RELATIOXS OF HOSPITALS TO PAUPERISM. 741 



they receive. Experience teaches that to do for an individual that 

 which it is possible for him to do for himself will invariably tend 

 to harm, unless he gives in return an equivalent, either by actual pay- 

 ment or in gratitude. And experience also teaches that human na- 

 ture can only feel gratitude toward an individual. 



Besides this tendency in hospitals as charitable institutions to in- 

 crease pauperism, another serious objection to the use of public hos- 

 pitals for the purpose of treating the sick beyond the extent abso- 

 lutely demanded by necessity is, that every time an individual is 

 removed from his home let that home be ever so humble and taken 

 to a hospital, the family as an institution receives a blow. 



Then, too, except to those already degraded, life in a pauper hos- 

 pital, especially in the case of the young, is hardening to the feelings, 

 while in many cases it subjects the moral to the influence of the 

 immoral. 



Another objection to hospitals is the bad sanitary condition of 

 many of them, and unless this is improved, both as to the plan and 

 the construction of the buildings, and the general and internal man- 

 agement, so as to give a smaller death-rate and fewer deaths from 

 hospital-diseases than in the vast majority of hospitals now in use, it 

 will be decidedly better, on sanitary grounds alone, to treat in their 

 homes all the sick poor who have homes, even though they may be 

 very bad and unhealthy places to live in. As to the expense of treat- 

 ing the poor at their homes, it certainly would not be greater than 

 the expense of running the hospitals, if the interest-money is added 

 which could be had from the immense sums that are sunk in the mas- 

 sive, many-storied hosjntal buildings, and the expensive city lots on 

 which they stand. 



But as poor-relief is now administered, and, no doubt, under the 

 best system that could be devised, a certain number of hospitals for 

 treating the sick poor will be necessary. When properly constructed 

 and managed they are a great blessing to the poor, while, from 

 the advantages they afford for the study and teaching of clinical 

 medicine and nursing, they are of incalculable value to the whole 

 community. 



Since the establishment of the Training-School for Nurses in con- 

 nection with St. Thomas's Hospital, by Miss Nightingale, in England, 

 fifteen years ago, and, in this country, of the School for Nurses in 

 connection with Bellevue Hospital, New York, three years ago, the 

 great advantages of hospital-instruction are recognized for those who 

 are studying nursing. 



In the founding of hospitals, the question of their usefulness to 

 medical education has not been given due consideration. As a rule, 

 the idea of rendering immediate personal relief to the suffering poor 

 is the first, and in many cases the only acknowledged object aimed at 

 in establishing them. 



