Charles Richmond Henderson.

Modern methods of charity; an account of the systems of relief, public and private, in the principal countries having modern methods online

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Experience seems to have shown that there must be system-
atic cooperation between the Central Relief Association or
C. O. S. and the police, because so many street beggars are actu-
ally vagrants and should be corrected in a workhouse under
severe discipline. In order to discover what persons require to
be under the discipline of penal institutions the charitable asso-
ciations of cities are obliged to appoint special investigators who
are practically detectives and who follow up street beggars until
their habits and character are thoroughly known and evidence
for the magistrates is collected and presented, or the honest men
put in a way of earning their own living. In some cities this
special method of treatment has been introduced with encour-
aging results.

^ By C. R. Henderson. * E. Freund, Police Power, p. 99.


The municipal lodging house is a necessity in large towns,
and while it should be conducted in a fair and humane spirit, it
should be in close touch with the police. The wandering man or
woman is registered, cleansed in a bath, the clothing disinfected,
a comfortable bed is furnished, wholesome food is provided, and
the person is sent out to designated places to secure employment.
If employment is not sought, or is refused when found, the per-
son is summarily tried for vagrancy and sent to a workhouse.
In this way the search for employment is used as the work test.

While the United States government has exercised its sov-
ereign right to exclude persons liable to become a charge upon
public charity, the several States cannot interfere with the liberty
of citizens to travel where they will so long as they are not actu-
ally chargeable. When a person becomes dependent he may be
sent to the place of settlement and there required to remain,
under the control of the authorities.

It is impossible to secure accurate and reliable statistics of
the tribe of wanderers in the United States. We have no system
of registration of those who come and go as may be found, for
example, in Germany. The number naturally varies greatly
with the years ; in times of industrial depression many regular
workingmen mingle with the army of vagabonds and tramps and
sometimes form the tramp habit.

A careful recent study^ has brought out the causes of va-
grancy and methods of treatment in a very clear and forcible
way. Unwise philanthropy, bad systems of public relief, faulty
municipal administration, errors in methods of transportation
and the personal defects in character and training are cited as
the causes. It is said that there are 200 common lodging houses
in Chicago, 113 in Baltimore, 104 in New York, 106 in Philadel-
phia and no adequate supervision and control in any city.

Methods. — Wayfarers' Lodges : Mr. Marsh says of these : "Ade-
quate provision should be made for every respectable homeless
man to secure his board and lodging for a limited time while
looking for remunerative employment, in return for three or four
hours' work daily. This will involve in all cities of over 50,000
a Wayfarers' Lodge under private or public management, with

^ Mr. B. C. Marsh, in Annals Amer. Acad., May, 1904, p. 37.


compulsory bath and medical examination." In charge of these
cheap inns of the best type are men who take a genuine interest
in men and boys who are in love with vagabondage and who
seek to win them to the ways of regular industry. The sick are
sent to hospitals, the honest laborer is found employment, the
criminal is trained in a house of correction.

The experience of Chicago is cited. During 1901 the number
of homeless men and boys lodged in the police stations of Chi-
cago was 92,591, During 1902 the number lodged at police sta-
tions was 5,740. During 1902 the number lodged at the mu-
nicipal lodging house was 11,097; so that the decrease of the
number of homeless men and boys lodged at the expense of the
city was 75,754 in one year.^

Among the municipal measures employed with good results
are control of peddlers, schools and asylums for the blind and
crippled to keep them from street begging, supervision of lodg-
ing houses by the police and detectives, and the elimination of
habitual criminals.

In Massachusetts the State government has been establish-
ing reformatory measures which deserve study and imitation.
Mendicants are brought into court and released under suspended
sentence on probation. The condition of the release is that the
holder of the permit does not return to his former habits of
vagrancy and dissipation. Drunkards are committed to the State
Farm and when discharged are placed under the care of proba-
tion officers.

The probation officer is an essential factor in dealing with
vagrants set at liberty on condition of leading a right life. Fifty-
nine volunteer probation officers serve the State of Massachu-
setts, and the number of vagrants on the State Farm has dimin-
ished from 42 per cent, of all inmates in 1892 to 16 per cent, in

The application of the Bertillon system of measurement and
identification has not yet been made to vagrants, though it has
been proposed. We have still to look to the future for uniform
legislation in all the States, and the adoption of measures of

^ The horrors of the police station stone floor as a lodging place are depicted in
W. A. Wyckoff's The Workers (The West), p. zi-



inspection and oversight which are already in successful opera-
tion in some commonwealths.^

H. Medical Relief of the Poor.^ — In the poorhouse of each
county the i-nmates are ordinarily treated by a medical officer
who is paid a fixed sum by the year or a fee for each visit, ac-
cording to a contract. As the poorhouse is usually at a distance
from towns this service is occasionally very imperfect and suf-
fering results. It seems certain that neglect of dental work is
a cause of much misery among paupers, although this is a topic
rarely thought of or discussed.

Paupers are attended in their homes by the "poor physician,"
who is not seldom the same person who visits the inmates of the
poorhouse. He is generally a young man, fresh from the med-
ical college, to whom the practice, the small salary and the dis-
tinction of a modest office are the considerations. In the large
towns and cities this outdoor medical relief is more systematically
ordered and connected with the outpatient departments of public

The census of 1890 gave the total number of patients "in
benevolent institutions in hospitals" as 22,473 (12,990 males, 9,483
females), of whom 11,690 were in the North Atlantic division,
1,404 in the South Atlantic, 6,302 in the North Central, 1,611 in
the South Central and 1,506 in the Western. Of course this
exhibit for a single day's registration gave an imperfect notion
of the total annual number of patients treated.

Hospitals. — The tables collected by Burdett indicate that the
finances of hospitals in this country are so managed that they
seldom run into debt and pay interest, and it is said in explana-
tion : "This is very satisfactory, because it indirectly proves
that the interest felt by individual citizens is constant and
considerable. It further indicates that the financial management
is on the whole satisfactory, although the fact that the majority
of the hospitals are rate-supported may account in some measure
for the circumstance to which we refer."

As to the cost of treatment Burdett says: "The highest cost
per in-patient per diem at a general hospital in the United States

^ See Proceedings of National Conference of Charities and Correction, 1904,
for further discussion.
* By C. R. Henderson.



of America is that at the Johns Hopkins Hospital, Baltimore,
namely, $2.25 or 9s. 3d, Dividing the other hospitals into two
classes, those with 200 beds and over, and those with under 200
beds, we find that in the former class at the Lakeside Hospital,
Cleveland, the cost per in-patient per day was $2.18 or 9s., at the
Pennsylvania University Hospital, $2.12 or 8s. 9d. ; at the Roose-
velt Hospital, New York, $2.01 or 8s. 4d. ; at the Hartford Hos-
pital, $1.90 or 7s. lod., and at the Western Pennsylvania, $1.68 or
6s. iid. ; while at the other end of the scale is the Pennsylvania
Hospital, with $1.24 a day or 5s. id." In the second class the
highest amount is expended at the St. Luke's Hospital, San
Francisco, $1.90 or 7s. lod., and the lowest at the Garfield Me-
morial Hospital, $1.31 or 5s. 4d.^

The cost of maintaining hospitals has greatly increased of
recent years. An officer of a metropolitan hospital has said that
in 1871 the average cost of each patient per diem was $1.01
and in 1903 had come to be $2.08, including all expenses except
improvements in the plants. This increased cost per diem is
due chiefly to the higher prices for food and other necessaries,
to the greatly improved methods of treatment, the higher stand-
ards of care, and the better wages paid for nurses. The aggre-
gate sums expended have been increased because the cities are
larger, the houses are more crowded and unfit for the treatment
of many medical and almost all serious surgical cases, and be-
cause there are more persons in need of charitable help during
sickness in the great centers of immigrant population.

In consequence of this heightened cost many urban hospitals
on private foundations are in a serious financial condition and
compelled to face curtailment of service in the face of increasing
need. Mr. Frank Tucker showed that the deficits of twenty
hospitals in New York City in 1902 aggregated $432,368.78, and
he stated that there were grounds for fearing that the deficits
were often met by taking from the principal of productive funds,
a policy which must before long be ruinous.

Several proposals have been made for improving the situa-
tion, but these suggestions are by no means altogether consistent
with each other. It has been urged that more dependents be
treated in their homes and thus obviate the necessity for enlarg-

^ Burdett's Hospitals and Charities, 1903, p. 161.


ing hospital service. Others who think hospital service is even
now inadequate think that immense endowment funds must be
raised so that the interest on these funds will cover the de-
ficiencies. The experiment has been tried of charging even poor
persons a small fee, when it is possible for them to pay, but this
cannot be carried far without excluding those who most need
medical aid. Others insist that cities and counties should at least
pay the full actual cost of dependent patients treated by private
institutions ; but this would be, so far as it went, public and not
private charity.

Meantime municipalities are extending their medical and sur-
gical care of the indigent sick and thus narrowing the field of
benevolent institutions.^

Dispensaries. — The medical dispensary is thoroughly established
in the cities of the United States. The poor are attracted to it
for advice and medicines because it enables them to secure com-
petent physicians, and many are utterly unable to pay the cus-
tomary fees. The physicians are ready to render gratuitous serv-
ices from various motives, as philanthropy, the desire to advance
the interests of their science and art, the love of distinction, the
necessity of having clinical material for their instruction as
teachers in medical schools, and the chance to advertise them-
selves as practitioners. The extent to which dispensary prac-
tice is carried is indicated, though not accurately exhibited, by
the results of investigations in Philadelphia and New York City.
In Philadelphia it was found in 1903 that there were 61 dis-
pensaries devoted to the relief of the sick and injured, more than
half of which were connected with hospitals. In 42 of the dis-
pensaries 305,980 cases were treated during 1902. In New York
876,070 patients were treated during 1900. There is a manifest
tendency to increased use of the clinic.

The public is interested both in the philanthropic service and
the scientific and professional results of the clinics. "It is often
to the advantage of the Community that persons able to pay a
small fee should be treated without further return than their will-
ingness to serve as subjects for demonstration for classes of med-
ical students. It is a strong argument for confining free dispen-
saries to teaching institutions."

^ See Charities, Jan. 2, 1904.


The chief evils of the dispensary of which physicians and
other competent observers complain are : the use of the clinic by
persons who are able to pay fees, and the consequent loss to the
income of regular practitioners ; the pauperization of persons who
thus get something for nothing; the negligent treatment of
patients which arises from the attempt in crowded dispensaries
to handle many persons in a short time.

One of the most significant attempts to keep the free dispen-
sary while minimizing the abuses is that of the State of New
York. A law provides that all dispensaries shall be licensed by
the State Board of Charities, and this board has power to inspect
Hcensed dispensaries and, after due notice, to revoke licenses
if the public interest seems to require such action. All emer-
gency cases must be admitted and receive prompt care and treat-
ment. All applicants who are thought to be needy are treated.
If there is reason to think the patient may be able to pay, an
investigation is made and the results recorded as a means of
checking future imposition. A further safeguard is the clause
which requires the patient to sign a statement of his condition
and makes it a misdemeanor to record a false statement.^

One of the serious defects in medical relief in rural communi-
ties is the absence of proper hospital facilities. Persons of
wealth can be taken to city institutions if their physical condi-
tions admit of transportation. But in numerous instances it is
not safe to move the patient and in cases of poverty the means
are lacking. Indiana, by an act of the legislature (March 4,
1903), has authorized the establishment and maintenance of hos-
pitals by boards of county commissioners, either with or with-
out the aid of hospital associations. Indigent patients may be
sent to such hospitals on the certificate of the township trustee,
who is the relieving officer. Pay patients may be received and
charged ordinary rates for such service. Indigent patients may
be received from other counties for a payment of cost, and two
or more counties may unite in erecting a hospital. Private phy-
sicians may send pay patients under regulations of the board.

It is very common in certain States for the Catholic sisters
to establish a hospital in a city or town of moderate size, man-
age it with great industry and economy, add to its wealth and

^ F. B. Kirkbride, Annals Am. Acad., May, 1894, p. 16 ff.



buildings from the profits on pay patients, gifts and subsidies
from the poor-relief fund, and in a few decades build up institu-
tions of the first class.

Red Cross Society.^ — The Red Cross Society came into existence
at Geneva, Switzerland, in 1866, when thirty-nine of the leading
nations of the world signed a treaty making neutral in war all
hospitals, their stores, physicians and attendants, promising pro-
tection to the latter who remained on the battlefield caring for
the dead and wounded, and making obligatory upon the members
of the society impartial care for every soldier of whatever nation-
ality. Under this treaty societies were formed in each nation,
with a National Committee at Geneva, with a common purpose
of ameliorating the condition of the sick and wounded soldiers
in time of war.

When the United States joined the Federation in 1884 under
the leadership of Miss Clara Barton the purpose of the society
was extended to include aid given in time of national disaster.
The terms of the treaty were then made to embrace the follow-

(a) In each country there shall be one national central so-
ciety to which the auxiliary societies in that country shall be con-
tributory, the central society being the medium of communica-
tion for all within the seat of war and with medical authorities.

(b) The societies shall in time of peace keep themselves
constantly prepared for war, thus securing permanency of organi-

(c) During war succor shall be extended to foe equally with

(d) Societies whose countries are at peace may give relief
to the belligerent armies without being considered as violators of

In the United States the work of the Red Cross has been
mostly done in time of national disaster, and the public have
come to depend upon the association as a medium for distribu-
tion of its contributions during such times. The most memor-
able services of the society were rendered at the time of the floods
of the Mississippi and Ohio rivers, the Michigan forest fires,

^ Written by Miss Ashcraft. See "A Story of the Red Cross," by Clara
Barton, 1904.


Texas famine, Charleston earthquake, the cyclones at Mt. Ver-
non, Illinois, and Pomeroy, Iowa, Florida yellow fever, Johns-
town disaster, Russian famine, the Armenian massacres, the
Cuban Reconcentrado wars and the Spanish-American War.

Tuberculosis. — The social movement to contend against this
"white scourge" of mankind may be regarded as typical, for con-
sumption is a communicable and preventable disease which di-
rectly affects the community, causes pauperism, diminishes indus-
trial efficiency, increases the burden of taxation and calls for
charitable assistance on a grand scale. The war on consumption
will teach the nation how to deal with pneumonia, diphtheria,
skin diseases, etc., and will inspire hope of success.

Tuberculosis is one of the most serious causes of misery in
the United States. One-tenth of all deaths are due to this cause ;
in the large cities the proportion ranges from 7 to 15 per cent.
About 100,000 die annually in this country from this cause. Dr.
Herman M. Biggs has estimated that the total annual loss to
New York City from this disease is at least $23,000,000, and that
the loss to the United States must be more than $330,000,000.
Here is one of the causes of pauperism and one of the chief tasks
of philanthropy. Sickness is said to be the cause of poverty in
at least one case out of four, and a lingering disease like con-
sumption, especially as it is likely to fall on the bread-winner,
becomes a specially heavy burden.^

The fundamental factor in this hopeful crusade against one
of the chief causes of misery is the advance in medical science,
the discoveries in relation to the nature and causes of tubercu-
losis made in pathological laboratories, hospitals, dispensaries
and practice. Social statistical investigations of the phenome-
non in relation to age, sex, race, marital condition, occupation,
dwellings, income, etc., have made important contributions.

Philanthropy has allied itself to the medical profession and
furnished resources for the wise action of experts in the heahng
art. Hospitals and sanatoria have been built by benevolent
persons, associations, religious bodies, cities, commonwealths
and the nation.

Mr. Henry Phipps gave $1,000,000 for the founding of an

^Lilian Brandt, The Social Aspects of Tuberculosis, in Handbook on the Pre-
vention of Tuberculosis.



institution for the investigation, cure and prevention of tuber-
culosis. Four cities (Cincinnati, Boston, New York and Buf-
falo) have erected municipal hospitals. Pennsylvania has a sani-
tarium in its forests. Massachusetts and 9 other States have
sanatoria. Cook County, Illinois, in which Chicago is situated,
has an isolated building for pauper consumptives on the grounds
of its almshouse.

Dr. S. A. Knopfs has given a partial list of sanatoria and hos-
pitals for consumptives in the United States, which shows that
such institutions exist in California, Colorado, Connecticut, Illi-
nois, Iowa, Louisiana, Maryland, Massachusetts, Minnesota, Mis-
sissippi, Missouri, New Mexico, New York, North Carolina,
North Dakota, Ohio, Pennsylvania, Texas and in Canada. These
are supported by fees of patients, private benevolent associations,
churches, counties. States, and by the general government.

Mr. Homer Folks, when Commissioner of Public Charities in
New York City in 1903, made a study of the cost of a municipal
sanatorium for tuberculous dependent patients. Estimating the
cost of land at $250 per acre he concluded that an institution for
500 persons could be provided at a cost of $450,000. In regard
to expense for maintenance he fovmd wide variations, from
seventy-five cents to $1.42 per diem. He thought the expense
of maintenance in a municipal hospital might be about $1.00 per
diem, including cost of food, clothing, bedding, salaries, medical
supplies, light and fuel, and ordinary repairs. Where there is
good land for vegetable garden, dairy and light farming the cost
may be somewhat reduced by utilizing the labor of the inmates.

Philadelphia has erected, at an expense of $80,000, a hospital
constructed of steel and glass, with roofs and walls so arranged
that they can be opened on hinges. New York has built a sana-
torium with 20 beds in the Adirondack mountains for the treat-
ment of incipient pulmonary tuberculosis. The New Hampshire
legislature in 1903 voted $5,000 to aid poor consumptives in a pri-
vate establishment. New Jersey gave $100,000 for a State hos-

By means of dispensaries, clinics and out-patient service of
hospitals many ambulant cases have been helped or cured and
made less dangerous to the community. District nurses' associa-

^A Handbook on the Prevention of Tuberculosis, 1903, pp. 357-9.


tions have sent their missionaries of health among the poor and
ignorant, have mitigated suffering and stayed the spread of the
terrible scourage.

In Chicago the anti-tuberculosis movement was organized
in 1903 by the Visiting Nurse Association by the appointment of
a committee of persons representing the medical profession and
the educational, charitable, social and industrial movements in
the city. District physicians examine and treat all cases of con-
sumption coming to the notice of the visiting nurses or the Bu-
reau of Charities. The physicians' headquarters are the twelve
district offices of the bureau, and a visiting nurse is assigned to
each physician, to care for the cases under his direction. Care-
ful records are kept of the clinical history and the material sur-
roundings of each case in order to locate infected districts that
these may be carefully investigated. By means of lectures, tracts
and circulars popular instruction is given.

• Charitable aid to the sick and to their families has made it
possible for men to remain away from work until they could
recover strength or has transferred them to occupations not too
severe and to surroundings more favorable to improvement.
Philanthropy, by means of diet kitchens, has provided nutritious
food at low cost or gratuitously, and gathered the money to pay
for medicines and nursing in homes.

Benevolent enterprise has taken the form of preventive meth-
ods, through the cooperation of public and private agencies.
Myriads of publications, weighty with the high authority of emi-
nent names of physicians, have been scattered among the people.
Notices have been fastened to the walls in public places and in
street cars. The people have been warned that consumption
is a disease which spreads from person to person ; that it is chiefly
caused by the filthy habit of spitting; that it is a disease which
may be stopped ; that people are seldom born with consumption,
and that it is caused by a very small living thing whose name
is "bacillus tuberculosis;" that these germs fall upon the earth
or floors where one spits, are carried by dry dust to throat and
lungs, and then set up the deadly malady. Men are instructed
that strong drink and all forms of dissipation enfeeble the body
and make it more liable to contagion.^

^And the New York Charity Organization Society adds: "If you wish to read



Charitable societies in cities have provided lectures by med-
ical men in schools, clubs, churches and elsewhere for the
instruction of the people. Boards of health have exacted re-

Online LibraryCharles Richmond HendersonModern methods of charity; an account of the systems of relief, public and private, in the principal countries having modern methods → online text (page 47 of 73)