USA > New York > New York City > New York panorama : a comprehensive view of the metropolis > Part 47
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Since the beginning of the depression, direct cash relief to the uner. ployed has come to be recognized as a primary responsibility of municip and state governments, substantially aided by the Federal treasury. But :p earlier years, the private agencies bore the chief burden of unemploymer In 1910, public funds provided only 19 percent of all relief in New Yor For years private charity continued to carry the greater part of the loadil But by 1930 it had become evident that voluntary agencies could r.lat longer assume such a responsibility, and by 1933 they were carrying on 12 percent of it. By 1936, out of the grand total of $310,000,000 give directly to clients as outdoor relief, largely necessitated by unemploymen and exclusive of administrative and operating costs, the private agencie do contribution had dropped to less than two percent.
Omitting unemployment relief from further consideration, then, hof does New York care for its inhabitants when misfortune overtakes themo Most impressive, by its sheer size, is the hospital system. Each year, abort two-thirds of a million New Yorkers, or roughly one in ten, are sic enough to need hospital treatment, and at least as many more requin clinical care or dispensary service.
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0; [The total property investment in New York's institutions for the care dso the sick amounts to some $430,000,000. Its 133 hospitals, public and hoivate, contain nearly 38,000 beds and care for a daily average of more 44an 30,000 patients. Fifty-four of these hospitals specialize in the treat- doorent of cancer, chronic diseases, eye-ear-nose-throat troubles, neurological f agiorders, orthopedic ills, tuberculosis, and communicable diseases, and in spettternity care. The two gigantic medical centers, New York-Cornell and guralumbia-Presbyterian, combine treatment and research in nearly all fields peal medicine, and make their findings available to the entire medical world. ork Somewhat more than a third of the total hospital work is done by the and al d city-owned hospitals, with 14,000 beds and an annual operating budget close to $23,000,000. In these, in 1936, 267,000 patients were hospital- d, the great majority of them without payment. The present construction dget of the city-owned hospitals calls for an outlay of $60,000,000 for spork to be completed by 1945.
The total operating budget of the 110 voluntary hospitals is about 2$5,000,000, of which in 1936 some $25,000,000 came from service tiofarges ($4,319,369 of it paid by the city for the care of needy patients ), eld $10,000,000 from donations and income from capital funds. In 1937, tot 5,000 persons received bed care in these hospitals, and about 1, 135,000 ore were cared for as out-patients.
hen cip The city's clinics, most of them departments of the hospitals, are numer- s and specialized. The Directory of Social Agencies lists 1,533, under the t Allowing general headings: arthritis, asthma, cancer, cardiac, dental, enabetes, ear, nose and throat, endocrine, eye, gastro-enterological, genito- oinary, gynecological, hay fever, health examinations, medical, neurologi- padl, orthopedic, osteopathic, pediatric, physical therapy, prenatal and post- tal, skin, surgical, syphilis and gonorrhea, tuberculosis, and vaginitis. on eatment at most of them is free to those unable to pay, and the fees warged to others are in most cases nominal.
en New York was the first city in America to establish a convalescent cielome. Today there are 46 convalescent institutions, with a total of 3,777 ds, some providing medical care and some merely needed rest, but all ofving free service when the patient cannot pay. The city pays half a mil- on dollars yearly for care of poor convalescent patients in 23 of these in- tutions.
Yet there is still another large category of sick persons who often do inot go near a hospital or clinic for years, who are only partially incapaci- ted or not visibly incapacitated at all. These are the chronically ill.
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Chronic illness, which frequently is long neglected because it does not Ebora sent symptoms demanding immediate care, saps the vitality and earni hes power of a huge proportion of our population, and it is growing so rd idly as to suggest that America may become a nation of invalids. But ber New York has not yet adequately met this problem, it has at least be litt sea among the first to recognize that chronic disease is not necessarily incura or incapacitating disease, and to shape a program on that premise. Mon ve ICE
fiore Hospital, established in 1884, was the first in America dedicated the care of chronic diseases. And as these lines are being written there rising on Welfare Island what will be the first municipally owned a Viv operated hospital of that type in the world. It is intended that this sh be a center of research in the field of chronic disease, which has been c
Sse of the neglected stepchildren of medicine, and that its findings shall made available to other cities. From this experimental research and pr tal tice, New York may in two or three decades produce results of inestimal value to all America.
New York has also been a pioneer in the systematic effort to eradic:
kd disease by educational methods. Its campaign against tuberculosis, co ducted at the beginning largely by a voluntary association, has been t chief factor in lowering the city's tuberculosis death rate from 280 }: 100,000 in 1900 to 59 per 100,000 in 1934, and the work is continui without relaxation. Diphtheria deaths among children under 15 years age were reduced from a percentage of 137.5 per 100,000 in 1907 to : percent in 1937, through a system of immunization inoculations wide advertised and free to those unable to pay. City medical authorities belie that diphtheria can be made as nearly extinct as yellow fever and smallpc But to achieve this end, 300,000 inoculations of children must be ma yearly-a requirement which, at this writing, is being fulfilled only to t extent of about 75 or 80 percent.
Under the national leadership of Dr. Thomas E. Parran, Surgeon Ge eral of the United States Public Health Service, New York has intensifi its efforts to control and eventually eradicate venereal disease. To this car paign the city is at this writing spending at the rate of nearly $300,000 year from its budget, plus a like amount contributed by the WPA and til National Social Security Board. From all sources, exclusive of fees paid f private treatment, New York will spend close to $2,500,000 on its an venereal campaign in 1938. The city Bureau of Social Hygiene issu hundreds of thousands of pamphlets yearly describing for the layman, . simple language, what these diseases are and how they may be cured. ]
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oratories issue without charge to all registered physicians the medi- es needed for the treatment of syphilis and gonorrhea (as well as those diphtheria, pneumonia and other diseases). And it is enlisting the co- eration of thousands of private physicians and social workers through- the city to help educate the public so that these once unmentionable eases may become as rare in New York as they are, for example, in eden, where the number of new cases of syphilis reported has been re- ed from 5,976 in 1919 to only 399 in 1935.
Imperceptibly, in the past two or three decades, the city's public and vate health agencies have become more and more active as centers of ventive medical work. The Health Department's nine health centers seminate literature, organize lectures, administer the work of local olic clinics, look after the health of public school pupils and arrange lth conferences with their parents. They give annually 2,000 lectures health for the general public, and hold 4,000 classes in health educa- n for parents. In conjunction with the central Health Department office the city laboratories, they maintain supervision over the 180,000 cases communicable diseases annually reported and investigated; control the 000 cases of ascertained tuberculosis ; diagnose 72,000 suspected cases tuberculosis and 102,000 of suspected diphtheria; perform more than 0,000 Wassermann tests for the detection of syphilis. They dispatch ir public health nurses on half a million home visits annually, though s represents but 16 percent of these nurses' work. They supervise the rk of 70 infant and preventive health stations, which give a wide variety service and advice to those who cannot afford a family doctor.
The work of New York's visiting nurses, including the 800 working th the Department of Health and those of the three voluntary visiting rse services, is educational as well as remedial. In the health clinics, sides assisting the physician, they interpret the doctor's orders to the tients and their families. They teach young expectant mothers how to ke -care of themselves and how to prepare for the coming baby. They struct parents in the preparation of food, initiate them into the im- rtance of correct weight, sun, air, cod liver oil and orange juice, into de value of immunization against diphtheria and smallpox. In the fields tuberculosis and syphilis, they emphasize the importance of early dis- very. In their home visits they consider the family's social, economic and ental hygiene problems in relation to health.
New York's hospitals and clinics are laying ever-increasing stress upon e value of medical social work in both the prevention and the cure of
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disease. In order that the physician may treat not only the disease l also the patient, he needs the assistance of the medical social worker. ut is her task to discover the environmental or emotional factors that aff ion disease in the individual, and to guide him in controlling those factors as to favor a speedy recovery-at the same time, of course, teaching h how to stay well.
More and more, New York's social and health agencies are recognizi that abnormal emotional conditions may not only complicate and ev cause disease, but that they frequently constitute disease in themselv. Many cases, once they are properly diagnosed by the psychiatrist, can alleviated by comparatively simple common-sense methods-a change attitude on the part of bullying members of the family, a created job responsibility for a man whose neurosis is aggravated by unemployme: Often, of course, the mere opportunity to talk candidly with an und standing person goes far toward relieving the condition. A large propo tion of future cases of mental illness can presumably be averted by time treatment of the child, whose behavior peculiarities of today may becor the anti-social or criminal tendencies of tomorrow. In New York's mental clinics (those for children are euphemistically called "child gui ance clinics") psychiatric advice is given free or at nominal charge to t thousands who visit them either voluntarily or, as is more frequent, ( the advice of the family worker or medical social worker, though consi: ently thorough treatment is an ideal of the future. Five excellent hospita also give specialized care to the more difficult cases.
The baby who makes his debut in New York City ought to be impress by the elaborateness of the structure set up to welcome him. Indeed, lor before he is born, this system has begun to function through the prenat clinics and classes and the nurses' visits, already mentioned. Seventy tho sand babies are born annually in New York's hospitals, and in every ca. T where the mother comes for early pregnancy examination the Wassermar. T
test is given, and where indicated, the anti-syphilis treatment which wi in most cases guarantee the baby against inheriting the disease. And cal of mother and child is continued in a large number of cases through th first year of the child's life.
The foundling baby becomes the ward of the Department of Chil Welfare, and is taken to. one of the three foundling hospitals until he . old enough to be assigned to one of the 72 child-caring homes in the city Later, perhaps, he is boarded out in a private family. So far as his back ground can be determined, he is brought up in the religion of his parent:
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here are 22 temporary shelters for children and 17 agencies which board t children in family homes, for which definite standards are set. Occa- affonally legal adoption is secured. Contrary to the usual belief, there are great many more homes asking for children to adopt than there are chil- en who can be placed.
For the child whose mother has to work, New York has 104 day irseries, some of them denominational, scattered, unfortunately, all too anlessly throughout the city. Here 7,000 children receive a hot lunch at nominal charge, and in many instances are given pre-school nursery lining.
When the child reaches school age the city attempts to keep an eye on s health, though its resources are at present most inadequate. However, e clinical facilities are fairly abundant. In 1936, 300,000 visits were tid by children to the city's dental clinics and 50,000 visits to the eye inics. The school and health departments are cooperating with voluntary encies in an attempt to work out a system of regular health examinations r all school children. Considering how many ailments and pathological nditions can be cured or prevented if the individual is examined in ne, this program should have a notable effect in lowering the city's ture disease and death rate.
Incidentally, New York is exceptionally thorough in examining its milk pply. All the cans containing the three million quarts of milk shipped to e city daily are examined as they are delivered to the dealer for bottling, id 500 samples from the cows that supply the metropolis are subjected bacteriological examination every week.
The charge used to be made against New York's public schools, and ith considerable justification, that they put all children through the same personal mill, without regard to individual aptitudes or disabilities. his charge, as far as it relates to the handicapped child, is no longer ue. The Board of Education spends $4,000,000 a year on the latter. wenty-seven thousand children receive special instruction for the correc- on of speech difficulties-instruction that is wholly or largely successful 1 90 percent of the cases. There are 101 special classes for pupils with efective eyesight-conducted, of course, in conjunction with the neigh- borhood clinic. There are nine special classes for the wholly blind in ele- entary and high schools. More than 10,000 mentally retarded pupils are ught in 536 special ungraded classes, the work of which is divided ap- roximately evenly between academic study, physical training and handi- afts.
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462 SOCIAL WELFARE
For the child of normal health the great need is recreation. In the city, recreational opportunities, though numerous, are geographically badis distributed. Public and voluntary agencies are seeking to meet the neve Some 140 non-profit vacation services offer a summer holiday for a wette or more to about 81,000 children free or at nominal charge. Playstreet playgrounds and parks (New York's park area was more than doubled I tween 1933 and 1938) are the city's answer to the need for outdoor rec. ation when weather permits. Tennis, baseball, golf, swimming, stre games are provided in fairly ample and increasing measure, though in cc gested neighborhoods the parks are usually too far away and the pla grounds are too few. For winter months and for non-athletic types play, the private agencies-the Y's, settlements, boys' clubs, scout grou -and the school community centers provide a varied program, with ill formal classes, hobby groups, esthetic and cultural activities. To get to greatest service from existing facilities, it is necessary to secure the up with adequate supervision, of all school buildings after school hours. T settlements, of which there are about 40 in the city, with an average some 1,000 participating members each, offer a wide variety of activitin in arts, handicrafts, hobbies and just plain fun. Similar work is carried . by many other social and recreational agencies.
Yet such group activities as these are still but a drop in the bucket. T. card catalogue of the WPA's youth department shows no fewer than 4,00 spontaneously organized boys' clubs which rent cellars, back rooms or lc" space where they may hold their "business meetings," play cards, or "thrc a dance." Some of these are on friendly terms with club leaders from s cial agencies and federate themselves into inter-club associations for at letic contests and other activities; many are going their chosen and oft questionable way with no sort of leadership. Yet according to a summa completed by the Welfare Council in 1935, 65 percent of the males New York between the ages of 16 and 25, and 75 percent of the femal in this instinctively gregarious period of life, belong to no club or orgar zation of any kind.
Every year in New York some 5,000 boys and girls under 16 years (, age are brought into court charged with the commission of some crin or misdemeanor which would land them in jail or penitentiary if the were of legal age. But with very few exceptions, these children are not p through the impersonal mill of court procedure. The Children's Cour which deals with these cases (there is a branch in each borough) h wide powers of discretion, and the young delinquent is usually placed :
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in the custody of a relative or friend, or of some social agency, to work out bads salvation under friendly guidance. Here the social agency, whether di- neectly or indirectly concerned, has an opportunity to investigate the young- weer's problem and give him the help he may need. This help may mean stree ed e straightening out of some family relationship or care by a medical psychiatric clinic, or merely the stimulating influence of a boys' club in recineighboring settlement. In any case, the youthful offender is likely to get strømane and sympathetic treatment.
n co But once he has celebrated his sixteenth birthday his situation before ple law is tragically altered. Though he will not be responsible for his acts es TOU der the civil law for five years more, before the criminal law he is al- ady an adult and must, in principle, pay in full the penalty for his acts. h the five-year span between the ages of 16 and 21 is today a no-man's-land t tf judicial and social practice in New York. For several years the Crime uprevention Bureau of the Police Department took all youthful offenders Tetween the ages of 16 and 21 out of the dreaded police "line-up" and ge ied to deal with them if possible, as individuals needing understanding vitand guidance. At present, boys between the ages of 16 and 19 may de referred to the Adolescents' Court, and girls between 16 and 21 the Wayward Minors' Court. Here the judge endeavors to give spe- I al attention to the circumstances, and often places them on probation ounder the care of a relative or a social agency instead of sending them to a leformatory or prison. But no student of delinquency in New York is sat- ro fied that an effective method of dealing with the youthful criminal has set been devised. Evidence accumulates that the average reformatory a rovides a high school course in the technique of crime, as the peniten- fttary offers a post-graduate course. It is evident that the courts, the police mond the social agencies must between them discover how to deal with the buthful wrongdoer so as to give him the best possible chance, while still rotecting society. They are far from having reached any agreement, but least they have passed beyond the slogan stage-the stage in which hrases like "pampering the criminal" and "environmental causes of time" do duty as arguments-and they are honestly working together to nd a solution. S
The adolescent, whether or not he has been fortunate enough to escape he attention of the law, will soon need a job. The public schools, as well s many voluntary social agencies, are expanding their work in guiding he boy and girl toward jobs to suit their aptitudes, and several public in- lustrial high schools train them for types of work in which large numbers
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of New Yorkers are employed-the needle trades, for example. The c spends more than $2,280,000 a year for classes in evening trade scho and other evening classes. In addition to the public schools, a number
voluntary agencies offer a variety of general and special vocational tra ing courses for from 20,000 to 30,000 handicapped persons in arts, han crafts and other fields.
In actually finding employment for the boy or girl, the outstandi agency is the State Employment Service, which since January 1, 1938, } reorganized its operations under the provisions of the Unemployment ] surance Law and will in all probability make an increasing number of fı placements in the future. An outstanding feature of its work has been t development of its junior employment offices. As in the vocational gu ance field, a number of non-profit employment services, dealing with : lected applicant groups, are also concerned with placement and find jc for 50,000 young persons annually. Through a "clearance bulletin" ini ated in 1929 under the auspices of the Welfare Council, these agenc. and the State Employment Service cooperate in pooling job orders, maki available to the applicants of all agencies the openings for jobs which a agency has and cannot fill from among its own applicants. In this fiel however, the basic need is not for more guidance and employment age cies, but for more jobs. And while unemployment persists, the soc agencies must continue to absorb as best they can the resultant shock al distress.
But most of the problems that confront the social worker are not sing and simple-not solely the need for a job or for treatment of a certa acute disease or for a place where the youngster may play baseball. Usual the case that has become desperate enough to demand the attention of : agency is complex, calling for not one but perhaps half a dozen diver kinds of aid. Here the family social worker, a too often misunderstoc ministrant, is called upon to exercise an uncommon degree of understand ing, skill, tact, resourcefulness and specific knowledge. A single examp from the records of one of New York's largest family welfare agenci will suggest what this work is.
The Jones family is poor, badly fed, half sick, fearful of the futur The father earns about $II a week as a taxi driver. The three-year ol daughter is seriously undernourished. A baby is on the way. The fathe approaching the end of his devices, has appealed to the welfare agency fc help. A case worker then endeavors to disentangle cause and effect. O her recommendation, the agency supplies the money needed to make up
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cent minimum family budget; a nutritionist shows the mother how to ake the small food allowance buy really nourishing food; a nurse from e agency arranges for prenatal care at a nearby clinic, secures hospital eatment, provides a layette. After the baby is born it is sent with its other to the agency's convalescent home in the country for six weeks. eanwhile, the father, his courage restored and improved in health, has creased his earnings to $17 a week, and expects soon to return to a bet- -paid former employment.
Multiply this story 18,610 times, with innumerable variations of cir- mstance and some conception of the work done by this one agency in a gle year (1936) will become apparent. That work involved 107,112 in- rviews and 102,999 medical and dental treatments. The particular agency ferred to is one of the few that have a number of diverse types of aid at eir command. Smaller agencies usually have to call upon others doing her types of work in order to supply all forms of aid needed in individ- 1 cases. Hence the necessity of constant contact and cooperation between em. In all, the family welfare agencies aided nearly 130,000 persons in 37.
One tragic circumstance that may befall even a self-sustaining family is e temporary incapacitation, from illness or any other cause, of the other. How will the children manage while the father is at work? Sev- al agencies in New York have in recent years been supplying house- eper service, or "substitute mothers," to such families. These mothers in rael, who are usually called in on recommendation of a hospital social rvice department or of one of the family service agencies, not only see at the children are fed and washed, but leave a good deal of dietary and nitary commonsense behind them in the home, and not infrequently tually prevent the disintegration of the family.
New York, like other cities, confines its welfare services, in principle, persons who have legal residence, or "settlement," within the city or e state. But strangers arriving within its gates often have need of help. here are a number of agencies which among their other activities assist ch persons, and one agency devotes itself exclusively to such work. This tter organization, whose representatives are found at all railroad and ans-Atlantic steamship terminals, works in conjunction with many of te city's other social agencies and with its 1,200 cooperating agencies America and foreign countries. In 1936 it gave aid to nearly 50,000 avelers in some sort of trouble, 11,000 of whom presented major prob- ms requiring intensive case work and care. More than 2,000 children under
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