CHARITY
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to the number of her children. Helped at the outset by charity on some definite plan, she may become selfsupporting ; and if her family be large one or two of her children may be placed in schools by the guardians, while she maintains the remaining children and herself. As far as possible there should be a division of labour between the poor-law and charity. Except where some plan such as that just mentioned is adopted, one or the other should take whole charge of the case relieved. There should be no supplementation of poor-law relief by charity. This will weaken the strength and dissipate the resources of charity without adding to the efficiency of the poor-law. Unless the guardians adopt a restrictive out-door relief policy, there is no scope for any useful division of labour between them and charity; for the many cases which, taken in time, charity might save from pauperism, they will draw into chronic dependence by their allowances a very much larger number. But if there is a restrictive out-door policy, so far as relief is necessary, charity may undertake to meet on its own lines distress which the poor-law would otherwise have met by allowances, and, subject to the assistance of urgent cases, poor-law relief may thus by degrees become institutional only. Then, in the main, natural social forces would come into play, and dependence on any form of annona civica would cease. Open-handed hospitality always creates mendicants. This is what the hospitals oiler in the out-patient and Hospitals casualty departments, and they have created a class of hospital mendicants. The cases are quickly dealt with, without inquiry and without regard to home conditions. The medical man in the hospital does not co-operate with any fellow-workers outside the hospital. Where his physic or advice ceases to operate his usefulness ceases. He regards no conditions of morality. In a large number of cases drink or vice is the cause of application, and the cure of the patient is dependent on moral conditions; but he returns home, drinks, and may beat his wife, and then on another visit to the hospital he will again be physicked, and so on. The man is not even referred to the poor-law infirmary for relief. ISTor are conditions of home sanitation regarded. One cause of constant sickness is thus entirely overlooked, while drugs, otherwise unnecessary, are constantly given at the hospital. The hospitals are thus large isolated relief stations which are creating a new kind of pauperism. So far as the patients can pay—and many can do so—the general practitioners, to whom they would otherwise go, are deprived of their gains. Still worse is it when the hospital itself charges a fee in its out-patient department. The relief is then claimed even more absolutely as a right, and the general practitioners are still further injured. The doctors, as a medical staff, are not only medical men, but, whether they recognize the fact or not, they are also almsgivers or almoners; what they give is relief. Yet few or none of them have ever been trained for that work, and consequently they do not realize how very advantageous, even for the cure of their own patients, would be a thorough treatment of each case both at the hospital and outside it. Nor can they understand how their methods at present protract sickness and promote habitual dependence. Were this side of their work studied by them in any way they would be the first, probably, to press upon the governors of their hospitals the necessity for a change. Unfortunately, at present the governors are themselves untrained, and to finance the hospital and to make it a good institution is their sole object. Hospitals, however, are, after all, only a part of the general administration of charity, though as they are now managed they have seldom any systematic connexion with that administration. Nor is there any co-ordination
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between the several hospitals and dispensaries. If one rightly refuses further treatment to certain applicants, they have only to wander to some other hospital, there to be admitted with little or no scrutiny. For usually outpatients and casualty patients are not even registered, nor can they be identified if they apply again. Practically they come and go at will. The definite limitation of cases, according to some standard of effectual work, association with general charity, trained almonership and inquiry, and a just regard for the interests of general practitioners, are stepping - stones to reform. In towns where medical charities are numerous a representative board w'ould promote mutual help and organization. Like the poor-law, endowed charities may be permanent institutions established to meet what should be passing and decreasing needs (cf. the arguments in The State and Charity, by T. Mack ay). charUies Administered as they usually are in isolation— C ar 'es' apart from the living voluntary charities of the generation, and consisting often of small trusts difficult to utilize satisfactorily, they tend to create a permanent demand which they meet by fixed quantities of relief. Also, as a rule, they make no systematic inquiries with a view to the verification of the statements of the applicants, for they have no staff for these purposes; nor have they the assistance of almoners or friendly visitors. Nor does the relief which they give form part of any plan of help in conjunction with other aid from without; nor is the administration subject to frequent inspection, as in the case of the poor-law. All these conditions have led to a want of progress in the actual administration of endowed charities, in regard to which it is often very difficult to prevent the exercise of an undue patronage. But there is no reason why these charities should not become a responsible part of the country’s administration, aiding it to reduce outdoor pauperism. It was never intended that the poor-law should extinguish the endowed charities, still less, as statistics now prove, that where endowments abound the rate of pauperism should be considerably above the average of the rest of the country. This shows that these charities often foster pauperism instead of preventing it. As a step to reform, the publication of an annual register of endowed charities in England and Wales is greatly needed. The consolidating schemes of the charity commissioners have done much good ; still more may be done in some counties by extending to the county the benefits of the charities of well-endowed towns, as has been accomplished by the extension of the eleemosynary endowments of the City of London to the metropolitan police area. Nor, again, until quite lately, and that as yet only in one or two schemes, has the principle been adopted that pensions or other relief should be given only in supplementation of the relief of relations, former employers, and friends, and not in substitution of it. Hence hitherto, in the main, the system has tended to weaken the family and to pauperize. In many places funds are raised for the relief of school children by the supply of meals during the ■winter and spring. Usually a very large number of children are said to be underfed, but inquiry shows that such statements may be taken c”?■,*!,r to a as altogether excessive. They are sometimes based on a ic ^00 information drawn from the children at school, or
sometimes on general deductions ; they are seldom founded on any systematic and competent inquiry at the homes. When this has been made, the numbers dwindle to very small proportions. Teachers of experience have noted the effect of the meals in weakening the independence of the family. While they are forthcoming women sometimes give up cooking meals at home, use their money for other things, and tell the child he can get his meal at school. Great temptations are put before a parent to neglect her family, and very much distress is due to this. The meals—just at a time when, owing to the age of her children, the mother’s care is most needed, and just in those families where the
