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BACK in the seventies when the public welfare move-
ment began to take form in America and Will Carle-
ton (the Edgar Guest of that day) wrote his popular bal-
lad, Over the Hill to the Poorhouse, the almshouse was the
country's most important public welfare institution. At the
first conference of .boards of public charities, held in New.j
York, the condition of almshouse populations occupied a
large part of the discussion. Children had been admitted to
almshouses in great numbers. While hundreds of new pri-
vate agencies for child care had been set up, as well as some '
similar institutions for their public care, most of this new j
work for children was isolated and sectarian. The almshouse
continued to be the catch-all and the hopper into which!
needy children fell. Hundreds still were born and bred I
there.

While poor directors of this period generally retained
their belief in the moral restraint and discipline of the poor-



76



SURVEY MIDMONTHLY



fur the adult pauper, they, alon^ uith state otliciuls
and a few workers from the new charity organization so-
cieties who attended their conferences, were becoming un-
easily conscious that the poorhouse atmosphere could bring
nothing but harm to children. At a welfare conference in
1SS5, a poorhouse population was described by a state offi-
cial as consisting of "a heterogeneous mass of humanity,
differing widely in individuality as helpless, docile child-
hood differs from garrulous self-assertive old age, with the
intervening class of raving maniacs, demented imbeciles,
irresponsible epileptics, gibbering idiots, and always a fair
proportion of helpless and unconsciously filthy inmates."

1'artly as the result of these conferences, in the early
seventies the movement to forbid admission of normal chil-
dren to almshouses gained real momentum. The New York
State law, passed in 1875, was reported to have removed
some three thousand children from poorhouses of that state.
Other state laws followed; yet in 1930 hundreds of chil-
dren still were in the almshouses of America children who
had slipped through the cracks of old laws allowing for
temporary care, children suffering from some disability and
for whom no other care was available, young children with
their mothers.

About the same time that attention first was given to
the problem of children in almshouses, strong currents were
running to divert other groups with special handicaps from
the almshouse door. Institutions for the blind were founded;
hospitals for crippled children and sanatoria for the tubercu-
lous were built ; homes for the aged were opened ; but still
the poorhouse and the old community attitude toward it
persisted. By the end of the nineteenth century, 128 hospi-
tals for care of the insane had been opened. New currents
of thought in regard to care of the insane had developed
through the leadership of Dorothea Dix and others, yet
how little this new thinking had affected rural almshouses
is shown by another contemporary book, Farm Ballads, also
by Will Carleton, which used to lie beside the Bible in
rural homes. Consider the story of Rob, the Pauper:

Rob the Pauper is loose again

Through the fields and woods he races . . .

He hath broken him loose from his poorhouse cell,

He hath dragged him clear from rope and fetter . . .

Rob the Pauper is wild of eye

Wild of speech and wild of thinking . . .

Yet there is something in his bearing

Not quite what a pauper should be wearing . . .

The poem goes on to tell how they hunted the Pauper
"with dogs and guns" until finally "a well-sped bullet goes
crashing through him" and he is brought back to lie "in a
box of rough-planed boards unpainted" at the "poorhouse
graveyard gate."

Times have changed ; the dogs and guns probably would
be discarded in the hunt for Rob today. However Rob still
might be in a poorhouse unless he had proved troublesome
enough to win a commitment to a state mental hospital.
Psychiatric service such as he plainly needed has not yet
penetrated many rural institutions, though it has restored
hundreds of persons to lives of usefulness, and has been
shown to pay for itself in the long run many times over.

In today's almshouse, then, still are found many members
of groups for whom other types of care long have been pro-
vided. There are fewer children today; fewer insane, but
many feeble-minded ; fewer able-bodied aged and blind,
since old age assistance and blind pensions have become a
charge against the state and federal governments. Those



who are left are increasingly a group of bedridden, disabled
persons, most of whom need institutional care of a type
suited to their particular needs. The poorhouse, in some
places running at a per capita cost of a dollar or more a day,
affords for the sick whom it houses a type of care which,
like the institution, dates back to the seventeenth century.
As recently as 1934 in one eastern state, only five of
eighty-five almshouses, housing in the course of a year over
27,000 people, had what could be called the rudiments of
a medical program for the inmates' care. Only eleven of the
eighty-five, for example, gave physical examinations to in-
mates at entrance, though one which did give such examina-
tions found that 74 percent of those admitted were suffer-
ing from a physical or mental handicap or disease. The fact
that hundreds of the applicants to the almshouses in this
state must have been seriously ill at entrance is evidenced
' "by the deaths during that year of 9 percent of the population.
The picture is not wholly black. Virginia has a progres-
sive law, and is moving toward a program of consolidation
that will transform almshouses into what they must become
hospitals for the chronically ill and infirm, to which any
of us might go if need be. In that state, sixty-eight aims-
houses have been replaced by six large district institutions.
The little state of Delaware already has taken a further
progressive step. One hospitalized institution, under com-
petent medical direction, serves the whole state. No longer
are there poorhouses in Delaware. Alabama reports that
within two years its almshouses have been reduced from
sixty-one to fourteen. Georgia has closed twenty-three aims-
houses recently, leaving thirty-six still in operation, and is
hoping to close within the year all but five large institutions.
Many city institutions have strengthened their medical and
nursing programs, though few have developed that individ-
ual service at the intake desk which discovers care in the
community for helpless persons who do not know where or
how to seek it. Progress is being made.

THE real answer to the persisting problem of the poor-
house, like the answer to many welfare problems
today, is quite simple. It lies, not so much in further at-
tempts to drain off inmates from the poorhouse, as in a
frontal attack on the institution itself. But this action in-
volves a step in public welfare that petty politicians, with
a death grip on their little jobs, will take only under great
pressure from the public. No small county, township, or
borough can afford a hospital for its chronically ill and in-
firm ; so it is in these smaller units of government that aims-
house care is still general and poor. Regional hospitals, cross-
ing county lines and planned under state direction, afford
the solution to the problem. Some of the larger city and
county institutions could be fully hospitali/.ed and adapted
to receive patients from nearby counties on a per capita
basis. In other parts of the country new buildings would be
needed to serve a specified area. Against their cost could be
applied the selling price of poor farms, sometimes valuable.
To bring this about, taxpayers groups and citizens who
can see beyond the boundaries of their own little communi-
ties will have to plan for the care of an increasing number
of chronically ill and disabled. Perhaps the day is not far
off when labor will take a more powerful hand in the treat-
ment of welfare problems. Pauper is not a popular word
with those who, in the face of growing insecurities, have
given their lives to building great industries. Meanwhile,
thousands of aged and infirm still totter over the hill to the
poorhouse, to seek shelter in that ill-starred institution.



M \RC:H 1938



77



The Common Welfare



Patronage Again

ONCE again the United States Senate has expressed its
will to patronage by amending the independent offices
appropriation bill to require Senate confirmation for ap-
pointments of "experts and attorneys" to positions paying
$5000 or more a year. It will be recalled that a similar
amendment last year obliged fifty-two members of the staff
of the Social Security Board to "clear" their professional
qualifications with their Senators as part of the process of
confirmation. [See Survey Midmonthly, July 1937, page
224, and September, page 288.] Last year's action was ret-
roactive ; this year's would keep the situation firmly in hand
the Senate's hand.

Senator McKellar of Tennessee, who fathered the amend-
ment in a form more drastic than finally adopted, is quoted
as saying that he will demand similar amendments to all
appropriation bills this session. Fortunately the House, if it
will, still can prevent an action which the National Civil
Service Reform League describes as "archaic, unwarranted
and a negation of the merit system."

Wage Earners' Money

IN his legislative message of January 5, Governor Leh-
man of New York urged a plan similar to the Massa-
chusetts plan whereby life insurance may be purchased
"over the counter" of local savings banks instead of by
costly door-to-door selling and premium collection. The
Massachusetts plan, worked out by Louis D. Brandeis, has
had thirty years of successful operation. [See Survey Graphic,
November 1936, page 598.] This effort to broaden New
York's social insurance program by the inclusion of savings
bank life insurance this year has had the vigorous support
of a newly formed Savings Bank Insurance League headed
by Dr. William Jay Schieffelin.

Even in the depression year of 1932, American wage
earners paid out over $700 million in weekly premiums on
so-called industrial insurance policies in the attempt to ob-
tain some measure of security for themselves and their de-
pendents. Yet the record for the eleven years from 1923
through 1933 shows that of all industrial insurance termi-
nated in that period, two thirds lapsed with no return of
any kind to the policy holders, and an additional 25 percent
was surrendered at a sacrifice. Only 5 percent was termi-
nated by the death of the holder. Studies of relief families
made during the same decade by the Metropolitan Life In-
surance Company, the Board of Child Welfare of Albany
County, N. Y., the Jewish Family Welfare Association of
Boston, show that from 11 to 19 percent of relief given
was spent for life insurance.

In his message, Governor Lehman stated :

The state has a responsibility to see to it that these [insur-
ance] services are properly regulated and moreover are ren-
dered at reasonable cost. . . . The experience in that state
[Massachusetts] proves conclusively that the cost of ordinary
life insurance sold by the savings banks is lower than that of
ordinary life insurance sold by private companies. A compari-
son of the cost of savings bank insurance and of private indus-
trial insurance is even more advantageous to the savings banks.
In addition, the terms of the savings bank insurance policies



are in general more favorable to the policy holders than those
of the private insurance companies. ... I recommend that you
give consideration to the adoption of a law empowering the
mutual savings banks of this state to establish insurance de-
partments under public supervision.

A bill modeled on the Massachusetts measure, sponsored
by Senator Livingston, is now pending at Albany.



Anniversary

^ I ^HE U.S. Department of Labor has rounded out its



,.



first quarter century of work. The tenth of the execu-
tive departments of the national government, Labor came
into statutory life on March 4, 1913, after almost fifty
years of agitation for its creation. The anniversary was
celebrated by a dinner in Washington March 3, with the
Secretary of Labor presiding.

In the twenty-fifth annual report of the Secretary of
Labor, Miss Perkins reviews the record of the department
over the years in its efforts on behalf of reasonable hours of
labor, adequate annual income for wage earners, safe and
healthful working conditions, elimination of child labor,
"practical industrial relations" based on collective bargain-
ing, conciliation, mediation, and arbitration through gov-
ernment agencies. She added :

Labor policy in a democracy is not a program conceived by
a government but rather a program of action which wage
earners and employers must work out together in a society
which develops naturally out of the work they do and the life
they lead. The function of government is to serve as a stimu-
lating agent to facilitate the formulation of such a policy, a
policy that will be just and fair to all the people and in line
with human progress.

This has been the keynote of Frances Perkins' adminis-
tration of the department, which has brought it to alto-
gether new estate.

Plain Man's Way

IN a world of arrogant dictatorships and devious diplom-
acy, it is well to be reminded that common men going
their quiet way still hold to ancient values of honesty and
fair dealing. From the files of the division of placement and
unemployment insurance of the New York State Labor
Department, a press release brings a grist of letters from
workers covered by the insurance law. One man scribbled
on the margin of the official notification that he was eligible
for benefits of $12.50 a week for not more than six weeks,
"Sir: I declare myself ineligible for insurance. I was for-
tunate enough to get placed during my waiting period."
Another wrote:

Received your statement of unemployment insurance bene-
fits and I am sending it back to you and here is the reason
why. I was unemployed for six months and was called back to
work January 13, 1938 and the same day I notified the Em-
ployment Service office that I have returned to work. So will
you please stop the money which I was to receive for being
unemployed. I'm not entitled to it now and I thank you very
kindly.

A similar note reads: "On January 13 I went to work
for X . In case the check comes, I will return same."



78



SURVEY MIDMONTHLY



Paul Sitton, administrator of the division, reports thai
several hundred eligible applicants have taken this direct
means of halting benefit payments, although the matter is
also handled through the State Employment Service as
placements are reported. But regardless of routine proce-
dures, here arc workers, many of them with resources ex-
hausted by weeks or months of unemployment, others with
.1 heavy overhang of unpaid rent and grocery bills, troubled
lest they receive modest benefit checks for $5 to $15 a
week which, as one of them wrote, "would not rightfully
belong to me."

More for WPA

WITH a unanimity rare these days both houses of Con-
- approved the appropriation of $250 million for
the Works Progress Administration asked by President
Roosevelt early in February. Efforts to increase or reduce
the amount or otherwise to tinker seriously with the appro-
priation were rejected. This new quarter billion, added to
the funds already available for the current fiscal year will
enable WPA, its officials estimate, to add 500,000 workers
to the rolls immediately. A peak of 2,500,000 will be
leached this month, with a gradual reduction through the
late spring as seasonal employment picks up.

There has been as yet no indication of the size or direc-
tion of the federal relief program for the fiscal year begin-
ning July 1. It might be noted, however, that while few
congressional voices were raised against the new WPA ap-
propriation fewer still were heard in behalf of any renewed
federal participation in direct relief.

Oklahoma on the Carpet

TO Oklahoma goes the dubious distinction of being the
second state on which the Social Security Board has
cracked down publicly for its administration of public as-
sistance services under the social security act, though any-
one with an ear to the ground might have named several
other states as likely candidates.

The action of the board in summoning Oklahoma offi-
cials to a hearing in Washington and, on the evidence there
presented, of withdrawing further federal participation in
nee services until the state's house is put in order,
'will have salutary effect, it is believed, over the country.

Since April 1936, when Oklahoma began receiving fed-
eral Brants for old age assistance, aid to the blind and aid
to dependent children, federal funds to a total of $9,505,-
788 have gone into the state. All but $1,115,571 was ear-
marked for old age assistance. At the end of last year, the
Bureau of Public Assistance of the Social Security Board
made a study of the administration of the three services by
ite Public Welfare Commission. In late February, as
a result of the study, checked against audits and other in-
formation, the board called the hearing to determine wheth-
er or not further payments should be made. In his letter to
the Oklahoma officials Arthur J. Altmeyer, chairman of
the board, detailed "failure of substantial compliance with
essential conditions" prescribed by the social security act.
Awards, he said in effect, had been made, withheld and
changed without the application of a uniform policy as to
the determination of need. Records "purporting to establish
eligibility . . . are not accurate and entries made in such are
clearly at variance with the actual facts in a substantial num-
ber of cases. . . . The result of these practices is hardship
to the individual and the diversion of federal and state
funds from the purpose for which they were granted."

MARCH 1938



According to the most recent data available, Oklahoma
tops all the states in the number of old age beneficiaries in
relation to persons of sixty-five or over in the state popula-
tion 590 out of every 1000. Washington has 288, Mis-
souri 241, California 200, Massachusetts 192, Pennsyl-
vania 154, New York 130. In aid to dependent children,
Oklahoma with 37 per 1000 under sixteen years is exceeded
only by Maryland with 38. New York has 17 per thou-
sand, Pennsylvania 14, Missouri none. In aid to the blind,
Oklahoma, with 74 per 100,000 estimated total population,
ranks fourth, exceeded by Maine with 133, Pennsylvania
with 107, California with 82. In amounts of assistance
Oklahoma fell far below the national average. In assistance
to the aged the average grant in November for all states
was $19.22; in Oklahoma, $14.95; in aid to dependent
children, national average per family $31.98, Oklahoma
$15.85; in aid to the blind, national average $25.58, Okla-
homa, $16.72.



How the Wind Blows

IMMEDIATELY upon the heels of the American Med-
ical Association's announcement of plans to stimulate
local medical societies to study problems of medical care for
all the people [see Survey Midmnnthly, February 1938,
page 47] one of them, the Medical Society of Westchester
County, N. Y., adopted a resolution on the subject. Ad-
dressed to the AM A and to all county medical societies, it
called for "a logical, affirmative and progressive policy"
and said, in part: "We believe and assert that good medical
care can be made available to the poor and to persons in
the lower income classes through more rational economic
arrangements than have yet been developed. . . ." An ac-
companying article in the society's bulletin asserted that
"American medicine as represented by the AMA has con-
stantly opposed the development of and the conditions inher-
ent in state medicine without offering an alternative. . . ."

This was not to be construed, the society added, as ". . .
revolt against the authority of the AMA . . . but only as
an endorsement of the AMA action," and as going a step
further in "stating terms under which we feel medical
groups can safely assume leadership. . . ." Comment in
other publications, however, did construe it as everything
from "sharp criticism" to "prevarication."

Whatever else it may mean, as the official action of a
body of 650 doctors it constitutes a large and meaningful
straw in the wind of local medical society sentiment.

Admiral Gary T. Grayson

FOR the second time in three years the American Red
Cross has undergone tragic loss. Gary T. Grayson, who
in 1935 succeeded the late John Barton Payne as chairman
of the national organization, died in mid-February at his
home in Washington. Admiral Grayson brought to the
American Red Cross not only competence as an administra-
tor but the warm personality that had made him the friend
of three Presidents, and of a host of lesser folk up and
down the land. In his relatively brief span in his Red Cross
office he exercised wide influence not only in this country
but abroad through the League of Red Cross Societies
which he headed as chairman of the board of governors.

The quality of Admiral Grayson's leadership was appar-
ent last year in the great Red Cross program of flood relief
in this country. Its' last public expression was the appeal for
funds to aid the civilian war sufferers in China.



79



The Social Front



Relief



O ISING expenditures in public relief

L are not a new phenomenon in this
country. For twenty years before the de-
pression the curve had been steadily and
inexorably upward. The great increase,
in the depression years, was only a sharp
acceleration of a manifest trend. In
Trends in Relief Expenditures, 1910-35,
Research Monograph No. 10 of WPA's
division of social research, Anne E. Ged-
des has brought together a great mass of
data not hitherto assembled.

Prior to 1910 public relief bulked so
small that no useful statistics were com-
piled. But it appears that in 1911 sixteen
of the largest cities in the country ex-
pended $1,559,000 for outdoor relief in-
cluding operation and maintenance costs.
In 1928, with prosperity at its peak, these
same cities expended more than $28 mil-
lion. While there are no comprehensive
records of private relief or of total pub-
lic and private expenditures prior to 1931,
Miss Geddes concludes that the rise in
public far outran the rise in private ex-
penditures so that by 1929 private funds
accounted for barely a quarter of the to-
tal. "Since the assumption of a share of
the responsibility for relief by the federal
government in 1932 the proportion of the
burden borne by private agencies has been
very slight."

The rising curve of public expenditures
is not the only trend revealed in black
and white by Miss Geddes' painstaking
and scholarly study. She notes the "rise
of categories" through special legislation ;
the progressive tendency to widen the
base of governmental responsibility for
relief beyond local units; the new and in-
creasing importance of work relief. Less
obvious are the facts that prior to the
depression the most rapid expansion in
public relief occurred in aid to depen-
dent children; that the increase in both
public and private relief expenditures
has been far greater than the growth in
population; that the rate of increase in
public relief expenditures has greatly
exceeded that of all governmental expen-
ditures combined; that since 1932 the,
expansion in relief expenditures has been
relatively greater in rural and town areas
than in cities.

Miss Geddes finds little evidence that
in the past special aid to children, aged
and the blind has resulted in reduced
general relief rolls. There has been some
shifting of cases but "to a considerable
extent the special types of assistance have
tapped new reservoirs of need. The in-
flux of new cases to the general relief



rolls, combined with rising standards of
care, has largely offset such absorption as
has occurred."

Looked at one way Miss Geddes' study
is a most discouraging document reveal-
ing as it does the deep roots and persis-
tent growth of a problem only lately ad-
mitted to general public concern. In any
case she and her fellow researchers of the
WPA have performed a valuable service
in bringing the facts to light and in put-
ting them on the record.

What Happened A clear, simple ac-
count of the highly involved "business of
relief" these past several years is A Sur-
vey of Relief and Security Programs pre-



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