My Life and Work/15
Why should there by any necessity for almsgiving in a civilized community? It is not the charitable mind to which I object. Heaven forbid that we should ever grow cold toward a fellow creature in need. Human sympathy is too fine for the cool, calculating attitude to take its place. One can name very few great advances that did not have human sympathy behind them. It is in order to help people that every notable service is undertaken.
The trouble is that we have been using this great, fine motive force for ends too small. If human sympathy prompts us to feed the hungry, why should it not give the larger desire--to make hunger in our midst impossible? If we have sympathy enough for people to help them out of their troubles, surely we ought to have sympathy enough to keep them out.
It is easy to give; it is harder to make giving unnecessary. To make the giving unnecessary we must look beyond the individual to the cause of his misery--not hesitating, of course, to relieve him in the meantime, but not stopping with mere temporary relief. The difficulty seems to be in getting to look beyond to the causes. More people can be moved to help a poor family than can be moved to give their minds toward the removal of poverty altogether.
I have no patience with professional charity, or with any sort of commercialized humanitarianism. The moment human helpfulness is systematized, organized, commercialized, and professionalized, the heart of it is extinguished, and it becomes a cold and clammy thing.
Real human helpfulness is never card-catalogued or advertised. There are more orphan children being cared for in the private homes of people who love them than in the institutions. There are more old people being sheltered by friends than you can find in the old people's homes. There is more aid by loans from family to family than by the loan societies. That is, human society on a humane basis looks out for itself. It is a grave question how far we ought to countenance the commercialization of the natural instinct of charity.
Professional charity is not only cold but it hurts more than it helps. It degrades the recipients and drugs their self-respect. Akin to it is sentimental idealism. The idea went abroad not so many years ago that "service" was something that we should expect to have done for us. Untold numbers of people became the recipients of well-meant "social service." Whole sections of our population were coddled into a state of expectant, child-like helplessness. There grew up a regular profession of doing things for people, which gave an outlet for a laudable desire for service, but which contributed nothing whatever to the self-reliance of the people nor to the correction of the conditions out of which the supposed need for such service grew.
Worse than this encouragement of childish wistfulness, instead of training for self-reliance and self-sufficiency, was the creation of a feeling of resentment which nearly always overtakes the objects of charity. People often complain of the "ingratitude" of those whom they help. Nothing is more natural. In the first place, precious little of our so-called charity is ever real charity, offered out of a heart full of interest and sympathy. In the second place, no person ever relishes being in a position where he is forced to take favors.
Such "social work" creates a strained relation--the recipient of bounty feels that he has been belittled in the taking, and it is a question whether the giver should not also feel that he has been belittled in the giving. Charity never led to a settled state of affairs. The charitable system that does not aim to make itself unnecessary is not performing service. It is simply making a job for itself and is an added item to the record of non-production.
Charity becomes unnecessary as those who seem to be unable to earn livings are taken out of the non-productive class and put into the productive. In a previous chapter I have set out how experiments in our shops have demonstrated that in sufficiently subdivided industry there are places which can be filled by the maimed, the halt, and the blind. Scientific industry need not be a monster devouring all who come near it. When it is, then it is not fulfilling its place in life. In and out of industry there must be jobs that take the full strength of a powerful man; there are other jobs, and plenty of them, that require more skill than the artisans of the Middle Ages ever had. The minute subdivision of industry permits a strong man or a skilled man always to use his strength or skill. In the old hand industry, a skilled man spent a good part of his time at unskilled work. That was a waste. But since in those days every task required both skilled and unskilled labour to be performed by the one man, there was little room for either the man who was too stupid ever to be skilled or the man who did not have the opportunity to learn a trade.
No mechanic working with only his hands can earn more than a bare sustenance. He cannot have a surplus. It has been taken for granted that, coming into old age, a mechanic must be supported by his children or, if he has no children, that he will be a public charge. All of that is quite unnecessary. The subdivision of industry opens places that can be filled by practically any one. There are more places in subdivision industry that can be filled by blind men than there are blind men. There are more places that can be filled by cripples than there are cripples. And in each of these places the man who short-sightedly might be considered as an object of charity can earn just as adequate a living as the keenest and most able-bodied. It is waste to put an able-bodied man in a job that might be just as well cared for by a cripple. It is a frightful waste to put the blind at weaving baskets. It is waste to have convicts breaking stone or picking hemp or doing any sort of petty, useless task.
A well-conducted jail should not only be self-supporting, but a man in jail ought to be able to support his family or, if he has no family, he should be able to accumulate a sum of money sufficient to put him on his feet when he gets out of jail. I am not advocating convict labour or the farming out of men practically as slaves. Such a plan is too detestable for words. We have greatly overdone the prison business, anyway; we begin at the wrong end. But as long as we have prisons they can be fitted into, the general scheme of production so neatly that a prison may become a productive unit working for the relief of the public and the benefit of the prisoners. I know that there are laws--foolish laws passed by unthinking men--that restrict the industrial activities of prisons. Those laws were passed mostly at the behest of what is called Labour. They are not for the benefit of the workingman. Increasing the charges upon a community does not benefit any one in the community. If the idea of service be kept in mind, then there is always in every community more work to do than there are men who can do it.
Industry organized for service removes the need for philanthropy. Philanthropy, no matter how noble its motive, does not make for self-reliance. We must have self-reliance. A community is the better for being discontented, for being dissatisfied with what it has. I do not mean the petty, daily, nagging, gnawing sort of discontent, but a broad, courageous sort of discontent which believes that everything which is done can and ought to be eventually done better. Industry organized for service--and the workingman as well as the leader must serve--can pay wages sufficiently large to permit every family to be both self-reliant and self-supporting. A philanthropy that spends its time and money in helping the world to do more for itself is far better than the sort which merely gives and thus encourages idleness. Philanthropy, like everything else, ought to be productive, and I believe that it can be. I have personally been experimenting with a trade school and a hospital to discover if such institutions, which are commonly regarded as benevolent, cannot be made to stand on their own feet. I have found that they can be.
I am not in sympathy with the trade school as it is commonly organized--the boys get only a smattering of knowledge and they do not learn how to use that knowledge. The trade school should not be a cross between a technical college and a school; it should be a means of teaching boys to be productive. If they are put at useless tasks--at making articles and then throwing them away--they cannot have the interest or acquire the knowledge which is their right. And during the period of schooling the boy is not productive; the schools--unless by charity--make no provision for the support of the boy. Many boys need support; they must work at the first thing which comes to hand. They have no chance to pick and choose.
When the boy thus enters life untrained, he but adds to the already great scarcity of competent labour. Modern industry requires a degree of ability and skill which neither early quitting of school nor long continuance at school provides. It is true that, in order to retain the interest of the boy and train him in handicraft, manual training departments have been introduced in the more progressive school systems, but even these are confessedly makeshifts because they only cater to, without satisfying, the normal boy's creative instincts.
To meet this condition--to fulfill the boy's educational possibilities and at the same time begin his industrial training along constructive lines--the Henry Ford Trade School was incorporated in 1916. We do not use the word philanthropy in connection with this effort. It grew out of a desire to aid the boy whose circumstances compelled him to leave school early. This desire to aid fitted in conveniently with the necessity of providing trained tool-makers in the shops. From the beginning we have held to three cardinal principles: first, that the boy was to be kept a boy and not changed into a premature working-man; second, that the academic training was to go hand in hand with the industrial instruction; third, that the boy was to be given a sense of pride and responsibility in his work by being trained on articles which were to be used. He works on objects of recognized industrial worth. The school is incorporated as a private school and is open to boys between the ages of twelve and eighteen. It is organized on the basis of scholarships and each boy is awarded an annual cash scholarship of four hundred dollars at his entrance. This is gradually increased to a maximum of six hundred dollars if his record is satisfactory.
A record of the class and shop work is kept and also of the industry the boy displays in each. It is the marks in industry which are used in making subsequent adjustments of his scholarship. In addition to his scholarship each boy is given a small amount each month which must be deposited in his savings account. This thrift fund must be left in the bank as long as the boy remains in the school unless he is given permission by the authorities to use it for an emergency.
One by one the problems of managing the school are being solved and better ways of accomplishing its objects are being discovered. At the beginning it was the custom to give the boy one third of the day in class work and two thirds in shop work. This daily adjustment was found to be a hindrance to progress, and now the boy takes his training in blocks of weeks--one week in the class and two weeks in the shop. Classes are continuous, the various groups taking their weeks in turn.
The best instructors obtainable are on the staff, and the text-book is the Ford plant. It offers more resources for practical education than most universities. The arithmetic lessons come in concrete shop problems. No longer is the boy's mind tortured with the mysterious A who can row four miles while B is rowing two. The actual processes and actual conditions are exhibited to him--he is taught to observe. Cities are no longer black specks on maps and continents are not just pages of a book. The shop shipments to Singapore, the shop receipts of material from Africa and South America are shown to him, and the world becomes an inhabited planet instead of a coloured globe on the teacher's desk. In physics and chemistry the industrial plant provides a laboratory in which theory becomes practice and the lesson becomes actual experience. Suppose the action of a pump is being taught. The teacher explains the parts and their functions, answers questions, and then they all troop away to the engine rooms to see a great pump. The school has a regular factory workshop with the finest equipment. The boys work up from one machine to the next. They work solely on parts or articles needed by the company, but our needs are so vast that this list comprehends nearly everything. The inspected work is purchased by the Ford Motor Company, and, of course, the work that does not pass inspection is a loss to the school.
The boys who have progressed furthest do fine micrometer work, and they do every operation with a clear understanding of the purposes and principles involved. They repair their own machines; they learn how to take care of themselves around machinery; they study pattern-making and in clean, well-lighted rooms with their instructors they lay the foundation for successful careers.
When they graduate, places are always open for them in the shops at good wages. The social and moral well-being of the boys is given an unobtrusive care. The supervision is not of authority but of friendly interest. The home conditions of every boy are pretty well known, and his tendencies are observed. And no attempt is made to coddle him. No attempt is made to render him namby-pamby. One day when two boys came to the point of a fight, they were not lectured on the wickedness of fighting. They were counseled to make up their differences in a better way, but when, boy-like, they preferred the more primitive mode of settlement, they were given gloves and made to fight it out in a corner of the shop. The only prohibition laid upon them was that they were to finish it there, and not to be caught fighting outside the shop. The result was a short encounter and--friendship.
They are handled as boys; their better boyish instincts are encouraged; and when one sees them in the shops and classes one cannot easily miss the light of dawning mastery in their eyes. They have a sense of "belonging." They feel they are doing something worth while. They learn readily and eagerly because they are learning the things which every active boy wants to learn and about which he is constantly asking questions that none of his home-folks can answer.
Beginning with six boys the school now has two hundred and is possessed of so practical a system that it may expand to seven hundred. It began with a deficit, but as it is one of my basic ideas that anything worth while in itself can be made self-sustaining, it has so developed its processes that it is now paying its way.
We have been able to let the boy have his boyhood. These boys learn to be workmen but they do not forget how to be boys. That is of the first importance. They earn from 19 to 35 cents an hour--which is more than they could earn as boys in the sort of job open to a youngster. They can better help support their families by staying in school than by going out to work. When they are through, they have a good general education, the beginning of a technical education, and they are so skilled as workmen that they can earn wages which will give them the liberty to continue their education if they like. If they do not want more education, they have at least the skill to command high wages anywhere. They do not have to go into our factories; most of them do because they do not know where better jobs are to be had--we want all our jobs to be good for the men who take them. But there is no string tied to the boys. They have earned their own way and are under obligations to no one. There is no charity. The place pays for itself.
The Ford Hospital is being worked out on somewhat similar lines, but because of the interruption of the war--when it was given to the Government and became General Hospital No. 36, housing some fifteen hundred patients--the work has not yet advanced to the point of absolutely definite results. I did not deliberately set out to build this hospital. It began in 1914 as the Detroit General Hospital and was designed to be erected by popular subscription. With others, I made a subscription, and the building began. Long before the first buildings were done, the funds became exhausted and I was asked to make another subscription. I refused because I thought that the managers should have known how much the building was going to cost before they started. And that sort of a beginning did not give great confidence as to how the place would be managed after it was finished. However, I did offer to take the whole hospital, paying back all the subscriptions that had been made. This was accomplished, and we were going forward with the work when, on August 1, 1918, the whole institution was turned over to the Government. It was returned to us in October, 1919, and on the tenth day of November of the same year the first private patient was admitted.
The hospital is on West Grand Boulevard in Detroit and the plot embraces twenty acres, so that there will be ample room for expansion. It is our thought to extend the facilities as they justify themselves. The original design of the hospital has been quite abandoned and we have endeavoured to work out a new kind of hospital, both in design and management. There are plenty of hospitals for the rich. There are plenty of hospitals for the poor. There are no hospitals for those who can afford to pay only a moderate amount and yet desire to pay without a feeling that they are recipients of charity. It has been taken for granted that a hospital cannot both serve and be self-supporting--that it has to be either an institution kept going by private contributions or pass into the class of private sanitariums managed for profit. This hospital is designed to be self-supporting--to give a maximum of service at a minimum of cost and without the slightest colouring of charity.
In the new buildings that we have erected there are no wards. All of the rooms are private and each one is provided with a bath. The rooms--which are in groups of twenty-four--are all identical in size, in fittings, and in furnishings. There is no choice of rooms. It is planned that there shall be no choice of anything within the hospital. Every patient is on an equal footing with every other patient.
It is not at all certain whether hospitals as they are now managed exist for patients or for doctors. I am not unmindful of the large amount of time which a capable physician or surgeon gives to charity, but also I am not convinced that the fees of surgeons should be regulated according to the wealth of the patient, and I am entirely convinced that what is known as "professional etiquette" is a curse to mankind and to the development of medicine. Diagnosis is not very much developed. I should not care to be among the proprietors of a hospital in which every step had not been taken to insure that the patients were being treated for what actually was the matter with them, instead of for something that one doctor had decided they had. Professional etiquette makes it very difficult for a wrong diagnosis to be corrected. The consulting physician, unless he be a man of great tact, will not change a diagnosis or a treatment unless the physician who has called him in is in thorough agreement, and then if a change be made, it is usually without the knowledge of the patient. There seems to be a notion that a patient, and especially when in a hospital, becomes the property of the doctor. A conscientious practitioner does not exploit the patient. A less conscientious one does. Many physicians seem to regard the sustaining of their own diagnoses as of as great moment as the recovery of the patient.
It has been an aim of our hospital to cut away from all of these practices and to put the interest of the patient first. Therefore, it is what is known as a "closed" hospital. All of the physicians and all of the nurses are employed by the year and they can have no practice outside of the hospital. Including the interns, twenty-one physicians and surgeons are on the staff. These men have been selected with great care and they are paid salaries that amount to at least as much as they would ordinarily earn in successful private practice. They have, none of them, any financial interest whatsoever in any patient, and a patient may not be treated by a doctor from the outside. We gladly acknowledge the place and the use of the family physician. We do not seek to supplant him. We take the case where he leaves off, and return the patient as quickly as possible. Our system makes it undesirable for us to keep patients longer than necessary--we do not need that kind of business. And we will share with the family physician our knowledge of the case, but while the patient is in the hospital we assume full responsibility. It is "closed" to outside physicians' practice, though it is not closed to our cooperation with any family physician who desires it.
The admission of a patient is interesting. The incoming patient is first examined by the senior physician and then is routed for examination through three, four, or whatever number of doctors seems necessary. This routing takes place regardless of what the patient came to the hospital for, because, as we are gradually learning, it is the complete health rather than a single ailment which is important. Each of the doctors makes a complete examination, and each sends in his written findings to the head physician without any opportunity whatsoever to consult with any of the other examining physicians. At least three, and sometimes six or seven, absolutely complete and absolutely independent diagnoses are thus in the hands of the head of the hospital. They constitute a complete record of the case. These precautions are taken in order to insure, within the limits of present-day knowledge, a correct diagnosis.
At the present time, there are about six hundred beds available. Every patient pays according to a fixed schedule that includes the hospital room, board, medical and surgical attendance, and nursing. There are no extras. There are no private nurses. If a case requires more attention than the nurses assigned to the wing can give, then another nurse is put on, but without any additional expense to the patient. This, however, is rarely necessary because the patients are grouped according to the amount of nursing that they will need. There may be one nurse for two patients, or one nurse for five patients, as the type of cases may require. No one nurse ever has more than seven patients to care for, and because of the arrangements it is easily possible for a nurse to care for seven patients who are not desperately ill. In the ordinary hospital the nurses must make many useless steps. More of their time is spent in walking than in caring for the patient. This hospital is designed to save steps. Each floor is complete in itself, and just as in the factories we have tried to eliminate the necessity for waste motion, so have we also tried to eliminate waste motion in the hospital. The charge to patients for a room, nursing, and medical attendance is $4.50 a day. This will be lowered as the size of the hospital increases. The charge for a major operation is $125. The charge for minor operations is according to a fixed scale. All of the charges are tentative. The hospital has a cost system just like a factory. The charges will be regulated to make ends just meet.
There seems to be no good reason why the experiment should not be successful. Its success is purely a matter of management and mathematics. The same kind of management which permits a factory to give the fullest service will permit a hospital to give the fullest service, and at a price so low as to be within the reach of everyone. The only difference between hospital and factory accounting is that I do not expect the hospital to return a profit; we do expect it to cover depreciation. The investment in this hospital to date is about $9,000,000.
If we can get away from charity, the funds that now go into charitable enterprises can be turned to furthering production--to making goods cheaply and in great plenty. And then we shall not only be removing the burden of taxes from the community and freeing men but also we can be adding to the general wealth. We leave for private interest too many things we ought to do for ourselves as a collective interest. We need more constructive thinking in public service. We need a kind of "universal training" in economic facts. The over-reaching ambitions of speculative capital, as well as the unreasonable demands of irresponsible labour, are due to ignorance of the economic basis of life. Nobody can get more out of life than life can produce--yet nearly everybody thinks he can. Speculative capital wants more; labour wants more; the source of raw material wants more; and the purchasing public wants more. A family knows that it cannot live beyond its income; even the children know that. But the public never seems to learn that it cannot live beyond its income--have more than it produces.
In clearing out the need for charity we must keep in mind not only the economic facts of existence, but also that lack of knowledge of these facts encourages fear. Banish fear and we can have self-reliance. Charity is not present where self-reliance dwells.
Fear is the offspring of a reliance placed on something outside--on a foreman's good-will, perhaps, on a shop's prosperity, on a market's steadiness. That is just another way of saying that fear is the portion of the man who acknowledges his career to be in the keeping of earthly circumstances. Fear is the result of the body assuming ascendancy over the soul.
The habit of failure is purely mental and is the mother of fear. This habit gets itself fixed on men because they lack vision. They start out to do something that reaches from A to Z. At A they fail, at B they stumble, and at C they meet with what seems to be an insuperable difficulty. They then cry "Beaten" and throw the whole task down. They have not even given themselves a chance really to fail; they have not given their vision a chance to be proved or disproved. They have simply let themselves be beaten by the natural difficulties that attend every kind of effort.
More men are beaten than fail. It is not wisdom they need or money, or brilliance, or "pull," but just plain gristle and bone. This rude, simple, primitive power which we call "stick-to-it-iveness" is the uncrowned king of the world of endeavour. People are utterly wrong in their slant upon things. They see the successes that men have made and somehow they appear to be easy. But that is a world away from the facts. It is failure that is easy. Success is always hard. A man can fail in ease; he can succeed only by paying out all that he has and is. It is this which makes success so pitiable a thing if it be in lines that are not useful and uplifting.
If a man is in constant fear of the industrial situation he ought to change his life so as not to be dependent upon it. There is always the land, and fewer people are on the land now than ever before. If a man lives in fear of an employer's favor changing toward him, he ought to extricate himself from dependence on any employer. He can become his own boss. It may be that he will be a poorer boss than the one he leaves, and that his returns will be much less, but at least he will have rid himself of the shadow of his pet fear, and that is worth a great deal in money and position. Better still is for the man to come through himself and exceed himself by getting rid of his fears in the midst of the circumstances where his daily lot is cast. Become a freeman in the place where you first surrendered your freedom. Win your battle where you lost it. And you will come to see that, although there was much outside of you that was not right, there was more inside of you that was not right. Thus you will learn that the wrong inside of you spoils even the right that is outside of you.
A man is still the superior being of the earth. Whatever happens, he is still a man. Business may slacken tomorrow--he is still a man. He goes through the changes of circumstances, as he goes through the variations of temperature--still a man. If he can only get this thought reborn in him, it opens new wells and mines in his own being. There is no security outside of himself. There is no wealth outside of himself. The elimination of fear is the bringing in of security and supply.
Let every American become steeled against coddling. Americans ought to resent coddling. It is a drug. Stand up and stand out; let weaklings take charity.