THE COOK COUNTY CHARITIES.

BY JULIA C. LATHROP,

Member of the lllinois State Board of Charities.

As the study of these maps reveals an overwhelming proportion of foreigners, and an average wage-rate so low as to render thrift, even if it existed, an ineffetive insurance against emergencies, we are led at once to inquire what happens when the power of self-help is lost. This district was chosen by the government for investigation because it was believed to represent fairly the most untoward conditions of life in Chicago; it was selected as a "slum," and is that portion of the city containing on its western side the least adaptable of the foreign populations, and reaching over on the east to a territory where the destructive distillation of modern life leaves waste products to be cared for inevitably by some agency from the outside. The preponderance of unskilled labor necessarily means the weakness of trade unions and mutual benefit societies; in short, the inability to organize and co-operate. When we inquire, then, what provision is made to meet sickness, accident, non-employment, old age, and that inevitable accident, death, we are asking what some outside agency performs. Here is a foreign population, living in every sort of mal-adjustment,--rural Italians, in shambling wooden tenements; Russian Jews, whose two main resources are tailoring and peddling, quite incapable in general of applying themselves to severe manual labor or skilled trades, and hopelessly unemployed in hard times; here are Germans and Irish, largely of that type which is reduced by drink to a squalor it is otherwise far above. Here amongst all, save the Italians, flourishes the masculine expedient of temporary disappearance in the face of non-employlment or domestic complexity, or both; paradoxically enough the intermittent husband is a constant factor in the economic problem of many a household. In this region west of the river, and stretching on into the seventh, eighth, and eighteenth wards, there are many streets where foreign tongues are more spoken than English; thousands of people who, having their own shops and churches and theatres and saloons, may be said hardly to come in touch with the commonwealth of which some immigration company has made them an unconscious part until they are given over as the wards of its charity. To meet the needs of such a city population, a whole system of charitable institutions has grown up; though they are carried on, not by the city of Chicago, but by the county of Cook. It is true, of course, that much private charity supplements the county's efforts, or rather that the county's provision is accepted when all the resources of private charity and of neighborly aid have been exhausted. Indeed, one may as well admit in starting, that the capacious bosom of the county is sought with much reluctance, even by the population of which we speak; and while this population represents the last degree of social submergence, the county is in turn its dernier ressort. There is, doubtless, a certain satisfaction to the philanthropist and the sociologist alike, in having touched bottom, reached ultimate facts; and this in a sense we have done when we have reached the county institutions. These are the infirmary, the insane asylum, the hospital, the detention hospital, and the county agency. The county maintains at Dunning, just across the city limits line on the north-west, the infirmary and the insane asylum, together constituting the poorhouse; the infirmary with an average population of about 1,500, and the asylum with from 800 to 1,000 inmates. To show the relation of the infirmary population to the population of this district, it is enough to state that of its 5,651 admissions during the year 1893, there were 3,563 persons of foreign birth. The nativity records show that of this number Ireland furnishes 1,457; Germany, 727; England, 299; Sweden, 202; Canada, 183; Scotland, 135; Norway, 116; Poland, 80; Bohemia, 53; Austria, 61; Denmark, 53; Switzerland, 41; Italy, 40; Russia, 37; France, 28; Holland, 23; the balance being made up from thirteen countries.

The infirmary is a great brick building, with many well-lighted wards, steam-heated and clean. It is fronted by a grass plat, with trees and flower-beds, and the open country stretches back for miles, giving a good sweep for air and sunshine. There is a separate maternity ward, an attractive and comfortable brick cottage, at a distance of several hundred feet from the main building.

A very little work is required of each inmate to keep the place in order. There is a hired attendant in every ward, and over the men a supervisor and over the women a supervisoress. The infirillary and the insane asylum are both under the control of one superintendent; and there is a corps of book-keepers and clerks who are necessary to keep accounts and registers, and do the office work required in carrying on the affairs of a community of this size.

The head cooks are regular employees, as are all the directing powers; but most of the work of the laundry, the wards, the bakery, the dining-room, the sewing-room, is performed by the inmates. In the work of the farm of one hundred and sixty acres, as many men inmates as possible of both the infirmary and the insane asylum are utilized. Divided among such numbers, there are still many hours of listless idleness for hundreds of these people, men and women alike. It is to be noted at once that there are no shops, no provision for industries. The clothing is the usual cotton found in such institutions; and that, together with the bedding furnished, is under ordinary circumstances abundant for warmth in buildings well heated by steam as are these.

The women's wards are never crowded as are the men's. By some curious law of pauperism and male irresponsibility, whose careful study offers an interminable task to any loving collector of data, men are in a great majority in poorhouses. In the Cook County infirmary we find the following proportions:--

A curious indication of the effect of hard times is shown in the sudden increase of 299 in the male population, and of only 16 among the women,--nearly 25 per cent in the first case, and a little over 4 per cent in the second, from January, 1893, to January, 1894.

There is a chapel, in which a kindly old Catholic priest and various Protestant clergymen alternately officiate. The solemn little room is always open; and after the early winter supper, old people clamber painfully upstairs to say their evening prayers before its altar. For one instant the visitor is hushed as he stands before the door, watching the straggling little procession of human wastage entering the dim apartment, and feels a thrill of thankfulness that these poor evidences of defeat and failure cherish a belief in some divine accounting more individual and generous than that of the sociologist and statistician.

In a winter so unprecedented as that of 1893-1894, the men's wards are always full, many of them fearfully over-crowded, and certain of the hallways are sometimes nightly' filled with straw ticks for sleepers who cannot be accommodated in the wards. In the men's and women's wards alike, the beds are set closely, and at best allow only a chair and a few feet by the window for each occupant. Ward 3 B, with beds crowded together, others made on the floor, and filled with a melancholy company of feeble and bedridden men and idiot children, must haunt the memory of whoever has seen it.

The surgical wards are of course less crowded, and are clean. The men's and women's consumptive wards are sunny and clean, and not painfully crowded. There are two resident physicians, a man and a woman, and their services are needed for the chronic and hopeless cases sent to the infirmary from the Cook County Hospital, and these would alone fill a small hospital. There are here usually from fifty to seventy-five children, of whom a large proportion are young children with their mothers, and very few of whom are for adoption. The remainder, perhaps a third, are the residuum of all the orphan asylums and hospitals, children whom no one cares to adopt because they are unattractive or scarred or sickly. These children are sent to the public school across the street from the poor-farm. Of course they wear hideous clothes, and of course the outside children sometimes jeer at them; and then if they are stout little lads like Jim Crow, they doubtless, as did he one day, teach courtesy to their tormentors with their fists.

And now what impression does the visitor receive who sees the infirmary, not as to the great problems of pauperism and crime, for the study of which this place offers infinite opportunity; not upon the value or efficiency of our system of caring for the dependent, but simply as to whether the work undertaken is adequately and reasonably performed? Do we have difficulty in understanding the universal dread of the "County"? ¹

Let us leave quite one side considerations as to the moral deserts of these people, admitting even that most are brought here by their own misbehavior or that of those responsible for them. The county of Cook has them as wards. The determining standard of treatment is not "what they have been accustomed to," but what experience and modern science show to be essential to the proper care of such a mass. The absolute lack of privacy, the monotony and dulness, the discipline, the enforced cleanliness,--these are the inevitable and, in the opinion of some, the wholesome disadvantages of the infirmary from the standpoint of the inmate. There is not a common sitting-room for men or for women in the whole great place; the supply of books and papers is so small as scarcely to be visible. Occasionally one may see a group of men playing cards upon a bed in one corner of a ward, and the old fellows have a tobacco allowance; but any provision for homely comfort, for amusements or distractions from themselves and their compulsory neighbors, is wanting, alike for the most decent and the most worthless.

If husbands and wives are obliged to come to the infirmary, they are always separated, no matter how aged and infirm, nor how blameless. How painful this separation may be, is indicated by the attitude of an old Irish couple of my acquaintance. They are past the power of self-support; their only child, a son, is an incurable lunatic, confined at Dunning. At one time they held title to a house and lot,--" worth $6,000 now," the old woman says with mournful pride,--and are, to judge from internal evidence, and from the testimony of the neighbors, honest, decent people. When Dunning was suggested to them they were panic-stricken; and the old woman; who is ninety odd, said, "Oh, he'll have to go in with the men; I'll have to go in with the women, and all our own clothes will be taken away from us. I can somehow sort o' do for myself; but he is somehow sort o' shiftless like, and he can't. I'll feel sorrier for him than for me. I am older than he is, but I can get along better'n he. Let us stay here."

The meals are served three times daily, in a common dining-room, from bare tables scrubbed white, and the seats are backless benches. The room is so small that the benches are filled and refilled, first with the women and then with the men, until all have eaten. The food is perhaps more nourishing than many had at home, but that has nothing to do with the case. Its original quality is, in fact, good or aggressively bad, depending upon the administration. The cooking is bad,--tea boiled forty-five minutes, mushes cooked very hard, three-quarters of an hour, cheap cuts of meat kept madly jumping in the pot for an hour or less, fats almost eliminated; such cooking cannot give from the materials employed a wholesome dietary.

But in the infirmary, as in the three other county institutions, the pivot upon which turns the question of sweet or tainted meat, as well as the care and nursing of all these feeble beings, is the change in the personnel of the county board, which annually, and hereafter biennially, means a change in practically all the officers of this institution. Is it strange that now and again grave scandals reach even the deaf ear of the indifferent public, when we realize that the appointment of all the persons who have charge of this community is made and changed solely according to political preference? "Not fitness, but 'pull,' " is necessarily their motto. It is this irresponsible supervision which must entail the greatest hardship upon this feeble-minded and irresponsible population.

The insane hospital is upon the same grounds as the infirmary, about a thousand feet distant. Here are gathered usually about eight hundred men and women, paupers, incurably insane. Can words express more pitiable condition? Certainly there are no creatures in a state of more painful helplessness. Here, as in the infirmary, all appears immaculately clean, and fortunately so, for the construction of the wards is such that only their perfect cleanliness makes them tolerable. Many are long, dark tunnels, in which it is the simple truth to say that sunshine can never penetrate, save for a short distance at either end. The plan is the old one of long interior corridors, from which open the sleeping-rooms on either side, with a dining-room also off the corridor. These rooms, together with bath-room and clothes-room, constitute the usual ward. On some of the wards the corridor broadens out transversely into a sitting-room, and on a few there is only a single row of sleeping-rooms, thus giving outside windows for the corridor; but the usual arrangement is the dark, narrow inside corridor. In this the patients must spend their waking hours. In such a hospital, there are a large proportion of patients sunk in various stages of dementia, who are dead to any save the most primal physical sensations; but, on the other hand, there are unfortunately a proportion of curable patients even here, and there are chronic cases not demented. For the year 1893, there are reported seventy-two recoveries, which is in itself a proof that the county is obliged to care for more than its legal charge; i.e., the incurable insane.

The admissions to the insane asylum for the year 1893 were 442, of whom 109 are entered as born in the United States; of the remaining three-quarters, Germany is charged with 96; Sweden and Norway with 45; Ireland, 74; Poland, 13; Bohemia, 8; Russia, 5; Austria, 8; unknown, 20; while the others are contributed from fifteen different countries. Here, as in the infirmary and other institutions where birthplace only is entered, without lineage, it is not possible to state from the records how many are Jewish; but it is certain that a considerable proportion are, probably, for instance, all of those born in Russia. Of the admissions for 1893, 288 were men and 154 were women, a preponderance of men far beyond the usual proportion in insane hospitals. In the State hospitals, in 1892, out of a total population of 5,177, there were only one-tenth more men than women.

Two physicians, a man and a woman, have charge of the medical sicle of the asylum. In addition to the main building, there are already four cottages, two for men and two for women, receiving about fifty patients each. Two of these are used as infirmary wards, and the others for quiet inmates. The Wines cottage has the lightest and most spacious sitting-room, and the darkest and most unattractive cellar dining-room imaginable. This is an illustration of the irregularity with which work is done for public purposes; for there is a still unexecuted conception of a great general dining-room, lacking which, this honest cellar is made to do duty. The ward dining-rooms have many disadvantages, and a general dining-hall would be a most wholesome improvement. It is intended that the food of the asylum shall be somewhat more liberal than that of the infirmary; but here, as there, the cooking methods are absolutely unscientific. The chief additional items are, that butter is allowed for all meals, and that pudding is given for dinner. There is mush for breakfast; for dinner, beef and potato and another vegetable--often cabbage; for supper, stewed apples or rice; with coffee or tea for breakfast and dinner, and tea for supper, and bread and butter for all meals. Unfortunately, this sounds better than it is in fact. Few persons could see the food as prepared and served (excepting the bread) without a sense of physical revolt.

The attendants are too few in number to give the patients proper out-door exercise, which they especially need, because of the darkness of the wards and the fact that they are seriously overcrowded according to modern hospital standards. There is no system of employment here for the patients, save some work in keeping the wards in order and about the house. The monotony and idleness, the unutterable dreariness, dull the faculties of those not already beyond change.

But if the constant succession of new attendants is prejudicial to the proper work of the infirmary, what must it be here, where insane people are to be cared for? A man or a woman overcome with an infirmity, which the laws of Illinois at last recognize as a disease, is placed in constant care night and day of-- nurses trained for such care? Not at all. But of some one who has a "pull." I chanced to be standing in the asylum corridor one day just after there had been a revolution of the county wheel, when a stout, aggressive and excited Irish woman, evidently an attendant, bore down upon one of the commissioners present, who was also of foreign birth, and said, "Mr. Blank, I want to see you." To which he replied with a helpless gesture, "Well, I hope you don't want anything, because I haven't got anything left." -- "Aw, don't tell that to me, Mr. Blank! Do you know I live only two blocks from your house, and we've got nine men in our house that worked mighty hard for you?" -- "~Well, I can't help it; I haven't got anything left. Can't you see I am busy talking now?" To which the attendant replied more imperatively than ever, "Well, I want to see you; I want to see you alone. Where is Mr. So-and-So?" with which she flounced on, to return later. The remarkable thing with our present system of appointments is, not that abuses occur, but that more do not occur. It gives one, after all, a new confidence in human nature, that the demands of helplessness and insanity develop in unpromising material such excellent qualities of patience and self-control as are sometimes shown.

Down in the city of Chicago the county carries on its remaining charitable undertakings. Out on Harrison Street, a little over two miles from the lake, stands the Cook County Hospital, to which were admitted in the year 1893 more than eleven thousand cases, while more than two thousand were dressed and sent home. It is due to the substitution of trained nurses for the former political-appointee attendants, that this hospital now stands in the front rank of American public hospitals, so far as the nursing care of the wards is concerned. Its benefits are given free of charge. The position of an interne in this hospital is only obtained after competitive examination, and it is much coveted. One reason why it is coveted may be found in the statement of an interne, whose naivete can no more be questioned than his truthfulness. "I like my position. In fact, I much prefer it to a similar place in a New York hospital. There about all an interne can do is to follow after the outside doctors on their rounds, and watch them, and hear what they say, and see their prescriptions. But here the outside doctors do not visit regularly, and do not interfere with the interne's treatment." There may be carpers who would pick a flaw in the county's method of educating doctors by self-instruction; but it would seem that no paternalist could question its care--for the medical profession. Yet just at this point the paternalist and the man of medical science do agree in questioning this care, and that on the ground of the best service for the hospital wards. They say that the attending physicians, who are now forbidden to bring students upon the wards, should be allowed to do so, on the same principle that the surgeons bring the students into the amphitheatre; that if the physician had this privilege, they would give the wards all due attention, and the education of the interne and the student would be better in proportion to the skill the attending physician could offer the patient. Neither the physicians nor the surgeons of the Cook County Hospital staff are salaried; and the appointments are valued for prestige, and for clinical advantages. As the physician and surgeon gain prestige through the reputations of their clinics, and as the forbidding of students upon the wards practically forbids the physician having any clinical advantages from the hospital, it is easy to understand why the salaried internes have full sway. Moreover, there can be no doubt that the practitioner feels himself spurred to his best efforts by the presence of students, the most mercilessly critical beings in existence; and thus incidentally the patient might be benefited. We are told that the opening of the wards of the free hospital of New Orleans to students resulted in a diminished death-rate. The great foreign free hospitals are open, and it would be difficult to find any sound reason for the closing of Cook County.

Here, again, the food problem is unsolved, save that here, again, the bread is of the average baker's quality. The ward cooking done by convalescents, cannot be satisfactory. The old kitchen is unwholesome in odor and appearance, and the whole culinary department shows an inattention to scientific methods more painful in a hospital than anywhere else. The constant change in the business management entailed by the constant succession of administrative officers of course makes it expensive and really impossible to carry on the business side of this hospital in the best manner.

Unfortunately the hospital is obliged to discharge many patients before they are strong enough to work, and oftentimes patients who are without money or home. The only place where a person without money or a home can go is Dunning; and self-respecting people decline that, and stagger along, beginning work too soon. This is, in the long run, financially expensive to the county, as it destroys or impairs the power of the individual to support himself. A proper convalescents' home would lengthen the working-life of many a man and woman, to say nothing of its increasing their comfort. And an establishment of this sort in country surroundings would be justified by the success of the Boston Convalescents' Home.

The detention hospital stands upon the same plat of ground with the hospital. Here the insane are brought and confined for periods of from twenty-four hours to eight days (in exceptional cases even two or three weeks), pending the weekly hearing of insane cases. The court sits in this building, so that no exposure is necessary in carrying patients to and from a down-town courtroom. This building, too, is immaculately clean. Indeed, it sometimes seems as though this were the age of institutional tidiness; and that in itself is a cheering sign of advancing care, though the polished outside of cup and platter may be delusive.

Through this detention hospital must pass in turn the insane persons of Cook County; and she now contributes more than twenty-five hundred to the insane population of the State. When this hospital was built, it was fondly hoped that many hysterical and recent cases might be cured by a few days or weeks of its tender care; but the facts, as shown by the investigation of the winter of 1894, prove how far from curative the institution is, and must be so long as it is managed upon its present basis. The attendants are political appointees. It is useless to enter into brutal particulars; it is enough to say that they are and must be ill-fitted for the care of insane patients who are received here at the most critical and violent periods of their malady. The detention hospital should be treated as a ward of the Cook County hospital, and trained nurses with specific teaching in the care of the insane placed in chargre.

There is at present no training-school for nurses for the insane in this State; and if one could be thus established, which should have in charge the detention hospital, it would be a starting-point for better work everywhere. In connection with the training-school for nurses, which has in charge most of the wards of the Cook County hospital, this is an entirely feasible plan. In fact, it only requires the taking of twelve appointments out of politics, and some changes in the medical attendance, not requiring more money, to make this hospital as nearly a model as its cramped quarters will allow.

The most spectacular proof of the poverty entailed upon Chicago by the general business depression of 1893, and locally by the inevitable human debris left by the World's Fair, could be daily seen during all the severer months of the winter of 1893 and 1894. It was a solid, pressing crowd of hundreds of shabby men and shawled or hooded women, coming from all parts of a great city whose area is over one hundred and eighty-six square miles, standing hour after hour with market-baskets high above their heads, held in check by policemen, polyglot, but having the common language of their persistency, their weariness, their chill and hunger. This crowd stood daily, unsheltered from the weather, before 130 South Clinton Street. Now and again a woman was crushed,--in one instance it is reported was killed, and the ambulance was called to take her away. Once a case of smallpox was discovered, and a sign hung out, and the office closed for a day or two; but this did not frighten away the crowd outside. It only served to give the clerks inside a little chance to get their work up. When once the applicant penetrates the office, he is in the great dingy waiting-room of the Cook County Agency, from whence is dispensed out-door relief. He furnishes his name and address, and is called upon later by a paid visitor, upon whose report the fuel and ration are allowed or refused. Or, if the application has been granted, the market basket discloses its raison d'etre, and the allowance of food and one bar of hard soap is carried hence, the coal being sent later from the contractor.

It is hard to go to the infirmary, hard to get relief from the county; but it is esteemed hardest of all to be buried by the county. The abhorrence of a pauper burial cannot be better indicated than by the fact that of the 607 inmates who died at Dunning in 1893, the funerals of 251 were provided by friends. Indeed, the one general effort at saving in this district is that sorry speculation in futures called burial-insurance. Of course there are numberless lapses of the policies, which make the business profitable. The dread of pauper burial is twofold. First, the lack of religious ceremony, and, secondly, the loss of a great social function, far exceeding in magnificence a wedding or a christening. The necessary cost of sickness and death is vastly increased by absolutely unnecessary items on the undertaker's bill. It is the hope of this anticipated pageantry which makes the burial-insurance collector a constant figure, threading in and out among the tenements, and collecting his weekly premiums. "And to think," exclaimed a mother, in a spasm of baffled prudence and grief, "that this child I've lost was the only one that wasn't insured!"

There is a constant criticism of the county relief office from the recipient's point of view. He says the coal is delivered slowly and in scant measure, that favoritism is shown by visitors, that burials are tardy and cruel; and the facts justify him. But any one acquainted with the daily work of this office must feel that the wonder is that the $100,000 allotted for its work is really as fairly divided as we find it. The methods of this office, with its records kept as each changing administration chooses, its doles subject to every sort of small political influence, and its failure to co-operate with private charities, are not such as science can approve.

These institutions cost the county for running expenses alone, nearly $700,000 annually, providing salaried positions for five hundred persons or more, and of course do in some degree meet the necessities of a great dependent population which is at present an unavoidable factor in our social problem. Yet such a state of irresponsibility as investigation now and again discloses must discourage us. We are impressed with the lack of system and classification among the beneficiaries of the infirmary and the county agency for out-door relief. We are shocked by the crudeness of the management which huddles men, women, and children, the victims of misfortune and the relics of dissipation, the idle, the ineffective criminal, the penniless convalescent, under one roof and one discipline. On purely economic grounds we need a children's home, or some provision so that no child shall be in a poorhouse. We need a home for convalescents. Both humanity and economy demand that there be workshops provided at Dunning for the sane and the insane paupers. Then there is that small remnant of blameless poor for whom we can surely make more dignified provision without pauperizing society. It is painful enough to see "desert a beggar," without seeing her thrust in to die disgraced by the association of a public poorhouse. Yet these measures, unfortunately, will be considered primarily only as furnishing certain "places" to be filled by political preferment. The comfort, the recovery, the lives, of all these thousands of dependent people, hang upon the knowledge, the kindliness, the honesty, and good faith of those hired to care for them. How are these people hired,--in the open labor market, for fitness, by examination? Not even an Altrurian would waste words on such a question. These places are scheduled, with the salaries attached, and each commissioner disposes of his share of the patronage. Commissioners are not responsible for this method; it is not unlawful, and it is convenient for them. They act from the plessure of public opinion translatable into votes, and modify their actions according to the strength of such pressure. How many persons in the city of Chicago whose incomes make them safe from the possibility of a personal interest in these places ever visit them, or perhaps know where they are? More, how many of them realize that their visits, their intelligent interest, are all that is necessary to make these institutions give really good service? There is no mal-administration so strong that it can persist in the face of public knowledge and attention. The public now has and will have exactly such institutions as it demands, managed exactly as its discrimination requires. It is as tiresome as that Carthage must be destroyed, but it is as true, that the charities of Cook County will never properly perform their duties until politics are divorced from them.

ENDNOTES:

¹ The one exception in the range of my acquaintance to this dislike of the infirmary is on the part of a little Irish woman, a soldier's widow, who is lame and feeble, but who by the aid of a small pension is able to fee the attendants a bit, and who moves from the infirmary to some humble friend in the city and back again with the elegance and dignity which only leisure and money can bestow.

From Jane Addams, Hull House Maps and Papers, Chapter 8 - "The Cook County Charities." New York: Thomas Y. Crowell & Co., 1895, pp. 143-161.

Forward to Hull House Maps and Papers, Chapter 9 - "Art and Labor."

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