Friendly Visiting among the Poor: A Handbook for Charity Workers

by Mary Ellen Richmond

CHAPTER VI

HEALTH

About one-fourth of all the poverty that has come within the scope of charitable investigation is directly caused by sickness. "In both American and English experience," writes Warner, "the percentage attributable to this cause sinks but once slightly below fifteen and never quite reaches thirty. The average is between twenty and twenty-five. This is one of the most significant facts brought out by these tables [of the statistical causes of poverty]. It is not one which the author anticipated when the collection of statistics began; and yet it has been confirmed and reconfirmed in so many ways that the conclusion seems inevitable that the figures set forth real and important facts. Personal acquaintance with the destitute classes has further convinced him that most of the {96} causes of poverty result from or result in a weakened physical and mental constitution, often merging into actual disease." [1]

This fact gives added importance to all the efforts of modern charity to secure improved dwellings, open spaces, cheap baths, and better municipal sanitation for the poor. But improvement in these matters cannot come entirely from without; "the model tenement implies a model tenant." As a London authority puts it: "The condition of the house may degrade its occupants. The careless life and habits of the occupants will spoil the house, and make it filthy and unhealthy." The friendly visitor should try to make the family healthily discontented with unsanitary surroundings, and so prepare them for better quarters. Removing families from unfit tenements is not enough, however, if these tenements are almost immediately reoccupied. Their condition should be reported to the Board of Health, and, if condemned, we should see that no one else is permitted to move into them.

I have often noticed that charity agents, {97} who work habitually in poor neighborhoods, get so accustomed to bad sanitary conditions that they hardly notice them. Volunteer workers are not so likely to fall into this error, though it is possible for volunteers to be very unobservant. They often feel that things are all wrong, without being able to state the specific difficulties. An observant visitor will learn the condition of the cellar, walls, yard, plumbing, and outhouses; will learn to take the cubic contents of a room in order to find out the air space for each sleeper; will learn the family method of garbage disposal; will see how the rooms are ventilated; and will learn all these things without asking many questions. Dampness is a very common cause of sickness; when the children cough it is a very simple matter to ask about the cellar, and even get permission to see it.

The prejudice against fresh air, especially night air, is a difficult one to overcome. One mother, who kept her children scrupulously clean, could never understand the value of fresh air until a visitor explained to her how air was polluted by the soiled air that we {98} breathed out, just as water was polluted when we washed our hands in it. When the children breathed this soiled air in again it made them "dirty inside"; and this homely statement left such an unpleasant picture in the mother's mind that her rooms were always well ventilated afterward.

It is difficult to ventilate a small room without making a draft, but, next to the chimney, the upper sash is the simplest ventilator, and should not be immovable, as it is in many small houses. A board about five inches wide under the lower sash will make a current of air between the upper and lower sashes, and, better still, two pieces of elbow pipe with dampers, fixed in the board, will throw a good current of air upward into the room. Another ventilator can be made by tacking a strip of loosely woven material to the upper sash and to the top of the window-frame. When the upper sash is dropped, the stuff is drawn taut over the opening, and, while permitting air to pass through, breaks the current.

Equal in importance with fresh air inside the house is exercise out of doors. I was {99} shocked some years ago to find that, of six Sunday-school boys who went with me on a little trip to our largest city park, five had never been there before. This had not been due to lack of time or money, though they had very little of either; but its sole cause had been lack of enterprise.

There is an impatient and popular saying that soap and water are cheap; like many other popular sayings, it is only half true. Personal cleanliness is rather expensive when one takes into account the time, energy, and frequent changes of clothing required to keep the body daintily clean. Visitors should realize this in any effort to introduce a higher standard of personal neatness, and should not be impatient when they do not immediately succeed. Cleanliness and health are so nearly related, however, that the effort is very well worth making. A visitor who hesitated to complain to a mother about her little girl's neglected condition, borrowed the child to spend the day, and brought her home at night sweet, clean, and rosy, with her hair well brushed and curled. The hint was taken.

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It would be very unfortunate for the visitor to be an alarmist, for there are imaginary invalids among the poor as well as elsewhere, but more frequently the poor neglect the earlier symptoms of sickness altogether, or else dose themselves with patent medicines. The quack doctors who advertise in the daily papers draw much of their custom from the very poor, who are also large consumers of cure-alls and proprietary medicines. We have seen how children's physical defects can pass unnoticed at home, and this is the case in a less degree with the defects and ailments of adults. The very cheap grade of medical service that is sometimes given by regular practitioners in poor neighborhoods has a tendency to discourage the poor from taking sickness in time. The visitor can help them to procure better medical service at reasonable charges or, when necessary, without charge. The grade of service in dispensaries varies greatly, but the medical advice and directions given there with the medicines can be made far more useful if the visitor will go with the patient and see that the directions are understood and carried {101} out. Often no adult in the family can spare the time to go with a sick child to the dispensary. Here, too, the visitor's service will be helpful. In cases of contagious disease, see that the Board of Health is notified promptly.

Other things being equal, an acute case of illness can usually be better and more economically cared for in a hospital than in a poor home. In fact, although hospitals were intended originally for the destitute sick, the practice of sending well-to-do patients there is rapidly spreading. The prejudice against hospitals, still so general among the poor, is a survival from a time when hospital care was far less humane than now. If the visitor has ever been a patient in a hospital, and can tell his own experience or the experiences of friends, or if he happens to know some of the doctors or nurses, and promises to see them about his poor friend, the prejudice can often be overcome. The dread of the untried and the unknown is natural enough, and yet it will happen now and then that hospital care is so clearly the best thing that nothing can take the place {102} of it, and suffering and loss will be entailed upon the family by their refusal to let the sick member go. In such cases charitable people may be justified in helping the family to a right decision by withholding all relief.

The prejudice against hospitals is strong in the negro race. In the first family I ever visited the mother, a colored woman, had been bedridden for thirteen months. According to her own account she had been "conjured," and at first the mention of a hospital made her hysterical. She consented to let a doctor, who was a friend of mine, see her, and he pronounced her disease sciatic rheumatism. He said she could never get well at home with four small, noisy children, and, besides, the walls of her house were damp. After two months of persuading, I got the mother into a hospital and the family moved into a dry house. Among the arguments that won her were my own acquaintance with the hospital nurses, and my promise to visit her frequently while there; and my further promise to see that the children were well cared for while she was away. But the argument that tipped the scale was the {103} promise to take her away to the hospital in a carriage with two horses.

Among the cases in which hospital care is not practicable are those of chronic invalids, of patients too sick to be moved, and of patients able to be treated as "out-patients" in the dispensaries. Confinement cases, where there are children in the family who must be placed temporarily in institutions if the mother leaves home, are best treated in the home. There are societies that provide a nurse and baby-linen at such times. Some families are so degraded that they look forward to times of confinement as times of plenty (see family cited on p. 55), and in these cases nothing but hospital care should be offered, while we place the children temporarily in institutions or with neighbors. For the destitute sick outside of hospitals, district nurses are now provided in many cities. When these nurses are careful to instruct well members of the household in the care of the sick, their influence is especially helpful, and they are often able not only to relieve suffering, but to raise the standard of living in the home. Diet kitchens, supplying food specially {104} prepared for the sick either free or at a nominal cost, are also found in many of our cities.

With all the charities provided for the sick, there is still need of better provision in this country for convalescents, who are sent from the hospitals too weak to resume work, and still needing rest, good food, and pure air to effect a complete cure.

Two classes of invalids remain to be mentioned in this condensed summary. First, accident cases, in which the visitor must be careful to see that legal redress is obtained when the case is one for damages, and must, at the same time, protect the victim from lawyers who are glad to take a sure case for "half the proceeds." Second, incurables, for whom homes are provided requiring an entrance fee, or for whom, more often, nothing remains but the almshouse. The visitor can sometimes secure the coöperation of friends and charities interested, and so raise enough money to provide the fee for such an invalid, when, without coöperation, as much money and more would be spent and the patient remain in the end unprovided for. Charitable people often {105} get tired; they will do a great deal for a while, and will then get interested elsewhere, and grudge the help that is still needed. In view of this failing, it is much better, in making plans for incurables, to secure a lump sum that will make adequate provision, than to depend upon the continued interest of a number of people.

The migration of invalids is the last point upon which I shall attempt to touch under this head. Any one who has visited California, Florida, Colorado, or any other part of our country where climatic conditions are supposed to be favorable for invalids, will realize the irresponsible way in which charitable people are accustomed to send the sick where they do not belong. The worst of it is that the sudden change of climate and the impossibility of securing proper care, so far from effecting a cure, in many cases hasten death. "The saddest thing about the life of a Denver minister," writes Rev. Samuel A. Eliot, "is the number of lonely funerals that he is called upon to attend. Often I have been hastily summoned to say a prayer over some poor body at the undertaker's {106} shop, where there would be present just the undertaker and the minister, with perhaps the keeper of the boarding-house where the lad died or an officer of the Charity Organization Society. I look at the youthful victim of ignorant good-will borne to his neglected grave, I imagine the mother and sisters in the farmhouse on the New England hillside, whose tenderness might have soothed his last hours, and I think with bitterness of the well-meant but misdirected charity which condemned him to a miserable exile and a forlorn death." [2]

It must be remembered that change of climate is helpful only in the earlier stages of disease, and only then when the patient is able to live in comparative comfort, free from worry and anxiety. To send invalids to a strange place in the name of charity, without providing them with the means of subsistence, is the refinement of cruelty.

Collateral Readings: Publications of local Board of Health.
Proceedings of International Congress of Charities, Chicago, 1893,
volume on "Hospitals, Dispensaries, {107} and Nursing." "Instructive
District Nursing," M. K. Sedgewick in "Forum," Vol. XXII, pp. 297 sq.
"The Feeble-minded," Dr. George H. Knight in Proceedings of
Twenty-second National Conference of Charities, pp. 150 sq. See also
discussion in same volume, pp. 460 sq. "The Care of Epileptics,"
William P. Letchworth in Proceedings of Twenty-third National
Conference of Charities, pp. 199 sq. "Industrial Education of
Epileptics," Dr. William P. Spratling in Proceedings of Twenty-fourth
National Conference of Charities, pp. 69 sq. "Destitute
Convalescents: After Care of the Insane," Dr. Richard Dewey in the
same, pp. 76 sq. See also discussion on pp. 464 sq.

[1] "American Charities," p. 40.

[2] Proceedings of the Nineteenth Conference of Charities, Denver, 1892, pp. 91 sq.

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