Library Collections: Document: Full Text

It is true that so-called black-lists are kept by groups of hospitals in different sections of the country; yet these prove of little avail, inasmuch as an attendant discharged, say, by an institution in New England, can go immediately to another section -- the Middle States, for instance -- and usually secure a position. Indeed, by applying for a position under a false name and telling the requisite number of lies to complete the illusion of a new identity, these discharged attendants often secure positions in hospitals which maintain for their mutual protection one of these relatively ineffective black-lists. I know of instances of such failure on the part of the existing system. A National Society, at comparatively small expense, could establish and operate a country-wide black-list which would effectually eliminate undesirable workers from among the ranks of hospital employees.

As a preliminary measure -- and added protection -- I advocate a universal statute making it at least a misdemeanor for any man or woman, dishonorably discharged from one such institution, to accept a position in another; and likewise a misdemeanor for any doctor in authority in a state or private hospital to employ as an attendant any man or woman whose references do not indicate a good record and some fitness for the work. A sworn statement on these points from each attendant, when engaged (together with his thumb-print, as a means of identification), would protect the doctors, and this statement, if untrue, would serve as a basis for criminal prosecution. The moral effect of such a statute would be such as to render its enforcement seldom necessary. Brutal and dishonest attendants would thus be forced into other lines of work, in which they might perhaps become useful members of society, or, at least, no longer a menace to society's defenceless portion.

We must admit that the problem of securing efficiency among attendants is not an easy one. To make it easier several improvements must be made in the lot of the attendants themselves. For one thing, the niggardly salaries now offered make it extremely difficult for a management to secure or keep the right type. Competent men and women can earn two or three times as much in other and more congenial lines of endeavor. The average scale of wages for attendants in hospitals for the insane ranges from sixteen to twenty-four dollars a month, with room and board. Women usually receive sixteen or eighteen dollars at the beginning; men from eighteen to twenty, though the rates vary throughout the country. There is a slight margin, too, for an increase in salary, but even the exceptionally able attendants seldom receive more than thirty dollars a month. This bespeaks a false, a vicious economy. Not that the average attendant deserves a cent more than he receives; but would it not be wiser, more humane, and, in the end, cheaper, to offer inducements calculated to attract to this neglected field of service a higher type of character? -- nay, and keep him there, for nothing is more demoralizing than the constant changing that goes on in the ranks of the present attendants. To offer a wage of, say, forty, with a maximum of fifty dollars a month, including board and room, would, no doubt, be a move in the right direction.

However, such a merely pecuniary inducement would not, of itself, accomplish the purpose. Indeed, alone, it might defeat the purpose. For, after discussing this problem with doctors who have employed attendants, I am brought to the conclusion that increased wages, unaccompanied by increased and deserved privileges, and more wholesome and refined surroundings, would probably appeal only to burly workers in rougher fields. Wages high enough to attract a more refined type are, at the present stage of hospital development, out of the question; whereas privileges and refining influences might even now be brought to bear with excellent effect. Model dormitories, and separate cottages for married employees, instead of mere sleeping places, shorter and less exhausting hours, and proper places in which the extra leisure could be enjoyed -- a library, billiard room, etc., -- these would go farther than money toward the great task of refinement. It is unfair to keep an attendant on duty twelve or fifteen hours a day (these are now the common working hours) and for the balance of his time confine him to his ward under restrictions nearly as irksome as those to which the patients themselves must perforce submit. A few States, notably New York and Massachusetts, have granted appropriations for the creation of such conditions as I am describing. If these appropriations were enlarged, and if other States followed the same policy, it is safe to predict that thousands of refined men and women would enter this field who are now debarred. And once in the work they should be offered the same chances for advancement as are offered to employees in any well conducted commercial establishment. Such a policy, carried to its logical conclusion, would include also a system of pensions for those attendants who should devote the better part of their lives to this noble service.