The

Care of the Dependent Poor

3ames 3. Malsb, flD.Eh, fl>b. Eh

New York

THE PAULIST PRESS

120 West 60th Street





AE P17/6

The Care of the Dependent Poor

BY

\

JAMES J. WALSH, M.D., Ph.D.

New York

THE PAULIST PRESS

120 West 60th Street

1917



Copyright, 1917, by “The Missionary Society of

St. Paul the Apostle in the*' State

of New York ”

DsaMer



The Care of the Dependent Poor

I.

THE SICK.

HE care of the dependent and the sick poor has

been and is, throughout human history, one of the

most important of social duties and one of the

most difficult of social problems. What care is

shown in this way is quite a safe index to the

true humanitarianism of a particular time. The care of the

ailing poor has in our time developed so marvelously, and

our hospitals have grown to be so efficient, that we have, and

deservedly, been self-complacent about the progress that has

been made. Indeed there is a tendency, if not a habit, to

forget the depths from which we have so recently risen or,

as one medical writer on the subject has ventured to suggest,

“ the veritable slough of despond in this regard out of which

we have only just succeeded in dragging ourselves.”

Very few realize how recent is the improvement in hospital

organization and how sadly that improvement was needed.

Ruled by current ideas of evolution, some writers have sup-

plied themselves with a theoretic history of hospital work.

According to it humanity has at last reached a point in its

development where selfishness has given place to altruism,

and this altruism finds its particular application in helping the

indigent sick. Before our time, this stage of humanitarianism

had not been reached; or at least sympathy for others was

very imperfectly developed, and so our forefathers are, per-

haps, not so much to be blamed for the almost unspeakable

conditions which existed in hospitals and, indeed, institutions

of all kinds for the care of the poor.

The presumption is that if hospitals were so bad a century

ago, as we know now they were, they must have been much

worse a century still further back, and so on progressively

until the less said about the hospitals of the Middle Ages the

better..



4 THE CARE OF THE DEPENDENT POOR

Now any presumption that there is a continuous evolution in

hospital organization and in the care of the poor is, like so

many other chapters of evolutionary theory, entirely imaginary.

It is true that we have reached a fine acme of advance with

regard to hospitals, but anyone who thinks that there is a

series of chapters of constant progress leading to our time

from crude, thoughtless, unfeeling beginnings in the long

ago, will be sadly disappointed. On the contrary, the surprise

is to find that the lowest period in history in hospital or-

ganization and nursing came just before our time. The

eighteenth century had much better hospitals than the nine-

teenth; and the sixteenth better than the eighteenth; and,

strange as it may sound to some ears, some of the finest hos-

pitals that the world knows of were erected in the later Mid-

dle Ages.

Jacobsohn, the German historian of care for the sick, calls

attention to the fact—he calls it a “ remarkable ” fact—that
“ devotion to the well-being of the sick, improvements in hos-

pitals and institutions generally and to details of nursing, had

a period of complete and lasting stagnation after the middle

of the seventeenth century or from the close of the Thirty

Years’ War.” The older hospitals had been finely organized,

and so their organizations carried them on for a time but in

an ever-descending curve, until about the middle of the nine-

teenth century they had reached a stage of decadence.

Miss Nutting and Miss Dock in A History of Nursing

,

after

tracing in the first volume the history of nursing during the

centuries before our own, have a concluding chapter, entitled

“ The Dark Period of Nursing.” The years of which the

chapter speaks are almost of our own time. “ It is commonly

agreed that the darkest known period in the history of nurs-

ing was that from the latter part of the seventeenth up to

the middle of the nineteenth century. During this time the

condition of the nursing art, the well-being of the patient an^d

the status of the nurse all sank to an indescribable level of

degradation

”

(italics ours).

It was only in 1872 that the trained nurse came to Bellevue

Hospital in New York, and that was her first appearance in

this country. Some young English women came over at the

invitation of the hospital authorities and organized trained

nursing. Dr. Stephen Smith, who is still with us at the age

of ninety-five, and who introduced the trained nurse, tells



THE CARE OF THE DEPENDENT POOR 5

us the story of how the nursing was carried on at Bellevue

before that time. It was an extremely difficult matter to re-

cruit any sort of nurses, and the constant problem before the

hospital staff was how to secure help even fairly dependable.

According to Dr. Smith, not infrequently the “ ten-day women,”

women sentenced to ten days’ imprisonment for disorderly con-

duct, were welcomed as nurses.

It seems impossible that this state of affairs prevailed only

forty years ago. Dr. Smith further tells us that at first the

medical board refused to allow the new trained nurses to care

for the men patients at Bellevue. So little was the real spirit

of professional work appreciated.

There was so much opposition on the part of the medical

board that for a time the ordinary nurses were left in charge

of the male ward, and to their lasting credit, be it said, it was

the trained nurses themselves who insisted on being allowed

to take their places and give their services to the sick men.

The trained nurses at Bellevue were quite a curiosity. Visitors,

interested in hospitals, came from all parts of the country to

learn of their work. The only hospitals which previous to

this time had been at all presentable were the Sisters’ hospi-

tals, which were always clean and neat, and in which the poor

received the best possible care and treatment. Even the Sis-

ters’ hospitals were far from anything like the standard of

the present-day hospitals, though they were far superior to the

municipal hospitals of those days.

The death rate in the mid-nineteenth century hospitals was

woefully high, and it is no wonder that the poor dreaded them,

and quite rightly feared that entrance into a hospital was

almost equivalent to a death warrant. In these pre-antiseptic

days, operations were very frequently followed by death. I

believe that the first six operations for ovariotomy done in

England shortly before the middle of the nineteenth century,

all proved fatal. The local coroner declared that he would

attend the next operation performed by Sir Spencer Wells,

the operator, in order to determine what the cause of death

was, and to act accordingly.

In 1870, Professor Nussbaum, of Munich, finding that the

death rate in operated cases for the preceding year was about

four in five of his patients, declared that he would operate

no longer, since he was evidently, with the best of intention,

only hastening death or making it more painful. No wound



6 THE CARE OF THE DEPENDENT POOR

was expected to escape infection, and it is easy to understand

that no wound did. The expression “ union by first intention,”

which means the immediate agglutination of wound surfaces

and their prompt healing without complication or sequela, was

still preserved in the traditions of surgery, but no examples

of it were seen, and many surgeons doubted whether the term

had ever had any real meaning except possibly by accident.

Every wound was expected to develop pus, and the one hope

of the surgeon was that this purulent secretion should not be

of yirulent character, but should be of some mild, more or

less, innocuous variety, which should not prove too serious

for the patient.

When, therefore, the best that could be hoped for was that

a patient would suffer only with less virulent, or as it was

called, laudable pus

,

it is easy to understand that the hospitals

reeked with infection. No wonder that Nussbaum and others

felt that the end of hospital usefulness had come.

The mortality rate in Lying-in-Hospitals was one in ten,

and sometimes rose as high as one in five. It was much more

dangerous for a woman to give birth to a child in a hospital,

than to have an attack of typhoid fever. Typhoid fever itself

ran a most fatal course, and it is now well understood that

nursing plays a most important part in its successful treat-

ment. About the middle of the nineteenth century, typhus and

cholera were both extremely common in large city hospitals,

and indeed typhus was not definitely differentiated from its

less fatal and less acute sister disease, typhoid, until after

the middle of the nineteenth century. Cholera sometimes

carried away whole wards of patients in one or two days . 1

Fortunately after the middle of the nineteenth century, Pas-

teur’s discoveries of the microbic cause of human diseases

1 The general health of New York City was at this time just

coming up from a depth of degradation almost unbelievable. The

death rate in the city for years before 1866 had been from thirty

to forty per thousand, though no city in our climate should have

a mortality of more than fifteen per thousand. Dr. Stephen Smith

had been one of the principal factors in bringing about a clean-up

of the city. He was the commissioner in charge of New York’s

health between 1868 and 1875. Anyone who wishes to read an

account of filthy living, supposed to be utterly impossible in the

second half of the nineteenth century, may read Dr. Stephen

Smith’s book. The City That IVas.



THE CARE OF THE DEPENDENT POOR 7

lifted some of the gloom in which hospital conditions had been

shrouded. When challenged at a public medical meeting, about

1870, Pasteur dared to go to the blackboard and draw a picture

of the rosary-like streptococcus which is, so far as we know

down to the present time, the cause of puerperal fever. His

discovery of the diseases of fermentation; the diseases of

silk worms, and the means of overcoming them, attracted the

attention of Lister, and then began the epoch-making series

of experiments in antisepsis, and the modern era of surgery.

It was not, however, until the coming of the trained nurse,

and the possibilities of meticulous cleanliness were shown by

the introduction of women in charge of hospitals, that the old
*

deadly conditions began to abate, and death rates were satis-

factorily reduced.

When one thinks upon the conditions that have been de-

scribed, it is hard to understand the contrast between this

decadence and the splendid work of the preceding period.

Jacobsohn writes: “The result was that in this period the

general level of nursing fell far below that of earlier periods.

The hospitals of cities were like prisons, with bare, undecorated

walls and little dark rooms, small windows where no sun could

enter, and dismal wards where fifty or one hundred patients

were crowded together, deprived of all comforts and even of

necessaries. In the municipal and state institutions of this

period, the beautiful gardens, roomy halls, and springs of

water of the old Cloister hospital of the Middle Ages were not

heard of, still less the comforts of their friendly interiors.”

Miss Nutting and Miss Dock in their History of Nursing

have described the gradual decadence of nursing: “In England,

where the religious orders had been suppressed and no sub-

stitute organization given, it might almost be said that no

nursing class at all remained during this period. It was

forgotten that a refined woman could be a nurse, except per-

haps in her own family; and even in good homes if an

attendant was called in, the sick-room became a scene of re-

pulsive squalor. The drunken and untrustworthy Gamp was

the only professional nurse. ‘We always take them without

a character,’ said an English physician, not very many decades

ago, ‘because no respectable woman will take such work.’

Even the sisters of the religious orders, though retaining their

sweet charm of serenity and gentleness, came to a complete

standstill professionally as nurses, on account of the persistent



8 THE CARE OF THE DEPENDENT POOR

sequence of restrictions which had been nemming them in from

the middle of the sixteenth century.”

It is pointed out by Miss Nutting and Miss Dock that the

hospitals passed out of the hands of women and into those of

men. The lesson of history is that women are the only suc-

cessful caretakers for the sick and the poor, and above all for

children. Whenever women are pushed out of positions of

authority and become merely subordinates in the charitable

work, then abuses flourish and decadence usually comes in with

a rush. In recalling the history of the dark period of nursing

and of the lowest epoch in the history of hospital organization,

the comment of the historians of nursing in this regard may be

repeated: “ In all of the hospital and nursing work of the

Christian era, this was the period of the most complete and

general masculine supremacy. At no time before or since

have women been quite without voice in hospital management

and nursing organization, but during this degraded period they

were all but silenced The state of degeneration to which

men reduced the art of nursing during this time of their un-

restricted rule, the general contempt to which they brought

the nurse, the misery which the patient thereby suffered, bring

a scathing indictment against the ofttime reiterated assertion

of man’s superior effectiveness, and teach in every branch

of administration a lesson that, for the sake of the poor, the

weak and the suffering members of society, ought never to be

forgotten—not in resentment, but in foresight* it should be re-
membered Only when men and women work together, as

equals, dividing initiative, authority and responsibility, can

there be any avoidance of the serfdom that in one form or

another has always existed where arbitrary domination has

been present, and which acts as a depressant, effectually

preventing the best results in work.”

Now comes the all-important question as to how and why

this sad change came about. Jacobsohn suggests fhe middle of

the seventeenth century as the beginning of the decadence.

Miss Nutting and Miss Dock, the historians of nursing, come

much nearer to the correct date, as it seems to me, when they

state that “ the religious orders having been suppressed and no

substitute organization given, it might almost be said that no

nursing class at all remained during this period.” There is

the crux of the matter. The suppression of the religious

orders marks the starting point of the neglect of the sick



THE CARE OF THE DEPENDENT POOR 9

poor; the decline in hospital organization and efficiency, and

the beginning of those lamentable conditions that culminated

in the unspeakable decadence of the middle of the nineteenth

century.

In a single word, the movement that led to the ruin of our

hospitals and of nursing was the so-called Reformation. Be-

fore that the hospitals had been in charge of the religious

orders, and had been under the ecclesiastical authorities.

They had not been without abuses. Nothing human ever is

without abuses. There were abuses in the old time hospitals

that had to be constantly corrected, but the buildings them-

selves were beautiful, extremely appropriate and the nursing

was finely organized.

The best possible proof of the thoroughness of the organiza-

tion of the old hospitals in every way is to be found in the

history of the surgery of the time. Whenever there are good

hospitals there is always good surgery and, conversely, when-

ever there is good surgery there must be good hospitals. Many

are inclined to think of surgery as a distinctly and exclu-

sively modern development. Fortunately, as convincing evi-

dence to the contrary, the textbooks of the surgeons of the

later Middle Ages have been preserved, and they bring home

the fact that there was a magnificent period of surgery dur-

ing the later Middle Ages. The old surgeons did practically

all our operations. They opened the skull for tumor and for

abscess of the brain; operated on the thorax for the removal

of pus and other fluids; their surgeons intervened very ex-

tensively for conditions within the abdomen, and succeeded in

doing successful work even under the difficult circumstances

presented by the peritoneal cavity.

It would, of course, have been quite impossible to practise

such extensive surgical procedures without an anaesthetic, and

I know nothing that illustrates better the ordinary ignorance

of history than the fact that most people, even most physi-

cians, do not know that there were several centuries during

which anaesthetics were generally used long before our time.

Anaesthesia is often hailed as a great discovery of the modern

humanitarian period, but most of the serious operations done

in the more important hospitals of Europe during the latter

Jialf of the thirteenth and the fourteenth and fifteenth cen-

turies were done under an anaesthetic. We know just exactly

what they used, a combination of the tinctures of mandrake



10 THE CARE OF THE DEPENDENT POOR

and opium, inhaled from a sponge. This produced the desired

anaesthetic result, though it is not so good a mode of anaes-

thesia as ether or chloroform.

It would have been equally impossible to have done such ex-

tensive operating without antisepsis. The mediaeval surgeons

employed strong wine for that purpose, and secured union by

first intention—with a linear scare that could scarcely be seen.
Some of the teachers of surgery declared, quite as our own

do, that if a surgeon got pus in an operating wound which

he himself had made through an unbroken surface, there

was some fault in his surgical procedures.

With the coming of the Reformation hospitals became

government institutions. Religion was now a national affair,

and hospital officials were appointed by the government. They

worked for the salary that they received, and salaried em-

ployees, according to the experience of history, very soon prove

inefficient in caring for the ailing or dependent. Abuses mul-

tiply, advantage is taken of the dependent poor and of de-

pendent employees. It is not long before all semblance of

charitable beneficence disappears, and neglect and disregard

for the feelings and sufferings of others become the rule.

Under particularly favorable circumstances the coming of such

abuses may be delayed, perhaps, for a generation or two; but

the lesson of history is that they invariably come when politi-

cal appointees have an opportunity to exploit the poor.

This attitude of the people after the Reformation is not sur-

prising once it is recalled what the teaching of the Reformers

was. The Reformers proclaimed that the only essential ele-

ment in religion was faith. Good works availed nothing.

Luther proclaimed St. James’ Epistle, which lays down the

doctrine of good works, to be an epistle of straw. Their very

religion, then, instead of encouraging rather discouraged the

doing of good to others. Protestantism has, of course, com-

pletely veered round from this teaching during the centuries;

it now proclaims that faith means very little, and good works

mean everything. It may be well to call attention to the

fact that the old Church always proclaimed salvation by faith

and works, and that there were two commandments, “ Thou

shalt love the Lord thy God ” and “ thy neighbor as thyself
”

as the only right fulfillment of the whole law.

In the Catholic countries after the Reformation, the govern-

ments encroached more and more upon the rights of the



THE CARE OF THE DEPENDENT POOR 11

Church, and interfered with that control of charitable institu-

tions which had made such a magnificent chapter of Christian

charity in the pre-Reformation time. Women were pushed

more and more out of the responsible direction of hospitals

and institutions generally for the care of the poor, and while

still retained as subordinates, were utterly unable to stem the

tide of decadence that set in.

Besides, quite contrary to what is usually thought in the

matter, education instead of being encouraged after the Ref-

ormation, suffered greatly all over Europe, and particularly

in the countries that had severed themselves from the See

of Peter. For example, in Germany, at the end of the

eighteenth century, Winckelmann seeking to restore the study

of Greek, was compelled to have his pupils write out a Greek

text of Plato, because no edition of Plato had been issued in

Germany for considerably more than a century. This deca-

dence in general education had affected also medical education,

so that in Germany and England, particularly, medical educa-

tion was at a very low ebb. The requirements for medical edu-

cation in the Middle Ages were a little higher than in our

own time, and we are gradually working back to them.

Hospitals, then, after the Reformation, went from bad to

worse until the awful conditions which we have described pre-

vailed at the end of the eighteenth and the beginning of the

nineteenth centuries, and secular hospitals reached a low

watermark of intolerable decay shortly after the middle of

the nineteenth century. I know almost nothing in history that

is so suggestive for profitable thought, and which should ef-

fectively cause the enthusiastic advocate of the secularization

of hospitals and government control of charities to pause

and hesitate, as this series of events.

It is very important to realize that reform in hospitals and

nursing began to make itself- felt before the great revolution

in surgery, which, after Lister, made hospital work so much

less fatal than it had been before.

With this historical decadence before him it is no wonder

that Virchow, upon receiving charge of the reorganization of

the growing city of Berlin, hesitated to place the hospitals

under secular care. He knew modern hospitals, and the

history of mediaeval hospitals. In the second volume of his

Collected Essays on Public Medicine and the History of Epi-

demics, Virchow pays a high tribute to the Church’s relation



12 THE CARE OF THE DEPENDENT POOR

to the magnificent organization of hospitals of the thirteenth

and fourteenth centuries. There was scarcely a town in

Europe of five thousand inhabitants or more that did not

have its hospitals. We knew the truth of this with regard
to the Latin countries from other sources, but Virchow himself

worked out the history of them for the Teutonic countries.

I need scarcely say that Virchow was not a Catholic. It is

to him that we owe the expression Kulturkampf—as if or-
ganized German opposition to the Pope and Catholic Faith

were
f

a struggle for culture—so prominent a slogan during the
early years of the seventies. Whatever Virchow might think,

or for political reasons say, as to the attitude of the Popes

toward culture, he knew thoroughly their relations to the

mediaeval hospital organization.

The one Pope of the Middle Ages for whom German his-

torians particularly have reserved the bitterest expressions is

Innocent III. It must not be forgotten, be it said in passing,

that the great German biographer of this Pope, became a

convert to the Catholic Faith while writing his biography,

which he had taken up with the intention of making it a

convincing document against Catholicism. Virchow pays

Pope Innocent III. a high tribute. Because of the circum-

stances under which it was given, it well deserves to be

recalled. He said: “It may be recognized and admitted that

it was reserved for the Roman Catholic Church, and above

all for Innocent III., not only to open the bourse of Christian

charity and mercy in all its fullness, but also to guide the life-

giving stream into every branch of human life in an ordered

manner. For this reason alone the interest in this man and

in this time will never die out.”

He added a little later in the same essay: “The beginning

of the history of all these German hospitals is connected with

the name of that Pope who made the boldest and farthest-

reaching attempt to gather the sum of human interests into

the organization of the Catholic Church. The Hospitals of

the Holy Ghost were one of the many means by which In-

nocent III. thought to hold humanity to the Holy See. And

surely it was one of the most effective. Was it not calculated

to create the most profound impression to see how the mighty

Pope, who humbled emperors and deposed kings, who was the

unrelenting adversary of the Albigenses, turned his eyes sym-

pathetically upon the poor and sick, sought the helpless and the



THE CARE OF THE DEPENDENT POOR 13

neglected upon the streets, and saved the illegitimate children

from death in the waters! There is something at once con-

ciliating and fascinating in the fact, that at the very time

when the Fourth Crusade was inaugurated through his in-

fluence, the thought of founding a great organization of an

essentially humane character, which was eventually to extend

throughout all Christendom, was also taking form in his

soul and that in the same year (1204) in which the new

Latin Empire was founded in Constantinople, the newly-

erected hospital of the Holy Spirit, by the old bridge on the

other side of the Tiber, was blessed and dedicated as the fu-

ture centre of this organization.”

We are not surprised then to find that, when Virchow re-

organized the hospitals of Berlin, he hesitated to make them

entirely secular as I have said, and stated his views, as was

his custom, very straightforwardly and quite unmistakably.

He wrote: “ The general hospital is the real purpose of our

time, and anyone who takes up service in it must give himself

up to it from the purest of humanitarian motives. The hos-

pital attendant must, at least morally and spiritually, see in

the patient only the helpless and suffering man, his brother

and his neighbor; and in order to be able to do this he

must have a warm heart, an earnest devotion, and a true

sense of duty. There is in reality scarcely any human occu-

pation that brings so immediately with it its own reward, or

in which the feeling of personal contentment comes from

thorough accomplishment of purpose.

But so far as the accomplishment of the task set one is

concerned, the attendant in the hospital has ever and anon

new demands made upon him and a new task imposed. One

patient lies next the other, and when one departs another

comes in his place.

“ From day to day, from week to week, from year to year,

always the same work, over and over again, only always for

new patients. This tires out the hospital attendant. Then

the custom of seeing suffering weakens the enthusiasm and

lessens the sense of duty. There is need of a special

stimulus in order to reawaken the old sympathy. Whence

shall this be obtained—from religion or from some temporal
reward? In trying to solve this problem, we are standing

before the most difficult problem of modern hospital manage-

ment. Before us lie the paths of religious and simple care



14 THE CARE OF THE DEPENDENT POOR

for the sick. We may say at once that the proper solution
has not yet been found.

“
It may be easy, from an impartial but one-sided view of

the subject, to say that the feeling of duty, of devotion, even

of sacrifice is by no means necessarily dependent on the hope

of religious reward, nor the expectation of material remuner-

ation. Such a point of view, however, I may say at once, such

a freedom of good will, such a warmth of sympathy from

purely human motives as would be expected in these condi-

tions, are only to be found in very unaccustomed goodness of

disposition, or an extent of ethical education such as cannot

be found in most of those who give themselves at the present

time to the services of the sick in the hospitals. If pure hu-

manity is to be the motive, then other circles of society

must be induced to take part in the care of the sick. Our

training schools for nurses must teach very differently to

what they do at present, if the care of the sick in municipal

hospitals shall compare favorably with that given them in

religious institutions. Our hospitals must become trans-

formed into true humanitarian institutions.”

No wonder, then, that all those who are acquainted with

the history of hospitals for dependents are very chary of secu-

larizing elements and government control. Inspection is al-

ways needed of any institution that cares for dependent human

beings. Without inspection abuses surely creep in. Govern-

ment control, however, has in the past always led to unfor-

tunate abuses apparently by an inevitable tendency. The

mere wage-earner cannot be expected to care properly for

human beings who need not only physical care but also human

sympathy. Man lives not by bread alone. The chapter of the

history of hospitals is only one emphatic illustration of this.

The care of children, of the aged and of the insane make

other and possibly even more insignificant chapters of the

same impressive story.

II.

CHILDREN AND THE AGED.

We have pointed out how the historians of hospitals and of

nursing attribute their extreme decadence to the seculariza-

tion of hospitals, and above all to the exclusion of women from

positions of responsibility therein. The beginning of the de-

cadence corresponds, according to Jacobsohn, the German



THE CARE OF THE DEPENDENT POOR 15

historian, in his History of Care for the Ailing

,

to a period

shortly after the so-called Reformation, and according to Miss

Nutting and Miss Dock, in A History of Nursing, to the

suppression of the religious orders. This latter event left

hospitals and other humanitarian institutions without trained,

experienced attendants.

That the exclusion of women from offices of responsibility

as a true cause of decadence in hospital organization and not

a mere feminist declaration is proved, first, by the fact that

the replacing of women in responsible positions has been one

of the greatest factors in the modern improvement of hos-

pitals. Moreover, other facts, very interesting and signifi-

cant, contribute to the same proof. Sisters’ hospitals, in spite

of the decadence of surgery, the neglect in hospital con-

struction and the almost absolute ignorance of the disastrous

consequences of dirt, for which of course the medical profes-

sion was entirely to blame, continued to be comparatively

much better institutions, and were better managed and or-

ganized in every way than the public hospitals.

At Blockley, the great public hospital and almshouse of

Philadelphia, prevailing conditions even in the latter part of

the second half of the nineteenth century were simply in-

describable. Miss Nutting and Miss Dock tell some of the

shocking details. They then go on to say:

“ Only one short interregnum of peace broke the long and

distressing reign of violence, neglect and cruelty in Blockley.

“ In 1832 there was a severe epidemic of cholera, and the at-

tendants demanded more wages. To keep them to their duties

the wages were increased, but were promptly spent for liquor.

An orgy of intoxication ensued, and the helpers, crazed with

drink, fought like furies over the beds of the sick, or lay in

drunken stupor beside the bodies of the dead. So complete

was the demoralization that the guardians applied to Bishop

Kendrick for Sisters of Charity from Emmittsburg. The call

was responded to promptly; indeed, the Sisters started two

hours after the summons zvas received. They took in hand the

whole desperate situation, at once restored order, and dissem-

inated about them an atmosphere of tranquillity and quiet

energy. The Sisters remained for some months, and their

work was so deeply appreciated by the guardians that the

Committee of the House, in a set of resolutions commending

their great services, resolved also that they be requested to



16 THE CARE OF THE DEPENDENT POOR

remain permanently. This, however, Father Hickey, their su-

perior, negated giving his reasons at length. He did not con-

sider Blockley the department of charity in which the Sisters

could be most usefully employed, so the guardians were obliged

to let them go, with glowing tributes which may well have

been heartfelt.”

Conditions in Bellevue Hospital, New York City, were so

pitiable as to excite the most poignant sympathy for its

neglected inmates, and reform was demanded. The creation of

a new medical board in 1847 was the first gleam of light

because, to some extent, it took Bellevue out of politics. The

physicians found, however, that they could do almost nothing

to improve internal conditions so long as prisoners and pau-

pers were employed as nurses. Some requested that Sisters

of Charity be placed in the wards. The Sisters of

Charity were not in a position at the time, however, to take

up the work. Some twenty years later, however, during an

epidemic of smallpox in New York, six Sisters of Charity by

invitation of the city went to Blackwell’s Island and cared

for the poor victims of the scourge.

What is thus true of hospitals is true also of every chari-

table work for the poor. This is well illustrated in the history

of the care of the aged poor and of dependent children. It

has often been said that the test of the real humanitarianism

of any period is the care shown for these two particular

indigent classes. Oftentimes selfish and personal motives

dictate the proper hospital care of adults because their health

is a valuable asset to the community, and their fellow-citizens

may at times be in their place. But the needy aged and

children have no near relatives, at least no influential ones;

and their care is, as a rule, a matter of pure charity. They

are incapable of vigorous protest, and abuse or neglect of

them comes but tardily to the notice of the public.

With regard to this problem—the care of the aged poor—

I

may say at once that our present mode of caring for them is

almost barbarous. Certainly nothing should bring home to

us more effectively our pitiable shortcomings in this matter,

so essentially one of a proper human dignity and proper

self-respect, than a brief review of some of the facts. The

needy aged have no one to care for them: the community

must provide till the end comes. These aged ones have per-

haps been deserted, forgotten or neglected: their children



THE CARE OF THE DEPENDENT POOR 17

\
ha\te died or else are too poor themselves to help others.

The number of the indigent aged is very large. Few realize

that statistics show that nine out of ten people who live to

be sixty-five or over must receive aid of some kind before

the end of their lives. Fortunately the majority have children

or friends who aid them, but the others must be cared by the

community.

Throughout the country the poor are usually housed in what

we call poorhouses. These are large buildings situated at

some considerable distance from the county seat, or well

beyond the limits of the populated section of the cities which

direct and support them. There is usually one large building

for the men and, some distance away, a similar building for

the women. These aged, who are public charges, are usually

widows or widowers, and fortunately, beyond the disgrace of

the poorhouse, have not to endure the additional trial of

separation from the living partner of their joys and sorrows.

When, however, husband and wife are both living, each must

live apart, though they may see each other occasionally, and

without much regard for privacy.

We place the old people in these poorhouses; give them

enough to eat and tell them to be happy. The old men must

associate with the men of their own age, usually tiresome

enough, but, harder still to bear, the old women must asso-

ciate with the women of their own age. There is not a chance

of a child coming near them, though the one thing that makes

life worth living for the old is to have the young grow up

around them. We call this charity. Apparently we forget

that man does not live by bread alone, and that the life of the

affections is of supreme importance.

Contrast with this, for the moment, the care of the old in the

Middle Ages as illustrated by what we still see at Stratford-on-

Avon in England. On one of the main traveled streets of the

little town is a group of neat, tiny, old-fashioned houses.

They were built about 1450, though they then replaced

dwellings used for a similar purpose that had been there for

several centuries. On the ground floor are two little rooms,

one of which, facing the street, is the sitting-room; an alcove

serves as bedroom. Back of the sitting-room is a tiny kitchen,

almost like the kitchenettes of the modern flat. The aged

mistress of the house need take but a very few steps in doing

her work, Even the most delicate and infirm of old women,

»



IS THE CARE OF THE DEPENDENT POOR

if she is able to be out of bed, can care for this little house

herself. In the older time, when she was ailing or if she was

very decrepit, and I believe the custom still continues, a

friendly visitor appointed by the guild came every day and

offered her services for whatever might be necessary. Here

the old folks lived out their lives together in their own little

home. The aged still live in these little houses.

They are the old guild almshouses. Mark you, they do not

call them poorhouses. That crude designation of a habitation

for public charges was reversed for a much later time. The

Guild of the Holy Cross in Stratford was a magnificent or-

ganization, composed mainly of laymen—clergymen could be-
come members, but could not hold office—who had charge
of the charities or, if you will, in modern phrase, the social

needs of the town. They cared for the old and the orphans

and the ailing poor, even for the entertainment and amuse-

ment of the populace, as well as for education and public

athletics and the provision of mystery and morality plays and

pageants and processions of various kinds for the townspeople.

The arrangements for the care of these old people were very

interesting, quite apart from the provision of the little homes

in which they might live together. Every phase of such care

was marked by supreme thoughtfulness. The little houses

were situated just down the street from the guild chapel.

Only the guild school intervened between them. The guild

had, as we know from its statutes which have been preserved,

four chaplains, whose duty it was to offer Mass every morn-

ing. The old folks, therefore, found it easy to assist at Mass

every day.

The guild chapel was only one of the evidences of thought-

fulness. The guild school represented another and even more

significant appeal to human nature. The children of the vil-

lage went by the almshouses five or six times a day on the

way to and from school. School in Stratford began at the

enterprising hour of six. The first hour was not devoted to

recitations, but to study. What we would call “ home work
”

was done during it. After the completion of the second hour,

which included the recitations of the day, the children went

home for breakfast, returning in about half an hour; they

then stayed until nearly twelve. They returned for an after-

noon session, with usually an interval of a couple of hours

in the middle of the day, and again returned home in the



THE CARE OF THE DEPENDENT POOR 19

evening at about five o’clock. The old folks then had a chance

to see them grow up around them, to know and share the

blessings which intimacy with childhood alone can give. 1

think it was good for the young folks too. They saw old

age at close range; realized its needs, learned to respect it,

and probably often at mother’s request brought various things

with them from home for the old folks, thus learning early

the precious lesson of personal charity and kindness to the

poor.

Best of all the guild playground was just behind the school.

The old folks could see and hear the children at play. With

what greater joy could old age be blessed! Needless to say

our mode of caring for* the old folks admits of no such ad-

vantages as these. The children are usually far away from

our aged and city charges; occasionally some relative may

bring a child on a visit, but our aged never see children at

play. I do not know whether this collocation of school and

chapel and almshouses was accidental or not. The guild

very probably bought the entire strip of property and then

put its various buildings thereon. I cannot help but think,

however, that somebody must have thought out seriously the

splendid solution of all the charity problems involved. Such

happy accidents do not happen by chance.

What is thus true of the care of the aged is quite as equally

true of the care of children. The high death rate from in-

fectious disease in mediaeval times left as many half and full

orphans to be cared for as the industrial conditions of the

nineteenth century. The guilds cared for the orphans just as

they cared for the aged, and their provisions were just as

humanly sympathetic and as beautifully charitable. To them

the orphan asylum was unknown. The orphan asylum is the

invention of post-Reformation times. None existed in Eng-

land before the Reformation. The growth of large cities has

made more or less necessary such institutions, but the guilds

cared for half orphans, if their mother was still alive, by a

pension which enabled the mother to keep the family together;

and if both parents were dead the children were distributed

among neighboring families. At this time a family generally

included at least six children. Where families are, as a rule,

large, another child is readily adopted; charity begets charity.

The orphans were called the children of the guild, and

special provisions were made for their schooling, their techni-



20 THE CARE OF THE DEPENDENT POOR

cal training, or for the higher professions if they had special

abilities. The guild usually had bourses at the university,

and many an orphan child thus secured the opportunity for

even the highest education. Indeed there was a tradition that

it was often more fortunate to be a child of the guild than

to have both parents living, for, so far as opportunities for

advancement went, the guild was better able to provide them

than the parents. In the smaller towns, where practically

everyone knew everyone else, there was little chance for abuse

of a child thus adopted, and, moreover, the guild saw to it

that its children were treated like members of the household.

When the question of caring for children in the larger cities

of the older time is to be considered, we must turn to the

Continent, where the cities were larger and the problems of

care more like our own. The one way to secure concrete

knowledge in the matter is to take a typical example, as, for

instance, what the American authors of A History of Nursing

call “ the most interesting foundling asylum in the world.”

This was, to give it a formal title, the Ospedale Santa Maria

degli Innocenti at Florence. Note that it was not called, as

in our ruder English designation, a foundling asylum, though

it was a home for children who had been abandoned by their

parents and found on the streets. It was called, as if to em-

phasize the fact and arouse the charitable instincts of all

those who heard its name, “ The Hospital of the Innocents.”

The history of this hospital, or place of hospitality for the

innocents, for that was what its title really meant at the time it

was founded, goes back to the earlier half of the Middle Ages.

The institution itself was evidently modeled after an institution

founded in Milan by a good monk in 787. At least this is

the suggestion of Miss Nutting and Miss Dock in their History

of Nursing. The good monk had been deeply touched by the

fact that charity did not always succeed in taking care of

foundlings early enough to preserve them, that sometimes

families that adopted them considered them as their absolute

possessions, to do with as they wished, and that they might

be sold or hired out at will.

The Hospital of the Innocents became one of the favorite

institutions of the citizens of Florence, and was taken under

the patronage of the guild of the silk merchants, who supplied

all its needs bountifully. Before the end of the Middle Ages

the silk merchants proceeded to erect the handsome building,



THE CARE OF THE DEPENDENT POOR 21

a model of fine architecture, which is still a favorite place

of pilgrimage for all lovers of the beautiful. This Hospital

of the Innocents shows clearly the spirit of the Middle Ages

that governed all such institutions. The foundlings were not

looked upon as beings for whom anything was good enough,

but on the contrary they were treated as future Florentine

citizens, and being charges of the public nothing was too good

for them. This hospital, then, became the home of beautiful

art, until it was richer in masterpieces than many a museum

of modern times. There are a number of beautiful paintings

on its walls, and its exterior is decorated with the well-known

della Robbia medallions. These are the large blue and white

porcelain placques, representing babies in swaddling clothes,

which have now become so popular that one sees small rep-

licas of them in plaster and porcelain and print nearly

everywhere. How few even of those who know them well,

think for a moment that they are associated with a mediaeval

foundation for the care of abandoned children, which dates

back well over one thousand years. Fewer still have any idea

that the beautiful bambini of della Robbia are strikingly sym-

bolic of the Christian charitable spirit of the older time blos-

soming into the finest organized charity.

As the foundation had been originally made because of the

abuse of selling foundlings into slavery, with a special cere-

mony, freedom was granted the little charges of the hospital.

They were made citizens at Florence and were never to become

slaves. From a very early time these children were placed with

families who promised to treat them as their own children.

Both boys and girls were taught trades, and special provision

was made for securing employment for the boys. The girls

when married received a dowry. A favorite form of legacy

among wealthy Florentines was to leave enough money to

supply dowries for poor girls. A special fund was created in

connection with the Hospital of the Innocents for this purpose.

All over Europe in the Middle Ages, or let us say before the

Reformation, this subject of dowering young women for mar-

riage received the most serious charitable attention. In Eng-

land it was no uncommon thing for a wealthy person who died

to leave dowries for the next half dozen or dozen young

women without substance who married in a particular place.

It was felt that the happiness of the young folk in their

marriage state depended not a little on their beginning well,



22 THE CARE OF THE DEPENDENT POOR

for love often flies out of the window when poverty comes in

at the door.

Almost needless to say this Hospital of the Innocents is not

only still in existence, but it is doing its work in a wonderfully

beneficent way down to the present day. The American authors

of the History of Nursing say of it in their chapter on “ Hos-

pital and Nursing Appliances ” in the first volume of their

history: “Today this richly historic house is in charge of the

Sisters of St. Vincent de Paul, under the direction of a highly

scientific and progressive council, chiefly consisting of medi-

cal men, and is one of the most perfectly kept and well-

managed institutions of the kind in existence, its union of

mediaeval charm with modern science being a congenial and

happy one.”

These are some of the facts chosen from the history of

charity in the older time, particularly with regard to the care of

the aged poor and of dependent children. While under the

charge of the religious authorities, or at least while religious

motives were the most important factors in the movement

which provided for them, they were cared for with a fine

feeling of humanity and fraternal love. It was a determined

successful effort to see that these needy ones had the chance

to live their lives as far as possible on a plane of true hu-

manity in spite of the handicap of old age, or the loss of

friends and relatives. Before the Reformation all this had

been beautifully organized, not so as to be ideal, for ideals

are not humanity’s everyday life, but accomplished with an

ideal in view so as to have as few abuses as possible. With

the coming of the Reformation these phases of charitable work

were secularized and deterioration began. The descent was

not noticeable for a time because the old spirit still lived on

to some extent; but in the seventeenth and early eighteenth

centuries serious abuses crept in, and by the beginning of the

nineteenth century reform simply had to come. The question

is now whether that reform can be expected to be as lasting

and as sure in its effects if it is founded merely on human

motives with wages and salaries as the most important ele-

ments, or whether an appeal to higher motives and a belief in

higher things is not absolutely necessary for the successful,

humane care of the poor. In the solution of that problem

these chapters of the history of charity which we have re-

viewed are very precious documents.



THE CARE OF THE DEPENDENT POOR 23

III.

THE INSANE AND DEFECTIVES.

The prevailing impression with regard to the history of

organized care of the insane is that in our time the process

of evolution and the gradual development of a right spirit of

humanitarianism has, for the first time in history, lifted the

efforts of our generation to a plane of high humane thought-

fulness for these poor unfortunates who were so sadly neg-

lected in the past. I feel sure that this does not represent

any exaggeration of the impression on this subject, which is

shared not only by those whose interest in the insane is merely

academic or purely social, but also by physicians, and even by

many of those who have specialized in the care of the insane.

The serious neglect of the insane and of defective children

and imbecile adults in the older time may not, of course, be

questioned. In the eighteenth century insane patients were

brutally and inhumanly neglected, and at times positively mis-

used. Indeed it is only in our own time, that is within a

generation, that anything like proper care for the insane has

developed, and even that is limited to certain of our munic-

ipalities and States which take their duty in this matter quite

seriously. The care of the insane in many American country

districts is even now a disgrace to our civilization.

The facile presumption is at times made that, if in the

eighteenth and nineteenth centuries there was so much neglect

and abuse of the insane, the treatment of them must have

been still v/orse in the seventeenth and sixteenth centuries.

For those who interpret history by this constantly descending

scale, the further conclusion is that the insane must have been

grievously mishandled in the later Middle Ages, and un-

speakably confined and manacled and brutalized in the earlier

mediaeval centuries.

We have already seen in the preceding chapter that any such

presumption of evolution and upward development of the ex-

ercise of charity is utterly unjustified by the actual history of

social service. Progress in the earlier centuries, decline later,

and then an awakening social conscience on the subject is the

historical truth. When the great French physician, Pinel,

struck the shackles from the insane of Bicetre Asylum near

Paris, the abuse of the insane had reached such brutal height



24 THE CARE OF THE DEPENDENT POOR

that it could go no further; a reaction had to come. There

were those who did not fail to raise their voices in protest.

Quaker philanthropists in England had revolutionized the

care of prisoners and of the insane. In this country under

similar Quaker influence a corresponding change began to

take place. The modification in the treatment of the inmates

of asylums, however, came very slowly, and was not welcomed

by those who might be supposed to have desired it most. Dr.

John Conolly in England and Miss Dorothea Lynde Dix in

America carried still further the practical reformation of in-

stitutions for the insane. But their influence was not felt until

well on toward the middle of the nineteenth century, so that

it is only a little more than half a century since the English-

speaking countries have taken up the problem of the rational,

humane care of the insane.

Up to that time when a poor human being became insane,

especially if he or she had shown any symptoms of serious

lack of control, he was likely to be confined in an asylum

for the rest of his days, no matter how much his mental con-

dition might improve. If these patients became violent they

were put in chains, and the chains would likely not be

taken off for the rest of their lives. The insane were very

much feared, and their malady was always considered in-

curable. The number of attendants in institutions was en-

tirely too small; the feeding of the patients was often utterly

inadequate; the buildings for their accommodation were al-

lowed to go into decay; they were like jails with barred,

narrow windows, dark cramped corridors, small straitened

doorways, lacking both ventilation and cleanliness. In order

to appreciate the extent to which neglect of the insane had

gone in this last regard, one must read some of the accounts

of the investigation of institutions not of long distant cen-

turies, but of the middle of the nineteenth century. It would

be quite impossible to reproduce some of the expressions

with regard to them here. Medical attendance on the asylums

was entirely inadequate, and the ordinary physical ills of the

patients were as a rule neglected.

Anyone who thinks this picture exaggerated should read the

account of conditions prevailing in some of the insane asylums

of New York State, made by a commission a few years ago,

or better still, obtain descriptions of the conditions that exist

in the insane departments of poorhouses in the Southern



THE CARE OF THE DEPENDENT POOR 25

States. During the past five years it has been found that there

exists in these poorhouses through the South, and especially

among the insane, a disease which was thought a few years

ago to be non-existent in this country. It is a disease called

pellagra, and is due to malnutrition and insufficient variety

in the food served. A distinguished professor of medicine, in

his textbook published less than ten years ago, declared that

pellagra was of very little interest to students of medicine in

America because we had no cases of the disease here. Since

that declaration we have found nearly one hundred thousand

cases of pellagra in our Southern States hidden away in the

county insane asylums and the poorhouses, and the disease has

evidently been in existence for at least one hundred years.

This striking incident will furnish abundant evidence of the

neglect of the insane even in our own time. Of the eighteenth

century very little need be said. Probably the most interesting

feature of the history of the insane asylums of that period

is given not in histories of medicine, but in essays and other

literary efforts, as well as private letters of the period. A

number of these describe visits paid to Bedlam, the large

London insane asylum. These visits were made by cultured

people, members of the nobility and others who were prominent

in social and intellectual life, and who went to the great city

asylum to view, as a pastime, the antics of the insane. It

was the custom to arrange parties as for the theatre; a

regular admittance fee was charged, and it is noteworthy that

a very large part of the hospital’s income was obtained by

the collection of fees of this kind. Quite needless to say

though Bedlam, or Bethlehem, as it used to be called, was

a church foundation of the thirteenth century, the Church had

nothing to do with it at this time. It was purely a State in-

stitution.

The number visiting the asylum for the purpose of being en-

tertained in this way must have been enormous, for though

the admission fee charged was only a penny, the resulting

revenue is calculated to have amounted, according to definite

records, to some four hundred pounds sterling annually, show-

ing that nearly one hundred thousand persons visited the in-

stitution in the course of a year.

It is sometimes maintained that there are three phases in

the history of the care of the insane. The first was the period

or era of exorcism, on the theory that insane patients were



26 THE CARE OF THE DEPENDENT POOR

possessed by the devil. The second was the chain and dun-

geon era, during which persons exhibiting signs of insanity

were imprisoned and shackled in such a manner as to prevent

injury to others. The third is the era of asylums, and the

fourth, only just developing, is the era of psychopathic wards

in general hospitals for the acutely insane in cities, with

colonies for the chronic insane in the country.

The era of exorcism and of the chain and dungeon are sup-

posed to include practically the whole history of the care of

the insane previous to the nineteenth century. Now it would

be quite improper to claim for the Middle Ages any absolute

solution of the serious problem that the care of the insane

always creates. One might think from the arbitrary classifi-

cation given above that nothing at all was done for the insane

except to exorcise or confine them. But history tells us that

any such supposition is absolutely unwarranted and is directly

opposed to facts.

The care of the insane in the Middle Ages rivals in its

thoughtfulness their charitable solicitude for the ailing poor,

both young and old. In reviewing the place of diversion of

mind as a therapeutic measure in the history of psychotherapy

at the beginning of my volume on that subject, I pointed out

that the old Egyptians had recognized the usefulness of

various forms of mental diversion in the care of the insane.

Pinel, the French psychiatrist, recalled that the Egyptians pro-

vided, in their temples dedicated to Saturn whither melan-

cholics resorted for relief, “ games and recreations of all kinds,

while the most enchanting songs and sounds the most melodi-

ous took prisoner the captive sense.” “ Flowery gardens and

groves disposed with taste and art, invited them to refresh-

ment and salubrious exercise, gaily decorated boats some-

times transported them to breathe amidst rural concerts the

pure breezes of the Nile. Every moment was devoted to some

pleasurable occupation or rather a system of diversified

amusements.”

The people of the Middle Ages also recognized the value of

recreation and diversion for the insane. The poor insane

were, for the most part, kept at home and cared for by their

own. But it soon became apparent that such care asked too

much of the sane people who undertook it. The monasteries

and convents then took upon themselves the care of the insane.

They built for their use separate structures, and as they were



THE CARE OF THE DEPENDENT POOR 27

situated in the open country the conditions were favorable to

the patients. And the later Middle Ages saw a great re-

awakening of interest in the use of hydrotherapy, diet, exer-

cise and air, as cardinal features of treatment for chronic

diseases. This chapter of therapeutics opened up at Salerno

as a reaction against the polypharmacy of the Arabs, who at

times gave so many drugs in a single prescription that these

documents are spoken of as “ calendar prescriptions,
:” because

of popular medicine, Regimen Sanitatis Salernitance, which went

out from Salerno to all the known world, declared that the

three best physicians for mankind were: “ Dr. Diet, Dr. Quiet

and Dr. Merryman.” Proper eating, rest of mind and body

and diversion of mind these were the best remedies. This

period furnishes us much evidence of the thoroughly rational

care of the insane, care that anticipated many of the ideas

now in vogue, and supposed to be so modern in origin.

It is easy to understand after reading this paragraph that

the treatment of the lunatics of that time must have been very

reasonable. The acute mental diseases of the ordinary peo-

ple of the cities and towns were cared for, at first, in ordinary

hospitals where special wards were set aside for them. This

may seem an undesirable mode of treatment, but as a matter

of fact in our time we have come to realize that it would be

much better for our insane patients if there were psycho-

pathic wards in the general hospitals, ready for their reception.

The old mediaeval idea, then, was an anticipation of what

we are gradually adopting.

After a time certain hospitals were reserved entirely for

sufferers from mental diseases, and one of the earliest of these

was Bethlehem Hospital in London, the name of which

gradually became softened in popular speech to Bedlam. In

pre-Reformation days the inmates of Bedlam, when they had

recovered their reason and shown for some considerable time

that they could be trusted, were allowed to leave the institu-

tion.

However, every inmate who left was compelled to wear a

badge or plate on the arm, which showed that he had once

been an inmate of Bedlam. This may seem to us an unnec-

sary stigma; but its effect in the later Middle Ages was to

make everyone who met these poor people sympathetic toward

them. People did not attempt to impose on them, fearful lest

there might be an uncontrollable access, of rage; they treated



28 THE CARE OF THE DEPENDENT POOR

them, as a rule, with consideration, and in many cases cared

for them. This was so well recognized that after a time a

number of lazy people, “ sturdy vagrants,” as they were

termed, tramps as we call them, took advantage of the kindly

feelings of people generally toward ex-Bedlamites. They ob-

tained possession of Bedlam badges, and putting them on

imposed on the good will of the community. Indeed, “ Bedlam

beggars ” became a by-word.

In one phase of the handling of the problem of insanity,

the medieval period was far ahead of our own. Curiously

enough this phase concerned the prevention of the affection.

It must be remembered that the insanity rate in the Middle

Ages was very much lower than that of our own day; in fact

the awful increase in that rate is one of the most ominous

features of our own day. A recent report of the Lunacy

Board in Great Britain shows that there are three hundred

and seventy-seven insane to every one hundred thousand of

the population. Fifty years ago the number was less than

half this. England is however practically no worse off than

we are in this country. Massachusetts has some three hun-

dred and fifty insane to every one hundred thousand inhabi-

tants, and New York about the same number. The number

of insane in Great Britain has doubled in about fifty years,

but the number of insane in this country has doubled in the

past twenty-five years.

Perhaps the most interesting phase of the subject we have

under consideration is the care of the mentally defective. Dur-

ing the past twenty years or so we have come to recognize that

the best way to care for defectives of various kinds is to give

them an opportunity to live a village life, that is, to live out

in the country under circumstances where various simple

trades can be practised, where nearly everybody knows them

and realizes the need of surveillance over them, where they

will not be abused nor exploited, but kindly encouraged to

occupy themselves with various kinds of work which interests

them and gives them exercise and occupation. The State of

New York has, for instance, created the State Craig Colony,

as it is called, for epileptics. Here the unfortunate victims of

this disease, especially in its severer forms, can be cared

for in country surroundings where they have sympathetic

treatment. More recently Letchworth Village on the lower

Hudson has been created for the accommodation of defective



THE CARE OF THE DEPENDENT POOR 29

children, who are there taught as much as they may be able

to learn, and are trained in various trades and live under

circumstances best suited to their defective conditions.

In the appendix of my volume Old Time Makers of Medicine

,

I have quoted from Bartholomasus Anglicus, who wrote in the

thirteenth century a well-known popular encyclopedia which,

with the similar works of Vincent of Beauvais and Thomas of

Contimprato, initiated this mode of diffusing general informa-

tion. Bartholomew has described insanity in a wonderfully

informing paragraph, in which he sums up the causes, the

symptoms and the treatment of the affection. The mediaeval

encylopedist said: “ Madness cometh sometime of passions

of the soul, as of business and of great thoughts, of sorrow

and of too great study, and of dread: sometime of the biting

of a wood (mad) hound, or some other venomous beast; some-

time of melancholy meats, and sometime of drink of strong

wine. And as the causes be diverse, the tokens and the

signs be diverse. For some cry and leap and hurt and wound

themselves and other men, and darken and hide themselves in

privy and secret places. The medicine of them is, that they be

bound, that they hurt not themselves and other men. And,

namely, such shall be refreshed, and comforted, and withdrawn

from cause and matter of dread and busy thoughts. And they

must be gladded with instruments of music, and some deal be

occupied.”

It might be thought that such developments were absolutely

new; and, indeed, most of those who have been engaged in

their organization have been quite convinced that they were

developing absolutely novel ideas. As a matter of fact, how-

ever, such institutions, or at least corresponding arrangements

founded on the same principle, though less artificial, have been

in existence for a very long time in Europe. Probably the

best known of these was the famous village of Gheel in Bel-

gium, where defective children of all kinds were cared for.

The story of Gheel is interesting. In this village, according

to a very old tradition, there is situated the shrine of an Irish

girl martyr, St. Dympna, who lost her life at the end of the

eighth century when the Irish missionaries were spreading

Christianity among the Teutonic tribes which then held Bel-

gium. It came to a pious belief that at this shrine defective

children of various kinds, sufferers from backwardness in in-

telligence, from defect of speech and from certain constitu-



30 THE CARE OF THE DEPENDENT POOR

tional nervous diseases, were cured through the intercession

of the saint. Accordingly a great many of them were brought

to the village, and the villagers became quite accustomed to

care for them.

Not a few of those who were brought to Gheel in the hope

of cure at the shrine of the saint remained unimproved.

Parents and relatives stayed with them for a while, hoping

against hope that further prayers might avail, and then made

arrangements to leave the children in the village in the hope

that they might yet be bettered through the saint’s intercession.

They also realized that this village, when there were a num-

ber of other defectives to whom various trades and occupa-

tions were taught, was a very suitable place for the children

to stay. Gradually, then, the village system of caring for de-

fectives grew up; the ecclesiastical authorities instituted regu-

lations to prevent abuses; and Gheel continued for probably

a thousand years to harbor and to care for defective children.

Its mission of charity and helpfulness continues even until the

present day, if the work has not been disturbed by the war.

American psychiatrists and neurologists, and especially those

interested particularly in the care of defective children, have

gone to Gheel, and have described just how the work was

carried on. Anyone who visits the town recognizes at once

that it represents an extremely suitable mode of caring for

these poor people, who will never be quite equal to the strug-

gle for existence under ordinary circumstances, and who if

subjected to the strain of competition with their better men-

tally endowed fellows will almost invariably succumb, if not

physically, then morally.

Nor was Gheel unique in this regard. Similar arrangements

were made in other villages, particularly of northern France.

Defectives of all grades and epileptics were cared for in the

midst of a simple village under like circumstances where all

the villagers practically were interested in their care, and

where, to as great a degree as possible, they were shielded

from their own foolishness, and above all from the impositions

of others.

It is sometimes the custom to say that such developments

when noted in the mediaeval period are merely happy acci-

dents, but then let us not forget that it is the taking advantage

of happy accidents which more than anything else shows the

genius of a people, of a generation and of an individual. New-



THE CARE OF THE DEPENDENT POOR 31

ton is said to have discovered gravitation as a consequence

of seeing an apple fall to the earth and- wondering why it did

so. Lord Kelvin attributed his discovery of the use of a

mirror for ocean cable purposes from having his eyeglass re-

flect the sun, and show him that the reflected beam of light

represented an absolutely weightless arm of any desired length

for an indicator. Galvani saw frogs’ legs twitch, and be-

coming, as some scoffingly said, a dancing master for frogs

opened up the whole series of questions relating to animal and

vital electricity. Others might have witnessed these same

happy accidents, but only genius could take full advantage of

them. So it was in the Middle Ages. The Christian genius

of the people enabled them to take advantage of circumstances

that seemed at first to have no significance at all with regard

to the beautiful good work into which they ultimately de-

veloped.



X

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