A Once Charitable Enterprise

A Once Charitable Enterprise: Hospitals and Health Care in Brooklyn and New York, 1885-1915

DAVID ROSNER
Copyright Date: 1982
Pages: 244
https://www.jstor.org/stable/j.ctt7zv9cn
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  • Book Info
    A Once Charitable Enterprise
    Book Description:

    This work, examines the transformation of American hospitals from a series of community- based charitable institutions into the large, bureaucratic system that existed by the end of the Progressive era.

    Originally published in 1986.

    ThePrinceton Legacy Libraryuses the latest print-on-demand technology to again make available previously out-of-print books from the distinguished backlist of Princeton University Press. These paperback editions preserve the original texts of these important books while presenting them in durable paperback editions. The goal of the Princeton Legacy Library is to vastly increase access to the rich scholarly heritage found in the thousands of books published by Princeton University Press since its founding in 1905.

    eISBN: 978-1-4008-5842-2
    Subjects: History, Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-iv)
  2. Table of Contents
    (pp. v-vi)
  3. Preface
    (pp. vii-x)
    David Rosner
  4. Introduction
    (pp. 1-12)

    ʺWhat do you mean ʹno roomʹ? If you want to [admit me] badly enough youʹll find a place.ʺ This was the complaint of a Jewish immigrant to the superintendent of Mount Moriah Hospital in New Yorkʹs lower East Side in 1909. Mount Moriah was a ʺpenny hospital,ʺ supported by the ʺpenniesʺ of working people who were members of the Galicia-Bokovina League, a society of Eastern European Jewish workers who had emigrated to the United States in the preceding decades. In this particular hospital the superintendent himself felt ʺupset that … many applicants [were] rejected for lack of space,ʺ because he...

  5. 1 Health care and community change
    (pp. 13-35)

    Nineteenth-century American life revolved around small communities and narrow personal contacts. Most Americans lived in rural villages and towns that were essentially isolated from each other, and even those who lived in the city lived in highly structured communities separated from each other by culture, ethnicity, and sometimes language. Because there were no adequate transportation and communication systems early in the century, there was little chance for relationships beyond oneʹs immediate neighborhood. In these so-called walking cities, life revolved around the local church, school, and other small institutions. Government was a neighborhood responsibility watched over by the local ward boss,...

  6. 2 Embattled benefactors: the crisis in hospital financing
    (pp. 36-61)

    The 1890s were hardly gay for the majority of Americans. Before the decade was halfway completed an economic depression of unheard-of magnitude had swept the country and threatened the very existence of millions of blue-collar workers, small businessmen, and even bankers. Following the panic of 1893, over 600 banks closed, 16,000 business firms went bankrupt, and 2.5 million laborers were suddenly jobless. The 1,300 strikes by workers in most heavy industries, coupled with the obvious plight of thousands of workers who marched on Washington in ʺGeneralʺ Coxeyʹs army, led one senator to fear that the country was ʺon the verge...

  7. 3 Social class and hospital care
    (pp. 62-93)

    Because hospital trustees could no longer depend primarily on private benefactors to support their institutions and were instead forced to begin charging patients significant sums, it became necessary to organize and present the hospital to the public in a new way. If patients were to be encouraged to pay for services, the hospitals would have to offer them something different from the services provided at minimal or no charge to the indigent. Some trustees and hospital spokesmen began to organize distinct services for different classes of the population – sometimes separate services within a single institution, and sometimes entirely separate...

  8. 4 Conflict in the new hospital
    (pp. 94-121)

    Despite significant efforts to attract merchants and other white-collar workers by advertising comfortable accommodations and new services, hospital trustees were forced to admit that only a few more such patients actually came to the hospital. By and large the hospital was charging the very working-class patients who had previously used its services without charge, and these patients were bringing in only limited funds. Trustees came to realize that even if middle-class clients were influenced by pleasant accommodations and advertising, they were still the patients of private doctors and would enter the hospital only at those doctorsʹ suggestion. Because family doctors...

  9. 5 Taking control: political reform and hospital governance
    (pp. 122-145)

    Although internal economic and organizational struggles altered the structure of many turn-of-the-century hospitals, some changes were the result of new policies in city government. Changes made during this era in the system of municipal reimbursement to the hospital have remained important until today and have had significant long-term effects. Local control and some forms of decision making passed from hospital trustees and their ward boss representatives to city administrators, who defined more narrowly the hospital work they would reimburse. Ultimately, changes in the municipal reimbursement system resulted in a loss of autonomy for many hospitals and a loss of funds...

  10. 6 Consolidating control over the small dispensary: the doctors, the city, and the state
    (pp. 146-163)

    As we have seen, the Progressive era brought major changes in the cityʹs political and social arrangements. The demographic shifts, economic upheavals, and political reforms that undermined the cohesiveness of neighborhoods and their small hospitals also hurt the freestanding dispensaries and small walk-in clinics located throughout working-class neighborhoods. Like the small hospitals, dispensaries were nearly totally dependent upon the influence of local merchants and leaders to obtain city money for their survival. When power shifted from locally elected politicians to city officials and bureaucrats, and when the state comptrollerʹs officials changed reimbursement regulations to favor large institutions, the freestanding dispensaries...

  11. 7 The battle for Morningside Heights: power and politics in the boardroom of New York Hospital
    (pp. 164-186)

    New York and Brooklyn community hospitals and dispensaries were organized and run by local church groups, merchants, and other organizations and leaders. These sponsors lent to their institutions the ethnic or religious flavor that made the services unique. Rarely, if ever, were the trustees and governors important on the regional, state, or national level. When the forces of industrial and economic change, commercial development, or demographic reorganization and political upheaval altered the relationships and neighborhoods in which these institutions were located, the hospitals found themselves subjected to pressures well beyond their control. In the face of these growing pressures, smaller...

  12. 8 Looking backward
    (pp. 187-191)

    By the end of the Progressive era, Manhattan and Brooklyn had gone through a radical transformation. Clearly, Brooklyn was no longer the ʺCity of Churchesʺ nor the ʺCity of Homes.ʺ Its nineteenth-century rural, bucolic flavor was gone. Manhattan had become the center of finance and industry for the entire country. New York was a highly industrial, crowded city with a large portion of its population composed of immigrants and their children.

    Manhattan, the home for millions of immigrants, thousands of banks and commercial enterprises, and a score of millionaires, became the undisputed economic capital of an increasingly powerful country. Brooklyn,...

  13. Notes on sources
    (pp. 192-193)
  14. Notes
    (pp. 194-227)
  15. Select bibliography
    (pp. 228-230)
  16. Index
    (pp. 231-234)