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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from the lack of such apparatus and very few organized agencies
have been established to provide them. The women's societies were
the first to take hold of this branch of service.

Nurses, Their Work and Training. — Care of the sick in homes
and hospitals has been the business of the religious orders during
many centuries ; but with the progress of medical science and art this


work has been greatly improved. The Roman CathoUc sisters were
naturally first in this field, and their orders labor with the inspiration
of traditions of mercy. The deaconesses of the Inner Mission have
also entered this great department of human service, so appropriate
for women who have skill, training, and the gentle spirit of cheer and
consolation. The sick need more than medicine and physical man-
ipulation ; their weariness and weakness of heart and mind call for
the help of hopeful and tactful companions. To meet this need the
leaders of the religious societies have sought to train nurses who shall
have both technical skill and the qualities of mind and heart which
are so heavily taxed in the sick room.

Some of the state institutions have followed the example of the
orders and made arrangements to train nurses for great municipal
hospitals, as in Saxony at Hubertusburg and in Hamburg. The
patriotic society of women supported the Sisters of the Red Cross
who are active in assisting the sick poor in their homes. The
primary occasion for the service of the Sisters of the Red Cross was
the call for nurses in times of war ; but the same organization is held
together to help as need arises in periods of peace. In the report for
1896 it was said that 589 sisters were in the society, an increase of
135 over the previous year. The Woman's Society also employs
deaconesses. The nurses attend lectures, have practical experience
under direction, and are taught by the chaplains of hospitals the
moral and spiritual side of their duties. After passing a careful
theoretical and practical examination the nurse is given a certificate.
In some places short courses of lectures with clinical work are
given for women who wish to be useful in cases of emergency or
war, and yet do not propose to follow nursing as a calling.

The Jewish societies have also made arrangements to train their

There is high authority for saying that experience in Germany has
taught the superiority of the system of associations of nurses, either
on a religious or other basis. The common dress is a protection ; the
discipline is more effective ; the danger from imposture and incapacity
is reduced ; the nurse herself has an asylum in the mother-house or
elsewhere in times of sickness and old age. The largest service thus
far has come from the church orders, although the private societies of
philanthropy have recently increased. The work is more backward
in the public relief. The best results are secured in parishes where



the relief societies and nurses cooperate in affording the destitute
families the means of help which are needed.

One of the matters discussed in connection with nurses is the
propriety of employing women for general practice. A few writers
have asserted that women should not be sent to nurse men because of
the tendency to immorality. But this criticism seems to rest upon
exceptional instances, and to have little weight in deciding the ques-
tion. Women are natural nurses, but in hospitals there are kinds of
service for which male attendants should be employed and which
female nurses should not be asked to do.

In this connection, as helping to account for the popularity of
female nurses, the fact is cited that their wages are lower than those
of men. While male nurses secure 20-30 marks per month in cities,
and 10-15 marks in rural parishes, women receive only about one-half
as much.

It seems decidedly advantageous to female nurses to belong to
some kind of an organization ; and of associations there are two
forms, religious orders or societies of deaconesses and sisters, and
free, secular societies. The nurse without such connections loses
time in making engagements and has no resources in sickness and
old age. It is now proposed by some writers to meet the needs of
nurses by old age insurance, homes for retreat, etc.^

Care of Households {HauspHege). — In 1892 a society was formed
in Frankfort to provide for the care of families in which the wife and
mother is disabled through illness. If the woman need to be sent to a
hospital she is often unwilling to go for fear her home will fall into
the hand of some person unworthy of confidence. This society em-
ploys women for a small consideration to cook and clean and keep
the house in order until the housekeeper can return to her task after
convalescence. The poor family may pay something for the service
if they are able, but the society assumes all responsibility, selects the
caretakers, and supervises their work through committees and agents.
Other cities have taken up this form of assistance and it gives promise
of wide usefulness. It is evident that a training as nurse is not
required of the assistant in the home, but only moderate intelligence
along with unquestioned character. The persons selected are usually
women of somewhat advanced age.

In Frankfort an interesting experiment is on trial. In poor

^Zeitschrift f. d. Armenwesen, April, 1903.



families a nurse or servant is an extravagance, yet when the wife is
sick it is a necessity to orderly family life. In connection with a
building society arrangements were made in 1902 to provide a nurse
and housekeeper where the family pay monthly in the rent 20 pf.
premium. To this premium is added a subsidy from an endowed
fund. The society is not legally bound to provide a nurse, but it is
hoped that experience will reveal a way by which a strictly legal con-
tract may safely be made.^

Care of Women in Confinement. — Among the poor in German
cities the need of better care is keenly felt. Those who are ignorant
are only too apt to hasten back to work too early, with serious con-
sequences to their health in after years and to the detriment of their
family. In some circles it is thought a mark of weakness not to go
about daily tasks immediately after the birth of a child. One of the
most serious tasks of charity is to educate the poor to think of the
consequences and to use proper precautions. But very often poverty
itself leads to neglect ; the mother must as quickly as possible be about
her household labors, since no other is at hand to do the cooking and
washing. At this point charitable relief is sorely needed, and various
private associations have come to the aid of the poor mothers,
although by no means adequate provisions have been made, and here
is a wide and neglected field for further benevolent effort.

Women sometimes need to be taken to a hospital for the confine-
ment, owing to the nature of the case or the household surroundings.
In this situation care of the household is required as in any case of
illness. Even if the mother is strong there will be need of help in
household work for two or three weeks. Factory labor is forbidden
for some days after confinement, but such laws cannot reach home

The training of midwives is undertaken in connection with hos-
pitals, benevolent associations, asylums and public poor-relief. In
some cases the asylum is made the center for training of assistants,
as of other nurses, and in others the nurses do all their work in the

Care of Convalescents. — The evil of requiring a poor man to
return too early after a serious illness in home or hospital has long
been recognized, but even to this time the provision for helping such
persons is insufficient. The workingmen's insurance laws have had

* Zeit. f. d. Armenwesen, July, 1903, pp. 215-217.


an admirable influence in this respect ; and the various institutions
which care for the insured are prompted by their exact knowledge
and by their interest to prevent the premature return to severe toil
after exhausting sickness. It is found cheaper to help a laborer to
get thoroughly well than to support him as an invalid through many
years. Hence the insurance authorities continue the payment of
indemnities so long as it is necessary to enable a man to become
strong. Mountain, country plains and seashore are as helpful re-
sorts for the poor as for the rich, and many cities and associations
have sought to make them accessible to destitute persons during con-
valescence ; for example, Berlin, Bremen, Breslau, Munich.

Tuberculosis.'^ — The agencies of relief join forces with the physi-
cians in the contest with the "white plague." The number of suf-
ferers from lung diseases in Germany is estimated to be about 1,300,-
000 annually, of whom 170,000 to 180,000 die.

Three forms of charitable aid are required : preventive methods,
curing the sick, caring for the family whose breadwinner is unable to

Preventive Measures. — To stay the inroads of consumption the
people must be armed with knowledge; they must be taught what
tuberculosis is, what causes it, how to guard against it, and how to
treat it.^

Women visitors examine houses where there are cases of tubercu-
losis, and have them cleansed, disinfected, and the patients sent to
other places. Children at school are examined by physicians, and
if it is found that they are liable to exposure they are carefully
watched over or sent to the country. The agents of the insurance
funds and the poor-relief authorities report cases to the sanitary

In 1902 the government gave 90,000 marks for scientific investi-
gations of tuberculosis.

Decrease of Mortality from Tuberculosis in Germany. — The mor-
tality from this cause in the cities of 15,000 and more inhabitants was,

* Verhandlungen der Deutschen Zentral-Komitees zur Errichtung von Heil-
statten fiir Lungenkranke. 7 Generalensammlung, 16 Mai, 1903. — Zeit. f. d.
Armenwesen, August, 1903, p. 225, and October, p. 313.

*An illustration of the vigor of this campaign is the fact that 1,300,000 copies
of "Merkblatt" were distributed. A publication of Dr. S. A. Knopf, of New York,
on tuberculosis, was scattered in 400,000 copies.


for every 10,000 inhabitants: in 1877-1881, 357.7, and then a steady-
reduction until in 1897-1901, when it was only 218.7.^

The Care of the Sick in Homes and in Sanatoria. — A general
report showed that in 1903 there were in Germany 60 sanatoria
already occupied, 22 buildings projected, 22 private establishments,
18 places for a day's retreat, and 6 places for tuberculous children,

Many sanatoria are built by private societies. The German Cen-
tral Committee for the Erection of Sanatoria for Consumptives and
the Society of the Red Cross for People's Sanatoria are conspicuous
in this work. The Empire granted to the former a subsidy of
60,000 marks.

The Invalid Insurance Boards have provided means of healing
consumptives, partly from financial considerations. It is cheaper to
cure a man and send him back to work than to support him in his
weakness out of the national funds. In 1901 the number treated
was 14,757, at a cost of over 5,000,000 marks, and with an average of
74 days' treatment. Sometimes the insurance board erects houses,
sometimes furnishes beds in existing establishments. In 1901 they
spent 49,000,000 marks for the erection of hospitals, sanatoria, etc.

The sanatoria have enjoyed a measure of success in restoring
consumptives to health. The insurance authorities affirm that 72
per cent, are restored to capacity for work ; but that if men return to
former conditions the rate falls in 3-4 years to 29 or 28 per cent.
Therefore, effort is made to place the patients after treatment in
open-air occupations and not let them return to shops.

The insurance laws permit the family to have one-half or one-
fourth of the sick indemnity ; this permits the breadwinner to stay
away from work until he is thoroughly cured, without fear that his
family will suffer by reason of his unemployment.

Relief of the Family. — In 1902 the poor-relief authorities at Ham-
burg decided to act upon the principle that the cost of caring for a
consumptive in a sanatorium should be borne by poor-relief when
this measure is necessary to restoration of health. A special physi-
cian is to watch over these patients on their return home ; and he
cooperates with the churches and benevolent societies of women to
secure suitable diet.

Care of Convalescents. — Berlin has four (4) places for recupera-

* Monthly Consular Reports, 1904, p. 839; quoted from Professor Mayet's
monograph, Twenty-five Years of Statistics of Mortality.


tion (Erhohingsstdtten), which in 1902 cared for 1,973 adults; 360
women with sick children were entertained. Other cities have similar
establishments : Frankfort, Frankfort a. O., Leipsic. Others have
projected arrangements for the same object : Spandau, Posen, Stettin,
Breslau, Dresden, Halle, Harburg, Hanover.

Sanatoria for Chronic Invalids. — In 1894 a sanatorium of 70 beds
was built near Berlin for workingmen suffering from chronic dis-
eases. In 1898 land was bought at Beelitz, and in May, 1902, the
department for men was opened. The entire cost has been about
9,000,000 marks, or about 15,000 marks per bed; the yearly expendi-
tures about 1,200,000 marks, or 5.50 marks per head per day.^

Chronic Nervous Disease. — Workmen injured in such a way as
to seriously impair their nervous health and to endanger society need
a treatment different from that possible either in accident wards of
hospitals or in hospitals for the insane. At Stotteritz near Leipsic
is the Herrmann-Haus, founded in 1900, which is based on these
principles : Persons suffering from nervous shock, but not insane,
are received for rest and treatment. The house is furnished and
provided, in respect to rooms, clothing, and food, according to the
customary mode of life with laboring men. Patients are kept under
observation, without annoyance to themselves. All who are able are
given proper opportunity to work. The number is kept small, —
about 40. All modern appliances for treatment are provided. The
leading physician has no financial interest in the profits of the insti-
tution. Abstinence from alcohol and tobacco is the rule of the house.

Diet for the Sick. — In his careful report to the National Society
of Charity in 1903, Dr. Blum gave the results of inquiries in 190
cities, about two-thirds of which sent replies to his questions. Peo-
ple's Kitchens {Volkskilchcn) are benevolent establishments which
serve wholesome food at low prices to families and persons whose
households are not able to supply good food. The families of labor-
ers where there are many children and meagre income, unmarried
working people, and employes in shops who have no home table, are
among the customers of these establishments. The kitchens aid the
cause of temperance by furnishing nutritious food without the ac-
companying temptations to drink. While it is expected that these
kitchens will be self-supporting, yet their highest usefulness depends

^ Die Arbeiterheilstatten der Landes-Versicherungsanstalt Berlin bei Beelitz.
Berlin, Lowenthal, 1902, pp. 95.


upon the supervision of intelligent persons who are wilHng to render
voluntary service.

The purpose of the diet kitchens is to furnish poor people kinds of
food which are required by invalids and which cannot be prepared in
their houses. Only in a few cities are these arrangements found;
diet kitchens for all classes being known only in Berlin and Stuttgart.

The German National Society of Charity passed two resolutions,
in 1903, approving these agencies, and asking the workingmen's in-
surance authorities to promote them, in cooperation with poor relief

Care of Drunkards.' — Experience seems to require in the institu-
tional treatment of inebriates that there should be a reception depart-
ment where the patient shall be kept under careful medical observation
for 4-6 weeks ; then a convalescent home, under separate direction
should follow ; afterwards the patient, if proved reliable, may be
placed in the care of families where abstinence is practised, where the
patient may be paid a little for his labor, and where he may remain 3-4
months. In more difficult and obstinate cases a colony is advisable,
and here the cost is about 2 marks a day and that of installation is
2,000-2,500 marks per bed. But most frequently the case comes too
late ; habits are fixed, and disease is deep-seated. The greatest hope
is in the progress of the temperance societies.

The Blind. — It is estimated that there are in Germany about
40,000 blind persons. Children are frequently cared for at home
and in ordinary schools up to the tenth year, and after that they are
trained in special schools. The raised Roman and the Braille point
systems are both used in their books, and of late much has been done
by societies to multiply copies of good works and lend or give them
to the blind. The children are instructed in the ordinary school
branches, so far as possible, and the effort is made to train them in
simple hand industries by which they make themselves independent.

Care of Deaf Mutes.^ — The first institution in Germany for the

^ Schriften des Deutschen Verein f. A. u. W., 1903 ; and Zeit. f. d. Armen-
wesen, October, 1903, p. 299.

*Zeit. f. d. Armenwesen, July, 1903, p. 219 ff. — Articles of Samter, Wald-
schmidt, Die Aufgaben der Armenpflege gegeniiber Trunksiichtigen Personen in
Schriften d. D. V. f. A. u. W.

* See Review of J. Kurth, Das Taubstummenbildungswesen in XIX. Jahr-
hundert in den wichtigsten Staaten Europes, in Zeit. f. d. Armenwesen, June,
1903, p. 162.


training of deaf mutes was founded at Leipsic, by Samuel Heinicke,
April 14, 1778. In 1788, his son-in-law, Dr. Eschke, established a
second school in Berlin, the first in Prussia. The Prussian institu-
tion prepared teachers. The first Bavarian school was established
at Freising in 1804 ; and others followed. In order to supply funds
various devices were employed. At first an attempt was made to
mingle deaf children with those in ordinary schools, and train teach-
ers to give instruction to all ; but this was found to be impracticable.
The movement received an impetus in Prussia after 1828 from a min-
isterial circular, and the number of teachers and schools increased.
After 1873 the provinces were charged with the duty of educating
deaf mutes and special schools were built for them. In 1900 there
were in Germany 91 institutions with 673 classes, 732 teachers, and
6,458 pupils. The average school period was 71-3 years.

During the development of the movement there has been much
controversy over the question whether the pupils should all be
boarders ; of late the tendency is to employ both methods, boarding
within the establishment and living at home.

Prussia made instruction compulsory and very stringent laws
have been made in several states to require indifferent parents to send
their children to school. The ordinary studies are pursued, natur-
ally with the exception of singing. Especial emphasis is laid on
drawing and feminine handwork. Trades are not taught in these
schools, but are learned in later years. The school assumes no re-
sponsibility for the mature life of the youth, although directors advise
with parents about the choice of a calling. The trades which they
can most easily and profitably learn seem to be tailoring, shoemaking,
saddlery, bookbinding, gardening. Girls learn dressmaking, ironing,
and ornamental work. Trade schools especially designed for the
deaf exist. There are 12 asylums for helpless women and various
homes for the aged deaf.

Cripples. — In 1902 in the Rhine provinces were found in a pop-
ulation of 5,759,798 not fewer than 49,508 cripples ; of whom 32,242
were males and 17,266 females; 40,928 were over and 8,580 were
under 16 years of age. Of the 49,508 over 16 it was found that
2,101 were mentally unsound ; 5,865 mentally sound persons, children
and adults, were without education. For all these there was only
one institution with 46 places, 2,753 adult cripples were entirely and
2,682 partly supported by public relief.^

^Zeit. f. d. Armen., 1903, p. 315.


Insane. — It is estimated that i in 300-400 inhabitants are insane,
and that in Germany 2 out of 1,000 of population need institutional
treatment. In 1890 only 56,234 insane persons were in hospitals and
asylums (43,251 in 122 public establishments, and 12,983 in 114
private establishments) ; 7,537 epileptics and idiots were included in
these figures, distributed among 47 special institutions.

The legal regulation of insanity is chiefly referred to the legisla-
tures of the several states ; imperial laws touch the matter only at a
few points. Most, but not all, the states have their own institutions
for treatment of the insane, frequently in connection with the univer-
sity clinics and scientific study of insanity. The provinces generally
erect the buildings and provide for administration. In some states
the ministry has a limited right of control over the institutions, in
relation to plans of buildings, competence of superintendents and
granting corporate rights to private associations. The reception of
a patient into an institution and his discharge are regulated by laws
of the states, and ordinarily a medical man's certificate is necessary.
The police authorities can act when that person is dangerous, even
without the consent of relatives.

The insane person can be declared incapable of managing his own
affairs {Burgerlichcs Gesetsbuch, Sec. 6 and refs.).

There are numerous private institutions for the treatment and cus-
tody of the insane, which generally owe their origin to the desire of
rich and well-to-do families to give their relatives more comfort than
they would have in public institutions, and also to spare themselves the
humiliation of dependence on public support, and the pain of know-
ing that their friends are in close contact with patients of an inferior
social class. The state recognizes and regulates these establishments.^

Family care of the insane has not been carried so far in Germany
as in Scotland and Belgium, and still it has met with favor and suc-
cess. Before 1880, Dr. Wahrendorff in Ilten was one of the first to
employ this method with selected cases of the insane. Dr. Alt in
Uchtspringe has developed a colony and gradually trained families
to care for the patients. Very interesting is the experiment made
with a hospital serving the great city of Berlin. At the Dalldorf

^ Loning, Lehrbuch des Deutschen Verwaltungsrecht (1884), lyy, Das Irren-

Hans Laehr, Heil und Pfleganstaltan fiir Psychisch-Kranke des Deutschen
Sprachgebietes, Berlin, 1891, and his article in Handworterbuch des Staatswissen-
schaften. — Schonberg's Handbuch der Pol. Oek., Art. Irrenwesen, by Jolly.


asylum the cost in the institution for each patient, between 1893 and
1897, was 2.12 marks per day, while the cost in families was only 1.28
marks, a saving of about 40 per cent. During the years 1893-1897
the Dalldorf institution sent out into families 822 male and 517 female
patients, or about 13 per cent, of all ; and it was found practicable to
find boarding places in the city itself, without sending to the country.^

Feeble minded and epileptics are treated, says Laehr, in a rather
stepmotherly fashion. Only exceptionally are they received into
hospitals for the insane, and most of the institutions for their care
are private and receive only those who are capable of improvement.

One of the most famous institutions in the world for epileptics is
that founded by Pastor von Bodelschwingh, near Bielefeld, West-
phalia. It is a colony with many houses and arrangements for
classifying the patients according to sex, occupation and stage of the
malady. It is supported partly by charitable gifts, by subsidies and
by payments for care. The population is under the treatment of
earnestly religious people and the church edifice is the center of all the
life of the place. Not on this account is medical advice neglected,
and the nurses, both men and women, are carefully trained for this
peculiarly difficult branch of service,
K. Children.

As in America, so also in Germany, relief organizations have
given special attention to caring for children. Whenever it becomes

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 7 of 73)