scope of the work undertaken by public health departments. The point was made that in so far as these bodies exceeded the limit of indispensable activities they were “pauperizing” the public. The accepted view was that the duty of sanitary authorities was not to help any one family to be healthy, but to prevent any one family from disseminating disease. But it is almost impossible to draw a line between necessary functions and those which are largely philanthropic. Thus many cities maintained a large staff of physicians and nurses whose duty it was to visit schools and even households, giving advice and treatment free. From the private practitioner's point of view this work was an encroachment on his legitimate sources of income, but free medical treatment in the case of school-children, for example, is merely an incident of free education, for the ability to receive education is in large degree dependent on physical fitness. It should be said, moreover, that in most cities free treatment was not given unless the recipient was unable to pay, and that in any case the community was only protecting itself by promoting the health of its individual members. The same question was involved in the establishment of sanatoriums in many parts of the United States for the treatment of tuberculosis and other communicable diseases, both aiding the sufferer and safeguarding the public from him, as had been done in the case of the insane for many years. In some of such institutions a nominal charge was made, but by far the greater part of the expense was paid by taxation. Hospitalization came to be expected as a right, regardless of the ability of the patient to pay the cost of treatment. Thus the American public was being taught to feel that the state or county or city was bound to provide certain kinds of public assistance which had been regarded as outside the scope of state subsidies.
Of the newer proposals for public assistance none gained more rapid headway than that for mothers' allowances or pensions. The first such law was- passed by Missouri in 1911, and granted allowances to widows with children and to deserted mothers; by 1920 there were similar provisions in 39 states. These allowances ranged from $2 a week for each child up to $25 a month for the first child and $15 a month for each additional child. The age limit, after which the allowance was to cease, was placed at 13 years in some states and as high as 18 in others. Up to 1920 the aggregate of these allowances had not become so large as to alarm taxpayers, and in so far as the system saved the children from being committed to public institutions orphan asylums and the like it was undoubtedly beneficial. Legislation for mothers' allowances, no doubt, tends to create a demand for old-age pensions, but up to 1921 no state had yet undertaken this form of subsidy. Taxes for mothers' allowances were mostly levied and administered by the county governments.
Another form of public assistance which grew rapidly in the decade 1910-20 was that connected with the health of children, particularly those attending school. As early as 1892 New York City provided for the inspection by health officers of school-children, and by 1920 practically every city had organized some form of health examination for all pupils attending public schools. In later years the scope of the work was considerably expanded; skilled medical examiners were employed to give especial attention to eyes, throats and teeth, and, where necessary, treatment was often given at public expense. Special open-air schools were opened in many places for tubercular children; and proper conditions maintained for giving the children adequate fresh air, rest and nourishment. In many poorer districts, where the educational progress of the children was found to be retarded by under-nourishment, it became customary for the school authorities to provide a daily luncheon, which was served either free or at a nominal price. In 1919 cities having each a pop. of more than 30,000 expended an aggregate of $1,849,624 on medical work for school-children, and an additional amount of $908,742 on other child conservation work, such as the employment of trained nurses to visit mothers in congested districts and the establishment of infant welfare stations where mothers could obtain medical advice and free treatment for their babies.
To determine the aggregate amount of public assistance in the United States it is necessary to state that such items as those for sanitation, prevention of epidemics, protection to life and property cannot properly be regarded as public assistance. The following tables, based on U.S. Census Bureau reports, show the increase in public expenditures in the period 1913-9 for health conservation and maintenance of charities, hospitals and correctional institutions:—
Health Conservation
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Thus the increase in expenditures for the purposes noted was somewhat more than $90,000,000 in six years. These figures, however, include the cost of certain activities which cannot rightly be classed as public assistance, and which are approximately one-third of the total. With respect to the more recent compilations of the Census Bureau, it is possible, because of the greater fullness of data, to exclude those items. Thus a tabulation of the expenditures by the states for public assistance in 1918 would include the following:—
| Health Conservation. | |
| Treatment of tuberculosis— | |
| In institutions | $5,105,556 |
| Elsewhere | 643,981 |
| Treatment of other communicable diseases | 1,488,186 |
| Conservation of child life | 285,674 |
| Other health activities | 764,497 |
| Charities, Hospitals. | |
| Supervision | 849,727 |
| Outdoor relief | 517,827 |
| Care of poor— | |
| In state institutions | 211,995 |
| Elsewhere | 121,101 |
| Care of children— | |
| In state institutions | 1,328,441 |
| Elsewhere | 2,023,205 |
| Care of blind, deaf and mute— | |
| In state institutions | 4,458,758 |
| Elsewhere | 1,713,274 |
| Other charities— | |
| State institutions | 8,924,208 |
| All other | 530,862 |
| Hospitals— | |
| General | 2,613,951 |
| All other | 3,149,100 |
| Hospitals for the insane— | |
| State | 47,860,528 |
| All other | 2,091,304 |
| Total | $84,682,175 |
The expenditures of cities for similar purposes in 1919 were as follows:
| Prevention and treatment of communicable diseases— | |
| Tuberculosis | $5,145,280 |
| Other communicable diseases in hospitals | 4,427,510 |
| Other treatment | 2,271,364 |
| Conservation of child life— | |
| Medical work for school-children | 1,849,624 |
| Other child conservation work | 908,742 |
| Charities and hospitals— | |
| General supervision | 854,466 |
| Outdoor poor relief | 4,631,697 |
| Poor in institutions | 7,715,940 |
| Care of children | 7,125,436 |
| Other charities | 3,570,051 |
| General hospitals | 16,735,615 |
| Insane hospitals | 3,871,082 |
| Welfare commissions | 47,307 |
| Total | $59,154,114 |
