Charles Richmond Henderson.

Introduction to the study of the dependent, defective, and delinquent classes, and of their social treatment online

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likely to trust them as solid and enduring corporations, whose
continuity of life does not depend on the conduct or pres-
ence of any particular person. The most substantial corpora-
tions, after all, are those of municipalities and commonwealths;
and the citizen always has a claim on these, while his connection
with particular firms or companies is accidental. This argument
points to government sick insurance. The functions of boards
of health may be extended to cover part of this field.

9. The Training and Service of Nurses. — Trained nurses are

- Medical Charities. 133

essential to the efficiency of hospitals and to medical and surgi-
cal treatment of the poor in their homes. The training schools
for nurses originated in charity hospitals. They have prepared
and sent out missionaries of health into many communities. A
new and honorable profession has been opened to self-supporting
women. In consequence of this charity those who are rich can
enjoy the aid of efficient attendants in illness, and thus they owe
it a debt.

Physicians and surgeons can treat patients with far greater
precision and certainty of results than was possible in the former
days of ignorant, stupid, and cheap nurses of the "Sairey Gamp "
pattern. Women trained to observe carefully, to use thermome-
ters and other instruments, to keep exact and faithful records,
and to carry out instructions intelligently, furnish a scientific
basis for the study and treatment of disease.

Hospitals which enjoy the service of skilled nurses become
more popular with the public, draw to it more pay patients,
attract the clients of physicians, and in many ways increase the
income of the institutions they so efficiently serve. For these
reasons hospital boards can afford to deal generously with training
schools and nurses.

Support of Nurses in Charity Work. — Voluntary service is
attracting attention. Either as members of religious guilds, or
by agreements among the graduates of particular schools, young
women are found willing to consecrate a week or more of each
year to gratuitous care of the poor in their homes. This is very
beautiful and useful, but it is necessarily limited in steadiness,
reliability, and extent. Besides, that is a very cheap philanthropy
which is willing to lay an undue share of the burden on the
devoted young persons who represent a church, bring honor to
its charity, and make all the sacrifices.

Another method is becoming common in America: trained
nurses are paid wages or salary by a voluntary association, and
are expected to support themselves and be independent. If the
families assisted are able to pay a part of the expense, this

134 Relief and Care of Dependents.

income goes to enlarge the work of the society among the indi-
gent. This form of support is most acceptable to many American
women, who desire to retain their personal independence and
be free to make changes in their life plans without the embar-
rassment of vows or contracts. It is the natural form of
organization for a non-sectarian association.

Siste7'hoods and Orders. — There are several sisterhoods and
orders devoted to this form of philanthropy. The deaconesses
or sisters give their whole time to the service, without salaries,
wages, or fees, except pocket money. They are supported by
funds of the community to which they attach themselves, are
cared for in sickness, and are provided with a home in old age.
Pay patients supply part of the. funds, their fees going to the
treasury of the order, or mother house, and not to the individual
nurse. This method of support is common in Europe almost
entirely with religious societies of various denominations. The
candidates are not received into full membership until they have
been tried in a period of probation and training, and then they
either take vows for life or seriously choose this for a vocation
without vows.

Fefision Funds. — It seems highly desirable, considering the
value of the service to society, the constant exposure to contagious
disease, the exhausting nature of the employment, and the uncer-
tainty and irregularity of employment, that a pension fund should
be established for sick, disabled, and aged nurses. The English
Royal National Pension Fund furnishes an admirable example.
To avoid danger of neglect and insure economy on the part of
nurses who depend on this fund, it might be required of those who
are earning wages that they make quarterly payments of moderate
sums, on the principle of insurance against sickness and old age.
, The endowment would be a contribution of society in recompense
for services of a public nature.

Training School for Nurses. — The candidate for instruction
should be a mature woman of vigorous health and more than
average strength, with at least a high school education, and some

Medical Chanties. 135

practical experience in cooking and housekeeping. She must
have steady nerves, tact, and considerable powers of endurance.

The training school must be connected with a well-equipped
hospital, which has a sufficient variety of medical and surgical
cases; and provision must also be made for dealing with obstet-
rical patients. The school should be a distinct department, with
an organization of its own, although it may be under the general
control of the hospital board. The immediate direction of the
pupils should be with the superintendent of the school, who is
herself a trained nurse, and who is endowed with the qualities
of an executive officer.

Very necessary is a suitable and comfortable home for the
pupils, outside of the hospital. The weary apprentice student
should be free from the harrowing sights, the unpleasant sounds
and odors of the sick room each day, long enough to rest and
gain the cheerfulness and energy which are required by her
exacting and exhausting task. Young women of the best type
cannot be induced to submit to the miseries and discomforts of
unfit lodgings. If this matter is neglected, only those of defec-
tive education and low standards of taste can be secured as

The course of instruction, given by means of text-books,
lectures, and clinical practice, includes the theory of the profes-
sional art of a nurse. The final examinations may be given, and
certificates or diplomas awarded, by a committee or board of
lecturers, composed of medical men and the superintendent of
the school.

The physician or surgeon has entire control of the treatment of
each individual patient, and his orders and prescriptions are the
law of the nurse; but the superintendent of the pupils should
have control of all discipline, and all failures should be reported
to her by the physicians. Any interference with her power is
fatal to the good order of the house.

District Nursing is an important branch of social service. The
trained nurses not only personally attend patients, but also, and

136 Relief and Care of Dependents.

chiefly, instruct the members of the families to take care of each
other. Parents cannot be taught the arts of hygiene merely by
tracts, books, and lectures. They require exemplification before
their eyes and in their own homes. To combat the evils of " dirt,
drink, diet, damp, draughts, and drains, "the advice and example
of a trained visitor are of the highest value. Florence Nightin-
gale, the apostle of nurses, says, " In all departments of life there
is no apprenticeship except in the workshops." It would be
impossible, and it is undesirable, to remove all the indigent sick
to hospitals. Most cases can be treated better in their homes
and by members of the family, if they are taught and shown how
to do it.

Perils and Safeguards. — We have elsewhere considered the
danger of pauperizing patients by free service. Another evil
accompanies philanthropic nursing like a shadow : the authoriza-
tion of incompetent persons by associations and city missionary
societies. There is a real danger in the mixture of two callings,
that of Bible readers and that of district nurses. Incompetence
will bring injury and reproach upon religion. If a deaconess
loses a patient by forgetfulness in critical hours, all her zeal in
proselyting or converting will only add to the dislike against the
church which she represents. Devotion, skill, success, gentle-
ness, sacrifice, humanity in all its finest expressions, will open
the way to still higher ministries. It would be more exact to
say that these qualities speak distinctly the highest message. It
is the duty, as it is the interest, of all religious associations to
send none but thoroughly trained and reliable nurses to represent
them in the sickrooms. Competent physicians will not tolerate
or respect any other kind; and it is the physician who gives
reputation to the work of the nurses.

One evil of no small magnitude is the overworking of nurses
in hospitals and outside. Pupil nurses should not be on duty
more than eight hours in one day, for they need time for rest,
recreation, and study.

The spoils system has not left the sacred ministry of hospitals

Medical Charities. 137

untouched by its foul fingers. Miss Dock has told of the trial
and the triumph : " These are the schools which, by the courage
and goodness of women preeminently, have been affixed to those
hospitals that need them most and want them least, the city or
county hospitals, where local politics grow at the expense of the
neglected sick poor, in all ugliness, contemptuous of disinter-
ested work, and hating to be interfered with. Individual ability
and determination alone have made it possible to force the puri-
fying influence of the training school into these places; for it
may safely be asserted that in no instance has the political ele-
ment of any municipal hospital ever voluntarily introduced reform
into the nursing, or yielded to it save on irresistible pressure
brought to bear from outside by those who had no political capi-
tal to make, who feared no one, and who were determined to

10. First Aid to the Sick and Injured. — Societies are organized
for the study of the best methods of meeting emergencies in case
of wounds, shocks, sunstroke, poison, in situations where a phy-
sician cannot at once be summoned. Herbert Spencer, so hos-
tile and cold toward many forms of organized charity, approves
this method of philanthropy. They are helpful to all citizens,
but are especially useful among the poor. Policemen and fire-
men should receive systematic training to prepare them to meet
emergencies of this kind. Any young physician, with some
leisure and few patients, might advertise himself in an honorable
way and gratify his humane feelings, by organizing boys' clubs,
miners, dock workers, hod carriers, and other groups of persons,
into associations for prompt assistance in emergencies.



1. Principles of Division of Labor between Public and Private
Charity. — ^ Public relief is relatively preferable when demanded
by public opinion as the duty of the community, when it can be
reduced to routine, and when the functions of administrators can
be formulated in laws or regulative rules.

Private relief is specially called for where experiments are to
be tried and pioneer work is to be done; where public opinion
requires education by example of new methods; where the
mechanical routine methods of public relief need to be supple-
mented by personal service, by individual gifts or helps of a pe-
culiar kind; where public provision is totally lacking or obviously
inadequate for relief and support; where particular groups are
more directly reponsible for certain classes of persons, as reli-
gious denominations, races, or neighborhoods; where there is
special danger of pauperization by public relief; where the sense
of degradation occasioned by dependence upon public help is
unusual, mental distress may be inhumanly aggravated, and the
spirit of self-help be broken.

2. Individual Charity. — The personal gift or service is most
direct, human, and natural. In personal charity the relation
may be made most like that of the family or of neighborly friend-
ship. The best help is that which is rendered as a social act
between real friends. Assistance offered with the evident pur-
pose of humiliating the recipient and of exalting the patron is
not of charity, but of pride; it curses him who gives and him
who takes; and it is not the gentle dew from heaven, but poison-*
ous exhalation from the lowlands of selfishness. Friendly help

Voluntary Charity. 139

in hours of trial does not degrade either party. Only noble
natures can give aid nobly, and then goodness is beautiful and

Individual charity is exposed to perils of its own. The act of
benevolence may be private and hidden, but the effects are cer-
tain to become public and social. In almsgiving at the door or
on the street lies one of the chief causes of vagrancy and low
imposture. He who gives blindly, ignorantly, and thoughtlessly
is as culpable as one who fires a gun into a crowd. There are
tramps because so many people give without investigation and
without cooperation. In cities it is more difficult than in rural
communities to learn the actual needs of those who beg. No
citizen has a moral right to give to strangers without using the
mediation of some bureau of information, like those of the
Charity Organization Society, which has records and means of
investigating and testing all applicants.

Fields of individual benevolence are many and wide. The
circle of friends and neighbors among the poor should be wide
enough to include some less fortunate than ourselves. Every
prosperous person should have real acquaintances among the
Have-Nots, and know them all the year around, and care for
them, and have their confidence, and learn from them. Often
a loan with counsel is better than a gift. The best help to the
depressed is fellowship in thought, wisdom, and sympathy.

The circle may be widened by service as a friendly visitor, as
missionary, or teacher in a Sunday-school. Frequently is it true
that those who have little surplus income, and themselves feel the
pressure of narrow circumstances, can best impart aid to suffer-
ing and discouraged neighbors, a lift that is worth more than
gold. There is work for all who are willing to labor.

Large sums, which only rich persons can give, are most useful
in establishing and endowing institutions, as hospitals, dispensa-
ries, schools, and libraries. In experimental charity, preventive
schemes, and educational beneficence, individual munificence
finds its safest field. Large communities are not easily led to

140 Relief and Care of Dependents.

consider swiftly changing conditions and needs; while far-seeing
business men, if they give study to our problems, or take expert
advice, may carry the weight of public tasks until the voters are
educated to appreciate the need and the remedy. Examples are
numerous and increasing: the Peabody Fund, for housing the
poor and for educating the negroes; the Slater Fund; the Pratt,
Drexel, Cooper, and Armour Institutes. The societies for pre-
venting cruelty to animals and children, the societies for aiding
discharged prisoners, kindergartens, day nurseries, manual train-
ing and trade schools, must generally be started and sustained by
individual givers.

3. Benevolent Associations ; Adaptations to the Situation. —
The requirements of destitution are usually too great for the
resources of individual beneficence. Combination of forces and
means makes possible enterprises which would fail if they rested
on a few persons. There are some kind persons who can give
money, but not service ; while others have time and strength and
disposition to visit, but have limited wealth. An association
brings these varied talents together. A group or a community
can unite for a charitable purpose, if ecclesiastical tests are set

A permanent and continuous service and policy are practicable
only by means of an association which is strong enough to com-
mand public confidence. Legal incorporation is frequently
required in order to secure and retain title to real property or
endowments. The rich patron may organize an incorporated
association to administer his charity after he is dead.

The situation in many cities demands a discriminating and
versatile agency to supplement the relief given by public officials.
Many indigent persons would suffer even to starvation or suicide,
rather than be compelled to associate with paupers in a public
office, have their social failure bruited abroad, and their names
recorded in a public register as weaklings. Self-respect is social
wealth, and it may be preserved by delicate and private offer of
loans or other temporary aid.

Voluntary Chanty. 141

The usual mode of organization includes the formation of a
voluntary association composed of members who contribute a
certain minimum fee or contribution. This general body, at an
annual election, chooses a board of directors. This board of
directors usually have an executive committee, a financial com-
mittee, and various standing committees on special branches of
work. A voluntary force of helpers, hardest of all to secure and
keep at good work, is required where friendly, personal service
is called for. The business direction is assigned to persons of
special training; and these must have a salary, if the duty
requires all their time. In small communities all offices may
be filled without salaries.

Fields of Operation. — All kinds of philanthropic activity
are carried on by such associations : relief of the poor in their
homes; indoor relief in almshouses or asylums; homes for
dependent, crippled, and defective children; homes for the
destitute and friendless aged, and for defectives who are not
cared for by the commonwealth; aid to the unemployed; medi-
cal charity, hospitals, nursing, dispensaries; cooperation in
charity organization, state conferences, and national societies.

Perils. — Such associations are so easily formed that there
is a temptation to multiply them unduly. There are only too
many professional philanthropists who "promote" societies
which, after they are started, must forever after be supported in
order to save the credit of the community. Thus it happens
that several societies exist in the same field and compete for
patronage, while various forms of need are neglected.

Relatively less deserving societies often absorb the available
charity resources of the community by their loud and persistent
advertising and solicitation. The expenses of management are
out of proportion to the volume of work actually accomplished.
Pauperism is encouraged in order to prove to the benevolent and
unsuspecting public that there is a need for the society, and
especially for its secretary, who has a salary. The promoters of
a charity may be quite as desirous of securing a respectable and

142 Relief and Care of Dependents.

lucrative position for some broken-down citizen as relief for a
group of destitute persons. Occasionally the most distinct
achievement of the association is the payment of an unearned
salary to an incompetent officer.

Private benevolent associations sometimes attempt to carry on
a work with inadequate income; and the result is imperfect care,
wasteful methods, injury of the poor, disgust of the public.
When charity comes to be recognized as having a basis in social
science, and as requiring the highest gifts of inventiveness and
pedagogical tact, it will be placed in more competent hands,
and the officers will be more highly honored and paid.

4. Financial Principles. — There are legitimate methods of
securing support. Full and candid publication of all that the
patrons and supporters ought to know in order to form a judgment
of the need, extent, and results of administration is required by
honesty and sound financial policy. These reports should be
attractive in form and style, though not extravagant in cost.
The use of photographic illustrations is valuable when used with
skill. All regular means of public communication may be
employed for securing attention, as meetings, illustrated lectures,
dicussions in clubs, circulars, personal letters, newspaper and
pulpit notices.

The directory of charities should be compiled and published
once a year, if practicable, by a representative committee of the
Charity Organization Society, and not by the interested agents
of the several benevolent associations; and this directory should
contain a careful and reliable statement of the objects, resources,
official staff, banker, income, expenditures, and other items which
enable the public to act intelligently in supporting and using the

The only unobjectionable and the most effective method of
securing means of support is to present all the facts to the pub-
lic, in all legitimate ways, and then ask people for contributions.

There are also illegitimate and demoralizing schemes. Any
method fails, however it may for a time draw out money, when

Voluntary Charity, 143

it fails to educate the community in genuine charity, sound prin-
ciples of work, and when it appeals to low and unworthy motives.
There always remains a question and a scruple about using for
charity the funds which come from the proceeds of entertain-
ments, plays, and balls. A more refined age, with a keener sense
of pathos and humor, and a more vivid imagination, may come
to read with pain the accounts of the shocking contrasts between
the gay and brilliant displays of the so-called "charity ball " and
the tolerated miseries which the fund is intended to relieve.
Sorrow and shame should not thus be associated with the mock-
ing images of splendor, extravagance, and ostentatious luxury.
Let the occasion of mirth justify itself, but never be masked as
a pretence of heaven-born charity. The indirect methods are
often so costly that the expenses swallow up the income. The
permanent dignity and value of the charity depend, not only on
the use made of the income, but also on the motives to which
appeal is made in securing it.

While something very plausible may be urged, in our present
defective civilization, in favor of such questionable modes,
absolutely nothing can be argued in favor of raising money by
gambling, lotteries, and kindred devices. Gambling habits are
already among the chief causes of pauperism and crime, and
they need no stimulation from the example of fashionable sets
and reputable church people.

5. Charity Aspect of Social Settlements. — The residents of
settlements naturally and properly object to classifying settle-
ments among "philanthropies" and "charities," on account of
the popular ideas connected with these offensive words. The
settlement does not work specifically for the defective and the
dissolute, but rather more for the furtherance of normal life
among self-respecting and self-supporting people, who scorn
dependence and ask only for justice. Here we have to do, not
with proud patronage of superiors toward inferiors, but a sincere
and democratic sharing and fellowship in the best things of life
among the neighbors of a given locality. The leaders wish to

144 Relief and Care of Dependents.

be thought of in this way. If the home should come to be
regarded as a charity, only the depraved and defeated would visit
it, and the residents themselves would be unfitted, subjectively,
for their peculiar task, by the narrowing of their aims to mere
rescue and relief of persons in the lowest stratum of society.

And yet, fellowship with a neighborhood involves relief of
suffering, direct and indirect, since all classes of neighbors are
considered, and none are rejected. So we find, as a matter of
fact, that the settlements are frequently the centres of the wisest
movements of rational charity. Settlement residents are in the
best possible position to study the facts, the causes, and the deep
effects of poverty, distress, and of philanthropic methods.
Cooperation with all available agencies of the community is a
fundamental principle of the movement. Hence we find the
residents rendering valuable aid to the Charity Organization
Society, the agents of public relief, and private charity. They
discover instances of distress which others overlook. They
bring rich and poor into personal contact, and they train friendly

6. Ecclesiastical Organization of Charity. — No fast line can
be drawn between ecclesiastical and other forms of voluntary
benevolence. This is especially true in the United States,
where there is no overshadowing state church, and where there

Online LibraryCharles Richmond HendersonIntroduction to the study of the dependent, defective, and delinquent classes, and of their social treatment → online text (page 12 of 35)