put and carried unanimously.

248

FIELD WORK IN CONNECTION WITH

CHILDREN'S DISPENSARIES.

ROBERT W. BRUÉRE, General Agent, New York Association for Improving the

Condition of the Poor.

(By Invitation.)

In a valuable paper on “Dispensary Ideals” contributed by your President, Dr. S. S. Goldwater, to the American Journal of the Medical Sciences, September, 1907, he called attention to the absence of an adequate district field service in connection with dispensaries. Speaking of New York as typical of all large centers, he said that "while a few New York dispensaries are now doing district work, this work is designed chiefly for the relief in their homes of patients who are too sick to come to the dispensary, and, except in isolated instances, is innocent of any intention of checking the development of disease by the promotion of better habits of living.”

The seriousness of this charge is happily receiving general recognition, and one hears frequent reports from many quarters of steps taken to relieve the reputation of dispensaries from its burden. In the most conspicuous instances of reformation, notably the out-patient department of the Massachusetts General Hospital and the Association of Tuberculosis Clinics of New York, of which Dr. James Miller is to speak this morning, an honorable part is being taken by social workers, and it is as a representative of social workers that Dr. Goldwater has considerately invited me to describe the work which the New York Association for Improving the Condition of the Poor is doing in the organization of a district field service, both in connection with the infant dispensaries which it has established and in connection with certain of the older children's dispensaries in New York.

A question no doubt arises in your minds as to why a philanthropic association should be concerning itself with the problem of dispensaries which on first thought is so peculiarly a problem of the medical profession. It is true that the New York Association for Improving the Condition of the Poor is primarily a relief agency. Like the Red Cross Corps in war, it follows the year-round struggle for existence, aids the disabled, and strives to re-equip them to re-enter the industrial ranks. But its function is not only the giving of relief, but also the preservation of working efficiency in the individuals who are compelled to earn a living in the ruthless competition of the unskilled labor market and who are not always equal to its demands. The Association has accordingly been responsible for many institutions for the promotion of physical fitness among the poor. As early as 1845 it was fighting for model tenements. In 1851 it founded the DeMilt Dispensary, and in the following year the North Western Dispensary in another quarter of the city. An old report says of these institutions that "in ministering to the sick poor they not only perform an imperative work of mercy and become conservators of the public health, but by restoring to the disabled the ability to labor, and consequently of self-maintenance, they make them cease to be a burden to others, and to become contributors to the resources and well-being of the community.” With a similar end in view, the Association founded the Society for Ruptured and Crippled Children, built the first public baths in New York, organized the Vacation Schools, established a great Fresh Air Home on the ocean front of Coney Island, maintains the first American Seaside Hospital for the treatment of tuberculosis of the bones, joints and glands in children, and is now organizing the field service in connection with children's dispensaries which I have been asked to describe. All these measures were designed to conserve life, to protect the working efficiency of the poor; and they were inspired by the doctrine of prevention through education which, as it makes it way to pre-eminence among the aims of the medical profession, tends to bring the physician and the social worker into increasingly intimate alliance.

Every physician knows that the birth of a child is a serious menace to the prosperity of the ordinary workingman's family, and that in the case of the unskilled poor in our great cities the birth of a second or third child even in prosperous times, usually spells disaster to the home. Until the first children are old enough to work, the mother must hire out or go into the factory. If, through lack of proper attention, the baby is allowed to fall sick or the mother's strength is wasted, the inevitable result is that from one to ten persons will be thrown upon public or private charity for support. The mother becomes an invalid, her children are neglected and underfed and make an early start upon the broad but not flowered way of degeneracy and pauperism. Let me illustrate. Last year one of the Association's visitors discovered a woman whom I shall call Mrs. Davis. Though only 37 years old she was the mother of nine children, the youngest a baby of five months, and six others under working age. She was still exhausted from the effects of her confinement,—they cry “next” very quickly in many of our great lying-in-institutions,—and she was much worn with the care of her large family. As usually happens in such circumstances, the baby, too, was in a very bad condition.

This family had long ago outgrown the father's capacity for wage earning. You can readily see that on the part of the Association, whose boast it is that it has never turned a deaf ear to a cry of distress, it was not only an act of mercy but also a measure of economy to save that mother and protect the lives of those children while they were still young, and while their constitutions were yet unimpaired. A nurse was immediately sent. As soon as the mother could be moved her six older children, who were not of working age, were sent to Sea Breeze, our Fresh Air Home, and the mother and her baby were sent to Caroline Rest, our convalescent home, where it required 62 days of nursing, fresh country air and good food to completely restore her.

Through the generosity of Mr. George H. F. Schrader, a retired New York inventor and manufacturer, the Association was enabled in the spring of 1907 to organize a corps of three nurses to attend such cases as I have just described. They not only go into homes where there are convalescing mothers or sick children, but they begin from one to six months before confinement to educate the women among the families that have turned to us for relief in personal hygiene and breast-feeding, and to prepare the house for the coming of the new life. They are laying the founda

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