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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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582 MODERN ^lETHODS OF CHARITY

that smaller and cheaper lodging houses must be provided to meet
the needs of a still lower stratum of wandering men.^ The Prinio
Alloggio Popolare at Trieste, erected by the general Council of
Charity, has provided a beautiful lodging place at a cost of 30 cen-
tesime each night, or even 24c. if paid a week or a month in advance.

H. Medical Relief. — The union of science and charity in the
cure and prevention of disease finds beautiful and impressive illustra-
tions in Italy. In 1898, including 20 children's hospitals, with 4,130
patients, there were counted 1,208 general hospitals with 426,766
patients. In 1885 there were 1,117 institutions with 335,255 patients.
The rate of mortality fell in the same period from 11. 7 to lo.i. The
hospitals are very unequally distributed : the largest number is at
Rome, — 34.8 patients to 1,000 inhabitants ; Tuscany, 24.5 ; Lombardy,
21.99; while Abruzzia had only 0.14, Basilicata 0.15 and Campania
0.26. In rural communes there is great lack of hospital service. In
lower Valtellin there is only one hospital to 25 km.

For maternity cases provision was made in 1898 in 13 special
establishments, in addition to 18 foundling asylums and 104 maternity
wards in general hospitals. The total number January i, 1898, was
870 inmates, and in the course of the year 16,567 entered (15 in 1,000
of confinements). But averages are misleading, if taken for very
wide areas, since in the southern provinces there is little provision for
maternity cases. The mortality rate is 1.6 per cent, in the hospitals
and 0.31 outside, but the report partly explains the fact by saying that
a very large proportion of the women who go to hospitals have reason
to expect difficult confinement, or are tmmarried mothers whose situa-
tion is peculiarly depressing and trying.

In the spring of 1900 the Minister of the Interior proposed the
draft of a law which should require the hospitals to receive sick per-
sons without circumlocution or delay. Out of 1,197 hospitals he
stated that 893 receive patients without regard to their residence, and
the bill proposed to require all hospitals to do the same throughout
Italy. The mayor or police could give order for the reception of
destitute patients, and in emergency cases the hospital might receive
at once and secure formal order afterwards. The cost of care of
dependent patients was to be paid to the hospital by the commune
where the patient has legal settlement; and the bill defined a legal

^ Riv. Ben. Pubb., 1902, p. 447 ff and p. 716.



ITALY



583



settlement for this purpose as the place where the person has hved for
two years, or the birthplace, or the habitual residence. The Con-
gress of V'enice in 1900 approved this bill. The bill did not provide
for increasing the number of hospitals. The report accompanying
the text showed that the accommodations for the sick are more
meagre than in other advanced countries. In Italy there were 13.8
receptions to 1,000 inhabitants; in Prussia, 18.08; in Bavaria, 21.96.
The rates of mortality were 9.9, 6.9, and 4.2, the reason for the higher
rate in Italy apparently being that the institutions were inferior, and
that the space being inadequate, only those dangerously ill were taken
to them.

The municipality of Padua in 1902 sought to extend relief of the
sick in their homes by furnishing medical advice, medicines and sick
diet. The results were satisfactory and the pressure on hospital facil-
ities was reduced. The municipal authorities were able to make
proper arrangements with druggists as to price and quality of medi-
cines.^

The hospital Maria Vittoria was the first to be established in Italy
for diseases of women and children. It owes its foundation to the
initiative of Dr. Joseph Berruti, seconded by the generosity of Prince
Amedee of Savoy, duke of Aoste. The hospital was opened to the
public in 1887 with only 12 beds and without endowment, but the in-
telligent work of the surgeons soon brought the institution to the
attention of the community and improvements were made. The
establishment has come to possess seven groups of buildings with 80
beds for women and 40 for children, and its property is over 500,000
lire. Both charity and pay patients are received. There are three
grades of payment for those who are able to pay : those of the first
class pay 10 lire a day, those of the second 5, and those of the third 3.
In the period between October 10, 1887, and December 31, 1899, the
hospital received 4,837 women and 946 children. More than half of
the sick persons were operated upon, and with such happy issue that
the mortality has been less than 3 per cent. All the halls for the sick
in the pavilions are provided with arrangements for surgery, with the
best modern appliances; and nursing, general supervision, laundry,
kitchen are under the care of sisters. Consultations and medicines
are furnished gratuitously at the hospital for those who may be cared

^ Riv. della Ben. Pubb., Jan., 1903, p. 46,



S84



MODERN METHODS OF CHARITY



for at home. The expenses in 1899 were 91,728 Hre, and these ex-
penses are met by voluntary contributions and payments of patients.
The institution was approved by royal decree of February 26, 1887.
It is administered by a council of nine members. The business man-
ager is directly responsible to the president of the council of admin-
istration.

Tuberculosis. — Italians have entered with commendable zeal and
intelligence into the movement to combat the ravages of consumption.
Before 1899 there was one sanatorium at Nervi, in addition to sana-
toria for children. By a ministerial order of May, 1897, the isolation
of tuberculous patients in hospitals was required. In 1899 the Na-
tional League against Tuberculosis was founded by Professor Gio-
vanni under the presidency of Baccelli, with its central office at Rome,
and it carries on its work through publications and discussions. The
Minister of the Interior, May 15 ,1899, requested the prefects to aid
all such efforts, and early in 1900 he offered a prize for the best plan
of a model sanatorium adapted to the needs of 100 patients, 50 men
and 50 women.

The Congress of Hygiene which met at Como in September, 1899,
discussed the topic; and the Congress of Charity in 1900 urged the
erection of sanatoria in all the provinces. Funds have been provided
for hospitals, and at Padua one was built with 30 beds and one for 100
incurables. In Milan a public subscription secured the erection of a
large institution, and for Naples the Sanatoria Filangiere was built.

Red Cross. — The international agreement of Geneva (August 22,
1864) was approved by royal decrees in Italy September 23, 1865,
It provided for a distinctive uniform and flag for the protection of
persons engaged in caring for the wounded and sick in war. The
law of May 21, 1882, provided for the incorporation of the Italian
Association of the Red Cross, relieved it of the ordinary supervision
of charitable societies, placed it under the control of the Ministry of
Army and Navy, and gave it free use of postal, telegraph and railway
service in time of war.^ By decree of May 31, 1896, the government
established a commission for deciding questions relating to the privi-
leges of agents of the Red Cross and abuses of these privileges. The
Red Cross Society in Italy in 1899 had 24,000 members, 363 sub-
committees, 682 communal delegates, a property of 6,474,674.23 Hre

' G. Saredo, Codice della Beneficenza Pubblica, pp. 432, 627.



ITALY 585

(capital of 4,188,917.98 and materials of the value of 2,285,756.27
lire). In the war between Spain and the United States, in South
Africa, and in China, this society has carried on its healing mission.
In times of peace it has improved hospital service, trained nurses, and
helped the victims of malarial fever.

The need for instruction in first aid to the injured created the
Samaritan School first at Turin in 1883, which was transferred to the
Red Cross Society in 1889.

In 1901 the Cassa Nacionale infortuni reported 20,247 accidents
to laborers, with 230 cases of death, 711 of permanent disablement,
and 19,306 of temporary disablement, and the fund contributed aid to
the value of 1,748,645.48 lire. Perhaps as many more, not connected
with this fund, suffered from accidents. These figures are an argu-
ment for the organization of classes in methods of first aid to the sick
and injured, and they have been influential in this direction.^

Two great plagues of Italy are the diseases of pellagra and ma-
laria. The government as early as 1888 passed a law forbidding the
sale of the defective maize (grantnrco) which causes the malady of
pellagra and increases pauperism by destroying industrial efficiency.
Paoli Doneti declared that the two diseases arise from a common
cause ; that the immature, innutritious, easily decaying maize grows in
the low, swampy places where malaria also originates ; and he de-
clares that the government could best strike both evils at once by
draining and redeeming the soil and restoring it to agriculture.^

By a law approved March 30, 1902, the government made ar-
rangements to furnish quinine gratuitously, or at reduced cost, to
laborers living in malarial regions and suffering from the fever, the
distribution to be made through communal officers and charity coun-
cils.^

J. Care of Defectives. The Blind. — The friends of the blind
have protested against the laws which classified these unfortunate
members of society among the incompetents, and have sought to give
them the juristic position of normal persons, unless serious mental
defects are proved in addition to loss of sight.*

^ Riv. Ben. Pubb., 1902, p. 156 (address of Dr. C. Galliano).

'Ibid., 1902, p. 229.

^ Ibid., 1902, p. 429 flF.

* Action of the IVth Italian Congress for the Blind ; Riv. Ben. Pubb., May, igoi,

p. 357 ff, 414.



586 MODERN METHODS OF CHARITY

The approved subjects of instruction are those given to normal
children, with special training in reading with the fingers according
to modern methods. All are to learn music and those who reveal
special ability are trained professionally. Industries in which the
sense of touch can be relied on for guidance are preferred for the
trade school. The telegraph and telephone have opened new callings
to the blind.

At the Paris exposition, 1900, a medal of gold was awarded to
the institute for the blind at Milan directed by the Abbe Vitoli. It is
described as a splendid establishment and of ancient origin. Among
the products of its industries shown were basket work and elegant
embroidery.

The institute of the Prince of Naples, at Naples, was founded in
1873 and recognized by royal decree of November 9, 18S5. It re-
ceives both boys and girls and teaches them trades. The articles
manufactured were shoes, blinds, baskets, bindings, printing, em-
broideries, all finely executed. A special appliance for writing and
copying music was shown, the invention of the director, M. Martus-
celli. The house has about 85 pupils, and the annual expenses are
about 40,000 lire. Support comes from gifts and subsidies.

At Florence is the Institute of Victor-Emmanuel II for young
blind persons, which was awarded a bronze medal ; while honorable
mention was made of the Society of Patronage of Niccolo Tommaseo
and to M. Victor Montrucchio of Turin for the invention of a writing
machine.

Deaf. — In 1800 there were in Italy only two schools for the deaf ;
in 1900 there were 47. All but one (that in Catania) are boarding
schools. They are supported mainly by voluntary gifts. A few
receive subsidies from the government on condition of giving instruc-
tion to a certain number of pupils. Ordinary school subjects are
taught. The school period is 7-10 years. The number of deaf chil-
dren of school age in Italy in 1898 was about 4,000, of whom 2,299
were in schools.^

Three institutes for the deaf made exhibitions at Paris in 1900,
all under the Minister of Public Instruction, one at Naples, the others
at Rome and at .Sienna. The institute at Milan was founded by a
Frenchman, Antoine Heyraud, in 1805. It is now administered as a

' Zeitsclirift fiir das Armenwesen, June, 1003, p. 167. — Storia del R. Istitr.lo
Nazionale pei Sordomuti in Genova, 1901, by D. Silvio Monaci.



ITALY 587

national establishment by a council of five members, of whom the
principal is one. There were 48 pupils (36 boys and 12 girls), who
were taught elementary studies and a trade. There is a school for
training teachers with 18 students. The annual expenses are about
78,000 lire, which are furnished by gifts and by subsidies ; 16,900 lire
were given for the support of 24 dependent children.

The institution at Rome was the first in Italy for deaf mutes, and
was founded in 1784. In 1870 it received the name of the Royal
Institute for Deaf Mutes, and now has 105 pupils, of whom 58 are
boys and 47 girls. The instruction is in elementary branches and
technical training. The council of direction is composed of seven
members, of whom four are named by the government and three by
the council of the province. The annual revenues are about 30,000
lire. The Minister of Instruction grants 27,000 lire a year. The
total receipts are about 81,000 lire annually, and expenditures 75,000
lire.

The Pendola institution at Sienna was founded in 1828. It is
governed by a council of five members, the president being named by
royal decree. The number of pupils is 86, of whom 48 are boys and
38 girls, all boarders. The instruction is the same as at Rome. The
resources flow from the annual income of funds and from govern-
ment payments. The total receipts are about 74,000 lire and the ex-
penses 71,000 lire.

At Milan is an institute for deaf mutes founded in 1853, with 193
pupils, 106 boys and 87 girls. Almost all are supported and taught
gratuitously. The oral method is employed and teachers have come
from France to study it.

There is a school at Naples and one at Lecce, which are mentioned
in the prize lists of the Paris exposition of 1900.

Insane. — There has been marked progress in provision for the
insane: there were in 1878, 57 hospitals with 15,173 patients and in
1898 there were 128 institutions with 34,802 patients.

S. Luigi Lucchini recently stated in the Chamber of the national
parliament (Feb. 9, 1904) that in the last 25 years the number of the
insane has increased from 20,000 to more than 40,000, and that the
capacity of the asylums is too small for the latter number, lacking
accommodations for 4,000 who require them. This means unsuitable
treatment, crowding and neglect, as we see only too often in other
countries.



588



MODERN METHODS OF CHARITY



The Vth National Congress of Charities, at Venice, in 1900, voted
a declaration of judgments which indicate the tendency of competent
opinion and at the same time reveal the conditions. The care of the
insane is the duty of the provincial administration. The resolutions
approve the custom of placing the quiet insane, and even idiots,
cretins and epileptics, if harmless, in poorhouses, but favor family
care under the direction of physicians. Endowed hospitals for
chronic sick are urged to relieve the commune of the cost of caring
for the quiet incurable insane, if permitted by their regulations and
their income. Private establishments should not be permitted to
care for the insane without official authority, and the director should
be upright and professionally trained. There should be in a hospital
for the insane one physician for 120 patients and a nurse for 12 pa-
tients. Provisional admission of a patient should be on the certificate
of a physician and the authority of a pastor. A provincial council,
under legal direction, decides within a fortnight whether the patient
shall remain or be discharged. Every hospital for the insane should
contain, in addition to the ordinary sections for the several classes, a
department for observation, a division for those engaged in outside
work on farms, a division for infectious diseases, a section for those
sent by courts for examination. The expenses for the buildings and
grounds should be met by the province, and those for maintenance by
the province and the commune where the patient has a settlement
{domicilio di soccorso). The repayment of cost by the family of the
patient is to be regulated by the provincial authorities. The Minister
of the Interior should inspect all hospitals and control their adminis-
tration.^

The House of the Insane of Saint Lazarus, at Reggio-Emilia, is
a good illustration of the best tendencies. This asylum was awarded
a medal of gold at Paris in 1900. It is directed by a medical super-
intendent, who is assisted by an administrative commission. It was
founded in 1820. In 1822 it had only 20 inmates, but it has steadily
increased in importance, and the recent average number annually has
been about 1,300. The receipts in 1899 were about 780,000 lire.
The institution received a silver medal at Milan in 1881, and one of
gold at Turin in 1884.

K. Children. Foundling Asylums. — A clear distinction should

^ Riv. Ben. Pubb., Feb., igoi.



ITALY



589



be made between the foundling asylums (brefotrofi) and the orphan-
ages {orfanotroU) ; the former had a very early origin and were
founded by charitable persons. In 1898 there were 113 foundling
asylums, which cared for 100,418 children, a few in the asylums, but
most placed out for care in families. During the year 21,307 were
received, while 21,504 were discharged, — not less than 10,127 of
them died. On Jan. i, 1899, 100,221 children remained under care.
In 19 provinces there are no foundling asylums and in these places
the communes care for foundlings. The mortality is very great ; the
average mortality in 1893-96 was 39.4 per cent. ; in 1897, 35 P^^ cent. ;
in 1899, 36 per cent.

Public attention has been fixed upon the foundling asylums in
consequence of discoveries made at Naples. Two questions have
been vigorously discussed, — the principles underlying such asylums
and the actual methods of administration in those which exist.

The principle of anonymity in the care of foundlings was gener-
ally at the basis of the earlier asylums, and the means of securing it
was the revolving crib (ruota), an arrangement for receiving the
infant without seeing the person who brought it. The wretched
mother could come at night, lay her unwelcome babe in the cradle on
the outside, give the wheel a turn, and at once place it in a world of
tenderness and care, cut off from its shameful relations. The argu-
ment for this method was that the unmarried mother might thus be
prevented from shame and despair, and would not be driven to suicide
or infanticide in the hour of suffering and desertion. The opponents
of this measure declare that, by relieving the mother of responsibility,
a premium is placed on immorality and the dissolution of family ties.
Moreover, the argument for prevention of infanticide is very weak,
since the statistics show that the rate of mortality with children de-
serted by their mothers is exceedingly high.

Thus Dr. Romani^ arraigns the ruota system as murderous in
effects. In the Napoleonic period, of 618 infants admitted at Mar-
seilles, only 18 survived ; at Toulon, only 3 out of 104. In France,
from 1816 to 1841, 794,831 (or 880,639 if we count those in asylums
at the end of 1815) were received and of these 484,127 died. In
Naples, in 1895, out of 856 infants only 3 survived one year. In
Rovigo, in 1886 (the year before an important reform in methods

-In Rivista Ben. Pubb., Feb., 1903, p. 65 ff.



ggo MODERN METHODS OF CHARITY

there), 74 died out of 142 (52.7 per cent.). In Padua, in 1876, out of
374, 275 died. In Milan, in 1898, 44.61 per cent. died. In Genoa, in
1900, 35.37 per cent. died. In Florence, in 1899, 55.59 per cent. died.
In Padua, in 1901, 27.73 per cent. died. The author well says : "The
unmarried mother who abandons her babe and refuses it her breast
multiplies its chances of death three times."

Medical men note the danger of syphilitic communication from
illegitimate infants to nurses and from nurses to infants. In 1889-
1898, in Milan, from 4.30 to 11.83 per cent, of infants were syphilitic
and from 8-31 per cent, of nurses were infected. This danger is
itself a strong argument in favor of requiring unmarried mothers to
nurse their own infants.^

Another source of mortality with illegitimate and all abandoned
infants is the neglect of those who carry them from the cities to the
country nurses. Romani quotes a description of Monod's "De I'in-
dustrie des nourrices" : "All who travel on the line from Paris to
Lyons to go to Auxerre or Mombert, or on the line from Paris to
Nevers, may any day verify this picture. These poor little creatures
are one month, six weeks, at most two months old. It may be in-
tensely cold or tropical with heat ; they quit the bosom of the mother,
and, instantly, without preparation, they pass from the sweet ma-
ternal life to cruel experiences. It is a terrible spectacle, the poor
infants packed upon each other, crying, for the nurses to save ex-
pense travel third class. Add one detail to this sad picture. Some
of these women, for the purpose of stilling these importunate cries,
administer to the feeble creatures narcotic drinks and procure arti-
ficial sleep, sometimes the sleep of death." And Romani adds : "Can
we believe that our [Italian] intermediaries, rude, ignorant and mer-
cenary, are better than the menenses of France?"^

The method has been employed in various countries and was of-
ficially recognized in France as late as 181 1. But of late illegitimate
children have come to receive better care, and the revolving cradle has
generally diasppeared. At the beginning of the kingdom the system
of the riiota was general in Italy, and these were used in 1179 com-
munes. Gradually it was abolished, not by law, but by the action of
provincial authorities ; 57 communes had abandoned the method before
i860 ; 193 others between i860 and 1869 ' 256 between 1870 and 1879 ;

'^ Riv. I>en. Pubb., Feb., 1903, p. loi.
'Cf. Zola, Fecundite, 1896.



ITALY



591



105 between 1880 and 1889, and 42 after 1890. In 1893 there were
still 526 communes in which the ruota was in existence, although only
in 462 was it used.^ To a great extent the ruofa has been abandoned
in Italy also, and the infant, which is never refused admission, even if
no information is furnished by the person who brings it, is received
openly. But in 306 communes of Italy it was reported that the ruota
was still in use. It has been learned that the ruota has been favored
much more to secure the care of the child than to hide the shame of
the mother by a secret surrender. When unmarried mothers came to
know that they would receive care and their infants be provided for
the number abandoned decreased. The province of Rovigo in 1888
introduced a new system and promised mothers who would acknowl-
edge their babes at first three years' support, and later reduced the
period to one and one-half years.^ Dr. Oliva declared that this revo-
lutionary change aroused determined opposition. But he was able to
prove for the period 1878- 1897, on the basis of testimony from over
100 physicians to whom he sent inquiries, that the new system was
satisfactory. Whereas in the decade 1878-1887, 1,358 children were
received (an annual average of 135), of whom 249 were acknowl-
edged by a parent, during the period 1888- 1897, 1,414 children were
received (an average of 141 annually), which were all acknowledged
by their mothers. And while of the 1,358 children of the former
period, 531 died under one year of age, 131 under two, and 787 in
other age classes, during the latter period only 99.81 and 180 in the
same age classes died. The expenditures decreased from 640,690 lire
to 583,937 lire ; and the reduction is still greater for recent years : in
the three years 1885-87 the annual cost was 65,000 lire and in 1895-97
only 35,000 lire annually. The assistance given to mothers was 9 lire
monthly for the first year and 5 lire for the following months ; but the
majority of the physicians consulted advised giving 12 lire monthly
for three years, and they urged careful supervision. In 1899 the
Charity Congress of Turin declared in favor of the Rovigo system,
the abolition of the ruota, the encouragement of mothers to acknowl-
edge their infants, and the condemnation of foundling asylums. At
the same time many writers are urging not only that mothers should
acknowledge their offspring, but that, as in Germany, Switzerland



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 60 of 73)