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 A BULLETIN 
 
 CONDITION OF THE COUNTY 
 ALMSHOUSES OF MISSOURI 
 
 CHARLES A. ELLWOOD, Ph. D., 
 
 Professor of Sociology 
 
 HI I^HKD I'.V 11!!' DF.PARTMEN 
 
 UNIVERSITY OF MISbOURl 
 May, I904' 
 
'vwwrarehiv'e.drg/d'efarlsyB 
 
A BULLETIN 
 
 ON THE 
 
 CONDITION OF THE COUNTY 
 ALMSHOUSES OF MISSOURI 
 
 BY 
 
 CHARLES A. ELLWOOD, Ph. D., 
 Professor of Sociology 
 
 PUBLISHED BY THE DFPARTMEXT OF SOCIOLOGY 
 
 UNIVERSITY OF MISSOURI 
 May, 1904. 
 
^^p^ 
 
A BULLETIN ON THE CONDITION OF THE 
 COUNTY ALMSHOUSES OF MISSOURI 
 
 The Condition of The County Almshouses of Mis- 
 souri. 
 
 Statistics, There is but one method of collecting 
 accurate statistics concerning social conditions ; and that 
 is to send experts into the field to gather the informa- 
 tion upon the spot. Unfortunately this method was not 
 open to the department of sociology when it undertook 
 to investigate the condition of the county almshouses of 
 Missouri. The desired information had to be obtained 
 by other and less accurate means. Wherever possible 
 a student or alumnus of the University was sent to 
 visit the almshouse about which information was 
 sought; but it was found possible to do this in only 
 about thirty per cent, of the cases. In the remaining 
 cases question blanks were sent to the superintendents 
 of the almshouses with the request that they be filled 
 out and returned to the department. In this way infor- 
 mation was received concerning fifty per cent, more of 
 the almshouses. But when no response from the super- 
 intendent could be elicited, the information was usually 
 obtained through the county clerk, although in the case 
 
 1 59882 
 
of three comity almshouses all efforts of every sort 
 failed to secm^e the desired information. Nevertheless, 
 in spite of the relatively crude methods employed in 
 gathering the statistics, there can be no doubt that they 
 present a fairly accurate picture of the actual condi- 
 tions of Missouri almshouses to-day. Small details, 
 both good and bad, may lie concealed, but the main out- 
 lines of the system stand out in clear relief. 
 
 The statistics here presented concern ninety of the 
 ninety-three county almshouses of Missouri. Twenty- 
 one counties of Missouri have no almshouses, but still 
 follow the primitive practice of boarding out their pau- 
 pers (usually very few in number) with farmers. These 
 counties are Benton, Camden, Carter, Dent, Douglass, 
 Dunklin, Gasconade, Hickory, Laclede, McDonald, 
 Madison, Maries, Miller, Oregon, Ozark, Pemiscot, Rip- 
 ley, Shannon, Taney, Worth, and Wright. St. Louis 
 county also has no almshouse, but sends its paupers to 
 the St. Louis City Poorhouse. 
 
 The chief statistics for each almshouse of the ninety 
 concerning which information could be obtained are 
 herewith presented in tabular form, beginning on the 
 following page. 
 
Religious 
 services. . . 
 
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 Employm't 
 of able- 
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 Cells for 
 
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 system . . 
 
 Cost per 
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 Cost per 
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 inmate 
 
 Expenses 
 per annum 
 
 Cost of 
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 Acres of 
 land . . . 
 
 Paralytic 
 
 Crippled. 
 
 Blind 
 
 Epileptic. 
 
 Feeble- 
 minded . 
 
 Insane.., 
 
 Between 
 2 and 14.. 
 
 Under 18 
 
 Between 
 18 and 60. 
 
 Above 
 
 Colored. 
 
 White 
 
 Female. 
 
 Male. 
 
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The total number of inmates in the ninety alms- 
 houses was 3,348, of whom nearly one-half were found 
 in a single institution, the City of St. Louis Poorhouse. 
 The usual preponderance of males, due undoubtedly to 
 the fact that dependent women are less likely to be sent 
 to the poorhouse than dependent men, is exhibited in 
 the Missouri almshouse population, over 54 per cent, or 
 1819, being males, and a little less than -46 per cent., or 
 1529, being females. As regards race, 3056 of the in- 
 mates are white, while 292 are colored. This makes the 
 proportion of almshouse inmates who are colored a lit- 
 tle less than nine per cent, while the colored element in 
 the total population of the State constitutes but a little 
 over five per cent. Classified as regards age, 1262, or 
 37.7 per cent, of Missouri 's almshouse inmates are above 
 sixty years of age; 1932, or 57.7 per cent, are be- 
 tween eighteen and sixty years ; and 154, or 4.6 per cent, 
 are under eighteen. It is evident from these figures 
 that in Missouri as elsewhere an undue proportion of 
 the aged end their days in the poorhouse. While per- 
 sons above sixty years of age constitute but a little over 
 six per cent, of the population of the entire country, they 
 form over thirty-seven per cent, of the population of 
 Missouri's almshouses. The proportion of children and 
 young persons in Missouri's almshouses is not great, 
 although it is much higher than it should be. Of the 
 154 inmates under eighteen years of age, ninety-two are 
 between two and fourteen years. 
 
 If classified according to physical condition, it is 
 evident that very few of the inmates of Missouri 's alms- 
 houses are able-bodied. Five hundred and nine, or fif- 
 teen per cent, were reported as able to do some work, 
 but probably not more than one-third of these might be 
 considered in any proper sense able-bodied. One thous- 
 and nine hundred and nine of the inmates, or fifty-seven 
 per cent., are mental defectives, being either insane, 
 feeble-minded, or epileptic. Four hundred and seventy- 
 
 8 
 
^ve more are reported as blind, crippled, or paralytic. 
 Bearing in mind the large proportion of the aged among 
 the inmates, it seems reasonable to conclude that Mis- 
 souri 's poorhouses are not to any extent places of re- f 
 sort for able-bodied persons who are too lazy or shift- » 
 less to support themselves. 
 
 The Condition of the Insane, There are 1177 in- 
 sane persons in Missouri's poorhouses; and of this 
 number three-fourths, or 884, are in the St. Louis City 
 Poorhouse. All but thirty-two of the ninety almshouses 
 reporting have insane inmates. The largest number 
 of these insane are not found in the poorer counties 
 which have poorly equipped almshouses, but in the 
 prosperous counties which have large and relatively 
 costly institutions. There seems to be a movement in 
 the State toward increased almshouse care of the indi- 
 gent insane. Indeed, the most effective argument for 
 building a new poorhouse often seems to be that the 
 county may ^*care for ks insane at home,'' and thus 
 save the expense of treatment at a State hospital. 
 Hence it comes about that many of the counties with 
 good almshouses have turned their institutions to a 
 great extent into local insane asylums. The following 
 item which went the rounds of the press of the State in 
 the summer of 1903 illustrates the tendency spoken of : 
 
 "The Ray county court, at its June session, made an order that 
 all of its insane patients should be removed July 1st from the asylum 
 at St. Joseph to the Ray county poor farm. The court figures that 
 the amount paid the asylum for keeping of the patients will more 
 than provide for them at their county farm." 
 
 That this movement is a mistake no one at all ac- 
 quainted with the history of almshouse care of the in- 
 sane can doubt. The inevitable result of such care 
 everywhere is various degrees of inadequate and brutal 
 treatment ranging downward to the sheerest cruelty. 
 That this is the result of almshouse care of the indigent 
 
insane in Missouri, there is abundant evidence to show. 
 However, in this bulletin we shall confine ourselves to 
 the evidence furnished by student investigators or by 
 the almshouse superintendents themselves. In the first 
 place, we have to note that fifty-four out of the ninety 
 almshouses reporting have cells for the incarceration 
 of the violent insane. Some even have a cell-house 
 which they go so far as to call a **jail.'' Again, the 
 question was asked whether any sort of mechanical re- 
 straint was used to control the insane. Of the forty- 
 eight who answered this question, thirty-seven admitted 
 that mechanical restraint was used. That is, seventy- 
 five per cent, of the almshouses which have insane in- 
 mates use mechanical restraint of some sort. And yet 
 it is supposed by some that the insane in our almshouses 
 are never violent! Of course, mechanical restraint 
 employed by a skilled physician may be sometimes of 
 great benefit to the insane ; but who would argue that it 
 would be so when used by an average almshouse of- 
 ficial? 
 
 A third line of evidence as to the condition of the 
 insane in Missouri's almshouses may be furnished by 
 certain quotations taken from the reports of investiga- 
 tors and even of the superintendents themselves. Thus 
 one superintendent says : ' ' Sometimes they are chained 
 to the wall till they are quiet ; if too bad they are kept 
 in a room and locked up.'' An investigator says: 
 ''When the insane are violent, they are put in cells, 
 handcuffed, and tied with ropes." Another investiga- 
 tor reports : ' ' One female has to be tied by block and 
 chain. ' ' Still another reports : ' ' The insane are locked 
 in cells and at times have been manacled. Their condi- 
 tion is too filthy for adequate description. They are 
 locked in small cells, a stool in each cell, excrement cov- 
 ers all about the stool, building filthy, persons unclean ; 
 enough to drive a sane man mad. ' ' Finally, in line with 
 the above the following may be quoted from the report 
 
 10 
 
of the Greene county grand jury on the condition of 
 the insane in the Greene county almshouse (December, 
 1903) : 
 
 "We found twenty-three insane persons confined in cells, of 
 which there are at least three, two men and one woman, violently 
 insane, that should be consigned to and kept in the asylum, as their 
 condition here requires them to be kept in dark blind cells, and their 
 constant and continual ravings, day and night, are a constant irri- 
 tation to the other inmates, preventing them from getting the sleep 
 so necessary to people in their condition." 
 
 Of course, the almshouse superintendents are not to 
 be blamed for the condition of the insane in the alms- 
 houses. They have to manage as best they can the per- 
 sons who are turned over to them by the county authori- 
 ties ; and usually they are conscientious in the perform- 
 ance of their duties. The blame ultimately rests with 
 the people of the whole State who permit by law the 
 commitment of the indigent insane to almshouses; and 
 the only remedy is legislation prohibiting such commit- 
 ments and providing for the gradual enlargement of 
 our State Hospital facilities, so that in time all insane 
 may be cared for in State institutions. 
 
 The Condition of Other Defectives. In addition 
 to the insane there are 551 feeble-minded persons and 
 181 epileptics in the almshouses of Missouri. These 
 numbers probably understate rather than overstate the 
 proportion of the almshouse population which belongs 
 to these classes, as many cases of feeble-mindedness 
 would not be recognized except by experts. From ten 
 to fifteen per cent, of the feeble-minded are helpless 
 idiots. The condition of these, of course, is equally as 
 bad as the condition of the insane. As for the higher 
 grades of the feeble-minded it may not be so evident 
 that their presence in the almshouses is to be condemned. 
 But from the social point of view they need, equally 
 with the insane, separate treatment in special institu- 
 
 11 
 
tions. Their presence in the almshouses is a menace to 
 society because their alBfiiction is hereditary. The in- 
 vestigation revealed at least two instances in which fee- 
 ble-minded women had become mothers of illegitimate 
 children while inmates of almshouses. 
 
 As for the epileptics, it need only be said that their 
 presence in the almshouses is a hardship to them and to 
 the other inmates. The almshouse surroundings are 
 such as to aggravate their disease and to preclude all 
 possibility of their cure ; again, they are often danger- 
 ous and their presence is necessarily unpleasant to other 
 inmates. The epileptics in our almshouses should 
 therefore, be sent to a State hospital or colony especially 
 provided for them. 
 
 There are in addition to these mental defectives a 
 large number of physical defectives in our almshouses. 
 The reports show 263 cripples, 114 blind persons, and 
 98 paralytics. Under the existing differentiation of our 
 chairitable institutions these persons are where they be- 
 long. But if the almshouse is to be made a comfortable 
 home for these infirm classes and for the aged worthy 
 poor, it must be freed from the classes which it can not 
 properly care for. Furthermore, it must have special 
 provisions for the care of the sick and the infirm both 
 in its construction and management. Only two alms- 
 houses in the State have nurses for the care of the sick 
 (Jackson county and St. Louis city), and these are not 
 trained nurses. The superintendent's wife is usually 
 matron, and is supposed to look after the sick; but on 
 account of her other duties she can do little or no nurs- 
 ing. Practically, then, the only nursing which is done 
 in our almshouses, both in the urban and in the rural 
 counties, is that which is done by the paupers them- 
 selves. 
 
 The Condition of Children. Statistics already 
 quoted show that there are 154 persons under eighteen 
 
 12 
 
years of age in the almshouses of Missouri, ninety-two 
 of these being between the ages of two and fourteen. 
 The chief reason why there are not more children in Mis- 
 souri 's poorhouses is that the Missouri Children's 
 Home Society is extremely active in taking children 
 from the poorhouses and placing them in good families. 
 Probably not more than one-half of the children be- 
 tween two and fourteen years which remain in the alms- 
 houses of the State are healthy children, the remaining 
 half being feeble-minded, epileptic, physically deformed 
 or diseased children who can not be placed in private 
 families. Again, the few healthy children to be found 
 in the almshouses are usually there in company with one 
 or both their parents, in which case it is difficult for the 
 Children's Home Society to get possession of the chil- 
 dren. Df course, the defective children should be sent 
 to the special institutions which exist for them, the fee- 
 ble-minded and the epileptic to the State Colony for the 
 Feeble-Minded and Epileptic at Marshall, and the blind 
 to the State School for the Blind at St. Louis. The 
 county authorities should understand that these institu- 
 tions exist especially for the care of defective children 
 of these classes ; and that they are there cared for and 
 educated at the expense of the State if they are indi- 
 gent. The problem of disposing of the deformed and 
 diseased children in our almshouses is not so easy, see- 
 ing that there exists no public institution especially for 
 them. But it would seem that the county authorities 
 should if possible commit them to private hospitals, or 
 else send them to the hospital of the medical school of 
 the University of Missouri, for treatment. The only 
 effective remedy for the evil of allowing children to re- 
 main in our almshouses, however, is legislation which 
 shall prohibit their detention in almshouses for a period 
 longer than one month. 
 
 Buildings and Grounds, Only twelve counties in 
 
 13 
 
Missouri have almshouse buildings costing $10,000 or 
 more, viz.: Boone, Buchanan, Clinton, Cole, Greene, 
 Harrison, Jackson, Linn, Macon, St. Charles, Sullivan, 
 and St. Louis city. Eleven other counties report build- 
 ings costing between $5,000 and $10,000. In all the 
 other counties reporting the almshouse buildings cost 
 less than $5,000 ; and in twenty-one out of the sixty the 
 cost of the building used as an almshous^e was less than 
 $1,500. In other words, it is probable that at least one- 
 third of the county almshouses have cost to build them 
 less than $1,500 ! 
 
 The ' ' cottage plan ' ' of construction is supposed to 
 be the best for almshouses. There is only one alms- 
 house in Missouri built consistently upon this plan, and 
 that is the Pike county almshouse. Unfortunately, 
 however, in this case the cottages are built of wood 
 and are without modem improvements. Pettis, Daviess, 
 and one or two other counties have ahnshouses ap- 
 proaching this type. Fifteen counties have alms- 
 houses of the ^institutional" type— one or more large 
 buildings several stories in height. Practically all the 
 other almshouses of the State are old farmhouses in 
 different stages of repair. 
 
 The actual fitness of almshouse buildings for their 
 work may perhaps better be judged by their sanitary 
 arrangements than in any other way, since sanitary ar- 
 rangements are so important in dealing with the infirm 
 and helpless classes found in the almshouses. Only five 
 almshouses in the State may be said to have fully mod- 
 em arrangements for heating lighting, ventilation, bath- 
 ing facilities, closets and sewerage, viz. : Buchanan, 
 Jackson, Macon, Putnam and St. Louis city. Seven 
 other counties have almshouses with nearly or partly 
 modern sanitary arrangements; viz.: Boone, Clinton, 
 Greene, Harrison, Linn, Livingston, Pettis, St. Charles, 
 and Sullivan. The remaining almshouses of the State 
 have only such sanitary arrangements as are found at 
 
 14 
 
VES3ITY 
 
 or 
 
 an ordinary farmhouse. Such primitive arrangements 
 may, of course, answer very well, where the number in 
 the almshouse is small, not larger than an ordinary fam- 
 ily ; but it is manifest that where a large number of sick 
 and infirm people are brought together the best sanitary 
 arrangements are needed. 
 
 The superintendents of the almshouses in their re- 
 ports to the department often show consciousness of the 
 inadequacy of their facilities. One writes: **This 
 county has very poor accommodations for its inmates ; 
 while there are not many still they are human.'' An- 
 other writes: ^^The equipments of the house are not 
 what they should be * * * not convenient for keep- 
 ing the class of people who go to poor farms.'' An- 
 other says, regarding the farm connected with the alms- 
 house : ^ ^ My opinion of the county farm iis that it is a 
 poor farm, sure enough. ' ' 
 
 This brings us to a consideration of the amount 
 of land which should be associated with the almshouse. 
 The prevalent idea in Missouri of what a county alms- 
 house should be is expressed in its most common name, 
 *' county poor farm." The idea is, not only that a 
 farm should be associated with the almshouse, but that 
 the institution should be made as nearly self-supporting 
 as possible through the labor of the paupers. Hence, 
 we find many county almshouses with large farms at- 
 tached. Of the eighty-five which reported the amount 
 of their land, twenty-eight had over 160 acres, forty-five 
 had between fifty and 160 acres, and twelve had under 
 fifty acres. It is. doubtful whether a large amount of 
 land should be associated with an almshouse. As was 
 shown above, only a few of the poorhouse inmates are 
 able-bodied : therefore, the idea that the institution may 
 be rendered self-supporting through the labor of its in- 
 mates is fallacious. Again, if the amount of land is 
 large the superintendent has to spend nearly all of his 
 time in managing the farm to the neglect of the inmates. 
 
 15 
 
Further, the economy of a large farm in connection 
 with the almshouse is now questionable on account of 
 the cheapness with which supplies may be purchased. It 
 has, at any rate, been demonstrated that an institution, 
 with a small amount of land can be run as cheaply as 
 one with a much larger amount. Finally, the weightiest 
 argument against the large farm in connection with the 
 almshouse is that it usually necessitates locating the 
 almshouse far in the country where it and its inmates 
 can be but seldom visited. A small farm near the 
 county seat is, therefore, preferable to a large one sev- 
 eral miles in the country. Probably the proper size of 
 farm for an average Missouri almshouse would be about 
 fifty acres, though, of course, the size should vary ac- 
 cording to the number of inmates and other circum- 
 stances. In any case it should be large enough to fur- 
 nish labor for all able-bodied inmates and to supply the 
 acreage needed for gardening and grounds. 
 
 Management, The most striking, and at the same 
 time the most regrettable, feature of almshouse manage- 
 ment in Missouri is that most of the almshouses are 
 managed by what may be called the '4ease system.^' 
 That is, the management of the almshouse is let out to 
 the lowest bidder, or, as it is usually reported, **to the 
 lowest and best bidder. ^ ' If the county court, which in 
 Missouri is the legal board of managers of all county 
 institutions, does not openly advertise for bids, it never- 
 theless usually lets out the care of the almshouse and 
 its inmates at so much per inmate per week. Only in 
 thirty-five counties of the State is the almshouse super- 
 intendent paid a fixed salary. In the remaining coun- 
 ties the lease system, under one form or another, pre- 
 vails. 
 
 This *4ease system,'^ making, as it does, the wages 
 of the superintendent dependent upon what he can save 
 from the inmates, is doubtless responsible for many of 
 
 16 
 
the worst conditions in our almshouses. Many of the 
 superintendents working under it express their disap- 
 proval of it. Thus one writes: *^The plan used in 
 this county does not meet my approval. ' ' Another can- 
 didly details the workings of the system as follows : * * A 
 few years ago the poor were let at $38.00 per head per 
 year. Under that treatment there were nine out of nine- 
 teen that died, and the county had to pay doctor's bill 
 and burial expenses which cost more than board and 
 clothes. They now pay $72.00 a head per year, and see 
 that it is cheaper and more humane. ' ' This is truly a 
 record of progress under the ** lease system; '' we wish 
 that we could record that that particular county had 
 progressed so far as to pay its superintendent a fixed 
 salary. 
 
 As regards the relative cheapness of the two sys- 
 tems, there can be no doubt that the poor can be cared 
 for quite as cheaply with humane and modern methods 
 under officials at fixed salaries as under the lease sys- 
 tem. There are many counties paying as high as two 
 dollars per week for each pauper under the lease system 
 and getting poor service ; while there are other counties 
 which have modern buildings and pay their superin- 
 tendents fixed salaries, and yet support their poor in 
 comfort at a less total expenditure per capita. The ex- 
 perience of a single Missouri county will serve to illus- 
 trate this. Clinton county, which has now one of the 
 best almshouses in the State, formerly cared for its pau- 
 pers under the lease system. The superintendent writes 
 as follows: *^It has proven more satisfactory to hire 
 the superintendent by the year than to let the inmates 
 out to the lowest bidder. This county has tried both 
 ways and the county court found it most satisfactory 
 to hire the superintendent and furnish the supplies. 
 The net expense for each inmate last year was $1.48 per 
 week; before they changed from boarding them out it 
 
 17 
 
was about $2.00 per week. So it is cheaper in this 
 county than letting them to the lowest bidder.'' 
 
 Nobody claims that the lease system is humane; 
 if it is not cheaper, the only argument in its defense 
 falls. There is no reason, then, why there should not 
 be at once mandatory legislation prohibiting this form 
 of caring for the poor in Missouri ; and this is an indis- 
 pensable step in the reform of our almshouse system. 
 
 Of the thirty-five counties which pay their superin- 
 tendents fixed salaries only eight pay salaries higher 
 than $600, and four out of these are urban counties; 
 twenty counties pay their superintendent salaries vary- 
 ing from $400 to $600 inclusive ; five counties pay under 
 $400: and two do not report the amount. From this 
 it would seem probable that the average Missouri 
 county would find no trouble in procuring a good man to 
 manage its almshouse for a salary of $600 a year in ad- 
 dition to the keeping of his family. 
 
 The average annual expense of eighty-one alms- 
 houses situated in rural counties is a trifle over $1,600 
 each. The total cost of the ninety almshouses not sit- 
 uated in the counties which contain our three large cities 
 is about $145,000 per annum. The aggregate cost of the 
 Jackson county, Buchanan county and St. Louis city 
 almshouses per annum is about $180,000. Thus the to- 
 tal cost of the almshouse system to the taxpayers of the 
 State is over $300,000 a year. The financial manage- 
 ment of each almshouse is perhaps best indicated by the 
 average cost per inmate per week. In this matter there 
 is great variation between Missouri almshouses, the low- 
 est cost per inmate per week reported being ninety cents, 
 the highest $2.90. However, in the majority of the alms- 
 houses the cost of supporting each inmate per week lies 
 between these two extremes. In forty-six out of sev- 
 enty-five almshouses reporting the average cost of car- 
 ing for each inmate a week ranges from $1.50 to $2.00 
 
 18 
 
inclusive. In twenty-three of the almshouses, it was un- 
 der $1.50 and only in six was it over $2.00 per week. 
 
 One of the most important matters in the manage- 
 ment of an almshouse is the proper classification of the 
 inmates. By this is meant the entire separation of cer- 
 tain classes of inmates from other classes, communica- 
 tion and association being allowed only under certain 
 circumstances with the consent of the superintendent. 
 Such classification and separation is universally recog- 
 nized by experts as the essential basis of successful 
 almshouse administration. The most fundamental of 
 these classifications is that of sex. The two sexes should 
 of course be absolutely separated from each other in 
 the almshouse, save only in the case of aged married 
 couples. A scarcely less fundamental classification is 
 that of race. Still other classifications should be made 
 according to the age, health, character, and condition 
 of the inmates. 
 
 It is too much to say that classification does not ex- 
 ist in the majority of Missouri's almshouses; but in all 
 save a few it is very imperfectly developed. In four- 
 teen of the ninety reporting, there is no classification at 
 all— not even separation of the sexes. In the remaining 
 there is separation of the sexes, but in many instances 
 it is to be feared that this separation is not very strict. 
 In fifty out of these seventy-six almshouses separation 
 of the sexes is the only classification attempted. Twenty 
 separate both sexes and races. Twenty-eight counties 
 have separate buildings for colored inmates, a few coun- 
 ties having these which have at present no colored per- 
 sons in their almshouses. Of the sixty-two counties 
 which do not make separate provision for the colored 
 people thirty-four have no colored inmates, and of the 
 twenty-eight which have colored inmates, but do not 
 make separate provision, seventeen have less than three 
 colored inmates. Three almshouses report a classifica- 
 tion according to sex and condition. Finally, three 
 
 19 / 
 
almshouses report a classification according to sex, race, 
 age, and character. These three are the almshouses of 
 Jackson, Clinton, and Macon counties, which alone of all 
 the county almshouses of the State may be said to have 
 an adequate classification. 
 
 Another very important matter in the management 
 of an almshouse is the enforcement of the *^work test;" 
 that is, the compelling of the able-bodied inmates to 
 work. If the almshouse is to be made a comfortable 
 home for the aged and infirm poor, in order that it may 
 not be an attractive place for the lazy and shiftless able- 
 bodied, there should be a vigorous compulsion to work. 
 In other words, work should be required of all able- 
 bodied inmates. It is disappointing, therefore, to find 
 that only in a few Missouri almshouses is there a work- 
 test in force. In sixteen only of the ninety reporting is 
 labor required; the remaining seventy-four report that 
 it is optional. 
 
 The regulations regarding admission and discharge 
 of inmates are also important in the management of an 
 almshouse. In nearly all counties the county court or 
 some member thereof has officially to decide upon the 
 admission of an inmate, but in some counties the super- 
 intendent of the ateshouse also has power to admit in- 
 mates provisionally at least. In only three or four coun- 
 ties do there appear to be definite regulations as to what 
 entitles a person to receive relief in the almshouse. 
 These counties require complete destitution on the part 
 of the applicant, and inability of either children or par- 
 ents, if any, to provide support. It is needless to say 
 that these regulations should be enforced in every 
 county, and in addition there should be some investiga- 
 tion to ascertain whether the facts are as alleged. The 
 rules regarding the discharge of inmates seem to be 
 even more lax than those regarding the admission of 
 inmates. In most instances the inmate is allowed to 
 
 20 
 
discharge himself without notice, provided of course 
 that he is not detained as insane. 
 
 Finally, a matter which should be considered cer- 
 tainly of some importance in almshouse management is 
 what is done to brighten and cheer the lives of the in- 
 mates. Even in our large city almshouses it is to be 
 feared that not much is done in this way. Only a single 
 almshouse in Missouri, for instance, has a library, and 
 that is Jackson county almshouse, a library for which 
 was provided by a few philanthropic women of Kansas 
 City. Nearly all the almshouses report that newspapers 
 are taken, but the extent to which they are taken is not 
 known. Amusements and recreation for the inmates 
 seem almost entirely lacking; and even work is not 
 systematically provided for all who wish to work to pass 
 away the time. Of the ninety almshouses reporting, 
 fifty-five have no religious services whatsoever, twenty- 
 five have only occasional religious services, and only 
 ten have regular services, six of these, however, being 
 monthly. 
 
 Model Almshouses, Strictly speaking, the model 
 almshouse still remains to be built in Missouri. How- 
 ever, several counties have almshouses so good that 
 they may well be pointed out as models for other coun- 
 ties to imitate. Only almshouses in rural counties are 
 here considered. Probably the best almshouse in a ru- 
 ral county in the State is the Macon county almshouse. 
 Not only is its cost greater than any other ($25,000), 
 but it seems best adapted to its work. The second best 
 almshouse in the State in a rural county is probably that 
 of Clinton county. Boone county has also a good build- 
 ing, though in some ways it is not well adapted to its 
 purpose and its sanitation is poor. Among other coun- 
 ties which have almshouses that might to some extent be 
 considered as models are Cole, Harrison, Putnam, and 
 Sullivan. 
 
 21 
 
Progress During 1903. Some commendable signs 
 of progress have been shown as regards almshouse con- 
 ditions during the past year. A number of counties 
 have agitated the matter of erecting new almshouses. 
 This has resulted successfully in at least two counties. 
 Johnson county has decided to build a model almshouse 
 in all respects, which it will call a * ' County Home, ' ' a 
 name which certainly deserves to be largely copied. St. 
 Francois county has also resolved to erect a new $8,000 
 building. At least two counties have changed from the 
 ^^ease system" to paying the superintendent a fixed sal- 
 ary. The greatest step in advance, however, has been 
 the appointment of county Boards of Visitors in several 
 counties according to the terms of the Act of 1903, which 
 makes it obligatory for the circuit judge to appoint such 
 a board for any county whenever fifteen reputable citi- 
 zens of the county shall petition that such a board be ap- 
 pointed. The duties of such a board are to visit and in- 
 spect the county 's charitable and correctional institu- 
 tions and report their condition quarterly to the State 
 Board of Charities, the county court and the circuit 
 judge. Such boards of visitors have already been ap- 
 pointed in the following counties: Andrew, Barton, 
 Benton, Boone, Butler, Daviess, DeKalb, Dunklin, Cal- 
 laway, Clay, Clinton, Gentry, Harrison, Jasper, Linn, 
 Livingston, Jefferson, Platte, Mercer, Nodaway, 
 Grundy, Putnam, Eipley, St. Clair, St. Francois, St. 
 Louis, Stoddard and Washington. These boards have 
 already accomplished much good in the short time that 
 they have been in existence, and they promise to do 
 much more wherever created. For example, the Board 
 of Visitors in St. Francois county secured the abolition 
 of the *^ lease-system'' and the decision to erect a new 
 almshouse. It is to be hoped that the next legislature 
 will make the law mandatory and thereby secure the 
 appointment of such boards in all the counties of the 
 State. 
 
 22 
 
IL 
 
 A Bbief Summary of the Principles Which Should 
 Govern Almshouse Administration. 
 
 It is universally recognized by those who have 
 studied almshouse administration that the almshouse is 
 not fitted to care for those classes of dependents who 
 require special or scientific treatment. By its very 
 nature the almshouse is a small local institution which 
 cannot be expected to have at its head an official with 
 professional training and experience. Therefore, cer- 
 tain classes who need special care involving special 
 knowledge should hot be committed to the almshouse. 
 These classes include children, delinquents, the insane, 
 the epileptic, the feeble-minded, the blind, and the deaf- 
 mutes. Let us consider in the order given the reasons 
 why these classes should be excluded from the alms- 
 houses. 
 
 1. Children above the age of babyhood should 
 never be committed to an almshouse because the child 
 through its imitative nature readily takes on the taint 
 of pauper surroundings which cling to it through life; 
 and because the education of no child can be properly 
 conducted in an almshouse. 
 
 2. Tramps and disorderly persons should never 
 be committed to an almshouse, as the almshouse is not 
 a correctional institution and cannot properly deal with 
 delinquent persons, while their mere presence in the in- 
 stitution brings it into such ill repute that the self- 
 respecting poor shun it even in the direst extremities. 
 
 3. Perhaps the presence of no other class in the 
 almshouse gives rise to such grave abuses as the pres- 
 ence of the insane. Because the insane need the medical 
 care of specialists, skilled attendants, cheerful sur- 
 roundings, and a scientific diet, all of which are lacking 
 in an almshouse, their condition often becomes very 
 
 23 
 
pitiable. This neglect easily shades off into the brutal- 
 ity of leaving the insane dirty and half -naked, confined 
 in steel or wooden cells. Insane persons should, there- 
 fore, never be committed to the almshouse, and those 
 who become insane after commitment should be speedily 
 removed. 
 
 4. Epileptics should not be committed to an alms- 
 house, because like the insane they need special medical 
 care and treatment, through which their condition is 
 always improved and permanent recovery sometimes 
 effected. As all epileptics become insane if their dis- 
 ease is neglected, the same objections to almshouse care 
 are applicable in their case as in the case of the insane. 
 
 5. Feeble-minded persons should not be kept in 
 almshouses, because their presence there is both a hard- 
 ship to the other inmates and a danger to the com- 
 munity. No almshouse is properly equipped to care 
 for and restrain idiotic and feeble-minded persons, 
 while the loose rules of admission and discharge allow 
 such persons to go and come as they please, which is a 
 danger to the community. This is especially a danger 
 in the case of feeble-minded women who, under such lax 
 care, almost invariably become mothers, and so trans- 
 mit their defect to succeeding generations. Feeble- 
 minded children should, of course, be put into special 
 institutions where, through training, they may be often 
 much improved. 
 
 6. The desirability of removing blind and deaf- 
 mute children from the almshouses to special institu- 
 tions for their instruction was early recognized ; but the 
 desirability of special institutions for dependent adults 
 of these classes is also now admitted. Certainly the 
 legislation for removing blind and deaf-mute children 
 from our almshouses should be enforced. 
 
 By the exclusion of all classes from the almshouse, 
 which require special scientific treatment, the true func- 
 tion of the almshouse discloses itself. Manifestly the 
 
 24 
 
class which remains for almshouse care is the aged and 
 infirm poor. In every old-settled community this class, 
 which requires no scientific treatment, is sufficiently 
 large, and it should be the function of the almshouse to 
 provide a home for them. 
 
 Even after classifying so many classes of depend- 
 ents out of the almshouse we still will not have a prop- 
 erly administered institution unless there is classifica- 
 tion ivithin the almshouse. It is generally recognized 
 that a good almshouse should classify its inmates in at 
 least four different ways. The first and most im- 
 portant classification is in regard to sex. The sexes 
 should be absolutely separated from each other, and if 
 possible housed in different buildings, if the institution 
 is to be kept free from scandal. A second classifica- 
 tion, which should not be neglected, is in regard to color. 
 Fully carried out this would result in duplicate institu- 
 tions, one for whites and one for colored. At the least, 
 it would mean a separate building for the colored if they 
 numbered more than three or four. A third necessary 
 classification is in regard to health. This means that 
 there should be special provision for the sick, and isola- 
 tion of those who have contagious diseases, such as con- 
 sumption. The fourth classification which should be 
 made is in regard to mental and moral condition. This 
 means that persons who are congenial should be 
 grouped together and that some persons should be given 
 a room alone. 
 
 Even in an ideal almshouse at least this much class- 
 ification is necessary. But in case the classes above 
 spoken of have not been removed from the almshouse 
 much further classification is required. There should 
 then be isolation of the mentally defective and special 
 provision to keep the children from being contaminated 
 by the other inmates. 
 
 The question of classifying properly the inmates of 
 the almshouse brings us to the question of the proper 
 
 25 
 
constniction of the almshouse. It is now generally 
 agreed that the cottage plan of construction is best. 
 There are many disadvantages to a single large bnild- 
 ing, not the least of which is that it does not make easy 
 proper classification and separation of the inmates. For 
 an average Missouri county the almshouse should con- 
 sist of three cottages, one for the female inmates, one 
 for the males, and one for the superintendent's family. 
 The cottages for the inmates should be built to accom- 
 modate from ten to twenty-five persons, and should 
 have both dormitories and single rooms to allow for 
 proper classification of the inmates. The cottage for 
 the superintendent's family would, of course, be smaller. 
 If needed, a fourth cottage for the colored inmates 
 should be added. The whole institution should be 
 equipped with the best modern sanitary arrangements 
 and should preferably be heated by a central plant. The 
 average cost of such an institution, if built of brick, 
 would not be above $15,000. 
 
 Of course, the care of the almshouse and its inmates 
 should not be let out to the lowest bidder, as is done in 
 about two-thirds of the counties of our State. This 
 * ^farming out'' of the poor, as it is called, gives rise 
 to serious abuses wherever practiced. The proper 
 method is to hire a competent man as superintendent 
 at a fixed salary, and then furnish supplies as needed 
 for the institution by requisitions on the county au- 
 thorities. 
 
 As to management, the most important matter, 
 after those already mentioned, is in regard to the ad- 
 mission and discharge of inmates. The *^ work-test" 
 should be rigidly enforced ; that is, no able-bodied per- 
 sons should be admitted without being required to work. 
 Only thus can idle and vicious persons, like tramps, be 
 effectually excluded. Inmates should, also, not be per- 
 mitted to discharge themselves, and should be released 
 
 26 
 
only when there is some assurance that they will be 
 properly cared for outside of the institution. 
 
 A¥ork should be furnished for all able and willing 
 to work. This should be done, not so much for economy, 
 as on the general principle that the normal person is 
 happier and more content when occupied than when idle. 
 As noted above, in the case of the able-bodied work 
 should be required, not optional. Eecreation and amuse- 
 ments should not be wholly neglected. For this reason 
 newspapers and books ought to be found in every alms- 
 house, and simple entertainments should be occasion- 
 ally provided for the inmates. Especially ought there 
 to be regular religious services of some sort, if possible, 
 weekly. 
 
 If these recommendations can be carried out, the 
 almshouse under a humane and intelligent superintend- 
 ent may yet become a genuine institution of philan- 
 thropy, where the respectable aged and infirm poor 
 may find a home such as enlightened Christian sym- 
 pathy would give them. 
 
 III. 
 
 •Almshouse Abuses and Their Coreection. 
 
 (Extracts from a paper read by Charles A. Ell wood, Professor of Sociology, 
 University of Missouri, at the National Conference of Charities and Correction 
 at Atlanta, Ga., 1903.) 
 
 To the practical philanthropist, who has not nar- 
 rowed his interest to a locality, a sect, or a class, there 
 is no more important problem than that of the correc- 
 tion of abuses in our county and municipal institutions, 
 and especially abuses in the management of our county 
 almshouses. 
 
 The conditions in Missouri are by no means excep- 
 tional. They simply illustrate the conditions which 
 obtain in many States. What efforts, then, can be made 
 
 27 
 
to improve these conditions and correct these errors! 
 First, there are certain abuses in the management of 
 almshouses which maj^ be corrected through the visita- 
 tion of local boards of visitors; second, there are 
 abuses which may be corrected through inspection by 
 State officials; third, there are abuses which can only 
 be corrected through mandatory and prohibitive legisla- 
 tion. That frequent and persistent visitation of the 
 almshouse by local committees can accomplish much 
 good is beyond question. It is an efficient means of 
 enlisting the interest of a number of intelligent citizens 
 in each county in the almshouse problem, and so fur- 
 nishes the basis for agitation for proper legislation. If 
 their visits are frequent enough (they should not be less 
 often than once a month) such local boards can easily 
 bring about in the almshouse humane treatment of the 
 inmates, cleanliness of persons and premises, better care 
 of the sick, and many other minor reforms. Further, 
 they can aid in providing reading matter, work, recrea- 
 tion, and religious services for the inmates, and their 
 interest in the almshouse will always be indispensable 
 for insuring the best possible management. 
 
 The laws of New York, Ohio and other States i^ro- 
 vide for such local boards of visitors ; and the last Gen- 
 eral Assem.bly of Missouri passed a law providing for 
 such county boards of visitors, from which many good 
 results are expected to flow. But in States which have 
 not such laws this work of visiting the almshouses can 
 be inaugurated in any county by a few philanthropic 
 men and women. 
 
 But local boards of visitors, whether authorized by 
 law or not, because the}' are local and made up of ordi- 
 nary citizens, not of experts, cannot effect such reforms 
 in the almshouses of a State as the inauguration of an 
 adequate system of classification, the erection of modern 
 buildings adapted to such classification and the exclu- 
 sion of classes which should not be in almshouses. In 
 
 28 
 
part, such reforms may be brought about through State 
 inspection and supervision by the State Board of Chari- 
 ties. I do not mean occasional visits by members of the 
 State Board of Charities (which in my opinion accom- 
 plish little), but the systematic visitation and inspec- 
 tion of all the almshouses in the State at least once each 
 year by the secretary of the State board or by a special 
 inspector working under him. The value of such inves- 
 tigation is great. 
 
 The inspector, being the representative of the State 
 and at the same time an expert, is in a position to sug- 
 gest and gradually enforce an adequate system of class- 
 ification of inmates in the almshouse, and to advise 
 about the construction of new almshouses. He would 
 also be able perhaps to influence the county authorities 
 to appoint better men as superintendents, to make more 
 rigorous rules regarding the admission and discharge 
 of inmates, and to require work of all able-bodied in- 
 mates. Finally, he might exercise considerable influence 
 in securing the removal from the almshouses of certain 
 classes of inmates who should be cared for in special 
 institutions, such as the insane, the feeble-minded and 
 the children. 
 
 But here the limitations of State inspection and 
 supervision without the support of mandatory legisla- 
 tion begin to become manifest. The chief value of in- 
 spection then is that it is a step toward securing definite 
 legislation. 
 
 Let us consider a few of the abuses which require 
 for their correction such legislation. In States where 
 the cost of caring for the indigent insane devolves upon 
 the county, ex]3erience shows that it is impossible to get 
 counties to send all of their insane to State hospitals, 
 since the support of an indigent insane person in a 
 State hospital costs always about twice as much as in 
 the county almshouse. 
 
 Legislation of one sort or another is, then, neces- 
 
 29 
 
sary to get the insane out of the almshouses. Either the 
 State must declare the insane to be State wards, taking 
 upon itself the burden of supporting the indigent insane, 
 or it must prohibit the keeping of the indigent insane 
 in almshouses and make obligatory their commitment 
 to State hospitals. The case with the feeble-minded and 
 epileptic is practically^ the same. Again, inspection and 
 the efforts of philanthropic societies, will- not suffice to 
 keep children, either defectives or normal, out of alms- 
 houses, but definite prohibitive legislation is necessary. 
 Finally, it is idle to talk of improving conditions and 
 correcting errors in the management of almshouses by 
 inspection and visitation as long as the system of man- 
 agement permitted by law is that of ' ^ farming out ' ' the 
 care of the inmates to the lowest bidder or to some one 
 who has a political pull. Under such a vicious system, 
 visitation and inspection can accomplish little except as 
 they result in agitation for legislative prohibition of the 
 *^ farming ouf system. 
 
 But how can these three m.ethods of improving con- 
 ditions in almshouses, visitation, inspection and legis- 
 lative enactment, be put practically into eifect in States 
 where none of these exist? The answer is, the order of 
 evolution is that indicated. First must come the visita- 
 tion of the almshouses by self-appointed local com- 
 mittees of philanthropic men or women. If a State 
 Board of Charities exists, the agitation can best be car- 
 ried on through that body, first to obtain State inspec- 
 tion and then definite legislation. But in States where 
 no State Board exists, philanthropic workers need not 
 be discouraged. A general educational campaign can 
 be carried on, visitation can be spread from county to 
 county, and even State inspection can be undertaken by 
 a voluntary State organization, such as a * * State Chari- 
 ties Aid Association,'' though above all efforts should 
 be concentrated on the securing of a State Board of 
 Charities of the supervisory type. Educational institu- 
 
 30 
 
tions, especially State universities, have here a duty to 
 perform. If university extension work is needed in lit- 
 erature, science and agriculture, how much more is it 
 needed in practical philanthropy. 
 
 In conclusion, let me point to the instructive ex- 
 perience of England. The workhouses of England 
 (which correspond to our almshouses) are kept in their 
 perfect condition through the three methods which I 
 have discussed— visitation by local boards of visitors, 
 inspection by State officials, and centralized legislative 
 and executive control. The English government has 
 found that none of these methods can be dispensed with 
 if the administration of its workhouses is to be the best 
 possible. It has found, too, that a more and more cen- 
 tralized system of control of workhouse administration 
 is necessary; and this I believe will be found necessary 
 also in this country in order to correct completely the 
 errors and abuses in the management of our county 
 almshouses. 
 
 31 
 
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