The hospital is rapidly being accepted as the central and strategic factor in medical care and in medical education. "The goal of medicine," as stated by Haggard, "is the control of disease, prevention of suffering, and prolongation of life." 1 It is a goal that may not be attained in its fullest realization. But through the hospital, with its elaborate organization, facilities, co-ordinated medical services, and trained nursing personnel, it may be approximated.
The modern hospital is a distinct community asset. It ensures to the community of which it is a part the highest type of medical services. Its greatest problem, however, is to make available to every citizen in the community the benefit of modern medical knowledge. There has been a decided cultural lag between the advance made in scientific medical knowledge, and its application to the general health needs of the individual, the community, and society in general ; and between the hospital's organization for teaching the public, and the growing public health consciousness toward the benefits of modern hospital services. Two factors may have been responsible for this lag—the hospital's isolation, and the superstition, sentiment, tradition, and customs upon which it has been founded.
"The proof of the vitality of any institution," states Jensen, "is its ability to test and to evaluate its functions according to the needs of the contemporary society." 2 Through surveys and studies to prove its effectiveness, hospital leaders have brought about radical changes, and continue to bring about changes to meet the needs of society. In view of this, hospital trends seem to be primarily in two directions: (1) to establish better public relations, and (2) to organize the hospital as a complete unit whereby it may give better service to the individual and to the public.
Public relationships begin with the individual patient, as stated previously. He is the most important person in the hospital, upon whom all attention is focused. Besides aiming to give him the best medical care, the hospital also aims to provide an atmosphere that is socially attractive to him. A great deal of emphasis had been placed upon the doctrine of asepsis, which has tended to make hospitals cold and cheerless. But with the increasing realization of treating the whole individual and not his physical ailments alone, hospitals are beginning to recognize more fully the aesthetic value in treating the sick. The pendulum of emphasis is now being swung from institutional coldness to beauty within the hospital as well as on its grounds, for the enjoyment of the patients.
Another innovation, to introduce the patient to the hospital and assist him in his orientation, is the hospital receptionist, or hostess. The hospital hostess is not yet a part of every hospital organization, but she is rapidly taking her place in it. Her services are valuable to both the patient and the hospital. She attempts to put all patients in a receptive state of mind, so that they will not misinterpret the spirit of the hospital. This is necessary because there. are many things which the patient as a casual observer cannot understand. The hostess tries to expedite the fulfilling of the patient's needs, comfort his worried relatives and friends, and build up good will and confidence in all who come to the hospital. In this way she contributes to the better care of the patient as well as to efficient administration.
Other innovations of benefit to patients, which promote their general welfare, are the literary clubs for them, lectures from the various heads of departments, and the recognition of special events, such as their birthdays, national holidays, etc. These are recognized by many hospitals. During such times, special decorations and menus are provided, so that the hospital will not be a dull place for its guests. Patients look forward to these events with a great deal of joyful anticipation. Especially is this true in the children's hospitals.
In many institutions a chaplain is connected with the hospital, and especially is this true of church hospitals. He conducts religious services and visits the patients. The chaplain is usually a welcome visitor among the sick. "When human strength fails, men feel their need of divine help."
There are many people in whose lives religion is a vitalizing force. There are also those who reach out after it when they are in pain or in fear of the inevitable, death. Then there are those who believe in the efficacy of prayer. It brings to them anew courage, hope, faith, and love—and these are the factors which promote health and prolong life. "A contented mind, a cheerful spirit, is health to the body and strength to the soul." Religion is, therefore, not infrequently a deciding factor in a patient's recovery.
Although a doctor or a nurse may make no profession of religion, or does not know how to pray when requested to do so by a patient, he or she should find someone who can pray. Every attempt should be made to find a patient's minister, his priest, or the hospital chaplain, if he requests to see one of them. This may mean life or death to the sick one.
In the field of public health the trend is not only to teach the public, the nurses, and the medical students, but also to gain a larger perspective of public health service, and of preventive disease as it expresses itself among groups of people, as stated by Emerson, in presenting a method of public-health teaching to medical students.5
The primary function of the hospital has been viewed chiefly from a humanitarian viewpoint. Its economic aspect has received comparatively little consideration. Yet its value is greater than ordinarily assumed. Spencer states:
"Looked at from a purely material point of view, the amount of savings in economic society which could be effected by a more intelligent, comprehensive, and thorough application of what medical science has revealed is incalculable.
"Industrial accidents, occupational and other diseases, place a tax upon industry more oppressive than the tax which the national and State government levy upon it. And while medical science is not responsible for this situation, it certainly must assume a large responsibility for assisting industry in checking this deplorable wastage of social energy."'
The need for education on matters of health is shown by the economic loss sustained by industry alone. In a study made of 352,591 workers employed in 16o different companies, in which a comparison was drawn between the occupational and nonoccupational diseases, some very interesting facts were revealed. It showed a net annual loss from occupational diseases and injuries of .6 a day a person, whereas the net annual loss from nonoccupational illness accounted for 8.85 days' loss for each employee. This means that the average employee loses fifteen times more time as a result of nonoccupational diseases than is lost as a result of occupational diseases or injury incident to employment.
Furthermore, statistics gathered over a period of five years among 2,200 employees of a public-utility company, regarding the incidence and causes of absenteeism, showed that sickness accounted for 92.1 per cent of all absences, and accidents of all kinds accounted for 7.9 per cent. Out of 14,280 cases of sickness that caused loss of time to a greater or lesser extent, 6,335 cases were due to so-called minor infections of the respiratory tract, such as the common cold, laryngitis, and tonsilitis. In this group some of the more serious acute infections, as influenza or pneumonia, were not included. These were placed in a group of 4,634 cases classed as miscellaneous diseases.
In the field of industrial medicine more than 50 percent of the time lost is caused by colds and their complications. It is estimated that each of the 42,000,000 persons gainfully employed in the United States loses two and one-fifth work days each year as a result of the common cold.'
The time lost in industry, through the non-occupational diseases, is due to the same diseases as are found in the community. These diseases are those of the upper respiratory tract, and are usually classed as minor diseases. However, if overlooked, they may be responsible for serious complications. At the head of the list is the common cold. What the common cold may do is shown by Lanza and his collaborator Vane, to whom he gives credit for having worked out the averages of loss sustained.
A study, dealing with sick absenteeism among employees of a public-utility company, covering the years 1933-37 inclusive, shows that the annual average number of colds which disabled employees for one day or more was 22 a hundred for male employees, and 40 a hundred for female employees. Various studies indicate that disorders grouped under the name of colds and acute respiratory infections average one day a year for each worker, male or female. At this rate "one arrives at a figure of a loss of 45,000,000 days of work each year, or the full time of 15o,000 persons for a year." If the employee earned an average wage of $4 a day, an approximation of the wage lost by employees would be about $350,000,060 a year. Add to this the conservative cost of $5 a year for each employed person (including the severe types of respiratory diseases) for medical care and drugs, and the cost would amount to 8250,000,000 a year. Add to this the wage loss of each worker, and the total loss would be $400,000,000.
The employer, too, sustains a loss. If he carries the burden of 15o,000 man years, there is another $400,000,000 loss. "In all, close to a billion dollars [is lost], and one would not have to strain the figures or imagination far to round out the total to a billion dollars." While all of these figures are not factual, because some have been based on conservative estimations, nevertheless they indicate the intrinsic need for health education. Piersol, in giving his reasons for the little progress that has been made to control the common cold, states:
"The common cold and kindred disorders is psychologic rather than bacteriologic. It is due to the general lack of understanding of the importance of these common diseases. . . . There is not any difficulty in impressing on even the dullest laborer the disastrous effects of a fractured skull or a crushed leg, but it is no easy task to convince even the worker with a high intelligence quotient that minor respiratory infections to which everyone is subjected at some time are far more serious to the community as a whole and to industry in particular than the comparatively rare major accidents."
References
1 Howard W. Haggard, M. D., "The Doctor in History," p. 393, New Haven, Yale University Press, 1911.
2 Deborah MacLurg Jensen, "An Introduction to Sociology and Social Problems," p. rot, St. Louis, Mosby Company, 1939.
3 Ellen G. White, "Ministry of Healing," p. 225, Mountain View, California, Pacific Press, 5909.
4 Id., p. 241.
5 Haven Emerson, M. D., "Purpose, Content, and Method of Teaching Public Health to Medical Students," J. A. M. A., x16:1043, March 15, 1941.
6 William A. Spencer, M. D., "The Hospital in Modern Society," Hospitals, 12 :12, June, 1938.
7 George Morris Piersol, M. D., "Role of the Physician in Industry in the Control of Acute Respiratory Diseases," J. A. M. A., 116:1339, March 29, 1941.
8 A. J. Lanza, M. D., "Incidence and Costs of Acute Respiratory Disease in Industry," J. A. H. A., 516 :1342-43, March 29, 194.
9 George Morris Piersol, M. D., "Role of the Physician in Industry in the Control of Acute Respiratory Diseases," J. A. M. A., 116 :1340, March 29, 194i.
