Every well-integrated social institution makes its contributions to society. The hospital as a social institution has materially contributed (I) to the community, (2) to the public welfare, and (3) to the advancement of civilization. Were the hospital suddenly to be withdrawn from a community, there would be seen an immediate effect upon the health, business success, and general well-being of a large percentage of the citizens.
I. Contribution to Community Life. The aim of the hospital is at all times to keep the population it serves in good health and "fit for the problems and work of life." To attain this end, the hospital has, through its own community organizations—national, State, and local—raised its professional standards whereby better service is rendered to the sick of the community. The leading medical associations. as the American College of Surgeons, the American Medical Association, the American Hospital Association, and the • American Nurses' Association, have originated to benefit the health and happiness, not only of the immediate community, but of society in general.
"Organizations tend to multiply until they cover the whole range of human interests." In the hospital, organizations have multiplied and tend to cover the whole range of the one supreme human interest for which hospitals were instituted—the care of the sick and injured.
As a community medical center, the hospital promotes the public health and the general welfare of the people. As a commercial enterprise, the hospital also contributes to the community. It gives steady employment to a large number of citizens, whose salaries and wages find their way into business. It pays large sums of money for its supplies and its equipment. Not infrequently, persons will come to the community because they wish to be in the hospital. Sometimes their relatives and friends come to stay. This all brings trade to the community.
2. Contribution to Public Welfare . In addition to its contribution to community life. the hospital also contributes to public welfare. As stated by Caldwell :
"Hospitals are human laboratories, and many, if not all, of the greatest lessons of medicine and surgery have been learned in them. The world would know little of the control of typhoid fever, the prevention of scarlet fever, the eradication of yellow fever, or any of the other achievements of modern medicine, if a profound study of these problems under competent supervision had not been afforded by our hospitals. And so the community benefits, not the individual alone, and whatever measure in dollars and cents the hospital costs the community, is returned a thousandfold."
Preventive medicine has been made possible through hospital co-operation. Hospitals contribute to the public health through improved techniques of treating the sick, better medical and nursing service, better organization, and better equipment. Their contribution has been epitomized by Bacon:
"Our hospitals constitute an endless road which twelve million patients travel yearly to health and happiness. To keep this road open we spend one billion dollars annually, not only in the care of the sick, but in training doctors, nurses, technicians, and health workers who form the nucleus for nation, State, and city health programs. Of this vast expenditure of money, $500,000,000 goes to an army of employees numbering 600,000. There is no industry in our land today that affords such steady employment to our people as the hospitals. Our doors are never closed. We care for the sick 365 days in the year, day and night. We must always be prepared for a peak load. We must give continuous and uninterrupted service at all times. We cannot shut down our plant and lay off our people because of a financial depression. We must carry on some way. There are some small cities that are almost entirely dependent for their existence on the institutions of healing in their midst." '
People are rapidly losing their fear of hospitals. They come to them to be restored to health in the quickest time, and the patient's stay in the hospital has been materially shortened. It was reduced from thirty-five days to twenty-eight days a quarter of a century ago.
In 1938 the average stay in the hospital was eleven days. Twenty-five years ago an operation for the removal of the appendix invariably hospitalized the person for twenty-one to twenty-two days. Today, he leaves the hospital in ten days, ready to resume his duties. This is an economical feature not to be disregarded. He saves both time and money. Bacon has made this observation : "If you figure his salary at five dollars a day, you will readily see that this saving in time over twenty-five years ago will pay his hospital bill if he has award bed!'
If emergencies arise, the hospital is always ready to take care of them. During epidemics, earthquakes, or other catastrophes, the sick and suffering are cared for regardless of whether they are able to pay or not. In time of war, the hospital personnel aids the soldiers at the front, while it endeavors to protect the health of the people at home. It works in co-operation with the Red Cross and other health agencies to benefit the health of the people. Many lives have been saved which have been a real economy to the nation. Without healthy bodies, there can be no true moral education, physical success, or happiness.
The hospital knows no creed but that of service. It entertains no bias or prejudice, except against disease. It knows no international boundaries, for every nationality is included in its patient list. Its services are at the disposal of everyone who passes its doors for care. It is the most democratic of social institutions.
The existence of hospitals is evidence per se of a civilization superior to barbarism, a civilization in which people are more interested not only in the well-being of themselves and their families, but also in the welfare of their neighbors. Hospitals have been a traveling companion of an improving civilization, of a progressive enlightenment, of a marked advance in science." '
3. Contribution to Civilization. Sociologically the hospital has contributed to the advancement of civilization. It has stimulated inventive art. The instruments and machines used in treating the sick are among the most finely adjusted and the most intricate mechanisms. It has stimulated creative art as revealed by the beautiful frescoes of the medieval hospitals, the murals, sculpture, wood carving, and architecture. It has fostered research in practically every aspect of scientific medicine.
The hospital, down through the ages of its recorded history, has been a dynamic institution. It has slowly changed both tradition and custom, sometimes reluctantly, but usually triumphantly, to meet social needs. Again, the hospital is in a period of change attempting to develop ways and means whereby it may aid society and solve the problem of making the fund of medical knowledge available to everyone.
Bibliography
1 Jesse Frederick Steiner, "Community Organization," p. 395, New York, Century Company, 1925.
2 Bert W. Caldwell, M. D. (Unpublished address delivered before Rotary Club, Atlantic City, New Jersey, 1928.)
3 Asa A. Bacon, "The Hospital's Contribution to Public Welfare," Transactions of the American Hospital Association, 32:336, Chicago, American Hospital Association, 1930.
4 Id., 1937.
5 Malcolm T. MacEachern, M. D., "Hospital Organization and Management," pp. 26, 77, Chicago, Physicians' Record Company, 1935.
