Hospitals

Prudent medical students, with June term-end in sight, have already placed their applications for internships with hospitals throughout the U.S. Some hospital staffs have gained high esteem in the medical schools not only for their knowledge but, more important, their tutoring ability. Such hospitals are already flooded with applications, while most others, generally of poor teaching facilities and low prestige, will later have to advertise and wheedle for interns.

With this situation the comprehensive tablature of U.S. hospitals and hospital service which appeared last week, as annually, in the Journal of the American Medical Association, was studied carefully by students, faculties and hospital staffs.

Interns. Medical school graduates, practically everywhere in the U.S. at present, must perform at least one year of internship in a recognized hospital before being acceptable as a practitioner. In the hospitals their work is supposed to be practical, the putting into practice of their academic knowledge. Their salaries are meagre, generally between $25 and $30 a month besides board, lodging and laundry. Orderlies earn $40 to $60 a month and keep. Nurses get more. But theirs is a trade, whereas the intern is an embryo professional man. He is paying in a way for his educational contracts with skilled physicians and surgeons.

The intern's ideal is to learn from the esteemed members of his staff how to diagnose and treat most accurately. The professional attitude towards patients, gleaned from frequent contacts is also invaluable. Some hospitals require rotating services, whereby the intern has. opportunity to deal with a wide variety of ailments. Other hospitals emphasize various services whereby the intern becomes a specialist of sorts and, except for the unusual man, remains somewhat fuzzy concerning the other services. Most medical school faculties recommend the rotating service for the recent graduate. The specialized service is considered advantageous for the matured or postgraduate student.

Hordes of medical students yearly apply for internships in hospitals justly famed from the work of their staffs. But such hospitals cannot place even a small fraction of the applicants. These rejected men and women turn to their next choice. Still come rejections, until the student is faced with the alternative of entering a hospital so poorly rated that his future career is endangered, or of waiting another and ofttimes futile year for admittance to a reputable institution. Meanwhile he or she does some sort of haphazard work to earn a living.

Hospital Procedure. The philosophy of dealing with patients in hospital has long been in flux. One attitude, though fairly rare, is to consider the patient as an impersonal "case." This, physician, that physician, this surgeon, that surgeon, examines him, gives his decision. The patient circulates under the eyes, stethoscopes, fingers, machinery and knives of the specialists. He feels like a piece of flotsam. But, importantly, he becomes cured.

Another attitude is for one of the staff specialists to take, or pretend, personal interest in the patient's particular case. To the patient's mind this individual coordinates all the hospital activities towards treatment and cure. And in great measure he does so, for the patient is at the centre of his attention. To aid himself he calls on the specialists of his group.

This latter attitude is admirably advocated by two papers on "Individual versus Group Responsibility for the Care of the Hospital Patient" in the current Journal, by Dr. Henry A. Christian of Boston and Dr. Hugh Auchincloss of Manhattan.

Hospital Census. In 1925 there were in continental U.S. 6,896 hospitals containing more than five beds each. The total bed capacity was 802,065 of which 629,362 on the average were constantly occupied. Thus 78% of the available beds were always in use. Of the estimated national population of 113,492,720 a bed existed for each 141.5 persons. This enumeration does not include the 34,511 bassinets or baby cribs, which swelled the total number of beds to 836,576.

Relatively unimportant is the actual number of hospitals or even of beds. New York had most hospitals, 630; California next, 490; Pennsylvania, 416. Delaware had fewest, 15. In bed (including bassinets) capacity New York led, 120,092; Pennsylvania, 67,984; Illinois, 57,784. Nevada had fewest, 955.

More important is the ratio of population to beds. In this regard ratios were: Nevada 1:84.7, California 1:84.9, Massachusetts 1:91.7, New York 1:96.9, Wyoming 1:102.4, Illinois 1:126.7, Pennsylvania 1:143.6, Delaware 1:165.

Four states have at least one hospital in each of their counties -- Connecticut, District of Columbia. Maine, New Hampshire. The counties of Georgia are poorest served -- 68.3% lack hospitals.

On the staffs of the 6,896 hospitals were 2,648 professional men. 1,676 registered nurses and 2,528 others -- various kinds of assistants.

The intern situation is interesting: 1244 hospitals used 5,910 interns; 203 lacked 308 interns of need. In face of the scramble for internships in Manhattan, 34 hospitals in the state stated they lacked 60 to complement their staffs. This was the worst state as far as numbers go. Nine states needed no more internes than were already working. Others needed only one, two or three more.