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 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 out-patients 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 would 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. Mackay). Administered as they usually are in isolation—apart Endowed charities.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 a few 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. This, coupled with good methods of inquiry and supervision, has proved very beneficial. Hitherto, however, to a large extent, endowed charities, it must be admitted, have 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; and an act has now been passed in England (1906) enabling the cost to be put upon the rates. Usually a very large number of children are said Relief to children at school.to be underfed, but inquiry shows that such statements may be taken as altogether excessive. They are sometimes based on 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 temptation is greatest, and where the family instinct should be strengthened—stimulate this neglect. Considered from the point of view of meeting by eleemosynary provision a normal economic demand for food, intervention can only have one result. The demand must continue to outstrip the supply, so long as there are resources available on the one side, and until on the other side the desire of the social class that is chiefly exposed to the temptations of dependence in relation to such relief has been satisfied. If the provision be made from the resources of local or general taxation the largeness of the fund available will allow practically of an unlimited expansion of the supply of food. If the provision be made from voluntary sources, in some measure limited therefore and less certain, this very fact will tend to circumscribe demand and limit the offer of relief. It is indeed the problem of poor-law relief in 1832 over again. The relief provided by local taxation practically unlimited will create a mass of constant claimants, with a kind of assumed right to aid based on the payment of rates; while voluntary relief, whatever its short-comings, will be less injurious because it is less amply endowed. In Paris the municipal subvention for meals rose from 545,900 francs in 1892 to 1,000,000 in 1904. Between 1894 and 1904 there was an increase of 9% in the school population; and an increase of 28% in the municipal grant. In that period the contributions from the local school funds (caisses des écoles) decreased 36%; while the voluntary contributions otherwise received were insignificant; and the payments for meals increased 2%.
The subject has been lately considered from a somewhat different standpoint (cf. the reports of the Scottish Royal Commission on Physical Education, 1903; of the Inter-departmental committees on Physical Deterioration, 1905, and on Medical Inspection and the Feeding of School Children, 1905; also the report of the special committee of the Charity Organization Society on “the assistance of school children,” 1893). After careful investigations medical officers especially have drawn attention to the low physical condition of children in schools in the poorer parts of large English towns, their low stature, their physical defects, the improper food supplied to them at home, their uncleanliness, and their want of decent bringing-up, and sometimes their want of food. Other inquiries have shown that, as women more usually become breadwinners their children receive less attention, and the home and its duties are neglected, while in the lowest sections of the poorer classes social irresponsibility reaches its maximum. Cheap but often quite improper food is provided, and infant mortality, which is largely preventable, remains as high as ever, though adult life is longer. This with a marked decrease in the birth-rate in recent years, has, it may be said, opened out a new field for charitable effort and social work. Science is at each revision of the problem making its task more definite. Actually the mere demand for meals stands for less; the reform of home conditions for more. So it was hoped that instead of making school meals a charge on taxation, as parliament has done, it would be content to leave it a voluntary charge, while the medical inspection of elementary Schools will be made universal; representative relief committees formed for schools or groups of schools; the cases of want or distress among the school children dealt with individually in