Many men take poverty as a natural condition. It is an unnatural condition. In the United States, there is no reason for it. Every man has not the ability to be the director of serving enterprises, just as every man has not the ability to jump five-foot fences, but with the subdivision of labour and the provision of so many jobs which require no skill, every man has the opportunity to earn a living. Some men will always be failures if left to their own direction. Thousands of farmers ought to be working in shops. They are wasting their time trying to farm — they have not the sense of management. Thousands of men in small business who are trying hard to make ends meet but never succeeding would do very well in a large corporation where they might have direction. Then, also, we have the effects of a bad industrial system which operates on the short-sighted profit motive, and which makes employment intermittent by, from time to time, through high prices, reducing the number of buyers.
Charity is no help in any of these cases. It is only a drug. There are emergencies when men and women, and especially children, need help, but these cases are not actually as numerous as they seem to be. The very fact that charity may be had increases them, for charity holds out the promise of something for nothing. The cases of real need can be looked after on a personal basis without destroying the self-respect as is done by the machinery of organized charity. We may not be able to teach people to help themselves, but we can direct them how to help themselves, and in time this direction will have its effects.
It is these thoughts which cause us to avoid anything and everything which have in them a suggestion of charity. Some years ago, we refitted a home for orphans, and once a week I went out there to see how it was getting on. We employed managers who were supposed to know how to run such homes. Probably they were qualified, as such qualifications go, but they had no conception of what a home for children ought to be — they seemed to think of the place as an institution in which to confine children. Finally, we had to give it all up for the sake of the children, and we found homes for them in families. The sickliest boy we had was adopted by a German woman who already had six children!
We rarely make subscriptions, but sometimes we have to consider making subscriptions, and the last moderately large one that we made was to an institution in Detroit. My son thought we ought to give something, and I suggested:
“We can do one of two things: we can either give a little and forget about it, or we can give a lot, get right into the management, and see to it that the place is self-supporting.”
We chose the latter course as being more useful. Our hospital is an experiment in seeing if a hospital can be made both self-respecting and self-supporting. Part of the story of the hospital was told in My Life and Work. The hospital has nothing to do with the Ford Industries. We own and control the hospital absolutely because we want to carry out in it certain theories which we believe will benefit the public.
Hospitals are undoubtedly public necessities. A vast amount of dissatisfaction exists concerning both the medical profession and hospital management. There is a feeling that the treatment of disease, the care of the sick, and the instruction of the well, should be put on a sounder basis. Surgeons of nation reputation are working toward the grading of hospitals according to merit. Many people are still afraid to go to hospitals — especially to municipal ones.
We could see no reason why a properly administered hospital could not give the highest medical and surgical service under the best possible conditions at an established schedule of going rates and be made to pay for itself.
The unit of a hospital is the room. We gave the men who had been selected to head the staffs a carpenter and some wall board and asked them to work out an ideal hospital room and bath — a room which would have all the space needed and none over. The devised a room — a unit. The building of the hospital was then only a matter of designing a building to fit the rooms, with whatever accessories were necessary. The result is the present brick and stone structure. The opening of the hospital was interrupted by the war. The Government took it over in August, 1918, as General Hospital Number 36 and turned it back again in October, 1919. Then the original plan went on.
This is the plan. The hospital staff, which consists of about one hundred surgeons and physicians, are all on salary from the hospital and do not engage in private practice. There are six services — Medicine, Surgery, Obstetrics, Pediatrics, Laboratory, and X-Ray. Each of these services is headed by men of recognized attainments in the beginning, there was a preponderance of John Hopkins men, but as the hospital has grown the staff has ceased to be representative of any single school. Now the men are so drawn that some fifteen or twenty of the leading medical schools in this country and Canada are represented. A majority of the men have been in graduate work both here and abroad. Several are members of the Royal College of Surgeons.
The nurses were at first graduate nurses and employed by the hospital on full time. They receive the Ford rate, a minimum of six dollars for a day of eight hours. They are assigned from four to six rooms, according to the condition of the patients. All the meals are served by special maids, so that detail is taken away from the nurses. A bathroom with ice water in addition to hot and cold water being attached to each room, supplies of linen being always at hand, and most of the unnecessary steps of the nurse being eliminated, she finds no trouble in properly caring for her quota of patients. She works eight hours instead of the usual twelve hours, and has no reason to be tired and cross.
Last year, we made provision for pupil nurses by opening the Clara Ford Nurses’ Home and the Henry Ford Hospital School of Nursing and Hygiene. The underlying thought is to train nurses to a real profession in which the care of the ill will be the sole objective. To this end, the new home has considerably better appointments than most first-class hotels. The home and the educational building are on the hospital grounds but at some distance from the hospital. The home has 309 individual rooms, all finished and furnished alike. Each room has a private bath. The rooms are grouped about central entrances or elevators with a sitting room and kitchenette for each group, to carry out the home idea. Connecting with a reception hall on the first floor are eight small parlours where the young women may entertain friends. Dining rooms, kitchens, laundry, sewing room, and trunk room are in the basement. At the rear of the building is a sunken garden extending out from between the two wings. The whole environment of the dormitory is planned with the aim of providing a complete change of atmosphere for the nurses after leaving the hospital wards or classrooms.
The School of Nursing and Hygiene conforms to the architecture of the Hospital and Nurses’ Home. This building is two stories high and 120 feet by 50 feet. Besides the classrooms and laboratories, there are two squash courts, a swimming pool, and an auditorium-gymnasium.
The nurses, while in the hospital, are held to a high standard of duty. Exactly the same policy is followed with the nurses as with the workers and executives in the factories — good pay, short hours, the best facilities for work, and plenty of work.
The hospital has both in-patient and out-patient departments, and although it tries to cooperate with outside physicians and surgeons, attendance and operating within the hospital are exclusively the function of the hospital staff. The fees are fixed in advance according to the diagnosis and according to a scale.
The standard rooms — those in the new hospital — are $8 a day, which includes board and nursing.
The hospital reopened with a waiting list of nearly five hundred in the latter part of 1919. Every patient on entering, either the in or the out department, goes through a thorough physical examination with blood tests, and so on, and a diagnosis is made on the basis of full information. The examination is continued through x-rays and the other well-known forms of medical inquiry, whenever the regular examination discloses any condition which ought to be further gone into. An examination takes about two hours and the charge for it is $15. It is thoroughly inclusive, and the hospital authorities regard it as a prerequisite to intelligent work.
Every patient is a private patient. It is a rule of the hospital that the privacy of a patient must be kept inviolate. A room may be entered only by the doctors or nurses in charge in their professional capacities or by such guests as the patient wishes to receive and his condition permits. A patient is a patient, not an exhibit.
The hospital neither encourages nor discourages its use by the wealthy. All patients pay according to the prearranged agreement, and in the eye of the hospital, all of the patients are of equal standing. The fees are payable in advance, but no one needing medical or surgical treatment has ever been turned away. Some method is always found by which the patient can meet the financial requirements in a wholly self-respecting way. We take it that self-respect forms a part of a patient’s health.
The hospital is not self-sustaining, but it will become nearly so in course of time. It is doubtful if a hospital which does all it ought to do in the way of research can become entirely self-sustaining. Some things must be paid for out of humanity’s general treasure. Our first object is not to make the hospital pay, but to equip it to do its work. Any profits which accrue will be ploughed back into the hospital.
We think we are finding out something about hospital management, but having the hospital has also brought us flatly up to the question: “Why should there be need for a hospital? Cannot most of these diseases be prevented?”
And that has taken us into broader questions. Take the matter of food, for example.
There must be a right food if there is to be good health. Bees create their queens by selective feeding, and the effect of food on health, disposition, morals, and mental power is just now a great and challenging problem.
The doctors are beginning to find out that illnesses spring from food. They have not yet gone a great distance in this direction, but I understand some very important work is being done. Men who are careful of their diet do not often fall ill, while those who are not careful always have something or other the matter with them.
The best doctors seem to agree that the cure for most indispositions is to be found in diet and not in medicine. Why not prevent that illness in the first place? It all leads up to this — if bad food causes illness, then the perfect foot will cause health. And that being the case, we ought to search for that perfect food — and find it. When we have found it, the world will have taken its greatest single step forward.
It is going to take some time to get this food. It may not exist in the world today in any form. It may be produced from some existing food or from some combination of existing foods. It may be that a new plant will have to be evolved. The one thing certain is that this food will be found. It would have been found long ago if only the attempt to find it had been earnestly made, but it is only lately that we have begun to realize that food is all-important.
This whole affair of food must be put on a business basis. Science working along does not move as quickly or as surely as when it is working as part of a business enterprise. Scientific men are just like other men in needing management. A scientific discovery is a fine thing of itself, but it does not begin to help the world until it is put on a business basis. Direct any set of men to a definite end, and in the course of time they will reach it; do not ask for an opinion in advance as to whether or not what you want can be done, for then you will only get all the reasons why it cannot be done. But if you say what you want and keep behind the men with whatever resources are necessary, the men will stay with their problem day and night until they solve it. That is what we are going to do with food.
Some day, someone will bring about a condition which will make hospitals unnecessary.