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sentation in such governing body.

"Third. That the dispensaries be so managed that all physicians
in their neighborhood would be onlv too glad to see to it that the
deserving poor foimd their way thither ; feeling, on the other hand,
confidence in their management, that the compliment would be re-
turned in a proper way, and that those who were able to pay would
be refused.

"Fourth. That some such plan be adopted as has been tried at the
South Side Dispensary, as stated by Drs. Hatfield and Park, of a
close system of investigation by personal inquiry, and a careful and
condensed and easily accessible record of each case. This, of course,
involves a small expense, which either the dispensary or the public
ought to defray.

In lieu of this plan it has been suggested that patients who appear
needy be treated at their first visit, and then be given a blank form
certifying that they are in positively indigent circumstances. This
should be filled out and signed by their nearest physician, druggist,
or priest, before they were given any subsequent aid. And it would
be better still if the two plans could be combined."

(The full report of this committee may be found in the Chicago
Medical Gazette, of April 5, 1880).

For my own part, I am most heartily in favor of any plan by
which those who visit the sick poor should be paid for it; whether
they be paid out of the public treasury or by some organization
devoted to charity work, makes no diiference. I am also equaUy
in favor of putting all this clinical material, to a proper extent, at
the disposition of students ; but I think that a man who spends an
hour or two lecturing to a small class in a dispensary is almost as
much entitled to pay as the one who spends the same time visiting
the poor at their homes. Or I mi^ht put it in this way : Whoever
does this work of attending the sick poor does a public service,
and, according to the spirit of republican institutions, he who does
this is entitled to pay. Work thus paid for is always better done,
and dereliction from duty can then be authoritatively dealt with.

It only remains now to make a few remarks concerning the hos-
pitals mentioned in the first part of this paper. From the account
there given it will be seen that Cook county, with a population in
round numbers of three-c^uarters of a million, has only the follow-
ing really charitable medical institutions:

Cook County Hospital; Cook County Insane Asylum; State Eye
and Ear Infirmary; City Small-Pox Hospital; Chicago Floating
Hospital; St. Luke's Hospital.

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The two latter are really deserving and thoroughly charitable,
and, as is so often the case, are always in need of funds. The two
former accomplish a good deal, but are subject to the ever-varying
"inflooence" of the dominant party of the day, and, aside from their
medical staffs, very few find their way into an oflScial or menial
connexion with them who have any recommendation other than
their devotion and services to party. For instance : we not infre-

3uently have had the melancholv spectacle of a medical superinten-
ent and his assistants being obliged to spend the greater part of
ihe week or two just preceding the annual election lobbying to
keep their places.

The principal explanation of this condition of aifairs is, that the
boards of county commissioners, or aldermen, or whatever they
may be, are, almost without exception, composed of illiterate, uned-
ucated men, foreigners often, whose energies have been misdirected
into politics, who may be able to manage their own private busi-
ness, but who know nothing of political economy, or the still greater
problems of public welfare and public health. The average commis-
sioner knows as much about the best interests of the insane as the
average alderman does about the proper ventilation and lighting of
public schools, which in either case is nothing.

So long, then, as the management of institutions which need for
their governance the ripe experience of educated and trained minds,
is relegated to the control of such men, what can we expect? In
our opmion, public institutions are never so well managed as when
they are under the direct control of two or three trustees, provided
these be well selected. Compare, for instance, our county insane
asylum with one of our state asylums, or the county general hos-
pital with the State Eye and Ear Hospital ; the county institutions
being managed by the board of county commissioners, and those of
the state by trustees appointed by the governor.

What shall be said about the other hospitals I have named, and
which depend largely or entirely for their support upon appeals to
the public in some shape? We have here the curious spectacle of
several boards of trustees, boards of councillors, boards of lady
governesses or what not, meeting and grappling with problems
too large for them; pondering on now to make five dollars pay ten
dollars indebtedness; organizmg fairs, getting up benefit entertain-
ments, ingeniously wording appeals to the generous public, and
continually devising expedients. We see them, too, with their petty
jealousies, their occasionally ill-concealed distrust of measures or
men, and now and then even an eruptive spasm, followed by a re-
organization. Much that passes for true charity is either unre-
strained desire for notoriety or an explosion of restlessness on the
part of some imoccupied or perhaps hysterical individual, usually of
the tender sex. Such an one finds the same gratification in the no-
toriety or excitement of starting a new charitable institution, and
devising means for accomplishing much with little, that others do
in the fervor of religious enthusiasm, or wild and impracticable
missionary schemes. An institution started under such auspices
needs a close succession of such enthusiastic leaders, or it must
Purely soon come to grief. There needs no apology for such com-
ment. The time has come when more can be accomplished by

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properly directing atid limiting charity ^ than by originating it; and^
if necessary, legislative aid should be invoked to refuse charters to
afiFairs not begun on a sound financial basis. Let us suppose it is
desired to found a "Hospital for Diseases of the Joints." Some
tender hearted lady, who has a relative suffering from a chronic
malady of this nature, has conceived the idea. She interests a few
of her church in the matter. They bring in a few outsiders; the

medical attendant of the poor invalid alluded to. Dr. , the

eminent orthopedist, being consulted, sees here a chance to increase
his reputation and income. He, therefore, cordially joins the move-
ment and agrees to organize the surgical stafif. A public meeting
is held, one or two cripples judiciously exhibited, ** public interest
is awakened,*' so it is announced in the papers; a few hundred
dollars are subscribed, after personal entreaty, a charter secured,
and all goes well for a few months. Those who have watched the
course of such hospitals can complete the picture, and can realize
the amount of work and drudgery needed to carry it on and prevent
a speedy collapse.

In Great Britain they often experience a trouble which we never
complain of here. Some of the London institutions are accumula-
ting such enormous endowments, that their incomes largely exceed
their expenses. Now and then an inquisitive person makes some
inquiry as to the ultimate disbursement of all this money, but
usually with very little satisfaction. Any such efforts by outsiders
are discountenanced at once. It is not noticed, however, that these
institutions make any the less loud calls upon the public for a
share of their subscriptions or bequests.

We have not yet attained to this happy condition. It will be a
long time before any of Cook county's mstitutions can lay aside
from their incomes a yearly surplus.

From what has been said of them, however, it will be seen that
they in no particular respect differ much from those of any other
large centre of population where charitable impulses run wild. We
have the same problems to solve; the same great interests to take
into earnest consideration ; the same proportion of imthrif ty pa^upers
to care for and protect ourselves against; the same lack of means
to do with; the same diflSculty in antidoting the evil influence of
politics, and guarding against the consequences of misguided and
ungovernable political aspirations in those least fitted for positions
of public trust; and, realizing that the struggle is not confined to
our midst, but is an universal one, we are watching to see what
others are doing for self-protection, ready to adopt any measure or
means which gives fair promise of success. That the Conference
of Charities of 1880 may shed additional light upon an abstruse
subject is the earnest wish of the writer.

It may be only justice to myself to state, by the way of apology for
the appearance of this paper, that it was only written at the
personal solicitation of the Chairman of the Committee on Medical
Charities, and was prepared amid the press of other work and

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The GbiminaIi Dockets.

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appe:n^dix VI.

FoBMS AKD Suggestions for E^eepe^g the

Accounts of the Public Institutions

OF THE State of Illinois.

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Before proceeding to discuss the proper mode of keeping the
accounts of public institutions of a benevolent, educational or penal
character, it may be of service to dei&ne briefly the relations which
the state institutions of Illinois bear to the people.

The second section of an act to regulate the state charitable
institutions and the state reform school, approved April 15, 1875,
declares that the trustees of each of the said institutions shall be a
body corporate and politic for certain purposes, namely: "to re-
ceive, hold, use and convey, or disburse moneys and other property,
real and personal, in the name of said corporations, but in trust
and for the use and by the authority of the state of Illinois." This
section also provides **that the general assembly shall have power
at any time to amend, alter, revoke or annul the grant of corporate
powers herein contained, or heretofore expressed, in any and all
charters previously granted to any of said institutions."

The language of this section is an unequivocal declaration of pro-
prietorship in and sovereignty over the state institutions. They
belong to the people of the state; they were created for their ben-
efit. The trustees and other officers are simply the agents of the
people for accomplishing certain specified ends; and the state re-
serves to itself the right of dissolving these corporations, whenever, in
the judgment of the people, they cease to subserve the purpose of
their creation, or the necessity for them no longer exists.

Since these institutions are not established for the purpose of
making money, and are neither productive nor speculative in their
nature, they are sustained, for the most part, by appropriations
directly made from the state treasury. In some states a different
system prevails, where a charge is made by the state for board,
tuition or treatment, and collected from private individuals and from
counties or towns, that is, from lesser municipal corporations. In
Illinois, on the other hand, the state institutions are free to all the
people of the state. No charge is made, even against private indi-
viduals, for the benefits received from them. In every sense, there-
fore, the institutions are immediately responsible to the people of
the state, in their corporate capacity.

A trust like this is doubly sacred, because, in addition to the
sanctity which attaches i< all fiduciary relations, it is administered
in the name of charity. To charity is equally applicable the apos-
trophe of Madame Roland to liberty: **0! Liberty what crimes
have been perpetrated in thy name!" The negligent or corrupt

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discharge of a charitable trust is not only a violation of confidence,
but a blow at that sentiment of benevolence in the human breast,
without which society could not exist. Accordingly, it is both the
right and the duty of the state to throw around the administration
of public charity every possible safeguard; but of all the motives
which tend to hold men to a strict performance of their duty, none
is so powerful as a strong sense of accountability. In order to cre-
ate and keep alive this sense, all the agents entrusted with this high
responsibility must be frequently and thoroughly called to account.

It is further evident that the state must appoint or detail some
officer especially charged with the execution of this function. It is
in the highest degree improbable that an incompetent or corrupt
agent will, of his own accord, make such a report to the legislature,
and to the people represented in the general assembly, as wiU fur-
nish the evidence of his incapacity or want of integrity. Even
the reports made by an honest man, anxious to do his whole duty,
may be so imperfect, in consequence of the natural indulgence of
human indolence, or of his want of appreciation of the relative import-
ance of the items of information desired by the people, as to fur-
nish little insight into the real character of his administration of
the afifairs of the institution under his charge. For the purpose of
securing the desired accoimtabihty, the state of Illinois has estab-
lished a board of public charities, to which the state institutions
must make stated reports and submit all their accoimts for examin-
ation and verification. Since the state board is not to account, but
to be accounted to, it has been granted no executive power, so that
it has no executive responsibility; but it has the right, and it is its
duty, to visit and inspect the state institutions, their premises,
property, inmates, books and papers ; to examine their officers, if
need be, under oath; to inquire into all their methods of transact-
ing their business; to satisfy itself as to the character and extent
of the results accomplished; and to express its opinion to the
general assembly upon all matters connected with the administra-
tion of their affairs freely and without reserve.

Institutions which possess powers to expend public moneys are
responsible first of all in a financial sense. The public, perhaps,
attaches an undue importance to this kind of responsibility, that is
to say, the cost of an institution is not, in fact, of equal importance
with its usefulness; and the real fundamental question concerning
it is, how far does it accomplish its purpose? what actual benefits
do the people receive from its establishment? But, undoubtedly,
the people feel with reason that financial success is an indispens-
able element of success in a larger sense. They apply this practical
test to the management of every public institution, and the institu-
tion which cannot stand the test loses ground in the public

This board, therefore, has directed its attention primarily to the
financial management of the public institutions subject to its 8ui)er-
vision, believing that improvement in this respect would secure as
its natural sequence a corresponding improvement in general
efficiency and usefulness. The act to regulate the state institutions,
enacted, in 1875, at the suggestion of the state board, was a great
step in advance, but much still remains to be done. The accounts

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of the institutions, although better kept than formerly, are still far
from perfect, and the board, desiring to complete the reform which
it has inaugurated, has caused the preparation of the following
manual of business for the use of the trustees and officers of the
institutions under its direction.

It seems scarcely necessary to present any form of argument to
prove what is almost self-evident, namely, that an institution called
to account must furnish a statement of its afiPairs in a form satis-
factory to the authority to which the law requires it to make
account; and that where a number of concerns are responsible to
one and the same authority, it is of the utmost importance that
the forms of statements should correspond as nearly as may be
practicable. But in order to uniform statements, uniform records
are essential. Hence, this board, having already secured substantial
uniformity of statement, now undertakes to suggest a uniform sys-
tem of book-keeping, to the end that comparisons between the
institutions may be more easily made, and that the result of such
comparisons may be more manifestly equitable. A further end
which the board has in view is to secure the adoption of such a
system of book-keeping as will furnish a complete record of all the
internal relations of the state institutions, such as is not furnished
by any set of books now kept by any of them. It has also a pro-
found sense of the importance of having the methods of book-keep-
ing in use in our institutions conform to those adopted by all great
mercantile estabUshments everywhere, so that they will be perfectly
intelligible to experts, and that no errors can creep into them with-
out bemg discovered. It may be confidently asserted that such a result
is impossible without the introduction of the system of double entry.

There are two objections which may be urged against the pro-
posed improvement. First, that the clerks employed by the insti-
tutions are not acquainted with the system of double entry; and,
second, that the records proposed are too complicated and involve
too much labor, which is another word for expense. The answer to
both is very simple. A clerk who is not alreadv familiar with the
science of book-keeping can easily master it by the careful study of
any. good elementary treatise on the subject. If not, he is incom-
petent for his position. On the other hand, if good, thorough book-
fceeping is essential to financial success in the conduct of an
enterprise which has for its sole object the making of money, it
must be equally advantageous in the management of an institution,
whose principal object is to save money.. If the extra cost pays in
the one instance, it will in the other also. Since a state institution
derives its income and support from the state, and the cost of
making records is paid by the state, the state has certainly the
right to prescribe the form of record to be kept, and the institution
is under obligation to employ the extra help required, if necessary.
But all experience demonstrates the truth of the proposition that
books which are properly kept involve less labor than where an
accountant does not understand his business. A book-keejper should

?roperly be an assistant to the business manager of the mstitution
y whatever title he may be called, steward or clerk, and the
book-keeper should have no duties to perform which will interfere
with the discharge of his immediate function.


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To what has been said, we may add that a perfect system of
accounts is an aid to the superintendent of an mstitution, and a
protection. It aids him, by enabling him to understand more
clearly wherein lies the secret of his success or failure as a. financial
iQanager, and to ascertain not only the relative cost of the several
departments of his business, but the comparative efficiency and
pecuniary value of his employes. It protects him, because it renders
it possible for him to show, first, that his management has been
honest; and, second, that it has been economical. A former gov-
ernor of this state once made the wise remark, that "for every man
in public life two things are of the utmost importance: first, that
he should do right ; and, second, that he should appear to do right.
The appearance of wrong-doing may be as injurious to the man
himself, and to the interest which he is set to defend, as if a wrong had
actually been perpetrated."


The books essential to be provided, in order to keep accounts
according to the system here proposed, are as follows :

First, to be kept by the clerk:

1. A journal day-book.

2. Book of receipts.

3. Book of orders.

4. General ledger.

6. Individual ledger, containing accounts with inmates.

6. County ledger.

7. Clothing day-book, containing charges against inmates and
hospital, for clothing, bedding, etc.

8. Statement boon.

Second, to be kept by the storekeeper:

1. Invoice book.

2. Journal.

3. Classification ledger.

4. Department ledger.

Journal Day-book.

Forna No. 1 of the forms appended below represents the ioumal,
which is designed to be a book of original entry, upon which all
transactions, of every kind, are to be recorded, in proper form
for posting to the ledger, at the time when they occur, or when
reported to the clerk by the storekeeper or by any other person
authorized to transact business for tne institution. But the cash
receipts and orders drawn on the treasurer of the institution need
not be entered upon the journal, if the book of receipts and book
of orders are kept, which are designed to take the place of the
journal to that extent.

The entries upon the journal, as printed, illustrate the proper
mode of opening a set of books, by crediting the "State of Hlmois,"
(which is the proprietor), with the amount of the inventory.

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On page one of the journal several parties have been credited
with the amount of invoices furnished the institution for the entire
quarter, and the store debited with the total amount. This entry
was made to avoid making any more entries than are necessary to
illustrate the point in question. In an actual set of books, however,
the book-keeper will enter upon his journal the amount oif each in-
voice received to the credit of the party furnishing the same, and
debit the store with the amount of invoices received during the day»
In the case of some of the smaller institutions, or at particular pe-
riods when the purchases are small, it may not be necessary to
enter up these invoices more than once a week.

The journal will contain a record of all transactions of every de-
scription, with the following exceptions, namely: the cash receipts
of the institution, and the Ust of orders drawn in payment of ac-
counts rendered. These will be entered upon subsidiary books,
namely: d book of receipts and a book of orders.

Book of Receipts.

The book of receipts (Form No. 2) is a record of all moneys re-
ceived by the institution, either from the state treasury or any other

The only explanation of this form which seems to be neces-
sary relates to the manner of posting and the reference to the
ledger folios. It is supposed that each item received will be credited
at once to the account upon which it is received, and the column
* 'ledger folio" wiU show the page on which such credit is entered.
These accounts may be credited on one of three ledgers — the general
ledger, the county ledger, or the individual ledger, as the case
may be. One column will answer for the page of all these post-
ings, since the account itself will show, by inspection, on which
ledger the credit should properly be given. In order to com-
plete the posting, however, these accounts must be entered as debits
to the treasurer of the institution; but this need not be done until
the end of the quarter, when the entries to be made will correspond
to the footings of the several columns respectively. In order to
show the folio of the' general ledger on which the debits are to be
made, it will be necessary to bring these footings down in the right
hand column, and enter the page in the column "ledger folio," as
shown in the form. The receipts from miscellaneous sources are
debited on folio seven, because these are regarded as part of the ordi-
nary expense appropriation. The receipts on account of special appro-
priations will go to the folios set apart for these funds in the ledger.
Moneys received on accoimt of a county or inmate, for clothing fur-
nished, will be credited upon the folio set apart in the county or
individual ledger, as the case may be ; but the total amount received
from counties or individuals during the quarter will be debited to
the treasurer under ordinary expense fund.

The plan of numbering receipts in consecutive order, and plac-

Online LibraryIllinois. Board of State Commissioners of Public IllinoisBiennial report of the Board of State Commissioners of Public Charities of ... → online text (page 32 of 36)