The house on Henry Street

by Lillian D. Wald

The nurse who took possession of the sickroom refrained from mentioning the hospital; but when the mother saw the skilled ministration, and the tired father, on his return from work, watched the deft feeding of the unconscious child, they awoke to their limitations. The poor, unskilled woman, bent with fatigue, then exclaimed, “O God, is that what I should have been doing for my babies?” When the nurse was about to leave them for the night the parents clung to her and asked her if a hospital would do as much as she had done. “More, much more, I hope,” she said. “I cannot give here what the little ones need.” Late at night three carriages started for the children’s ward of the hospital; the father, the mother, the nurse, each with a patient across the seat of the carriage.

Said the critic when I had finished my story: “I think the nurse should have asked permission of their doctor before she granted the request of the parents.”

All the social agencies combined have not been able to dislodge permanently the quack who preys upon ignorance and superstition. One day a teacher in a nearby school asked us to visit a pupil who was highly excited and uncontrollable. The mother, when questioned, confessed that she had employed the “witch doctor” to exorcise the devil, who, he said, had taken possession of the girl. In our efforts to free the girl from this man’s control I invoked the aid of the parish priest, suggesting that his powers were being usurped. The County Medical Society finally secured conviction of the “doctor” on the charge of practicing without a license.

In the Italian quarter this species still preys upon the superstitious fears of some of the people, and the secrecy involved in his “treatment” makes permanent riddance extremely difficult. The people on the whole, however, give remarkable response to the “American” custom of employing a regular practitioner and the visiting nurse.

In this country, unfortunately, we have little data on morbidity. Statisticians desirous of obtaining figures for study have found interesting material in our files, and it has been possible to make comparison of the results of hospital and home treatment. Those who are familiar with the discussion upon papers presented by children’s specialists in recent conferences on the saving of child life have had their attention drawn to the disadvantage of institutional treatment. Discussion of this subject is recent, and the laity do not always know that certain complications incident to the hospital care of children are obviated by keeping them at home. Among these are cross-infections, while the high mortality among infants in hospitals has long been recognized and deplored as unavoidable.

We soon found that children’s diseases, particularly those of brief duration, lent themselves most advantageously to home treatment. Our records show that in 1914 the Henry Street staff cared for 3,535 cases of pneumonia of all ages, with a mortality rate of 8.05 per cent. For purposes of comparison four large New York hospitals gave us their records of pneumonia during the same period. Their combined figures totaled 1,612, with a mortality rate of 31.2 per cent. Among children under two—the age most susceptible to unfortunate termination of this disorder—the mortality rate from pneumonia in one hospital was 51 per cent., and the average of the four was 38 per cent., while among those of a corresponding age cared for by our nurses it was 9.3 per cent.

Doctors and nurses highly trained in hospital routine are apt to be hospital propagandists until they learn by experience that there is justification for the resistance, on the part of mothers, to the removal of their children to institutions, and that even in homes which, at first glance, it seems impossible to organize in accordance with sickroom standards, the little patients’ chances for recovery are better than when sent away. Diseases requiring climatic or operative treatment, or peculiar apparatus, must usually be excluded from home care.

In a letter written to a friend more than twenty years ago I find this account of one of our patients:

“Peter had pneumonia, complicated with whooping-cough. He is a beautiful yellow-haired boy, and even if the hospital could have admitted him, or his mother would have agreed to his removal (which she wouldn’t), I should not have liked to send him. The sense of responsibility for the sick child seemed a force that could not be spared for rousing an erring father. He is, apparently, devoted to the child, but had been drinking, and there was not a dollar in the house. The child, desperately ill, clung to him, calling upon him with endearing names. During the illness he worked all day (he is a driver) and sat up all night, and I think he will never forget his shame and remorse. The doctor had ordered bath treatments every two hours. These I gave until eight o’clock and the mother continued them after my last visit, but when the temperature was highest she was worn out, and active night-nursing seemed imperative. This Miss S⸺ willingly undertook—a service more difficult than appears in the mere telling, for the vermin in these old houses are horribly active at night, and this sweet girl ended her first vigil with neck and face inflamed from bites. Yet the people themselves were clean, and in this were not blameworthy. There is nothing harder to endure than to watch by a night sick-bed in these old, worn houses and see the crawling creatures and the babes so accustomed to them that their sleep is scarcely disturbed. Peter has had a beautiful recovery, rewarding his nurses by a most satisfactory return to a normal state of good health.”