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CHAPTER XI

THE COST OF HOSPITALIZATION IN AMERICA
WHY HENRY FORD'S IDEA WAS NOT PRACTICABLE

    NOTHING points a more accusing finger at allopathic inefficiency than the enormous growth and cost of hospitals in the United States. The report of the American Hospital Association issued in 1923 contained the following figures: There were at that time 6,000 hospitals in this country with a total of 600,000 beds; and the annual expenditure for maintenance was $525,000,000.

    The annual expenditure for new hospitals and equipment was placed at 450 millions, and the value of buildings and grounds at two billions. "There are 500,000 patients at all times in these hospitals," reads the report. "Ten millions are treated there annually and 30,000,000 more visit the 4,000 dispensaries established throughout the country."

    Since these figures were published other facts and figures bearing on the number and significance of hospitals in this country have been brought to light. At the seventy-sixth annual convention of the American Medical Association in Atlantic City, 1925, Dr. Arthur Dean Bevan of Chicago, chairman of the Council on Medical Education and Hospitals, in his report stated that hospitals had increased from 2,411 in 1906 to 7,370 in 1925. That the total bed capacity had grown from 217,658 in 1906 to 813,926 in 1925. In five years 328 counties that had been without hospitals were provided with them, most of them being small hospitals with from ten to twenty-five beds.

    Dr. Bevan stated also the very significant fact that "83 per cent of all the new hospitals built since 1920 had been of the open-staff kind where any reputable physician might go and practice." This means, of course, greater professional interest in hospitals and more professional support for the system of hospitalization, the growth of which is indicated in the recent rapid development of the American Hospital Association. This started twenty-five years ago merely as a group of hospital superintendents, and in the past ten years has enlarged to include executive heads, trustees and other hospital officials. To-day its institutional membership is nearly 1,000 and its active membership twice that number.

    At its annual meeting in Louisville, Kentucky, in 1925, Dr. E. S. Gilmore, the president, said in his address: "The A.H.A. represents vast interests. Thousands of lives are constantly in its hands. The value of its property is estimated in billions. . . . We are spending over a million dollars a day for new buildings and equipment alone. We spend a billion dollars a year in the care of the 12,000,000 people who come to us for aid. . . . In business the day of millions is passing and the day of billions is upon us. Have you ever tried to comprehend a billion? There have been fewer than a million minutes since the crucifixion of Christ. A billion soldiers placed four abreast at ordinary military intervals would require five years to pass a given point. The A.H.A. sends a billion soldier dollars annually into the war against sickness."

    Dr. Joseph C. Doan, medical director of the Philadelphia General Hospital, is quoted in Modern Hospital Magazine (August, 1925) as saying: "In the last half century there has been a phenomenal growth in both the number and size of the country's hospitals. This increase of almost 5,000 per cent in number, and 2,000 per cent in beds, represents the difference between 149 hospitals with 35,000 beds in 1870 and the more than 7,000 hospitals with more than 800,000 beds at the present time."

    The amazing thing in these medical reports on hospitalization is the note of exultant felicitation sounding through them—as if hospitals were pleasure gardens and something to be proud of, instead of the places of torture that many of them are, and in what they tell of medical failure surely something to be ashamed of.

    As if sensing in a way the public's wonderment at the appalling cost of these institutions, Dr. Doan seeks to justify the vast outlay on economic grounds, and to feature the hospital system as a national asset. Starting with the trite truism that "a nation's health is a nation's wealth" and the usual allopathic assumption that health and allopathic practice are synonymous, Dr. Doan essays to beguile us with the following hypothesis:

    "If 13,000 beds for the reception of acute medical and surgical cases (and each bed of this group ought to serve two persons a month) are able to shorten the incapacity of each patient even one day, their industrial, civic and economic justification could not be disputed. Nor can the expenditure of over $100,000 daily to maintain them be looked upon in any other light than the soundest of investments, which will return usurious rates of interest in restored earning power, industrial prosperity and more firmly established family life."

    "IF," Dr. Doan! But where is the proof that your costly hospital medication brings any of these enumerated benefits? On the contrary, we have only to cite your own flaunting statistics to show that the more hospitals you build the more you need to build, to house the ailing multitudes constantly streaming in and out of their portals, those dismissed in worse shape oftentimes than when they went in.

    Nor do these hospital figures—enormous as they are—tell the whole story of impaired health under allopathic ministrations in this country, although the hospitals under consideration are all medical institutions, of course. They take no account of the number of sick people treated in their own homes by M.D.'s, nor those treated in doctors' offices. Neither do they embrace the vast army of discouraged and disgruntled ones—now reaching into millions—who have turned away from medical treatment entirely to seek relief in other modes of healing.

    Seeing that this defection from allopathic standards is so marked as to evoke expressions of grave concern from the M.D.'s themselves; seeing also that such eminent medical men as Sir Arbuthnot Lane in England and Richard C. Cabot in America have quite recently come out rather strongly for the principle of Nature Cure in disease, it may be of interest to the ailing public to learn why—from the viewpoint of Nature Cure—"regular" medical methods of treatment can only result in swelling the rising tide of illness in the world.

    Dr Gilmore's statement that "the American Hospital Association sends a billion soldier dollars annually into the war against sickness," furnishes a key to the puzzle-picture. Herein is the beginning of allopathic misconception of the nature of disease, that it is something to be fought—to be suppressed—"stamped out"—to quote the favorite medical phrase.

    The Nature Cure concept of acute illness, on the other hand, is that it is a crisis of toxemia, which manifests as dis-ease, or discomfort, only because the Life Force within us struggling to rid the body of accumulated toxins and unable to use the ordinary channels of elimination because these have ceased to function, forces the poison out through some unusual and vicarious channel. And every vicarious process is attended with suffering.

    In the Nature Cure concept, the inflammation, pain and fever which are the natural symptoms of this vicarious housecleaning are nothing to be alarmed about. Certainly not something to be combated and suppressed. As soon as the body is cleared of its toxic encumbrance in this natural and normal way, the unpleasant symptoms will disappear automatically and the patient's recovery will be complete and permanent. According to the Nature Cure philosophy, every acute malady is a cleansing and healing process, and cannot, in the very nature of it, prove fatal. The fatalities occur from the suppressive treatment—not from the disease.

    The only outside assistance Nature requires for her cleansing and curative work, is cooperation to the extent of giving the patient absolute rest—physical, mental and physiological. This last-named, the physiological rest, the patient almost never gets from a "regular" practitioner. It is the immemorial medical custom to mask acute symptoms with both drugs and food, after which no doctor on earth can tell which is the effect of the drug, which the effect of the food and which the effect of the disease.

    So far from aiding Nature's eliminative process of cure, medical tactics only abort and thwart her efforts by driving the systemic poison back into the body, adding to it the poison of drug or serum, and further complicating the situation by forcing useless food into sick stomachs. Dr. Edward Hooker Dewey among old-line "regulars" stands alone in his declaration: "The giving of enforced food in illness and the drug that corrodes are medical barbarisms unworthy of the enlightened age in which we live."

    Dr. Dewey put forth that utterance fifty years ago and the good old doctor has long since been gathered to his fathers; but his medical brethren are still administering "enforced food in illness and the drug that corrodes."

    In more recent times the psycho-analysts have admonished the medical profession as well as the rest of the world, that suppression is not cure. What psycho-analysts are saying about the forcible suppression of powerful emotions, nature curists have been saying for a hundred years about the forcible suppression of acute physical illnesses; namely that we do not get rid of the trouble that way; that it simply goes under water, so to speak, to reappear in a worse form later on.

    Yet the medical profession as a whole, disregarding all these warning voices, past and present, have steadily pursued their obstructive and destructive tactics, with the result that the main work of their hospitals has been to transform acute ailments into chronic ones which in a later stage join the gruesome ranks of the "incurables."

    It is not denied by anybody that these suppressive methods are employed in medical practice. It is not denied that the multitude of chronic incurable are with us always. It is not to be expected that medical men, or their lay partisans would connect the two as cause and effect—but he who runs may read. The frightful increase in disease, indicated only partially by the 5,000 per cent rate of increase in the number of hospitals in the past fifty years, far outstrips the increase in population for the same period. And there is no good reason why—in any intelligent control of disease—that it should even keep pace with the growth of the population.

    To camouflage and minimize medical failures, and to arrogate credit which rightfully belongs elsewhere, is part of the medical code, of course; and it does not surprise us to hear the president of the American Hospital Association make the following reckless claim:

    "Largely through the aid of hospitals, the average length of life has been increased twenty-one years during the generation just passed, and it may be freely predicted that another twenty-one years will be added in the next half-century."

    This recalls the story of Mark Twain's linguistic dog who in the reckless use of long words "got so she wasn't afraid of anything, she had such confidence in the ignorance of those other dogs!" Such, apparently, is Dr. Gilmore's attitude toward the laity.

    The prolongation of the human span—about which we are hearing so much just now, and for which modern medicine is taking the entire credit—is a moot question, fraught with conflicting opinions and many confusing factors. Sir Arbuthnot Lane, on his recent visit to America, said: "I am inclined to believe that the average duration of life was greater in ancient times than it is now." George Chandler Whipple of the Massachusetts Public Health Council, in his recent work on "Vital Statistics," says:

    "Nor does the average age at death afford a fair index of the healthfulness and physical welfare of a community. A high average at death may mean simply that the birthrate is low."

    Professor Raymond Pearl of the Department of Vital Statistics at Johns Hopkins, takes the wind out of the collective medical sails on this point by affirming that "the decline in the death-rate from those diseases against which public health officials have been especially active—like smallpox, diphtheria and tuberculosis—is no greater than from those against which little or nothing has been done."

    Anyway, why all this fuss about extending the life tenure, unless it can be shown that the conditions under which it is lived have also improved? Few things are less desirable than mere length of days without a corresponding increase in the joy of living. Dr. Alexis Carrel of the Rockefeller Institute (already quoted in these chapters) is an important witness as to the part played by modern medicine in enhancing the joy of life. Dr. Carrel "doubts" whether the alleged victory over infectious disease "has so far brought much happiness to the world, or greatly modified the position of the average man as regards disease and death." He denies that "the expectation of reaching seventy-five or eighty years has markedly increased in the last fifty years"; but he says the adult of to-day "surely has more prospect of being tortured by some form of cancer, afflicted with slow diseases of the kidneys, the circulatory apparatus, the endocrine glands, and of becoming insane."

    As to the medical boast about "conquering infectious diseases," for such conquest of these as is anywhere observable, and for cleaning up the plague-spots of the earth—such as Cuba, Panama, Manila, etc.—we are far more indebted to the sanitary engineer and to the labor union which has improved economic conditions than to the medical profession which has added to the sum total of internal filth with its drugs and serums and laid heavier economic burdens on the people with its costly hospitalization.

    There is, moreover, a very substantial weight of evidence—and a very respectable body of expert opinion—on the side of those who say there is no such thing as infectious disease except the infections of filth and of fear. The medical profession supplies both of these infections much oftener than it removes them.

    "It is not to be disputed," says Dr. Doan, "that this hospital business has—as has any of the industrial plants of this State—a principal commodity, to produce which the institution was founded. To restore the sick in the shortest possible time—with the least expense to the hospital—is, of course, the chief aim of our efforts."

    This may be accepted without question by those who have hypnotized themselves with the idea that medical aims and purposes are always inspired by altruism and humanity. It is not necessary, however to discredit the sincerity of hospital aims in order to point out the unsatisfactory character of hospital products. How long does Dr. Doan suppose an automobile factory, for example, would last which was constantly turning out halting, ramshackle cars—running at half-speed most of the time, and at frequent intervals in the ditch?

    And who would accept the management's plea for such bad workmanship, that the workers were "doing the best they could?" No. Good intentions do not take the place of efficiency in the modern industrial world, and if the hospital proposes to put its product on the same economic basis as an industrial plant, it should be held to the same stern economic accounting.

    If the M.D.'s really were "restoring the sick in the shortest possible time and at the least expense"; and if they were at the same time instructing their patients how to keep well—which is certainly part of their job if they are interested in promoting health—even the wayfaring man must see that there would not be the constant demand for more and more hospitals and at an ever-mounting cost. A billion dollars a year is entirely too much to pay for the sort of health service the medical hospitals of this country are turning out.

    And this is the answer to the failure of the Henry Ford experiment in low-priced hospitalization. Mr. Ford having put into practical operation the principle of greater efficiency translated into a cheaper product to the consumer in the manufacture of automobiles, not unnaturally thought he could apply the same principle in the conduct of a moderate-priced hospital for people of moderate means. The expectation seemed all the more reasonable in that he did not desire nor expect a profit from the hospital, as from the automobile plant. All he asked of the hospital management was that it should not be run on a charity basis in any department and that the uniform flat-rate to all patients should be sufficient only to cover cost of maintenance and depreciation of the property. So no provision was made for "free wards" or "free clinics" in the new Henry Ford Hospital at Detroit. There were just 600 private rooms, all of the same class in fittings, furnishings and price. Every patient was on an equal footing with every other and there were no extras.

    In the beginning a flat-rate of $4.50 per day was charged for room, board, nursing and medical attention; and it was announced that this rate would be lowered as the increased business of the hospital should justify—even as the price of cars had been lowered on the same basis. The maximum charge for a major operation was fixed at $125 and the charges for minor operations were put on a graduated scale, much like the parts of an automobile—all the charges being tentative.

    "The hospital will have a cost system," said Mr. Ford when inaugurating it, "just like the factory; and there seems no reason why the same kind of management which permits a factory to give fullest service will not permit a hospital to give fullest service and at a price so low as to be within the reach of all."

    Surely he had a right to expect that a principle which applied to the manufacture of cars had made him the richest man in the world, would, when applied to hospitalization, yield at least enough returns to make ends meet. For it is said that Henry Ford does not believe in organized charity and that he designed his Detroit hospital to meet the needs of people who do not wish to accept charity, but who are unable to pay the exorbitant rates of the better class medical hospitals.

    "There are plenty of hospitals for the rich," he is quoted as saying, "and plenty of hospitals for the poor. But there are none for those who can afford to pay only a moderate amount, and yet desire to pay without being made to feel they are objects of charity."

    Other statements ascribed to Mr. Ford at the time of launching his hospital project were:

    "It is not at all certain whether hospitals as they are now managed exist for patients or for doctors. . . . There seems to be a notion that a patient—especially when he goes into a hospital—becomes the property of the doctor. . . . Many physicians appear to be more concerned about sustaining their own diagnoses than about the recovery of their patients."

    The practice of employing the Ford Hospital staff—doctors and nurses—by the year at fixed salaries, and the reason assigned, would indicate that Mr. Ford is not without insight into the economic aspects of the medical game.

    "These men have been selected with great care," he said, "and paid as much they would ordinarily earn in private practice. They cannot practice outside the hospital, and they have, therefore, no financial interest in any patient. Nor does our system make it desirable to keep patients in the hospital any longer than necessary."

    Such openly expressed sentiments were not calculated to enhance Henry Ford's popularity in medical circles, any more than the financial policy of his hospital was calculated to make a hit with hospital managers. The new Ford Hospital was foreordained to medical censure, and the "regular" profession in Detroit and the Wayne County Medical Society fought it openly and secretly from its inception. And when after ten years experimenting with his new principle in hospitalization, the man whose name is the synonym of success to the average American was forced to admit failure, and to surrender the ideal with which he started so optimistically, the outcome was exultantly greeted in medical circles and everywhere acclaimed as "a fair vindication of the ancient fee system of the medical profession."

    For instead of meeting expenses and lowering charges as promised, the Henry Ford Hospital had faced a deficit every year until it totaled about $2, 500,000. Since this must come out of Ford's own pocket, it was tantamount to running the hospital on the charity plan which was precisely the idea in hospitalization he was trying to get away from. This led to the abandonment of the flat-rate policy and the adoption of the usual sliding scale in medical practice. Since September, 1925, rates in the Henry Ford Hospital range from $4.50 to $10. per day, with an additional maximum charge of $70. per week for medical attendance, and $1,000 maximum charge for a major operation.

    It is rumored in Detroit that Mr. Ford is very sore over the outcome of his hospital venture and very averse to talking about it. He might well be.

    The property, grounds, buildings and equipment, from first to last have cost him about $20,000,000. That is quite a neat sum to invest in a disappointment. Meantime it may interest the public—as well as Henry Ford—to inquire into the reason for the failure in hospital administration, of an idea which had succeeded so gloriously in the manufacturing field.

    In the first place, the Ford factories are manned by mechanical experts who know exactly what they are about; whereas the Hospital has been conducted by medical wise-acres who very seldom know what they are about; who proceed always on the principle of "trial and error," whose outcome shows them mostly in error.

    Secondly, Mr. Ford is accredited with considerable personal knowledge of mechanics, which enables him to keep personal tab in a measure on the efficiency of his workmen. If he were to come on a machinist in one of his shops doing such terrible things to the mechanism of a car as are being daily perpetrated against the human organism in his Detroit hospital, the chances are that blundering machinist would be thrown out on his head.

    Yet although Mr. Ford is quoted in the press and elsewhere as being opposed to drugs, and as favoring the eating of natural food and a general regimen of hygienic living in preference to medical formulas in the care of the body; he nevertheless places the conduct of his hospital experiment entirely under orthodox medical control, and employs the highest priced medical men as members of its staff. The result was what might have been expected. The only surprising thing is that one of Henry Ford's native astuteness failed to see that any hospital run by medical doctors would also be run for them.

    Everything in modern orthodox medical procedure, from drugs to insulin, from vaccine-serum inoculation to vivisection and tonsillectomy, is endorsed and practiced at the Henry Ford Hospital. It's founder's opposition to the use of drugs—if it really exists—is nowhere reflected in the hospital regime; and he who is said to be so sensitively anti-vivisectional as to wince at seeing a growing flower pulled, is here put in the anomalous position of seeming to sanction all the senseless cruelties and futile torture of dumb creatures, dignified in medical parlance as "animal experimentation."

    Mr. Ford's mistake has been in subordinating his own common-sense notions about health and disease to the alleged superior knowledge of medical men. Whether this was in deference to what he conceived to be public opinion, or because of his own inferiority complex toward the medical profession, is immaterial. The result is the same, and he is simply paying the penalty of that mistake. Had he put the hospital in charge of men more in sympathy with his own views; had he ruled out of it all the costly and destructive surgical equipment, all the barbarous and futile laboratory activities; had he banished drugs, vaccines, and serums; and instead of all this medical show installed a few practical dieticians and experienced clinicians—with a body of competent nurses trained in the principles of Nature Cure as well as the mechanics of good nursing—had this been the order of the Henry Ford Hospital instead of the regular medical order, he might have realized his dream of a low-priced hospital without being driven into charity practice on the one hand or a huge financial deficit on the other.

    Proof of this is afforded by the experience of the fifty or more drugless sanitariums scattered throughout the country, which have thriven and prospered on a low scale of prices—ranging from $15 to $50 per week for complete service. Not only have these been self-sustaining, but some of them, like Lindlahr's in Chicago and Tilden's in Denver, have grown from very small beginnings into large and flourishing institutions.

    Under the medical domination of the hospital field, very little opportunity is given for making comparison between the results obtained in the drug-less hospitals and the medical results; and when the drugless men have proposed a show-down on the comparative merits of their system of caring for the sick with the medical methods', the proposal was dismissed with the usual airy insolence of medical arrogance.

    Nevertheless certain concrete and significant facts have leaked out to the public, illustrating the superior character of the drugless service, especially when combined with natural methods. Thus in the Lindlahr Sanitarium during the flu epidemic of 1918-19, three hundred cases were successfully treated without a single death; while at the Cook County Hospital just across the street, fifty-four deaths occurred out of three hundred cases treated by medical methods.

    The Lindlahr Sanitarium also holds a continuous record of more than 20 years successful treatment of appendicitis without surgery and without a death, although some of the cases received came with the usual alarming prognosis of "abscess and threatened infection of the peritoneal cavity." Although these scare-head phrases are used to frighten people with abdominal pains onto the operating table, and under their influence millions have been needlessly despoiled of a useful little organ, and further incapacitated for the battle of life, the mortality from appendectomy has been—and is still—very high, according to the testimony of a very famous appendectomist, Dr. John B. Deaver of Philadelphia, who held a record on one occasion of snipping off seven appendices in an hour and ten minutes!

    Aside from the natural, common-sense reasoning, that if the vermiform appendix performed no useful office in the bodily economy Nature would not have supplied us with it, we have it upon such high medical authorities as Dr. Charles Sajous, Clinical Lecturer in Jefferson Medical College, and Dr. David MacEwan, Professor of Surgery in the University of Dundee, Scotland, that the appendix secretes a relatively large quantity of succus entericus, an alkaline fluid that is both an auto-antitoxin and a powerful digestant, that insures asepsis of the appendix and the cæcum and also aids digestion.

    Add to this the fact—established upon clinical records—that not more than 15 per cent of the cases operated on for appendicitis exhibit the trouble in the appendix—the other 85 per cent showing involvement of some other part of the peritoneal cavity— and the advantage to the public of having these cases cared for in drugless and non-surgical institutions must be apparent to any one not afflicted with medical myopia.

    Yet the drugless institutions have had to combat not only poverty and insufficient equipment—unaided by the endowment funds of medical hospitals—but have also had to face the medical persecution which has striven wherever possible to drive them out of business.

    Henry Ford has missed a great opportunity to demonstrate on a large scale, what could have been done with Nature Cure methods in a hospital like his, of unlimited facilities, perfect in appointment and equipment, when conducted by intelligent and efficient doctors and nurses trained in the principle that "Nature is all-in-all in the cure of disease."

    The foregone success of such an institution, under such auspices, could not have been hid in a corner. It would have been trumpeted round the world, and might quite conceivably have been an inspiration to other wealthy philanthropists who have grown rather weary of donating to medical failures.

     

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