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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ports from physicians ; have isolated dangerous cases ; have
warned those who were in peril ; have condemned unfit habita-
tions or cleansed, disinfected and renovated those which could
be improved. Legislatures and councils have enacted police
ordinances and regulations to prevent spitting. The whole
movement to secure better dwellings for the poor,^ with neces-
sary light, ventilation and space, is in alliance with the anti-
tuberculosis crusade.

The C. O. S. of New York City in 1901 appointed a commit-
tee of 12 physicians and 15 laymen to prosecute the effort to
instruct the public. In one year 83 lectures were given and there
was an attendance of 6,290 hearers. Montreal, Washington, St.
Paul, New Haven, Cambridge, Scranton, Chicago, Boston, Phila-
delphia and other cities have followed the same policy.

Much that is done to prevent the adulteration of food, the
sale of decaying fruits and meats and impure milk, to secure
more ample space for parks and playgrounds, cheap excursions
and country outings, vegetable and flower gardens and open air
recreations has for its motive the prevention of enfeebling dis-
eases. The wardens and directors of prisons are laboring to
secure better light and ventilation in the institutions of correc-
tion which have long been notorious breeding spots for consump-
tion, especially where they are dark and crowded, and where
isolation wards and shops are not supplied. The managers of
theatres and other public places of amusement are beginning to
heed the warning of science ; medical men are urging churches
to have their edifices hygienically constructed, well ventilated
and without fixed carpets, and are urging clergymen to refuse
to lend their names to patent medicines, which are so frequently
made of cheap whiskey and dangerous ingredients. Newspapers
are exhorted to cease advertising these nostrums and quack

more on this important matter, write to the C. O. S. for information." Other
societies are doing similar work.

^ See DeForest and Veiller, The Tenement House Problem, 1903, and Tenement
Conditions in Chicago (City Homes Association Report, 1901).


remedies for consumption. Employers are urged to take proper
precautions in places of work, in factories and stores.

The anti-tuberculosis enterprise has inevitably become a
temperance crusade. Thus Dr. Knopf, one of the chief apostles
of this movement, says: "Concerning alcoholism and other in-
temperate habits, which are so often the forerunners of con-
sumption, I desire to speak plainly. ... I consider alcohol a medi-
cine, at times indispensable in the treatment of certain diseases;
but liquor as a beverage is never useful and nearly always harm-
ful. Alcoholism must be considered the greatest enemy of the
welfare of the nation, the most frequent destroyer of family hap-
piness, the cause of the ruin of mind, body, and soul; and cer-
tainly the most active cooperator of the deadly tubercle bacillus.
.... Alcohol has never cured and never will cure tuberculosis.
It will either prevent or retard recovery."

Certain trade unions, especially those of the garment workers,
have rendered considerable help to sanitary officers by investiga-
tions of their own ; and this is an important ally.

M. Casimir-Perier, formerly President of France, in an ad-
dress before the Central International Tuberculosis Committee
in 1903, said : "The struggle with tuberculosis is intimately
bound up with the solution of the most complex economic prob-
lems, and no plans will be complete which have not for their
basis the material and moral improvement of the people. The
struggle with tuberculosis demands the mobilization of all social
forces, public and private, official and voluntary."

In consequence of improved methods of dealing with con-
sumption the mortality from this cause has diminished since
1890. In the registration area the general death-rate in 1890
was 196.5 in 10,000 population, and in 1900 was 178.0 or 9.4 per
cent. ; while the death-rate from consumption fell from 24.5 to
19.1, — a decrease of 22.4 per cent. In the State of New York
since 1886 the rate has fallen 35 per cent. ; the deaths from 4.27
per cent, of population in 1881 to 2.5 in 1901.

During these years much thought, discussion and action have
been devoted to tuberculosis. The people generally have been
taught by medical men, boards of health and popular articles to
understand the nature and causes of the disease and modes of
preventing communication. Physicians themselves have a better


knowledge on the subject. The cities have been making a more
vigorous effort to secure better conditions of cleanHness, and
the means of sustaining vitahty have been improved. Improve-
ment has been 5 per cent, greater in cities than in the rural part
of the registration area.

J. Defectives. The Blind and the Deai.^ — The teachers of
the blind and of the deaf in the United States earnestly protest
against classifying their pupils among objects of charity. They
assert that the State acknowledges the obligation of giving an
elementary education to all children, and that the schools for the
blind and for the deaf are parts of the free public school system.
This plea is accepted ; and yet, as a matter of fact, these defects
do cause an expenditure for support which is a burden upon pub-
lic charity, and in adult life special measures are necessary to pre-
vent or alleviate the sufferings of the destitute.

The methods of instruction and training in the schools should
be considered rather in special works on pedagogy than in an
account of charitable systems.^

Defective Children in Public Schools. — There are great advan-
tages in retaining children at home so far as this is possible.
They need the care of father and mother and the companionship
and freedom of family life, especially during childhood. The
burden of support should fall primarily on the family and the
neighborhood of the home. The artificial life of the institution
is a poor preparation for the ordinary modes of existence. For
these reasons the public schools are gradually providing special
rooms and teachers for children who are slow, refractory, pe-
culiar, blind, deaf and crippled. Thus in Chicago (Report of
Superintendent for 1902) provision was made in 13 different
school buildings for 23 classes of deaf children, with an enroll-
ment of 192 and an average daily attendance of 148. The per
capita cost of instruction, including all current expenses, but not
including repairs and permanent improvements and incidentals,
was $103.97 ^oi" the school year, — or $135.15 for average daily

* By C. R. Henderson.

^ Education of Defectives, by E. E. Allen, in Education in the United States,
Ed. N. M. Butler, iqoo. Also, monograph distributed at the St. Louis Exposition,
1904. — G. S. Hall, Bibliography of Education, p. 254 ff. — W. S. Monroe, Bibli-
ography of Education, p. 82 ff.



attendance. Provision was made for blind children in three
different public schools, in three rooms, with 21 pupils, and
$202.35 per capita cost on enrollment. In two buildings 99 crip-
pled children were taught by four teachers, in rooms especially-
suited to their needs on the ground floor; and in the summer a
camp in the country gives them vacation enjoyments.

It is very gratifying to an American to read the favorable com-
ments of Europeans on our methods of teaching and caring for
children with defects of hearing. Professor G. Ferreri, after a
visit to America, praises the location, the buildings, the sanitary
arrangements, the dormitories, the methods of instruction and
the spirit of hope which are observed in our institutions.
"L'americano non discute mai quando crede di fare un' opera

The Insane. — The laws of the several States provide that an
insane person may be placed in an asylum for treatment, without
his own consent, if he is dangerous or even for his own benefit.
While all the States provide for the insane, private institutions
are also permitted to receive patients afflicted with mental dis-
ease, though not without State supervision and control. No per-
son can be deprived of liberty without judicial process. When a
State board of lunacy or of charities has been created these pri-
vate establishments are placed under central supervision ; the
qualifications of the managers are made the subject of inquiry;
the facilities of the house are examined; reports are required;
modes of treatment are studied ; and regulations for safety are
established. The general policy in the United States is to pro-
vide for all the dependent insane on grounds of public safety and
humane duty; to permit even those who are able to pay to use
the hospitals on the ground that as taxpayers they have con-
tributed to their support and have a right to their benefits when
required ; and to give full liberty to families of means to make
more comfortable provisions for their unfortunate relatives in
private institutions which are supervised by the State.^

It is still in doubt whether the number of the insane is actually

^ See Istituzioni americane per I'educazione dai sordomuti, F. Ferreri, 1903;
notice by P. Parise in Riv. Ben. Pubb., Feb., 1904, p. 148.

^ The law of commitment has already been mentioned above. See also E.
Freund, Police Power, p. 242 ff.




increasing in the United States. The statistics probably indicate
an increase somewhat more apparent than real because more
patients are sent to hospitals and the records of cases are more
complete than formerly. But there is no room for doubt that
the number of the insane who are dependent on public relief has
increased, and the financial burden has become one of the most
serious factors in State taxation, Massachusetts has kept good
records for over 40 years, and while in 1863 there were 1,900
insane paupers out of 6,000. in July, 1902, there were 8,497 insane
out of 16,324 paupers, an increase in ratio from one-third to one-
half. In six States of New England there are 19,000 insane in
a population of 5,800,000, or one to 300 inhabitants.

In i860 the total number of the insane, including idiots, was
48,824; in 1870, 59.677; and the ratios i to 728, and i to 637 re-
spectively. In 1889 the total number treated in both public and
private hospitals was 97,535- Dr. Maudsley's explanation of the
apparent increase in England applies to the United States.
There is no satisfactory evidence of an increase in the proportion
of cases of insanity to the population. The registration of the
insane is now more complete than formerly, the diagnosis of the
disease being better understood. The lower rate of mortality
accounts for part of the total amount of insanity.

Almost all the States have one or more institutions for the
treatment and custody of the insane, and many of these rank
among the best in the world and meet the highest requirements
of modern knowledge. But the provision remains inadequate;
institutions are often crowded ; acute cases are occasionally re-
fused ; indigent chronic patients are frequently sent back to rural
almshouses to suffer unspeakable misery from ignorance and

It would be unprofitable and apart from the scope of this
volume to enter into the medical technique of treatment of the
insane in the United States, since only the methods of social
organization and administration are here under consideration.
But there is one matter which relates to the professional side of
the subject that should receive attention of the public, the con-
nection between the merit system and the advancement of that
branch of medical science which deals with mental diseases. In
some way the people must learn that the most eminent service of


investigators cannot be given by a medical officer who is hounded
by partisan poHticians and who is uncertain of the tenure of his
office. The development of knowledge goes on only in quiet and
security. Fortunately in some States these offices are almost
entirely "out of politics," and the medical officers are fairly cer-
tain that they can go steadily on improving their methods and
perfecting their policies without rude and brutal interruption
from place-hunters.

The writer would be profoundly gratified if he could honestly
publish to the civilized world that this happy condition is true of
all States ; but with the evidence before him from repeated and
extended investigations he is ashamed to confess that in some
commonwealths the changes are frequent, unreasonable and de-
structive of all possibility of contributing to the science of psy-
chiatry or the art of curing or helping the insane. At the same
time the abuses are not quite so great or common here as in some
other branches of the public care of dependents, because the
dangers to the community are so obvious and terrible if the help-
less maniacs are entrusted to the incompetent. In some States
it remains true that every time there is a change in the party
strength, or even if a new faction of a party gains a victory over
the clique in power, all the sviperintendents and their corps of
assistants are given notice that their places are wanted for others,
and these others are frequently persons without professional
training for the positions.

The policy of providing for all patients by the State in Massa-
chusetts includes the following recommendations of the board :
hospital buildings for the acute, curable class ; industrial and
home colonies for the quiet, harmless and able-bodied insane ; in-
firmaries for the sick and the feeble ; buildings specially adapted
to the care and treatment of chronic patients who are disturbed ;
farmhouses for farm working patients ; tuberculosis pavilions ;
separate houses for nurses ; private residences for superintend-

The classes of persons who come under the supervision of the
Massachusetts Board of Insanity are the insane, the feeble-
minded, the epileptic and the inebriate. Gradually all the insane
will be removed from local almshouses to State institutions.
Private institutions must be licensed and supervised by the board.



The experiment of boarding out a limited number of harm-
less patients, carefully selected, in supervised families, is going
on under the care of the State Board of Insanity in Massachu-
setts. On September 30, 1903, 159 patients were in this cate-
gory. During the year 194 different persons were thus placed,
and the average number at one time 144. The total expenditure
was $23,050.84, and the weekly rate for public charges was $3.45.
There was no accident of a serious nature during the year. The
results in respect to improvement and comfort of patients are re-
garded as encouraging. Most of these patients are women and
are boarded with farmers or with widows in the country,^

The policy of Wisconsin is in contrast with that of Massa-
chusetts. This policy, which has had considerable influence in
other States, is one of county care of the confirmed cases of in-
sanity, but with supervision by the Board of Control. The re-
cent and supposedly curable patients are sent to the State hos-
pitals, but when it is thought that they are beyond recovery they
are sent to the county asylum. It is claimed that this plan is
economical, since the per capita cost is less than in a large estab-
lishment ; and it is also asserted by advocates of the system that
it is more humane, since the numbers kept together are smaller,
freedom of movement less constrained, and visits from relatives
and friends more frequent. Criticism of the method is very strong
in some quarters, and one reads complaints that supervision is
very ineffective where the small institutions are so numerous and
widely scattered. It is also claimed that the medical service
is defective ; that patients are sometimes abused ; and that super-
intendents trained to care for the insane are not and cannot be

Certainly the Wisconsin plan is far superior to that of many
other States where the pauper insane are confined in county poor-
houses without any kind of State supervision. Some of the de-
scriptions of such poorhouses are revolting in the extreme. As
there is not room in the State hospitals the dependent insane are
sent back to the counties from which they came to make room
for acute and curable patients. The number of the insane in-
creases so rapidly that the legislatures are slow to build enough

* Fifth Annual Report of the Massachusetts State Board of Insanity, 1904, p. 66,
Dr. Owen Copp, executive officer.


new hospitals to accommodate all, and thus there is no alternative
but to crowd the poorhouses with these helpless and often dan-
gerous patients. As the superintendents of these small estab-
lishments are without training for the delicate task of caring for
the insane, and as there are seldom competent nurses, the dis-
turbed and violent patients are often chained to a wall, or thrust
into a cell, or punished with whipping as if they were criminals.
In some instances the miserable county jail has been used for
the confinement of lunatics. Almost any kind of inspection by a
State board will improve these conditions in some degree ; but
even after many years of such inspection stories of barbarity re-
appear and shock the community, while many of the worst abuses
never come to the knowledge of the humane public. One thing
is made perfectly clear by American experience. State central
control, as well as supervision, is necessary to prevent the wrongs
sure to occur in local poorhouses and jails, unless the oversight
is extremely strict and eflfective.

State inspection of hospitals for the insane is a necessary
means of securing reliable service. This inspection is sometimes
made by boards of charities and sometimes by special commis-
sioners. Dr. D. H. Tuke stated that he found the medical super-
intendents averse, in many instances, to supervision of visitors
who were without medical training. He expressed the judg-
ment: "Some irritation and annoyance will almost inevitably
arise at times, in regard to advice tendered on points upon which
doctors ought to be, if they are not, better judges than their ad-
visers. But it appears to us that, officious and harassing as indi-
vidual members may sometimes be, such a board is of use, and
must certainly be continued until medical lunacy boards are intro-
duced ; and even then I should regard it as very desirable to
secure the unpaid services of the same class of men and women
as visitors, though no longer as commissioners. . . . Ladies may
prove invaluable in this way, for they often see the necessity
of certain comforts and changes which may escape the attention
of officials."^

Reception Hospitals. — Very general regret is expressed among
alienists in this country that many families fail to send their rela-
tives to a hospital for the insane until the psychosis is so far ad-

* D. H. Tuke, The Insane in the United States and Canada, 1885, p. 73.



vanced that cure is hopeless. The ordinary physician has httle
experience in the diagnosis of insanity, and people dread the dis-
grace of having a friend in the confinement of State institutions.
To remedy these evils it is proposed to have wards of general
hospitals in cities set apart for this class of patients, with trained
attendants and specialists in charge of the medical service. To
enter these wards of detention and observation a tedious and try-
ing legal inquisition would not be necessary. Patients would go
to them voluntarily. Some beginnings have been made already
in this direction, as at Bellevue Hospital, New York City ; Al-
bany, New York ; Philadelphia, and at the University Hospital
at Ann Arbor, Michigan.^

Fechlc-Minded and Epileptics. — Only in part has the difference
between the insane on the one hand and the feeble-minded and
epileptic on the other been practically acknowledged in the social
methods of the United States. It has not been very long since
they were all herded together in jails or almshouses, or left, if
harmless, to go about exposed to ridicule, outrage or cruelty. It
was an advance to establish hospitals and custodial asylums for
the insane, with whom idiots and epileptics were mingled. It
was a mark of further progress when special wards, pavilions or
cottages were assigned to epileptics. Now the process of further
specialization is urged by the National Conference of Charities
and Correction, by State conferences, by medical officers and b^
enlightened philanthropists, and the effects of this agitation are
to be noted. As the sun moves from east to west, so the progress
of a social idea may be observed to follow the direction from New
England westward, along the line of social development, migra-
tion and settlement ; only that now in the West and South inde-
pendent centers of original initiative are established and multi-

The earlier conception of work for the feeble-minded was
symbolized in the word "school," since it was thought that many,
if not most, of this class could be educated and trained for inde-
pendent life. It is still held that each child should have- ali the
help which can be given it to develop its limited and crippled
faculties, but the emphasis has come to be placed on the idea of
custody, segregation and prevention thereby of propagation.

^ N. C. C, 1903, p. 436, Drs. Spink and Herdmann.



Rarely are those who are seriously affected restored to civil life.
Those who wander about, or are given freedom of entrance to
almshouses, especially feeble-minded girls and women, are ex-
posed to grave dangers and evils. Generations of defectives re-
turn to the poorhouse and a source of contamination is kept open.
Social defence calls for the isolation and permanent custody in
farm colonies of all members of this class, and this claim is now
generally accepted, although the means of carrying out the right
conviction are given grudgingly by legislatures. The beliefs of
scientific minds must be more widely diffused before the back-
ward States can be brought up to the level of the more advanced.

The earliest movement in the United States on behalf of the
feeble-minded was made under the leadership of Dr. S. G. Howe
in Massachusetts, and the legislature of that State in 1846 appro-
priated $2,500 for an experimental school. New York followed
in 1851. A private school was opened at Barre, Mass., in 1848,
and it is still in successful operation. Pennsylvania established
a school at Germantown in 1853. The Ohio Institution for the
Feeble-Minded was created in 1857. Then followed Connecti-
cut, Kentucky (i860), Illinois (i860), Iowa (1876), Minnesota
(1879), Indiana (1879), Kansas (1881), California (1883), Ne-
braska (1887), Maryland (1888), New Jersey (1888-9), Wash-
ington (1891), Michigan (1895), Wisconsin (1897), North Da-
kota. Other States, as Colorado, New Hampshire and Maine,
have made progress toward providing training and asylums for
members of this unhappy class.^

The separate care of epileptics makes its way more slowly
than that of the feeble-minded, and their situation in most of
the States is still truly pathetic, especially when the jail is the
only place owned by the county where the dangerous patients
can be restrained. The almshouse, with its lack of medical care,
is but one shade better. The epileptics are not wanted by man-
agers of the insane, for they are a disturbing factor and render
recovery of other patients more difficult. Epileptics themselves,
in their lucid periods, feel the companionship of the insane and
of the feeble-minded to be irksome and, in a degree, humiliating.
The highest standards of science and of humanity require sepa-
rate treatment, and a few of the commonwealths have already

* Letter of Dr. A. W. Wilmarth. in Kly, Evolution of Industrial Society, p. 183.


shown the way for the others by estabHshing special hospitals
and colonies for epileptics.

The State of New York has taken an advanced position in
the care of epileptic patients. The Brunswick Home, incor-
porated in 1887, is a private charity. In 1902 it cared for 248
patients (epileptics, idiotic and paralytic), of whom "jy were pay-
ing patients and 171 were supported by public funds. But the
chief institution is at Sonyea, named from an eminent philanthro-

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 48 of 73)