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REESE LIBRARY

OF THE

UNIVERSITY OF CALIFORNIA.
Class



METHODS OF SOCIAL ADVANCE



METHODS OF SOCIAL
ADVANCE



Sbort StuOies in Social practice
various Hutbors



EDITED SY

C. 8. LOCH, B.A.



SBCBKTABT OF THE LONDON CHARITY ORGANISATION SOCIETY



' If citizens be friends they have no need of justice, but, tho*
they be just, they need friendship or love also; indeed, the
completest realisation of justice seems to be the realisation of
friendship or love also.'



^ OFTSE^

UNIVERSITY
4\>
ion

MACMILLAN AND CO. LIMITBD

NEW YORK : THE MACMILLAN COMPANY
1904



PBEFACE

IN December 1902 a letter, here reprinted, was addressed to
the Times, in which suggestions were made for social reform
and the prevention of distress. The suggestions of the letter
have since served as a kind of agenda for discussion during
the present year (1903) at special meetings of the Council
of the Charity Organisation Society. On most of them
papers were written, and many people interested in them
from different points of view took part in the debates.
Afterwards it was thought that the papers would interest
a yet larger audience. Accordingly they have been published
in this book with some additions.

Most of the papers have appeared in the CHARITY
ORGANISATION EEVIEW. Each author is responsible for his
own paper.

C. S. L.



157701



CONTENTS



PAGE

Preface v

Introduction : Distress and its Prevention . (C. S. Loch) 1

I. Out-Patient Departments and the Rearing of Children

(Edmund Cautley, M.D.) 7

II. The Work of a Hospital Almoner

(Helen Q. Nussey, Almoner, Westminster Hospital) 18

III. Charitable Action in Phthisical Cases

(E. E. Mudd, Almoner, St. George's Hospital) 29

IV. Physical Education . . . . . (Col. O. T. Duke) 39

V. A Policy of Hustling ; or, The Lock and Key . (J. R. Motion) 59
VI. Agriculture and the Unemployed Question (H. Rider Haggard) 64

VII. Past Experience in Belief Works . . (Helen Bosanquet) 79

VIII. Emigration and Want of Employment . (John Mwrtineau) 88

IX. Municipal Labour Bureaux . ... (T. Hancock Nunn) 96
X. Industrial Partnership and the Prevention of Distress

(George Livesey) 107

XI. Apprenticeship (Miss M. K. Bradby and Miss F. H. Durham) 118

XII. Wages and Housekeeping . . . . (Helen Bosanquet) 131

XIII. The Separate Payment of Eates . . . . (C. S. Loch) 147

XIV. Poor Law Reform (T. Machay) 158

XV. A Charities Board . . . . . . (C. 8. Loch) 169

XVI. A School of Sociology . . . . . (E. J. Urrvich) 180

XVII. ' If Citizens be Friends ' . ; . . . * (C. 8. Loch) 189




INTEODUCTION

DISTKESS AND ITS PBEVENTION

No small part of our indecision and failure in dealing with\
social difficulties is due to our lack of any clearly conceived
social purpose. Our real purpose, I take it, is to make and ,
keep our people competent. We would add to their ability, ^
energy, and resources, strengthen their affections, and increase
their pleasure in a healthy, robust existence ; and, as we do
this, it would follow, as the night the day, that their power of
preserving their independence in all the ordinary contingencies
of life and in the strain of hard times would increase pro-
portionally.

It follows, further, that to make the people more com-
petent our appeal must be made, not to their weakness, but
to their strength, however elemental or undisciplined that
strength may be. We must add strength to strength. This
view is of vital importance. It affects the whole question of
relief and the use of means. Belief or even increased wage or *
income will not help the people (of whatever class they be),
but will rather weaken them, if it does not coincide with some
movement on their part which makes for better social habit v
In this, and not in any new form of dependence, does the
remedy lie. All the experience of that long history of the
enfranchisement of the poorer classes from system after
system of social control and eleemosynary or statutory serfdom
enforces this conclusion; and, so far as we can yet judge
them by results, the experience of German, colonial, and other
schemes for the new dependence of the infirm and the aged
tells the same tale.

One source of life-long weakness, physical and moral, is



2 METHODS OF SOCIAL ADVANCE

incompetence in the rearing of children. By this social habit
is undone at its very inception. At children's hospitals, as
has been said, far the larger part of the disease and sickness
for which aid is sought is avoidable. But the mothering
power of our womenkind is deficient. They do not know,
nor do they learn, at the home, or the school, or, except in a
slight degree, at the hospital, the simple facts that^ above all
in a crowded town, are essential to the well-being of children.
If we ought to educate the people according to their real
needs, should not education in social habit form a chief part
of our school teaching ?

Another remedy may be found in playgrounds and games
for both boys and girls. Dr. Dukes has once more drawn at-
tention to this. Municipal authorities not infrequently make
clearances in central districts under Dwellings Acts. The
commercial value of the sites thus cleared is written
down to its * dwellings' value a very great loss; and
dwellings are built ; and, a most unnatural process, to them
new settlers, usually of a superior class, are attracted,
migrating to mid-London instead of away from it. Would
it not be better, costly though it may seem, to use the cleared
sites in part as open spaces and playgrounds, and afterwards,
when by the normal outward movement of the population,
the demand for school accommodation in the district decreases,
to sell them at the market price ? And in the ever-increasing
suburbs of our large towns, why should not at least two
acres be provided as playground for every new school ? Or,
why should not a fixed proportion of acreage be preserved for
playground and recreation as the town pushes outwards?
There are many means of doing this, through corporations
and colleges who have building estates, through a * national
trust' like that for places of historic interest or natural
beauty, or through some public body such as the Trustees
of Public Keservations in Massachusetts.

Not less important as a means of preventing distress is
the physical and military drill, the adoption of which Lord



INTRODUCTION



3



Charles Beresford has urged on the Council of Education.
But will not the Government go further and put before the
country some well-considered proposal for the disciplining of
our people as citizen soldiers ? This would check hooliganism,
and it would do more. It would give men and boys a larger
conception of duty and new ideas as to the use of means, would
harden them physically, and make them cleaner and more
temperate, more adaptive and self-reliant. And, if we are to
have the reservist system, should not the men be so taught
and disciplined while they are on service that morally and
educationally they become competent for well-paid skilled
work when they leave the ranks ?

Much distress might be prevented by other means also.
Under safeguards not difficult to provide, the friendly society,
as well as the savings bank, might be organised in the closest
relation to the school system. A habit of forethought in life
would thus grow up, strong enough to bear the strain of the
years that follow school age, a habit which is neither un-
generous nor miserly, as it is often said to be, but which is to
the soul as is a sound constitution to the body. And as the
power of husbanding is usually a first step to civilisation, why
should not the visitors of parochial and other agencies become
collectors of savings humble work indeed, but it enables
many people, who otherwise would never think of putting by,
to harvest the fruit of their labours, and it opens out to them
a better life than that of hand-to-mouth hopelessness.

And we should not oppress the people with taxation. In
some districts this is increasing out of all proportion to the
increase either of population or of rateable value. Thus in
three boroughs in different parts of London the increase
per cent, between 1890-91 and 1899-1900 is as follows :





Total Rates


Rateable Value


Population


St. Pancras
Poplar
Camberwell


+ 84-2

+ 52-7
+ 66-7


+ 13-0
+ 14-6
+ 21-2


+ 0-4
+ 1-2
+ 10-2



B 2



4 METHODS OF SOCIAL ADVANCE

This represents in Camberwell an increase of 219,694 on
the assessment and of 210,682 on the annual expenditure.
In West Ham, with an increase of 47*1 per cent, on the rate-
able value, the increase of expenditure on * the relief of the
poor and purposes connected therewith ' between 1891 and
1900 has been 102 per cent.

These large additions to the rates combined with rising
assessments are indeed a grave form of economic oppression.
And how they are raising rentals and pushing industries to
other districts the people do not realise. They forget that,
as increased duties are as far as possible passed on to the
consumer, so an increase of Is. in the pound in the rate
represents usually an increase of at least 2d. or 3d. a week on
a 5s. rental. The remedy lies largely in the collection of the
rates from the individual occupant. An increase in the rates
will then be expressed definitely as the equivalent of so many
pence collected periodically by, or on behalf of, the rate col-
lector. And a sense of responsibility, one of the first safe-
guards for the good use of means and so against distress, will
thus be created.

Another suggestion may perhaps be considered. Ingenuity
in associative mercantile contrivance is by no means exhausted,
as the history of trusts in the past year shows. Is it exhausted
on the distributive side ? Trade unions may aid skilled labour ;
they cannot benefit unskilled labour permanently. To im-
prove his economic position the unskilled labourer must have
recourse to some other method. With him progress lies in
the better use of wage, or, if it can be arranged, in profit-
sharing, or in similar co-operative relations between employer
and employee. Sir George Livesey has shown how the
employees of a gas company may become property holders.
Is it not possible to extend the system to labourers generally,
or at least to most of those who work at the docks and to that
large group of partially casual labourers who work for different
masters for sometimes long periods together ? As a matter
of justice, should not workers share in profits according to



INTRODUCTION 5

some estimate of the extent to which they have helped to
create them ? Were this possible a new element of security
would be given to life which, accruing as a reward of work
done, would bring with it alike self-restraint and economic
hopefulness. A reserved share of profits would be of the
greatest service in the periodic depressions of trade.

In the last half-century our Poor Law system has changed
in much. But two things remain. ' Ins and outs ' come and
go, and for them social neglect does not carry with it the
penalties or the discipline of social reform. A class border-
ing on the Poor Law might be largely modified by even the
prospect of committal for a period of laborious and wholesome
detention as an alternative to ' in and outing.'

And the allowance system still reigns supreme, though,
as it now is, or has to be, administered under the Poor Law,
it is contrary to all the canons of charity. The key to
success in charity lies in persistent care for the individual
in close connection with the family and in discerning and
friendly aid, according to the needs of the particular case.
Few realise how great this success may be. But a statutory
and rate- supported allowance system reduces all remedies to
one to the granting of money : it thus deprives the people
of one most useful means of social education, the personal
responsibility of charity, and it prevents any large growth of
that responsibility. In these circumstances little or nothing
is done to draw institutional relief into systematic relation
with personal and local charity. And the endowments of our
ancestors, which could be most usefully applied in close
alliance with the living charities of the day, are isolated,
unsupervised, and in large measure left to run to waste.
Nor, if we except the special and limited powers of the
Charity Commission, have we any recognised administrative
centre for association and guidance in charity a branch of
social work on which the nation should be able to rely as a
constant aid in the case of the disabled and worn-out and in
the regeneration of those who can be saved from debasement,



6 METHODS OF SOCIAL ADVANCE

Is it not worth while to consider whether a State Board of
Charities modelled to suit English needs would not help us
in the better supervision of charities and possibly in such
problems as the treatment of inebriates, the permanent care
of the feeble-minded, and in other ways ?

All the impulse that charity, in its fullest meaning,
religion, and personal devotion can give we want. From
these come a spontaneity and originality which are curative
as spring breezes. But ultimately all suggestions depend on
the education of public thought. A new and, as we believe,
truer patriotism now fills our hearts. There is fear lest it
should be merely combative and self-assertive. If it is real
it will quicken our minds and reform our organisation, and
make of the warring and merely competitive elements in our
nation a social whole. As this is realised, that cardinal want,
education in social life and economics, will perhaps be met,
and those who undertake the duties of administration or of
charity will learn that to promote competence in others they
must first make themselves competent, and that without
intelligence and a clear purpose neither personal devotion,
nor religious feeling, nor excited philanthropy, nor large
communal expenditure, can prevent or remove our distress.

C. S. L.



OUT-PATIENT DEPAETMENTS AND THE
KEAEING OF CHILDKEN

THE object of this paper is threefold, Firstly, I wish to
point out how greatly limited is the effect of the valuable
work done in the out-patient departments of hospitals for
diseases of children. Secondly, I desire to put forward
suggestions for supplementing the purely medical work and
making it of more than merely temporary benefit. Thirdly,
I think that steps should be taken to co-ordinate the efforts
of ^various charitable bodies and to direct their attention to
the possibility of assisting mothers, in looking after their
children, by a system of home visits. Unfortunately it is
still a superstition among the poor that the only necessity in
the treatment of disease is a bottle of medicine, and that
anything in the nature of advice need not even be listened
to. Practical demonstrations would, however, be more
attractive and doubtless more efficacious.

Reference to the returns of the Registrar-General shows
that the mortality of infants that is, of children under one
year of age is absolutely appalling, and that it does not
decrease with the progress of civilisation in the same way as
the mortality from other preventable diseases. During the
ten years, 1891 to 1900, a yearly average of 160 out of every
1,000 children born in London died under the age of one
year. The mortality is even higher in some other large
towns in the United Kingdom. More than two-thirds of the
deaths from diarrhoea are those of infants under one year of
age, and diarrhoea in infants is an affection which almost



8 METHODS OF SOCIAL ADVANCE

invariably arises from errors in diet. In addition to the deaths
from diarrhoaa, a large number resulted from wasting or
malnutrition, a condition entered in mortality statistics as
marasmus or infantile atrophy. This, too, is almost in-
variably due to bad feeding. Apart from deaths, there are
many secondary affections due to a similar cause. Notably
among these may be mentioned rickets, with its resulting
predisposition to fatal lung affections, to deformities, and to
imperfect development. It is obvious that both imperfect
development and deformities are likely, when present in the
parent, to affect the transmission of the species.

There is not a shadow of doubt that on the methods
of feeding and rearing infants, during the early stages of
existence, depend the health and strength of the children
and, in fact, the strength and physique of the nation. One is
almost justified in asserting that the physique of the nation
varies directly as its food supply during infancy and early
childhood.

Quite half the patients brought to the out-patient
departments, for ailments which come under the care of the
physician, are infants under one year of age. It would be
found on any day, chosen haphazard, that there would be
comparatively few cases to treat if all those due, primarily
or secondarily, to purely dietetic causes were excluded. In
other words, diet is the main cause of illness in infants and a
frequent cause in older children. On account of its over-
whelming importance my observations are mainly concerned
with the infants.

In treating these infants an enormous amount of energy
is wasted by the experts in charge of the departments.
Careful directions are given verbally, often written down and
handed to the mother, and frequently supplemented by a
printed pamphlet containing full details of what is required.
Yet for many reasons the desired results are not obtained.

It may be stated as an axiom that the amount of benefit
derived from the advice given by the physician is in inverse



OUT-PATIENT DEPARTMENTS AND REARING OF CHILDREN 9

ratio to the degree of intelligence possessed by the mother.
Even after many years of compulsory school education the
stupidity and ignorance of some mothers is astounding. And
yet every mother thinks that some inborn instinct enables
her to bear and rear babies successfully, without the least
advice or instruction.

Put shortly, failure on the part of the mother results
from one or other of three causes.

(1) Ignorance. The mother is anxious to rear her infant,
devotes much time and attention to it, but fails through not
having the least idea how to feed a baby, or through relying
on the advice of ignorant neighbours or landladies. Every
woman who has brought up one baby thinks herself a
competent adviser, and that she knows all about the
subject.

(2) Carelessness. The unfortunate child often has to
take its chance, perhaps a very small one by reason of the
dirty, slatternly, or drunken habits of the mother. Careless-
ness is most in evidence in the case of the later children of
large families and among those who are insured. There is
no doubt that, as a general rule, the younger children among
the poor have a smaller chance of survival than the elder
ones, partly because they are looked upon as superfluous,
partly because of the limited means of the parents. Un-
consciously, if not deliberately, less care is devoted to them.

The question of insurance is a difficult one. On the one
hand, it is adopted by the respectable poor from worthy and
justifiable motives ; on the other, it leads to carelessness and
neglect in some instances, from the fact that the insurance
money will provide for an impressive funeral, and, perhaps,
even a small balance. Consciously or unconsciously, on the
part of the mother, the insurance of infants leads, in my
opinion, to much carelessness in their management and to an
increase in the mortality.

(3) Criminal Neglect. The worst instances of neglect are
seen in the insured and in nurse-children, the latter being



10 METHODS OF SOCIAL ADVANCE

often illegitimate. It is sometimes seen in first-born children,
but is more common in large families. Where neglect ceases
to be carelessness and becomes criminal is an insoluble
problem.

One of the most difficult questions a hospital physician is
confronted with, and not an uncommon one, is to ascertain
whether the infant is being deliberately starved to death
from lack of food or from being fed on food which is known to
be unsuitable, or is dying as the result of mere ignorance on
the part of the mother or nurse. Needless to say, cases in
which the infants are insured, or are ' out at nurse,' are looked
upon with the gravest suspicion. It is a sad fact that there
are women who have learnt the trade of ' slaughterer of the
innocents ' so well that the poor victim is brought regularly
to the hospital, is kept beautifully clean and well clad, and is
being slowly and deliberately starved to death by actual lack
of food, though more commonly by being fed on a diet which
is known to be unsuitable and likely to cause death from
diarrhoea or convulsions. The infants are rarely kept with-
out food, but what they receive is of as little value to them as
if they were being fed on sand or stones. Such women
usually weep copiously over their ' little angels,' in the
presence of the doctor.

Criminal neglect is rather outside the scope of this paper.
It is to be hoped that some time Parliament, in a desire to
evolve useful legislation, will pass a law placing every nurse-
child under a system of registration and inspection, not
limiting such protective measures to those infants in the care
of women who take charge of more than one infant.

That remedies should be adopted to dimmish the enormous
waste of infant life, and to alleviate the still greater suffering
of infants and children, is as obvious as it is difficult to devise
suitable ones and to set in motion the responsible authorities
for initiating and carrying them out. It seems to me that
the responsibility should be shared by the State, by the
municipal authorities, and by the hospitals, and that it might



OUT-PATIENT DEPAETMENTS AND REARING- OF CHILDREN 11

be supplemented with the greatest advantage by other
charitable bodies.

The suggested measures are as follows :

(1) Printed Instructions. In the first place, there should
be handed to the parent of each child, when the birth is regis-
tered, a short paper of instructions on the simple methods of
rearing infants, great emphasis being placed on the impor-
tance of breast-feeding during the early months of life. Such
a pamphlet as that used at the Belgrave Hospital for Children
might be adopted. It gives simple and full instructions on
both the natural and artificial methods of feeding infants and
young children up to the age of three years. It has been in
use there for about ten years, and has proved of the utmost
benefit to all concerned. Arrangements as to the issue of
such instructions must necessarily be in the hands of the
State.

(2) Milk Supply. The management of artificial methods
of feeding infants is always much more difficult than breast-
feeding and more liable to result in failure. These difficulties
are much greater among the poor than among those who
are better off. Certainly every poor mother should be en-
couraged to suckle her child. Apart from the fact that the
natural food is much more likely to be suitable than an
artificial one, the breast-fed infant escapes the risks incidental
to all methods of hand-feeding. These risks are partly due
to unsuitable food, to lack of freshness, to carelessness and
lack of cleanliness in its preparation, and to dirty or
unsuitable feeding-bottles.

Here, too, the State might step in and protect infant life
by prohibiting the mother from undertaking any work which
interfered with the due performance of her maternal functions,
until the child is three months old. An exception might be
made in the case of women quite unable to suckle their
infants, on production of a medical certificate to that effect.
At present women are allowed to return to factory work one
month after confinement.



12 METHODS OF SOCIAL ADVANCE

The pamphlet, recommended for distribution, contains
full and simple directions about the hand- feeding of infants
from the day of birth. Cow's milk is the basis of the diet.
The medical profession is unanimous that the milk of the
cow, suitably modified and prepared, is the cheapest and
most readily available substitute for human milk, and that
it is almost invariably quite satisfactory. Unfortunately,
even printed directions are not always carried out, mothers
being so largely influenced by flaming advertisements of the
patent food-monger and by the foolish advice of friends.

A great part of the difficulty in establishing the use of
cow's milk among the poor for this purpose is due to the
difficulty in obtaining a supply of good milk at a reasonable
cost, and in keeping it fresh in their cramped, ill-ventilated,


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