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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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indigent.

The insistence upon the regulation that no one shall be treated in
a hospital when it is possible to administer relief to him at home is
upon economic and moral grounds. Lists of persons eligible for this
aid are made by a commission whose duty it is to arrange such lists.
When it becomes impossible to treat the sick one properly at home,
the attending physician must certify to this and state clearly the rea-
sons which necessitate hospitalisation.^ This certificate must be coun-
tersigned by the president of the bureau of relief, or the "maire" (un-
less he be the physician) or some one delegated by him. The recruit-
ing of physicians for this public service is fraught with difficulties.
The funds are limited. At present two systems are in vogue : ( i )
The prefect designates a physician who shall have charge of the sick
poor in his locality, and he is responsible for all whose names are on
his lists. (2) Any physicians who accept the conditions of the public
service are considered relief physicians, and those in need of care may
select from these the one they prefer. Local conditions determine the
method in use.

To be entitled to medical treatment, the petitioner must have a
"domicile of relief." This domicile is acquired by: (i) Residence;
(2) birth; (3) marriage. The length of residence must be at least

^Article i. 'Larrive, I'Assistance Publique en France, p. 13.

° Circular of the Minister of Interior containing instructions for the enforc-
ing of the law of free medical aid.



534



MODERN METHODS OF CHARITY



one year in the commune. Children are considered as having the
domicile of the father, or, the father being dead, that of the mother.
In cases of separation or divorce, the child takes the domicile of the
parent to whose care he has been committed. The wife takes the
domicile of her husband from the day of her marriage. The domicile
of relief is forfeited by an uninterrupted and voluntary absence of a
year( military service or absence in a hospital or asylum is not in-
cluded).

Dispensaries. — Free clinics are maintained in many of the hos-
pitals and houses for aid, and dispensaries are maintained throughout
the country. These are directed by the Department of Public Relief
with the aid of the local bureaus of relief.^

Hospitals. — These are of two classes: (i) General, — designed
for the treatment of all maladies ; (2) special, — for the care of certain
specified diseases.

In Paris there are 15 general hospitals for adults and two for chil-
dren, and seven special hospitals for adults and four for children.

For administrative purposes Paris is divided into "circonscrip-
tions hospitalieres," and according to his domicile, one is assigned to
a hospital. Since 1880 provision has been made for incurable adults.
A commission examines all requests for admission at its monthly
meetings. Incurable children are cared for also if their parents can
justify their state of need. Contagious cases are treated in isolated
rooms or wards. The isolation of consumptives is only beginning to
be practiced in France. Ordinarily the hospitals receive into their
maternity wards women on the eve of accouchement and keep them
only about ten days. Public opinion is now agitating for an exten-
sion of time in the interests of humanity and the increase of popu-
lation. Outside of the hospitals medical attendance in maternity
cases is furnished at home. Licensed midwives are sent out by the
bureaus of relief.

"L'Ecole des sages-femmes" is maintained in order that mater-
nity cases may be properly cared for. Tuition was originally free,
but now is paid by those who can afford it.

In 1898 there were in France 1,708 hospitals of all kinds main-
tained at a cost of 133,914,343 francs. Many of these more than
make their own expenses from private patients.

^ Derouin, Traite Thcorique et Pratique d'Assistance Publique, Vol. I, p. 365.



FRANCE



535



It is important to note the very great improvements that have been
made in the hospital service since 1872. After this date came their
rather startHng change from a rehgious to a purely sectarian basis.
The great hospitals in Paris are now a part of L'Assistance Publique.
It was not until 1881 that the municipality substituted trained nurses
for religious sisters and opened regular professional training schools
for nurses. Members of sisterhoods are now found as nurses only
in a few hospitals where their presence is demanded by the terms of
the gifts and bequests.

Care of Convalescents. — Some years ago, it was seen that the
poor, upon leaving the hospitals after certain serious illnesses, and
.sick persons cared for at home, nearly always require at least a few
days' complete rest before they are able to resume work. To meet
this need convalescent homes have been established. They are few in
number compared with the hospitals, because the necessity is less
urgent. Yet they are significant in that they represent a recognition
of a social need. There are, besides the two great national asylums
at Vincennes and Vesinet, some smaller institutions of this kind which
owe their existence to private initiative. The two public institutions
were created at the same time, by a decree of March 8, 1855, and were
opened about two years later. The grounds are spacious and beauti-
ful and the buildings of the best construction and ample in size. As
they are doing practically the same work, a discussion of the former
will be sufficient to indicate the general method. At Vincennes the
following classes of persons are admitted for convalescent treatment :
(i) Those injured or stricken with sickness while engaged on public
works. (2) Those connected with certain mutual aid societies. (3)
Those working in the homes of specified persons. (4) Patients leav-
ing the hospitals or sent by the bureaux of charity. This class in-
cludes by far the largest number. (5) Persons sent by special au-
thority of the Minister of the Interior, either upon payment of a fee
or to be cared for gratuitously. The institution is under direct au-
thority of the Minister of the Interior, and is administered by a board
consisting of executive officers and a medical staff. From 1857 to
1899 there has been an average annual attendance of over 8,000.
The number received in 1899 was 8,873.

The French government maintains a hospital in London, and in
1894 accorded a subvention of 100,000 francs to establish a convales-
cent home at Brighton.



536 MODERN METHODS OF CHARITY

Since 1891 the Societe des Grands Magazins du Louvre has had a
country home for convalescing or worn-out employes of the big shop.
In the year 1899 fifty-seven men and women were cared for.

Tiiherciilosis. — The first French sanatorium for adults was erected
by a society in Lyons in -1900. In 1901 the public relief authorities of
Paris opened a sanatorium, and the Conseil de surveillance ordered
separate hospital wards to be set apart for consumptives. In many
departments societies have been founded to establish sanatoria.

Cities, as Lille, Bordeaux and Paris, have begun to give dispen-
sary help in homes and other relief as needed. L'ocuzre dcs dispen-
saircs antitnhcrcxdciix in Paris had two dispensaries. The Oeuvre de
la tuhcrcuJosc hnmaine and the Oeuvre antitiihcrculcuse care for pa-
tients at home and send the curable to the country. In ]\Iarch, 1902,
a federation of anti-tuberculosis societies, 66 in number, was formed,
M. Brouardel presiding.

Training of Nurses. — A circular of the Minister of the Interior,
Oct. 28, 1902, directs the commission of administration to further the
work of preparing nurses for their duties, as a necessary factor in
carrying out the law of gratuitous medical relief.^

Hospitals. — The new director (1901), M. Monnier, in charge of
public relief in Paris, began his duties by calling attention to needed
reforms in hospitals, the increase of room and the building of isola-
tion pavilions for treatment of contagious diseases. Three new
children's hospitals were completed in 1901. He recommended the
employment of women instead of men for nurses, and the provision
of domestic servants for all common labor. M. Monnier died Aug.
19, 1902, and was succeeded by M. Mesureur.

School for Mothers. — In 1892 was established in Paris the first of
the Considtations de Nonrrissons, of which there are now 28 in Paris
and many in the cities of the provinces. They are connected with
hospitals and dispensaries or supported by private charity. The
mothers bring their infants to the class, when the little ones are exam-
ined and weighed, the mothers are taught how to feed and care for
them, and, when necessary, sterilized milk is provided.^

J. Care of Defectives, Public and Private. — The Republic of
France recognizes a special duty to the defective, more particularly

^ Zeit. f. d. Armenwesen, January, 1903, p. 17; M. Riviere.

'La Revue Philanthropique, February, 1904, article by Dr. Budin.



FRANCE 537

to the mentally defective members of society, and in this as in other
forms of charitable work we find a combination of public and private
control, individuals or societies furnishing the funds and the state
directing. The principal institutions are now under the direct con-
trol of the state.

Blind. — The first definite effort to relieve the hardships of those
deprived of sight dates back to 1227, when the Hospice National
des Quinze-Vingts was founded by Saint Louis. About this time a
number of blind people had formed themselves into a kind of mutual
aid society near the Palais-Royal. The king became aware of this
and was so moved by their misery that he built them a house and
ordered that it should always be used as a permanent home for needy
blind people up to the number of three hundred, and so originated the
above named institution. It is now classed among national charitable
institutions, and as such comes under the direct control of the Min-
ister of the Interior. Through changes and reconstruction, it has
remained true to its original principles, and still has three hundred
resident pensioners. But in addition to this, it extends aid to many
non-residents by means of clinics, consultations and other advice, and
in numerous ways renders aid to these unfortunates.

The school for the blind was a much later development, and we
find the first one in the world established in France in 1784 by Valen-
tin Haiiy. This institution gives intellectual and technical instruction
ranging all the way from arithmetic to history, and from agriculture
to sewing. Children are received between the ages of ten and thir-
teen years and are kept as long as may be necessary to complete the
course of study. Louis Braille, the inventor of the Braille system of
instruction for the blind, was for years a pupil and later a professor in
this national institution. There is a Braille School in Paris doing a
notable work for the education of the blind. One rather unique insti-
tution gives only technical or professional instruction, and candidates
for admission must be: (i) Totally blind; (2) between the ages of
eighteen and forty years; (3) of good health, and have special apti-
tude for the work.

In all the many institutions the most scientific methods are in use,
and the pupils go out ready to support themselves if need be. And
societies exist to aid the student in finding work. Instruction of this
kind has made remarkable progress during the past century, and the
indications are that a greater advance will yet be made.



538 MODERN METHODS OF CHARITY

Deaf Mutes. — Education of the deaf mutes naturally goes hand
in hand with that of the blind, for the need is equally apparent. The
earliest institution for the training of deaf mutes mentioned in his-
tory was founded in Paris in 1760 by Abbe I'fipee. It seems fitting
that France should take the lead in this as in the training of the blind.
In this school, from its inception, very young children have been re-
ceived. They are taken as early as six years of age, and taught lip
reading of short, easy words. In addition to this they are given other
simple tasks. At the age of nine, the education proper begins, and
this includes the usual school branches and the useful arts. The cost
is nine hundred francs a year, but there are always available scholar-
ships for the needy.

Another school, the national institution for deaf mutes in Cham-
bery, was founded in 1841. Its purpose is the same as the one just
described. The intellectual training includes articulation and lip
reading as well as the instruction usually given in primary schools.
The technical training, which is obligatory, includes, for boys : Agri-
culture, gardening, shoemaking, carpentry and tailoring; and for
girls, dressmaking, mending, knitting, embroidery, crochet work, lace
work, laundry work and all kinds of domestic work.

Besides these two, there are numerous institutions attempting
practically the same work and accomplishing equally good results.
Deaf mutes are thus enabled to take their place in society as useful
citizens. To aid such as must earn their living, a society was formed
in 1897 to help them find employment.

Insane. — Under the insane may be classed all types of mental
weakness, as institutions are organized on a sufficiently broad basis
to make possible the care of all. The insane poor are objects of spe-
cial care by the state when relatives are unable to support them in
suitable institutions. There is at Charenton a lunatic asylum founded
in 1641 and reconstructed between 1838 and 1845. This is under the
immediate direction of the national government and is open to pa-
tients from all parts of the Republic. It is regarded as a model insti-
tution for the care of mental diseases. Its ample funds make pos-
sible the organization of numerous divisions, each of which has
charge of a particular mental malady. Every effort is put forth to
make the inmates as comfortable as possible and suitable work and
entertainment are found for them. All other institutions for the
insane are local foundations. The law decrees that each of the



FR-\N'CE



539



eighty-seven departments must either provide a suitable place for
those of unsound mind, or make an arrangement, subject to the ap-
proval of the Minister of the Interior, with some other department to
assume this care. These institutions are supported by the depart-
ment and contributions from the various communes in which patients
lived, and these funds defray the expenses of inmates when relatives
are too poor.

Anyone desiring to establish a private asylum must obtain the
sanction of the government. A person applying for such a license
must be : (i) Of good moral character, and (2) a doctor of medicine
or have a medical man in charge. A thorough system of inspection
exists, and both public and private asylums are periodically inspected
by a committee composed of the following persons: (i) Prefect of
the department: (2) president of local tribunal; (3) local procurer of
the Repubhc; (4) judge of the peace; (5) mayor of the commune.
The public asylums are under the supervision of a committee of five
appointed by the prefects, and this committee holds meetings monthly
or oftener if necessary.

Patients are consigned to asylums in two ways : ( i ) Compul-
sory. Dangerous lunatics are placed in asylums for the protection of
the public, whether their friends are willing or not. (2) ''Placement
volontaire." In this case relatives or friends apply for admission.
Such application must be accompanied by a medical certificate given
by a physician who is not a relative. Patients are always accessible
to their friends, and a peculiarity of the French lunacy laws is that a
patient or his friends may claim discharge at any time before a civil
court.^

In 1892 a colony for family care of insane women was opened at
Dun-sur Auron and in 1900 at Ainay. a neighboring village, a colony
for men. The authorities had studied the systems of Berlin, Gheel
and of Scotland. The patients are carefully selected by medical men,
surpervised, and are comfortable and contented. They have been
transferred from closed asylums. -

Insane Convicts. — By an order of the ^Minister of the Interior,
after Jan. i, 1903, one wing of the old central prison of Gaillon was

^ In 1896 there were 64.522 insane persons in asylums, 1,862 of these were in
private establishments.

"Miss Julia C. Lathrop, National Conference of Charities and Correction, 1902,
p. 188 ff.



540



MODERN METHODS OF CHARITY



to be used as a public establishment of poor-relief, and so pass from
the administration of the prison to that of the public poor and sanitary
authority. Here are to be treated : ( i ) Convicted persons who
have become insane during incarceration ; (2) those who during trial
are found insane and are therefore not convicted; (3) inmates of
ordinary asylums for the insane who are declared by physicians to be
dangerous.^

K. Treatment of Children. History. — The custom of aban-
doning children was always common in France as in other countries
and during the Middle Ages it became a veritable curse which neither
rules nor edicts could check. In the 14th century the favorite place
for abandoning infants was at the church doors, where they were sure
to be found later and cared for in some way. For although parents,
for various reasons, cast away their children, it appears that they
hoped that they might live, only with the burden of care and support
transferred to other persons. Thus at this early period we find insti-
tutions of various kinds opened for the care of the helpless little crea-
tures whom Christian people could not leave to die from exposure.
In the larger cities it was customary to place cradles at the church
doors for the reception of such children, and the mere sight of these
led charitable people to give generously to the institutions which
cared for them. This, then, was the first stage in the development
of the highly organized system of the present. During the i6th
century we find infants deposited in hospital entrances, and this
raised a new problem, for it was manifestly impossible for such insti-
tions to assume what proved to be a great additional expense. From
this need developed regular foundling asylums, and the 17th century
saw the establishment of a large number of such institutions. In the
i8th century infants were exposed on the streets and open places in
the effort to conceal the identity of those abandoning them. The
risk of being seen at asylum doors was great, and so parents resorted
to this infinitely more inhuman method of abandonment. As a rem-
edy for this growing evil, turning boxes were placed in the walls of
hospitals in obscure places, and there children were deposited. At-
tendants within had only to turn the box to take out the child, and
they could have no possible knowledge of the person without, pro-
tected as he was by windowless walls. This method, which was

' Zeit. f. d. Armenwesen, 1903, p. 15 (M. L. Riviere).



FRANCE 541

adopted by all the hospitals, and even extolled by a decree of 181 1,
fell into disuse by the middle of the 19th century, and the last turn-
ing box in France disappeared about thirty years ago. One of the
evil consequences of such a system was the creation and development
of a gruesome industry conducted by persons (meneuses de tour)
whose business it was to go about through the villages and country to
gather children whose parents wished to dispose of them, and carry
them to the turning box of the nearest hospital. The promoters of
this business reaped rich financial rewards, as their services were in
great demand. A system making so simple the desertion of children
naturally increased this particular crime, and it was abandoned none
too soon for the good of the coimtry and its morals. But the experi-
ments of generations paved the way for modern methods of dealing
with the great problem of child desertion.

Public protection of infants in the modern sense was instituted in
France by the law of December 23, 1874. Outside of the official
state protection thus guaranteed, many private institutions are doing
notable work. According to the law of 1874, every child under the
age of two years which is cared for, for hire, outside of the home of
its parents becomes an object of public guardianship in order to pro-
tect its life and health. Legislators believe that an antidote for the
decrease in births is to be found in lessening the number of deaths,
and so justify themselves for the far-reaching rigidity of the law. It
can readily be seen that such a law properly enforced would have
great social value, and to this end the administration is invested with
power to attach penalties for evasion or non-enforcement.

As a further protection to infants, the Society of Maternal Lac-
tation, organized in 1876, provides necessities for a nursing mother
when her need has been established. This aid is of two kinds : (i)
Each month a certain quantity of food and clothing is given to the
mother; (2) milk is furnished to the child when a physician declares
the mother's supply to be insufficient. Between the years 1877 ^"^
1898 the society aided in one or both of the above ways 36,427 infants.

In addition to this there are many other societies doing practically
the same work as the ones indicated, and from the aims of all of
these one learns that France is making vigorous efforts to save her
children. All such societies are supported by public funds, supple-
mented by private donations, and are administered by the state
through boards.



542 MODERN METHODS OF CHARITY

Institutional Care. — We find in France a great number of insti-
tutions, both public and private, for the temporary care of chil-
dren, and their purposes and methods are adapted to the particular
class the institution aims to help. One such institution in Paris re-
ceives : (i) Indigent children ; (2) morally abandoned children ; (3)
children whose parents are ill in a hospital, or under quarantine, or
sentenced to imprisonment for not more than six months; (4) a cer-
tain number of children of both sexes arrested for vagabondage or
petty offences and sent there by the magistrates; (5) sick and needy
children from the country who cannot be given proper care at home ;
(6) sick children brought for the purpose of consultation with physi-
cians and surgeons, and whose condition is so serious as to demand
immediate attention. Large numbers of these various classes are
cared for each year and the character of the care given is a tribute to
the worth of the institution.

The "Oeuvre de la Chaussee du Maine" is designed for children
whose mothers are ill at home or in a hospital, and thus unable to give
needed maternal care to their offspring. Boys are admitted from the
age of six months to six years, and girls from six months to fourteen
years of age. The time limit of attendance is from fifteen days to
four months. It is only a temporary asylum. A charge of one franc
per day is exacted, except in the case of chilldren admitted by a sub-
scriber, who can always recommend that no charge be made.

Another institution, unique as well as useful, is "La Maison Ma-
ternelle" in Paris, founded in 1891 by private beneficence for the pur-
pose of caring for the children of wage earners incapacitated by ill-
ness or lack of employment. Boys from three to six years of age and
girls from three to twelve are admitted ordinarily for a period not
exceeding three months, although in special cases an extension of
time is allowed. There is no provision made here for sick children, —
they are sent to the children's hospital, — but the well are taken care of,
and sent each day to the primary or parish schools, according to their
age. In this way the institution strives to fill temporarily the par-
ents' place, but in no sense does it try to usurp that place, as every
effort is made to keep parents in touch with their children in residence.
The institutions cited are merely types of those effectually aiding
needy children in France. Many thousands are helped each year by
such organizations, and they amply justify their existence.

Day Nurseries. — Creches or day nurseries are established to aid



FRANCE 543

working mothers in the feeding and care of their children, for it
is not always possible for a woman to take her child with her to her
place of labor. This is possible only in household work by the day,
and even then it is not always possible, so philanthropic people saw a
vast field of opportunity opening to them in providing places where



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 55 of 73)