History of Long Term Care

This section of ElderWeb is a comprehensive overview of how our long term care system has evolved by examining the events and decisions that changed the way that we have provided and paid for the care of our elderly over the years.

Be sure to look at the narratives and illustrations in the Appendix. Many photos and documents come from the wonderful Library of Congress American Memories collection. There are also graphs, tables, and charts of data like changes in life expectancy and long term care utilization.

Long Term Care Backwards and Forwards

1776-1799

Summary: America is a young society, "Old age security" meant having children or wealth, Poorhouses became home to the indigent elderly, The earliest federal welfare and pension programs are developed.

The United States Was a Young Society

The United States in the 1700's was predominately comprised of young people for a variety of reasons. Life expectancies were much shorter than they are today, primarily because so many people died in infancy or childhood. That meant that a relatively small percentage of the population lived to old age.

Other that the Native Americans, the country was populated almost entirely by immigrants, many of whom came came from England or other parts of Europe. Getting here required an extremely hazardous ocean voyage, and life on the new continent was equally difficult. The immigrants who came here voluntarily were either fleeing from persecution or were poor and hoping for a better life in the new world, the only reasons they would take such a risk. Few people who were old or ill would have attempted such a trip, and many of those who did probably died in the process. The slave population was also young. Slave-traders were not going to waste their time bringing over those who were old or ill, and relatively few slaves survived long enough in the harsh conditions most of them endured to live to old age. 

Old Age Security Was Children or Wealth

In the early years of this country, few people lived to old age, but for those that did, "old-age security" meant having children or property. Having family living nearby wasn't often an issue. In those days before railroads and automobiles, families were large and few children ventured far from home. 

Before 1800, less than 5% of the U.S. population lived in cities. Everyone else resided in rural areas where extended families could live together easily and cheaply. Generally, people worked for themselves. As a 1937 Social Security pamphlet described it, "The home of a pioneer family was a little world in itself. Members of the family were their own farm and factory workers, butchers, bakers, and barbers; policemen and firemen; often their own doctors and nurses, and sometimes their own teachers as well." (Social Security, 1937) You didn't need cash to survive in that economy, and families were fairly self-sufficient.

(See 1800-1990: Changes in Urban/Rural U.S. Population.)

Having a family was the key to survival. As later described in that Social Security pamphlet,

"A young man then could hardly afford not to marry. He needed a wife as a business partner, children as helpers. In early New England not only spinsters but bachelors were under a cloud. Bachelors, in fact, were regarded with suspicion. Usually they had to live where the court told them to. Single people had to attach themselves to a family to get a chance to work for their living. Both the children and the old people earned their place at the family table." (Social Security, 1937)

Children were expected to split their earnings with, or otherwise provide for, their parents. If a parent needed care, the children were expected to provide it. Elderly people in need of care who were childless but wealthy could hire whatever help they needed. Dependent elderly people who could not be cared for by their own families could be 'boarded out' with surrogate families, and the adult children paid for the cost of that care. Those elderly who were poor and childless, or whose children refused or were unable to care for them, ended up dependent on charity or public welfare. 

Slaves, of course, had neither families nor property. Their families were often split up, so it would have been impossible for children to look after their own parents. The quality of their life in old age was completely dependent on the master they worked for. 

Poorhouses Became Homes for the Indigent Elderly

The public welfare system in the 18th and 19th centuries was a local, not a federal, obligation, patterned on the English "Poor Laws". The Poor Laws established the government's responsibility to provide for those who could not care for themselves, but left the details about how to do it up to the local town or county officials.

Initially, "paupers" were given cash payments called "outdoor relief", which was paid for by the taxpayers of the city or county. As the cost of outdoor relief increased, governments decided to create a more cost-effective system, called "indoor relief". They built poorhouses, almshouses, poor farms, county infirmaries, asylums, or county homes to house people who were too expensive to support with outside relief, and required welfare recipients to go to these facilities if they wanted assistance. In some states, the state owned and operated some or all of the poorhouses, in others, counties or cities ran them. A few states avoided the cost of building and maintaining poorhouses by boarding paupers out, sometimes with their own relatives, or paying farmers to care for them. Tennessee actually auctioned their paupers off to the lowest bidder. (The Atlantic Monthly, 1881)

A common concern of the public at that time was that the opportunity to get free room and board would be so attractive that people would deliberately pretend to be poor so they could live an "indolent life" in the almshouse at the expense of the taxpayers. Consequently, poorhouse life was made as unappealing as possible. The "inmates" were expected to wear a poorhouse uniform rather than their own clothes, and they were not allowed to leave the poorhouse. Many of the poorhouses had attached farms so they could produce their own food and be self-sufficient, and they were often located far out in the country to keep them out of sight. To offset the cost of care, the inmates were expected to do the work needed to keep the operation going. Even the older women were given jobs like sewing. 

(See 1809-1930: History of Hospitals in Michigan.)

Operators also were careful to check before accepting someone into the poorhouse to see if anyone else could be supporting the potential inmate. If a poorhouse applicant had adult children, he might have to prove that his children were unable or unwilling to support him before he would be accepted. The local government was only responsible for people from their jurisdiction, so they could, for instance, refuse entry to a widow who grew up somewhere else. Someone who had lived in several places might find that none of them considered him or her eligible for taxpayer support. This happened often enough that there were bands of poor homeless people who roamed from place to place, staying in each one only until the authorities ordered them to move on.

Concerns about the high cost of operating the poorhouses lead to other indignities. For instance, New Jersey law included a provision forbidding emancipation of slaves who were 40 years old or more "for fear of the distant contingency, that this freedman might become a public burthen to the township, by being a pauper in his old age, and rather than subject the towns to that they preferred to let the man and his posterity remain in slavery." (Library of Congress: Slaves and the Courts, 1740-1860)

As time passed, the poorhouses became catch-alls for anyone who couldn't survive in the outside world, and they became home to poor dependent elderly people, where they lived in the same rooms with "miscreants" (petty criminals), "inebriates" and "intemperates" (alcoholics), orphans, unwed mothers, and the "feeble-minded" (mentally ill). 

Early Federal Pension Programs Created

One alternative to sending people to the poorhouses was to make cash payments to specific groups of disabled or indigent people to help them support themselves in their own homes. For many years, the only group eligible for federal cash benefits of any kind were veterans and their families. Although these payments were often called "pensions", many were dependent on the disability and/or indigence of the recipients, so some of them took on aspects of welfare payments. 

One of the first acts of the new government in 1776 was to authorize pensions for disabled Revolutionary War veterans. The initial military pension law offered half-pay for the rest of their lives to soldiers who were so disabled in the war that they were unable to work for a living. The federal government and the states disagreed about who should pay for and administer the program. The federal government didn't have the authority to raise funds by taxation at that time, so they said that the pensions were to be administered and paid for by the states. The states didn't want to bear the cost and they refused to do anything, so the federal government took back responsibility. However, the newly-formed government hadn't yet created any organized system for accepting and paying pension claims. For several years, a separate act of Congress had to be voted on to appropriate funds for each individual that requested a pension, until, finally, a general appropriation was made in 1790, and a pension law was enacted in 1792.

The rules for veterans pensions were changed numerous times in the next few years. Gradually, veterans benefits were expanded to include pension payments even for those who were not disabled, if they served during certain wars and time periods -- first for officers, then, several years later, for enlisted men. 

Benefits for veterans' surviving spouses came later, and most were limited to spouses who were indigent. In 1780, the first benefit for surviving spouses was created for widows of officers who died in the Revolutionary War. In subsequent years, the law was changed include officers who died in service after the War, and to their children under age 16, if their mother was deceased. Eventually, when the government needed incentives to get men to fight in the War of 1812, benefits for widows and children were made available to enlisted men as well as officers.

1800-1899

Summary: Families disperse, Poorhouse system comes under scrutiny, Old-age homes are established, Hospitals and home health emerge, Early retirement communities appear, Some elderly move to insane asylums, State and employer pension and welfare systems develop.

Families Disperse and Children Move Away

The country grew quickly and by the 19th century land in the settled areas was no longer cheap. There was a limit to how many times a father could subdivide his land among his children to give them a plot of their own, so more and more children had to leave the family home in order to make a living. Some of them went to the cities to find work, and others moved west where cheap land was available. 

In the early 1800's, much of the travel to the west was on trails like the "Cumberland Road," later called the "National Road," which funneled early pioneers into the midwest. In the early- to mid-1800's, pioneers began to travel farther west on the Oregon Trail, the Santa Fe Trail, and other major wagon train routes. By the middle of the century, the railroads were beginning to make travel easier, and in 1869 the transcontinental railroad was completed, making it possible to ride coast to coast in comparative comfort on a train. 

Railroads encouraged the use of their new western lines by offering to sell land to potential settlers at low prices, over long terms, and at low rates of interest. Later, the federal government decided to further encourage the development of all the western states and territories by enacting the Homestead Act of 1862. The Homestead Act declared that any citizen or intended citizen could claim 160 acres of unoccupied public land in "public domain states," virtually any part of the country outside the original 13 colonies, Tennessee, Kentucky, Texas, and Hawaii. Claimants had to improve the plot with a dwelling, grow crops on it, and live there for five years. If the original filer met these requirements and was still on the land five years later, it was his property, free and clear. The opportunity to get free or low cost land drew millions of people out to the west, including many of the new immigrants pouring in from Europe and other parts of the world.

In 1800, the largest cities in the country were all in the original 13 colonies. By 1850, some of the "gateways" to the West, like Cincinnati, St. Louis, and New Orleans, overtook the eastern cities as the largest cities in the country. By 1900, the Midwest had become quite settled and many of the largest cities in the country were in the Midwest. (Largest U.S. Cities) (Population Percentage by Region)

(See 1790-1990: Population Percentage by Region.)

The westward migration of the country contributed to the dispersion of families. Although a few families took their elderly relatives along on the difficult journey west, a number of the western settlers left their parents and other relatives behind in the East. Some families made several moves, perhaps settling in the Midwest for a time before moving farther west. Each time they moved on, some members of the family might decide to stay put, leaving relatives scattered along the migration route. Over time, the massive westward migration made it less likely that many, or any, children lived near enough to their parents to provide help. 

Many Elderly Live With Children

Family living arrangements have always had an impact on the need for long term care. Women were less likely than men to have accumulated assets of their own that they could use to take care of themselves in retirement, and unmarried people of both sexes were more vulnerable in old age because they had no partner who could provide them with physical and financial assistance. The most vulnerable group of all were unmarried elderly women. 

Older women were far more likely than older men to be unmarried (whether they were widowed, divorced, or never married). Only about one-third of age 65+ women were married in 1880, less than half the percentage of age 65+ men who were married. Although their life expectancies weren't much longer than men's, most women married men who were much older than themselves, so they often out-lived their husbands. Older unmarried women largely had to rely on children and other family members for help, and often ended up living with them. 10% of married women and nearly 60% of unmarried women age 65 or older were living with children or other family members as dependents in 1890. (Costa, 1997)

Poorhouse System Comes Under Scrutiny

The poorhouse population exploded in the early 1800's and conditions in the poorhouses ranged from barely tolerable to horrific. They were often run by people who got their jobs as political favors. The operators often did as little as they could get away with in exchange for a paycheck, and the governing bodies often did as little as possible to keep costs down and discourage over-use. The operators were particularly incapable of caring for mentally-ill residents. Dorthea Dix reported finding women chained and kept in pens in some poorhouses. The insane patients, criminals, and alcoholics frightened, and sometimes injured, the frail elderly living in the same rooms. 

Ending up in a poorhouse was everyone's nightmare. Songs like "Out from the Poorhouse" illustrated the public perception. In that song, a man bemoans the fact that he gave his children his farm and all his savings and they sent him to the poorhouse instead of taking care of him.

The poorhouses were becoming enormously expensive. "Ohio, which is not especially afflicted with pauperism, pays more than half the money obtained by the state taxation for the welfare of her criminals and paupers; and the estimate does not include the public charities of her cities, or any township aid." (The Atlantic Monthly, 1881)

One way to control cost and deter use was by segregating the poor. New York City purchased Blackwell's Island (now called Roosevelt Island) in 1828 as a remote spot for their paupers. On Blackwell's Island they built a penitentiary for criminals, men's and women's almshouses for the poor elderly, hospitals for those who were poor and ill (Charity Hospital, Smallpox Hospital, and the Hospital for Incurables), a workhouse for the able-bodied poor, and a lunatic asylum for the poor who were mentally-ill. (NYC Corrections History)

In response to the growing concerns about abuse and squalid living conditions, nine states (Massachusetts, New York, Rhode Island, Pennsylvania, Illinois, Ohio, Michigan, Wisconsin, and Kansas) created state-run "Boards of Charities" in the mid-1800's to oversee and report on the local poorhouse operations. These boards, precursors to today's Departments of Welfare, were supposed to inspect and control the poorhouses, and the reports they produced led to some efforts to improve conditions and to "classify" residents to separate the insane from the sane, and the dependent elderly from the able-bodied. 

The growing costs, combined with the rising concerns about quality, arose from the inherent conflicts between the desire to provide good care to those who were truly needy and to reduce the cost to the taxpayers.

"Generally, the county officials lean to the side of mercy; the quality is not strained, since it costs them nothing; for, be it noted, there are two sets of principals in the business, the county directors or supervisors, who manage the almshouses, and are responsible for their expenses, and the justices of the peace and poor overseers, who commit paupers to the almshouses, and have nothing more to do with them. It is for the interest of the poor directors and supervisors to have as few paupers in the almshouse as possible; it is for the interest of justices, who are paid for each order they write, and of overseers, who depend for reelection upon the suffrages of the poor but warm hearted populace, to show a liberal spirit. And, as Sydney Smith has observed, everybody is full of humanity and good nature when he can relieve misfortune by putting his hand into his neighbors pocket. Who can bear to see a fellow-creature suffering pain and poverty, when he can order other fellow-creatures to relieve him? The result of all this is that, practically, most States give almshouse lodging to any one having a settlement who can bring himself to ask it." (The Atlantic Monthly, 1881)

There was a lot of debate about society's role in caring for the poor, but by the mid-1800's, many felt that the "deserving" poor, like children, the insane, and the elderly, should get better treatment than the "undeserving" poor, like alcoholics and those who were healthy but shiftless or lazy. Reformers like Dorthea Dix convinced legislatures to develop better facilities to care for the mentally ill, and they were gradually moved out of poorhouses. Laws prohibiting children from residing in poorhouses were passed, and the children were moved into orphanages. 

That left poor, dependent, elderly adults who had no place else to go as the last group of the "deserving poor" who needed a place of their own, but the poorhouse was still the only public facility available for them. They were sometimes treated slightly better than the "undeserving" inmates, as in New York and Boston where the elderly were eventually separated from the rest of the poorhouse population. Nevertheless, they were still in a poorhouse. (New England Magazine, 1898) 

(See 1898: Boston's Pauper Institutions.)

Institutionalization Reigns

In spite of the problems of the poorhouse system, most people seemed convinced that building large institutions was the best way to deal with those who needed help of one kind or another. In the newly industrialized society these institutions built to "efficiently" care for the poor, the sick, and the elderly bore an eerie resemblance to factories. They were large, warehouse-like buildings that housed dozens, or even hundreds, of people. "Inmates" slept in huge dormitories, with their beds beds neatly organized into rows, and ate at huge tables in a dining hall where meals could efficiently be served.

"The poor and the insane customarily were relieved within the family [in the Colonial era], the orphan was apprenticed to a household, the criminal, after being fined and perhaps whipped, was then returned to his residence. The 18th century community had recourse to institutionalization only when some extenuating circumstance--such as debilitating illness or violent insanity--made no alternative arrangement feasible. These ad-hoc institutions that came into being during the colonial era resembled the household both in routine and construction."

"In the decades after 1820, America turned with unprecedented enthusiasm and energy to the construction of custodial institutions for the poor, the insane, the orphan and the criminal. Institutionalization now became the first rather than the last resort. The institution and not the household became the preferred setting...Americans during these years also seem to have shared a confidence in the ability to design an environment and construct a setting in which these faults could be eliminated and the causes of dependency thus eradicated...And, understandably, with the beginnings of a factory system, the institutions built after 1820 were more influenced by and more nearly resembled the factory; whereas those built before 1820 more nearly resembled the household." (Abe Bortz, 1970)

Some Elderly Moved Into Mental Facilities

In 1845, Congress enacted a law giving public land to each of the states "for the benefit of indigent insane persons", and the states started to build insane asylums and hospitals for the insane. Many of the mentally-ill poorhouse inmates transferred to these new facilities were elderly. (Vladek, 1980) 

That group probably included some victims of dementia. The words "dotage" and "dementia" had been used by physicians and researchers as far back as Roman times, but the distinctions between dementia, other types of mental illness, and normal aging were not well understood in the 1800's. The term "senile dementia"  was first used in 1838 by Dr. Jean Ã?tienne Esquirol. Dr. Alois Alzheimer would not discover that "Alzheimers Disease" resulted from plaques and tangles in the brain until 1906. (David Shenk, The Forgetting, 2001)

Early Nonprofit Old-Age Homes Established

(See 1898-1987: History of the Odd Fellows Home of Springfield Ohio.)

In response to the problems of the poorhouses, numerous nonprofit organizations began building old age homes to give "respectable" poor people a way to avoid the degradation of the poorhouse. 

"Benevolent societies" or "fraternal organizations" affiliated with nearly every ethnic, religious, trade, profession, and social group imaginable were established during the 19th century. Hundreds of benevolent societies emerged, including the Irish Benevolent Society, the German Benevolent Society, the Hebrew Benevolent Society, the Odd Fellows, the Masons, and the Knights of Columbus. These were called "voluntary" organizations, because each eligible person could choose whether or not to join. 

Although they had other purposes for their existence, the benevolent societies created one of the earliest organized old-age assistance programs. Members paid monthly dues to the Society while they were young and healthy, then received help when they were elderly, infirm, or in need. The Societies provided cash and food to support people in their own homes. Since that wasn't enough for older members who couldn't live alone any longer, the benevolent societies began to build "homes for the aged" where their elderly members could live. The significant expenses of erecting and maintaining these buildings were paid for by the members of the benevolent societies.

Some of the earliest voluntary homes were designed to house both orphans and the elderly, but eventually state-run orphanages were built and the orphans were moved into them. As that happened, the benevolent societies closed down their facilities for children and concentrated their attention on the elderly.  (Odd Fellows Home History)

New laws were written in the 1800's to allow the creation of charitable organizations that could operate like corporations. In addition to those established by the benevolent societies, many charities were established by bequests from wealthy benefactors, whose wills included stipulations that the money or property be used to provide assistance to people who fit certain criteria, like "deserving widows and deserted wives" or "colored persons over the age of fifty of respectable character" or "old and worn out seamen." To carry out their work, the organizations built "old age homes" to house those who couldn't live on their own.

In sharp contrast to the poorhouses, the voluntary and charitable facilities seemed luxurious. Many were newly-constructed buildings, built specifically to house the elderly, and others were stately old mansions whose owners had died. The facilities were much nicer, but they were still operated with the paternalistic viewpoint of the times. "Inmates" were under the supervision of a "matron" who had complete control. Residents generally had to get permission even to have visitors or leave the facility. In most,  "inmates" were also expected to do chores, and to do sewing or other services that could help bring in money to support the cost of the home's operation. 

Some of these facilities required the recipients to pay an up-front fee and turn over their pensions and any other income or assets they had to the facility, in exchange for a guarantee that they would have a home as long as they needed it. This concept re-emerged a century later as something we now call "lifecare". 

(See 1850: Aged Women's Home, Baltimore, MD.)

As an example of some of the homes that were built in Brooklyn, New York in this century, Polk's Medical Register lists the following:

  • Baptist Home, 665 Greene Avenue, established in 1869 with 60 beds
  • Brooklyn Home for Aged Men, 745 Classon Avenue, established in 1878, 150 beds
  • Brooklyn Methodist Episcopal Church Home, New York Ave & Park Place, established in 1882, 70 beds
  • Denmark Home for Aged, 1051 41st, established in 1906, 20 beds
  • German Evangelical Home, Chauncey & Bushwick, established in 1881, 265 beds
  • Graham Home for Old Ladies, 320 Washington Avenue, established in 1851, 80 beds
  • Greenpoint Home for Aged, 137 Oak, established in 1882, 15 beds
  • Home for Aged, 464 Herkimer, established in 1850, 60 beds
  • Home of the Aged of the Little Sisters of the Poor, Bushwick and De Kalb
  • House of the Good Shepherd, Hopkinson & Pacific, established in 1868, 500 beds

Although they seem to be a precursor to nursing homes, most of the old age homes were more residential than medical. They probably provided something ranging from "room and board" or "board and care" to what we now call "assisted living". There are references to "infirmaries" in some old-age homes, and others included a separate building or section that they called a "hospital" where people who were very ill would be housed. The infirmary or hospital section of these facilities was probably comparable to what we call a "nursing home" today.

Hospitals and Chronic Care Evolve

In studying the evolution of long term care, it's important to understand the way that hospitals were evolving, since there was some overlap between "old age homes" and "hospitals." Hospitals have some roots in the poorhouse system, just as nursing homes do, since from the beginning of the country many of the poor have been old and sick, and many of the old and sick have been poor. Some of the first hospitals in the country were built on poor farms to house the sickest of the poor population. (Medical History of Michigan, 1930) Where there was no poorhouse hospital, private hospitals received money from the county poor fund to care for the sickest paupers, which often made up a significant percentage of their patients. A few poorhouse hospitals, like Cook County Hospital in Chicago, still exist today as public hospitals. 

Nineteenth century hospitals were not places where you expected to be cured, they were places to go when all other options had been exhausted. In the early part of the century medical science was very crude, and often consisted of "cures" like bloodletting, where the doctor cut the veins of the patient to let "bad blood" escape. In some cases the best outcome you could expect was that the "cure" wouldn't kill you. It wasn't until the latter part of the 1800's that researchers began to understand how to deal effectively with illness and disease.

In the earliest years of the country, and in the parts of the country that weren't yet settled, people cared for their sick at home. If a doctor was needed, he would come on horseback or by buggy, sometimes staying overnight. As time went on, some doctors began to board a few of the sickest patients in the doctor's own home. As demand grew, religious and other nonprofit organizations built better facilities and hired additional physicians. Hospitals as we know them today began to emerge in most of the country in the early- to mid-1800's, a bit earlier than the voluntary and non-profit old-age homes. Some early hospitals included care for the elderly as a part of their mission, even building "homes" attached to the hospital where the poor elderly could live. (Medical History of Michigan, 1930)

Unlike the younger, healthier patients, poorhouse patients tended to have chronic conditions that required long term care. People who weren't poor cared for the chronically ill at home. Those who were poor and ill, many of whom were also elderly, often ended up in hospitals for very long periods of time. (Charity Hospital, 1890)

Early Retirement Communities Are Created

(See 1889: William Enston Home, Charleston, SC.)

There were some surprisingly modern concepts used during this period by private and non-profit developers, including some early planned communities and retirement campuses. 

One of the earliest planned "retirement communities" was the William Enston Home in Charleston, SC, constructed in 1889. It is described by the National Park Service Register of Historic Places as follows: 

"The home is comprised of 24 residential cottages; Memorial Hall, a community building; an infirmary; an engine house; a water tower and an entrance gate. Designed in 1889, the water tower served as the centerpiece of a model waterworks system, and the spacious, landscaped grounds exemplified suburban planning ideals of the 19th century...Enston specified that the complex be comprised of neat and convenient two-story brick cottages with at least eight acres of land. He also stipulated that potential residents be the old and sick, from 45 to 75 years old, of 'good honest character,' and not suffering from 'lunacy'." (National Park Service)

Sailor's Snug Harbor was built in 1833 on Staten Island New York as a 130-acre campus for "old and worn out seamen", funded by a generous bequest from Robert Randall, who left the bulk of his fortune to endow "...an Asylum, or Marine Hospital, to be called "Sailor's Snug Harbor" for the purpose of maintaining and supporting aged, decrepit, and worn-out sailors." Randall had originally made a bequest of land in Manhattan, but by the time litigation surrounding the will was settled, New York City had grown substantially and the Trustees of Snug Harbor decided that Randall's farmland was too valuable a piece of real estate to be used for a seamen's retreat, so they sold it and used the proceeds to purchase the 130-acre Isaac Housman farm in what was then a rural area of Staten Island. Eventually, the site included dormitories, gardens, a greenhouse, dining rooms, workrooms, barns, a dairy, a hospital, a sanitarium, a bakery, a laundry, a snack bar, a library, a vaudeville house, a church and a chapel. 

(See 1873: Sailor's Snug Harbor, Staten Island, NY.)

Sailor's Snug Harbor was continuously in operation until the late 1960's, creating an interesting opportunity to see life in an old age home across several eras. That long span of existence and its location near a large city meant it was well-documented. Author Theodore Dreiser, lived nearby and got to know the the inmates of the place well. In his 1899 book, The Color of the Great City, he concluded that institutionalization was not a good solution for their old age, because "...this is a great institution and indeed a splendid benefaction, but it insists upon what is the bane and destruction of heart and mind: conformity to routine, a monotonous system which wears as the drifting of water." (Snug Harbor Cultural Center) More insight was provided in an article in Harpers Magazine which describes life in Sailor's Snug Harbor in 1873, and in another article from the depression-era Federal Writer's Project which describes life in Sailor's Snug Harbor in 1938.  (Harpers Magazine, 1873) (Federal Writer's Project, 1938)

Some Elderly Move Into Private Homes

A small number of the non-indigent frail elderly people lived in early "proprietary", privately-owned facilities called "rest houses," "convalescent homes," or "medical boardinghouses", generally just rented rooms in a family home. 

(See 1888: Berkshire Home for Aged Women, Pittsfield, MA.)

Professional Home Health Care Emerges

Nursing began to emerge as a profession in the late 19th century, along with professional "home health care." The newly created hospitals needed nurses to care for their patients, and developed schools to train them. As trained nurses became available, wealthier families sometimes hired them as live-in care providers for invalids and the elderly.

"The basis for all nursing was the care that the mother bestowed upon the members of her household in time of illness. Her anxiety for her loved ones, along with her desire to give aid and relief to the suffering, made her gentle and painstaking in the methods she used. At first, the mother was concerned with her own family, but as settlements grew larger, she would offer her services to a neighbor in time of trouble. Apparently there was no need for greater skill than that acquired by experience within the family and the neighborhood. Certain women, however, were handier in caring for the sick than their neighbors; naturally they would be called into service very often. Gradually, women, because of their natural inclination and repeated experience, were set aside by the neighborhood to minister to the sick. These women were called nurses.

"As communities grew, the limits of friendship were less observed and women skilled in giving aid to the suffering were called into homes of strangers and would receive remuneration for their services. This was the beginning of the practical nurse for hire, and for decades she was sufficient for the needs of the people." (Medical History of Michigan, 1930)

Poorer families couldn't afford to hire private nurses, but home care services for the poor also emerged around this time, launched by women like Lillian Wald of New York City, who had been trained as a nurse and was studying to become a doctor. During her medical studies Wald volunteered to visit poor immigrant pregnant women, elderly, and disabled people in their homes. When she saw the need of the poor for medical care, she dropped her medical studies and organized the Henry Street Settlement in 1893, also called the Visiting Nurse Society (VNS) of New York. These early home care agencies were directed to the poor and were supported by philanthropy, often "Societies" of wealthy women interested in public works. (VNSNY

Veterans Benefits Cover More People

The Civil War created thousands of newly disabled people who needed long term care and beneficiaries for veterans benefits of all kinds. The Civil War involved 2.8 million men, about 10% of the entire population of the country, compared to the 300,000 men involved in the Revolutionary War. Hundreds of thousands of wives, children, and elderly parents lost the family breadwinner in the Civil War, either because he died, or because he ended up disabled and unable to work. 

Because of the devastating impact of the war, veterans benefits were expanded during and after the war, first to stimulate recruitment, and later to avoid sending a flood of disabled soldiers and indigent widows to the poorhouses. This expansion in benefits led to what may have been the first instance of fraud and abuse of a federal benefits program. Thousands of profiteers throughout the country encouraged everyone, eligible or not, to sign up for these new benefits. The deluge of claims overwhelmed the Pension Bureau, slowed down claims processing, and added huge, and unexpected, costs to the veterans' pension program. (Atlantic Monthly, 1890)

Cash assistance wasn't enough in some cases. Eventually, the federal government started building hospitals and homes to provide long term care to disabled soldiers and sailors, where many lived into their old age. In spite of the problems and limitations, veterans benefits succeeded in providing a source of income that kept many veterans and their families out of the poorhouse. The cash payments could also be used to help pay for care in other facilities.

Employers Begin to Provide Assistance

At the end of the century, employers began to take a role in providing assistance for their employees. In 1875, American Express developed the first private employer-sponsored pension program. It wasn't available to all retirees, but was limited to those age 60 and over who were incapacitated and unable to work. The Baltimore and Ohio Railroad inaugurated a pension in 1884 and its example was quickly followed by  other railroads. The railroad pensions required no contribution from the employee, but were designed to tie the employee to the employer for life by limiting benefits to employees with very long tenure, as long as 30 years. Other employers created innovative programs, some even provided housing for employees or retirees.

Some States Provide Cash Assistance to Poor Elderly

California passed the first state old-age assistance law in 1883. Helen Valeska Bary, who had worked at the California State Department of Social Welfare and later became the 8th employee of the Social Security Administration, recalled,

"Back in 1883 a law had been passed giving money to anybody over sixty who was in need. It provided no system of administration. It could be just given out by the counties and was an open end drain on the State Treasury. That was the first law in this country for what you would say was an old age pension. That went on until 1895 when the country ran into the depression of the '90s and the State Treasury was being drained. By that time, the number of people getting pensions had increased so much that the legislature had to abolish it." (University of California/Berkeley Oral Histories Project: Helen Valeska Bary)

Robert Lansdale, a professor who headed up a study of state old-age assistance programs for the Social Security Administration in 1936, thought that people in the West were particularly sensitive to the need of the poor elderly. He said,

"In Colorado and on the Pacific Coast one found more general concern for old people than was encountered in the East. The social economists who have written the history of the old age pension movement in this country have looked largely to the industrial nations of Europe for origins because that was the source of their own ideology. They have never satisfactorily accounted for the fact that California had a program of state aid for the aged in the 1870's and 1880's and that the first two old age pension laws in this country were passed by Alaska and Arizona in 1914. This early action did not arise in an industrial economy. For want of a better explanation, I ascribe this movement in the West to a concern for the pioneer. In the East, down to the Great Depression, economic success was generally attributed to individual acumen, and failure to personal inadequacies. In the Far West, it appeared to me that there was greater tolerance for the old person who had not "struck it rich," attributable perhaps to the fact that those who had, knew that good luck rather than superior virtue accounted for their success." (Robert T. Lansdale,1960.)

1900-1929

Summary: Non-profit old-age homes are built, Elderly have many years ahead of them, Urbanization increases care needs, Home care expands, More cash benefits are available from states and employers, Table of institutionalized elderly from 1900-1930.

More Old Age Homes Are Built

Hundreds of huge voluntary and non-profit old-age homes were built in the late 1800's and early 1900's, many set on large pieces of property with farms or gardens to help support the residents of the home. As their populations grew, they added additional buildings, like hospitals, barns, and homes for some of the staff. Some became small cities in themselves.

Elderly Had Many Years to Live

The number of people living to old age and the number of years they spent in old age continued to increase. The average life expectancy at birth increased by 10 years from 1900 to 1930, and increased by another 15 years from 1930 to 1990. This change occurred largely because fewer people were dying in childhood, so larger percentage of the population lived to old age. (Changes in Life Expectancy

In 1900, those hardy souls who outlived diseases and injury in childhood and early adulthood had nearly as many years ahead of them as today's seniors do, and finding a place where they could live for what might be a fairly lengthy period of time was just as important then as it is now. People who reached age 65 in 1900 could expect to live another 10-12 years. Those that reached the age of 85 could expect to live another 4-5 years. (Changes in Life Expectancy) To underscore the fact that the elderly of this period could live a very long time, an 1898 magazine article names hundreds of people who lived to the age of 100 or older, including a man alleged to be the oldest person in the United States -- a pauper who died in a North Carolina almshouse in the summer of 1896 at the reputed age of 128 years. (North American Review, 1898)

Urbanization Created More Problems for Elderly

At the same time, the United States had become an urban society. At the start of the twentieth century, 40% of the population lived in the cities, and by the end of the century over 75% of the population were city-dwellers. (Changes in Urban/Rural U.S. Population) Some of these people were coming from the rural areas, and others from the flood of immigrants entering the country for the first time. 

As the population of the cities swelled, only the rich could afford to build new buildings, and they abandoned homes in the city centers to move farther out. For everyone else, this meant that more and more people had to pack themselves into the buildings that already existed in the central cities, creating the tenements. Rooms in old buildings were divided and subdivided into apartments that sometimes didn't even have a window, until, as the New York City health department put it, "There are numerous examples of tenement-houses in which are lodged several hundred people that have a prorata allotment of ground area scarcely equal to two square yards upon the city lot, court-yards and all included." (Jacob Riis, How the Other Half Lives, 1890)

This had an impact on the care of older family members:

"The cost of maintaining an aged relative in the country is so small as to seem an insignificant burden. In the crowded tenement houses of modern cities the situation is very different. Here, as industry is now organized, there is little for an aged person to do. The positions for which men or women over sixty- five years of age are suited are few, and there is always an excess of old men and women looking for such positions. Furthermore, the cost of maintaining an aged relative in the city is an appreciable item in a wage earner's budget, and even when the burden is cheerfully borne, it means so much less for other necessary family expenditures." (Seager, 1910)

The structure and size of families was changing. City families were much smaller than country families. In the country, a large family was an economic asset, but city children were economic liabilities. They had to be housed and supported, but couldn't contribute to the support of the family for many years. It was not economical to have a lot of children, and the shrinking size of families would continue to have an impact far into the future, when fewer children would be available to provide for their aging parents.

(See 1800-1990: Changes in White and Black Fertility Rates.)

City-dwellers also overwhelmingly worked for others, rather than for themselves, in jobs they could not do indefinitely. Many working class jobs required physical strength and endurance, and employees would be let go when they no longer were able to do the work. Some jobs were dangerous, and injuries could create involuntary "early retirement". These "long term care" recipients lost their salary, and were financially dependent on their wives and children, who often could not earn enough to support the family. (Jane Addams, 1899) (Federal Writer's Project, 1939) 

For the first time, older people faced the prospect of being unemployed, a word which wasn't even in the dictionary before 1888. (Social Security, 1937) If older people couldn't work, they had to depend on their families even more. In this new society, unemployed and unemployable older men and women could become a significant financial burden on their families.

Tuberculosis Epidemic Spurs Chronic Care Facilities

Around the turn of the century, tuberculosis or "consumption", the "White Plague" of the eighteenth and nineteenth centuries, became epidemic. Tuberculosis was highly contagious, and spread rapidly in the newly-urban society because so many people were living crowed together in cities. Since the disease was so contagious, patients to be separated from the general population, preferably out in the country where they could get plenty of fresh air, which was believed to be a necessary part of curing the disease.

The spread of tuberculosis was instrumental in spurring the development of public institutions designed to provide chronic care, since patients needed to be maintained for a fairly long period of recuperation. To effectively control the disease, even those who could not pay for their care had to be removed from the general population and cared for at the expense of governments or charities. A large percentage of these patients were indigent. For instance, it was estimated that 85% of those stricken with tuberculosis in Michigan were unable to pay for their own care. (Medical History of Michigan, 1930)

New buildings were built for this purpose by state or local governments, preferably with an attached farm to help provide for the cost of caring for the indigents. Some counties found a perfect spot for these buildings on land they already owned -- their poor farms, which already had working farms and were generally located far outside the city walls. Over time, conditions improved in the sanitariums as laws were changed and the government and medical community learned how to provide chronic medical care in institutional settings. 

"The [Michigan] county sanatorium law of 1925... insures high standards and adequate financial support. The standards require that a sanatorium have a minimum capacity of fifty patients, thus eliminating the old, small tuberculosis hospital that was often nothing more than a boarding-home or retreat for consumptives on county poor farms, where doors and windows were shut, and where medical treatment occasionally consisted of self-administered cough medicine. The institution must employ a full-time physician, provide modern X-ray equipment, have a graduate nurse as supervisor of the nursing staff, and must furnish patients with occupational therapy work." (Medical History of Michigan, 1930)

Home Care Explodes

While the professional nurses and nurse training schools had originally emerged to serve the hospitals, there was a growing demand for nurses to care for the sick in their own homes, either as "private duty" nurses, who were paid directly by the family to care for an elderly or infirm family member, or as "visiting nurses" working for an agency. Dozens of nurse training schools opened or expanded their programs to accommodate the need.

In many places, local families would approach the nursing schools looking for help, and the schools would arrange for their students to serve as private duty nurses during their studies. Once the new nurses had graduated, many returned to their home communities. Individual nurses needed a way to find the families that needed help, and families needed a way to contact them. To bring some order to the process of finding and hiring private duty nurses, the Michigan nursing association established a central registry. Nurses who were willing to go out on call would list their names on the registry and work for a set daily fee. Eventually, there was a need for nurses who could work for less than a whole day, and an hourly fee schedule was established, as well.  (Medical History of Michigan, 1930)

The "Visiting Nurse" associations around the country were growing. By 1905 there were 455 visiting nurses in the country employed by 171 visiting nurse associations. By 1909 that had tripled to 1,413 nurses employed by 566 associations. The growth was fueled as the organizations started getting financial support from sources other than private charity. State and local boards of health and education began to sponsor public health nursing, which was focused on prevention and education. In 1912, the American Red Cross created a rural visiting nurse association. The response to the Red Cross program "was so tremendous that the Red Cross could not keep up with the chapters' demands for nurses." (Indian River

In 1909, Lillian Wald convinced Metropolitan Life Insurance Company to finance home care: "Armed with data documenting that nursing care saved lives, Wald urged MetLife to hire visiting nurses to care for policyholders during illness. For a modest fee per policy, Wald believed that MetLife could reduce the number of death benefits paid." (VNSNY)

The program was so successful that in 1911, it was expanded nation-wide. MetLife hired visiting nurses to provide the services, and, by the close of 1916, they had made visiting nurses available to over 90% of their 10.5 million industrial policyholders in 2,000 cities. The insurance funding gave the home nursing agencies a new source of income which allowed them to thrive, and from 1909 to 1924 the number of visiting nurse agencies in the country more than doubled, from 1,413 to 3,183. (VNSNY) (Indian River)

States Provide Limited Help For Poor Elderly

As more people became unable to support themselves or rely on their families in their old age, there were movements in various states to provide public cash assistance to the poor elderly in order to keep them out of the poorhouses. Arizona enacted a law in 1914 which abolished almshouses and provided pensions for aged persons and people with disabilities. That law was declared unconstitutional by the State Supreme Court in 1916, but they made some changes and passed a law that did conform with the constitution.

Most of the state old-age assistance laws were somewhat limited. For the most part, the state would help to finance the cost of assistance only for people who had no other source of income, and only if counties could pass old-age pension laws and pay for part of the cost themselves. This meant that welfare varied, not just from state to state, but from county to county. (Old Age Security Staff Report, 1934)

Another limitation of these plans was that they applied a "means test" against both the elderly person and any of his or her relatives before awarding benefits, to ensure that none of them was financially able to provide any help:

"I should like to point out one very significant factor which differentiates the old age pensions in the United States from the systems prevailing in other countries, and that is the introduction of the 'means test' not only for the aged themselves but for their so-called responsible relatives... American pension legislation evidently assumes without argument that...support by children, is at least as desirable as, or perhaps preferable to, public support through old age pensions. It makes the violent assumption that wherever such support is found it represents a socially satisfactory answer to the problem of old age. It says little concerning the social cost that the imposition of this burden of support of the aged upon their children represents; it gives no consideration to the lowering of the standard of living of millions of families and their children. It assumes that the average wages today are sufficient not only for the maintenance of the worker and his wife and children, but even of ancestors." (National Advisory Council, 1934)

Employers and Financial Institutions Get Involved

Progress had been made for older adults who were not disabled or in need. In 1896, New Jersey created the first state-sponsored pension plan for teachers. In 1911, the first pension program for all state government employees was instituted in Massachusetts. In 1920, the Civil Service Retirement Act created a retirement system that covered many governmental employees. 

More private companies were providing retirement programs. By 1910, Seager would write:

"Already twenty or more such corporations, including the American Steel and Wire Company, the International Harvester Company, the Standard Oil Company, the Metropolitan Street Railway Company, and the Western Electric Company, have [pension] plans in operation, and many more are contemplating their introduction." (Seager, 1910)

Financial institutions were also developing new products aimed at helping people prepare for retirement:

"The Massachusetts Savings Bank Insurance system was introduced three years ago, for the purpose of bringing cheap life and old-age insurance within the reach of all wage carriers who patronize the savings banks...[and] the Metropolitan Insurance Company has recently offered a combined life and old-age annuity policy at rates that bring it within the reach of all wage earners, except the very poorest, who have the forethought to provide against these contingencies. The Metropolitan Company has also sought to have the insurance laws of the various states amended to enable it to offer group policies." (Seager, 1910)

The Institutionalized Age 65+ Population

Somewhere between 2% and 4% of the population age 65 and older may have been living in some sort of institutional setting prior to the Great Depression. Not all of these people needed "long term care". In some cases, they just had no other place to go. Only estimates are available because there were no reliable national statistics available.

Bruce Vladeck estimated that by 1930 there were as many elderly people in facilities for the mentally ill as there were in poorhouses and voluntary and charitable facilities combined. If his estimates are accurate, about half of the total elderly population living in an institution in the early 1900's may have had some sort of mental disease or condition, about the same ratio as we see in nursing homes and assisted living facilities today. (Estimates of Institutionalized Population)

The Institutionalized Age 65+ Population, 1900-1930
The Age 65+ Population 1900 1910 1930
Age 65+ as % of total population 4.1% 4.3% 5.4%
Total population (millions) 76 92 123
Population age 65+ (millions) 3 4 7

Source: Vladeck, 1980; Johnson, 1985

Number of People Age 65+ Living in Institutions
Institutionalized Population by Location 1904 1910 1930
Institutionalized residents as % of 65+ population 2% 2% 3%
Facilities for the mentally ill 20,000 35,000 100,000
Poorhouses & almshouses 53,000 46,000 50,000
Voluntary and proprietary facilities ?? ?? 50,000

Source: Vladeck, 1980; Johnson, 1985

Old Age Dependency

A staff report prepared for the committee that studied old age security in 1935 relied on a few reports done in individual states. One of the more comprehensive surveys was done in New York just prior to the 1929 stock market crash. It determined that 50% or more of the age 65+ population was dependent on relatives or friends (either living with them or getting financial assistance from them to live somewhere else), 2.5% were living in poorhouses or mental hospitals, and 1-2% were living in private homes for the aged. If those percentages were representative of the national experience, that would mean that about 175,000 people age 65 or older were living in poorhouses or mental hospitals and 70,000 were living in nonprofit or proprietary homes. Note that a significant percentage were self-sufficient because they were still working. (Estimates of Institutionalized Population)

Percentage of Older New Yorkers Self-Sufficient in 1929
Self-Sufficient Persons 65 and over Persons 70 and over
Total Self-Sufficient 44% 36%
Still working 29% 17%
Pensions 10% 14%
Living on personal savings 5% 5%

Source: Old Age Security Report

Percentage of Older New Yorkers Not Self-Sufficient in 1929
Dependent Persons 65 and over Persons 70 and over
Total Dependent 56% 64%
Dependent on relatives or friends 49% 56%
In community with public or private charity 3% 4%
In poorhouses or other government institutions 3% 2%
In nonprofit or proprietary homes 1% 2%

Source: Old Age Security Report

1930-1939

Summary: Great Depression adds to poverty and destroys families, State assistance is little help, Social Security Act creates national old-age welfare, New benefits kill poorhouses and stimulate for-profit homes, Federal and state governments share costs.

Great Depression Changes Everything

Family life and working conditions drastically changed during the Great Depression. Nearly half of the working age population became unemployed in some parts of the country. Even young, healthy people lost their jobs and watched their savings dry up. (Federal Writer's Project, 1938) President Roosevelt quickly initiated numerous Federal Emergency Relief (FERA) programs after his election, and his Committee on Economic Security estimated that by the end of 1934 there were 750,000 single persons and 4.2 million families receiving some sort of emergency relief. Counting all the members of the affected families, nearly 19 million people, 15% of the total population, were dependent on FERA programs. (Committee on Economic Security,1935)

The problems hit the elderly particularly hard. Those who were retired or close to it watched a lifetime of savings disappear, and they weren't well enough to work or couldn't find the jobs that would allow them to rebuild their lost investments. That made many of the elderly completely dependent on their families, but hard times for younger family members often meant little or nothing left to provide for their parents. 

Hard Times Destroy Support Networks

Families couldn't support their members and often split up. "The divorce rate fell, for the simple reason that fewer people could afford one, but the rate of desertion soared. By 1940, over 1.5 million married couples were living apart." (American History Files) Hard times generated new waves of migration. Unemployed workers crossed the country to search for jobs, further dispersing families. Children were sent away to orphanages and older family members who had no income of their own were more likely to end up in the poorhouse or dependent on charity.

State Assistance Plans Are Little Help

By 1928, just prior to the start of the Great Depression, only 6 states and territories had old-age assistance laws. As the Depression deepened, that number increased, until there were 28 states and 2 territories (Alaska and Hawaii) with old-age assistance programs by 1934, most just enacted in the prior year or two. Unfortunately, the plans were quite limited, and inconsistent from state to state. As summarized in the final report of the Old Age Security Staff to Chairman Witte, the state plans included the following features and restrictions: 

  • All but Arizona and Hawaii refused to make payments to older people who had children or relatives who could support them.
  • Most limited assistance to elderly people who were age 65 or older, but quite a few set the limit even higher, at age 75.
  • Most required that beneficiaries must have been citizens and residents of the state for 15 years, some had even longer residency requirements than that.
  • Many required that the beneficiary must transfer to the pension authority any property they possessed before any payment would be made.
  • Most had property and income caps to limit eligibility, generally a maximum of $3,000 in property and $300-$365 a year in income.
  • Most required that benefits would be denied to anyone who gave away property in order to qualify for public assistance.
  • Most required that a lien be placed on the estate of the beneficiary to be collected upon their death.
  • Most required that recipients be "deserving", and benefits were denied to anyone who deserted a spouse, failed to support their families, had committed any crime, or had been a tramp or beggar.
  • Benefits were denied to inmates of jails, prisons, infirmaries, and insane asylums, although a few permitted the payment of assistance for inmates of a benevolent fraternal institution.
  • Most set a cap on monthly payments at $30 a month, although they actually paid about half of that, or $15 a month on average.

The restrictions were so severe and the number of states that actually had launched their plans and committed funds to them were so limited that even in 1935, in the depths of the Depression, there were less than 200,000 people covered under state old-age assistance plans. (Old Age Security Staff Report, 1934)

Society Expects Federal Government to Intervene

The Great Depression made it clear that hard work alone couldn't guarantee financial security, and most people expected the government to help them out. 

"The pressure for relief to the elderly did not come so much from the old people as it came from their children. Their children needed help... Sometimes people seemed to feel that it was greedy old people who wanted something for themselves, but it was much more their children, who wished to be relieved of the burden. The law said that children must support their parents, their grandparents, their children, their grandchildren, their brothers and sisters. Those laws were sometimes enforced very brutally." (University of California/Berkeley Oral Histories Project, Helen Valeska Bary

As the depression wore on, private charities and benevolent societies couldn't keep up with the demands for assistance, and the people they would otherwise have helped had to rely on public welfare instead. Local governments couldn't care for the exploding numbers of poor people on their welfare rolls and turned to the states for help in meeting their obligations. The states couldn't operate with deficit budgets or issue new money to pay their obligations, but the federal government could, so the states began to look to the federal government for help. 

A 1937 Social Security pamphlet said, 

"Old people, like children, have lost much of their economic value to a household. Most American families no longer live in houses where one can build on a room or a wing to shelter aging parents and aunts and uncles and cousins. They no longer have gardens, sewing rooms, and big kitchens where old people can help make the family's living. Old people were not dependent upon their relatives when there was need in a household for work they could do. They have become dependent since their room and their board cost money, while they have little to give in return. Now they need money of their own to keep the dignity and independence they had when their share in work was the equivalent in money." (Social Security, 1937)

The Committee on Economic Security reported to President Roosevelt in 1935 that one-third to one-half of the 7.5 million people age 65 or older in the country were dependent on either public assistance or help from their families, and that only a relatively small percentage of that group were receiving any help from the government. (Committee on Economic Security,1935).

By 1935, a majority of legislators agreed that a federal program for old-age pensions and welfare was required, to help the individuals in need, to stimulate the depressed economy by getting cash into the hands of citizens, and to "retire" older workers without impoverishing them in order to make their jobs available to younger people.

Social Security Provides Reliable Income

There were numerous plans proposed to provide assistance to the elderly. Some of the best-known included:

  • Dr. Francis E. Townsend's Townsend Plan would provide $2,400 a year ($200 a month) to everyone age 60 or older, financed by a 2% sales tax.
  • Huey Long proposed a plan to guarantee $5,000 a year to every family, with an unspecified pension to everyone age 60 and older.
  • Upton Sinclair proposed a plan called End Poverty in California (EPIC) to provide $600 a year ($50 a month) to those age 60 and older who were needy, financed by income and inheritance taxes and a tax on idle land.
  • The "Ham and Egg $30 every Thursday Plan", organized by Roy Owens, Lawrence and Willis Allen, and Robert Noble, would give $1,560 a year to every unemployed person in California age 50 or older.

The cost of many of these plans would have been enormous. In contrast, the 1935 Social Security Act as it was finally written seemed relatively modest. The "Old Age Insurance" (OAI) program we call "Social Security" today was created as Title II of the Social Security Act. It established a pool of funds that workers would pay into while they were working, which they could draw upon to support themselves in retirement. The government would not pay for it. Instead, it would be funded out of contributions of both workers and employers. To keep the cost of the program down, the initial Social Security law limited the program to workers in commerce and industry other than railroads. However  amendments to the law in subsequent years have added more and more groups to the program until it is now nearly universal.  (Social Security Act, 1935)

Social Security Act Creates National Old-Age Assistance

Title I of the 1935 Social Security Act created a program, called Old Age Assistance (OAA), which would give cash payments to poor elderly people, regardless of their work record. OAA provided for a federal match of state old-age assistance expenditures. Among other things, OAA is important in the history of long term care because it later spawned the Medicaid program, which has become the primary funding source for long term care today. 

Although many people today only know about the Old Age Insurance (OAI) portion of the Social Security Act, in 1935, when the Act was passed, it was OAA that everyone was really interested in. Support for Old Age Insurance was much weaker, and President Franklin Roosevelt had to work hard to convince Congress that OAI was an important component of the Social Security Act. One problem with the Old Age Insurance plan was that reserves had to be built up before they could begin paying benefits, and no OAI benefits were supposed to be paid before 1942. 

In the meantime, there were many elderly people who needed immediate help, and many others who would never receive much benefit from the OAI program because they were already retired or only had a few years left to work. Among others, Edwin Witte and Arthur Altmeyer,  key contributors to the Social Security legislation, were concerned about those who were age 45-50, a group they called "the half old." OAA was designed to provide a stop-gap to make sure that those people had some help from the government as they aged, since they would not be able to contribute enough before they retired to collect a meaningful benefit.

OAA was fabricated out of the 28 state old-age assistance programs that had been put in place by the early 1930's. These programs varied quite a bit, but they were mostly brought into the new federal system as-is. Each state was allowed to set its own standards for determining eligibility and payments, with the federal government providing cash for a 50% match of up to $30 a month in aid. The lack of federal control was deliberate. The legislation was written that way to to get the support of states that wanted the federal government's assistance without too many strings attached. Only a few federal requirements were added:

  • The old-age assistance program had to be available throughout the state, not just in certain counties.
  • The State had to provide at least some of the financing for the program. (In some states the existing old-age assistance programs were only funded at the local level).
  • Residency requirements could not be any longer than 5 out of the last 9 years, and the minimum age for receiving benefits could not be any older than age 65.
  • The state had to create a single state agency to administer the plan and a system of administration and reporting to the federal government..
  • The program had to include an appeals process for people who believed they had unfairly been denied old-age assistance.
  • If the state or local governments collected money from the estate of any recipient of old-age assistance, half of that money had to be given to the federal government.
  • Payments to anyone living in a "public institution" were prohibited.

All the other provisions of the existing plans continued into the OAA program. This meant that in many states OAA was not available to elderly people who had families who "ought" to be supporting them, and that beneficiaries could be required to turn over everything that they owned before receiving any assistance, while other states had no such restrictions.  

Aging Issues Generate National Interest

One interesting outgrowth of all this focus on the elderly was the emergence of "aging" as an issue of national interest.

"Most of the early state old-age assistance program were administered apart from other public aid in accordance with the intent of the legislation. The leaders in these programs were trail-makers in pointing up the special needs of older people...It was not until the 1937 session [of the American Association of Social Security] at Indianapolis that the National Conference of Social Work devoted separate program time to the subject of aging and even then somewhat reluctantly. A special subcommittee was allowed to schedule two meetings but the hours allotted were the least desirable--two to four on Friday afternoon and eleven to one on Saturday morning, by which time most delegates would ordinarily be on the way home. Much to everyone's astonishment, both meetings brought out a full house." (Robert T. Lansdale,1960)

Legislators Debate Institutionalization

One of the big debates in the development of the Social Security Act legislation was how to provide assistance to the poor elderly while getting rid of the poorhouse system that had become so problematic. The National Advisory Council was quite sure they did not want to encourage care in the poorhouses. One way to do that was to give individuals cash payments, which they called "pensions", that would hopefully allow the recipients to remain in their own homes.

"Old folks homes present a traditional and popular escape for some, but are altogether unacceptable for sound psychological reasons to many. Institutional care will always be needed for some proportion of the aged. This may be easily admitted in the case of those who are incapacitated either physically or mentally, but may be optional with healthy old men and women, depending upon their comparative sense of gregariousness. On the other hand the public poorhouse will be condemned by most and, in fact, has been one of the most potent factors in popularizing better methods of provision.

..."The obvious problems that present themselves as soon as the whole question is considered are what to do with the unknown distressing residuum, the people on the bottom, the people who manage to get along, we don't know how. And only slightly above them is the population of our poorhouses and county homes. They present the picturesque though gruesome aspect of the problem of old age. For them private social agencies have advocated private assistance or even public outdoor relief, and more recently old age pensions." (National Advisory Council, 1934)

In addition to the controversy about whether care in a poorhouse was appropriate for the elderly, there was a question of cost. One Council member pointed out that it would cost half as much to support older people with a cash payment in their own home than in an institution. This was founded on the assumption that the older person would continue to work to help support himself if he lived at home, an argument which made sense if those in the poorhouse were too poor to support themselves but were generally healthy, or if they had family or friends who would take care of them in the community. 

"Why is it that an old person can live on a pension of $14.00 a month when it cost $28.00 a month to maintain him in a poorhouse? The answer is found in the fact that the person is not lost to the community and is still partially self-supporting. These old timers earn something. They do some mining, take care of public parks, act as watchmen, and engage in various kinds of activities that permit them to earn a part of their living. They remain among their friends who help them. Remove them to a poor farm and they are lost to society forever. Their self-respect is gone as is their meager earning capacity, and they become dead weight, with nothing to hope for but the call of the Almighty." (National Advisory Council, 1934)

Another consideration was that by keeping people at home the government could further benefit by getting repaid from the sale of the person's house after their death, a house that they wouldn't own if they were in a poorhouse. Again, this argument made the assumption that many of those in the poorhouse owned homes prior to ending up there.

...Often a pensioner has some real estate, but an income of less than $300 per year. It may consist of a home. Before granting the pension the commission may require that this property be deeded to the county, effective upon the death of the pensioner, and from the proceeds of the sale of this property at the time of the death of the pensioner, the amount of pension paid during his lifetime, plus 5 per cent interest, is repaid to the county, and the balance from the sale of property goes to the pensioner's heirs. Thus the counties are often reimbursed the entire amount of the pension paid, with interest. Heirs, who in the lifetime of the pensioner have not been interested in his welfare, do not succeed to the pensioner's property until the county has been repaid." (National Advisory Council, 1934)

The Council had little information to work with. They didn't even have an accurate count of the number of elderly people living in poorhouses, let alone any information about their health, wealth, or family support. The most recent national inventory of poorhouse residents was 10 years old at the time, and it was useless. It had been done before the Great Depression began, and the poorhouse population had exploded since that time.

After much debate, the final decision was to structure OAA to forbid the provision of federal  matching funds for any payments made to residents of "public institutions." The hope was that this would discourage the use of public poorhouses to care for the elderly, and that beneficiaries would use the cash payments to remain in their own homes. 

The law never really did address the question about how to provide for elderly people who did require institutionalization. 

"No provision for any type of institutional maintenance is proposed. Yet there are, of course, aged persons who, while not needing hospitalization, do require constant custodial care. The almshouse or poorhouse of most of the states is, of course, a most unsuitable answer to their needs. The staff is aware of this situation, but feels that lack of factual data bearing on these county institutions and their inmates prevents intelligent planning for this problem now. It therefore recommends that the United States Department of Labor undertake at once a special survey of such institutions with a view to working out a constructive program for the improvement of institutional maintenance of the aged." (Old Age Security Staff Report, 1934)

New Benefits Stimulate For-Profit Nursing Homes

The prohibition on care in public institutions did have an effect on the use of poorhouses -- many of the poorhouses and poor farms saw their population dwindle sharply after 1935. Following a pattern that was repeated throughout the country, 15 Minnesota poor farms closed between 1935 and 1950. (Ramsey County Nursing Home)

Although some potential poorhouse residents may have been able to remain at home, that didn't solve the problems for everyone. The payments were not generous, and some recipients needed to find shared quarters in order to get by. Others needed a level of care or supervision that they couldn't get at home. They couldn't go to a poorhouse without losing their benefits, but they did have some money to pay for their care. Most of the nonprofit old age homes restricted access to members of their own organizations, and, since they were dependent on donations and contributions for survival, they had a limited ability to expand quickly. That left proprietary nursing homes as the only facilities with an unlimited potential to grow to fill the emerging need. As a result, the number of for-profit facilities began to quickly multiply after the Social Security Act became effective. 

OAA recipients were able to pay cash at a time when there was little real money in circulation, making them very attractive customers for proprietary operators, and old age homes were a perfect "cottage" industry. They could be easily and often inexpensively launched by "mom and pop" operators who boarded their elderly customers in unused rooms in private homes. Some were run by unemployed nurses who provided rudimentary care in addition to room and board, giving rise to the term "nursing home." In a time when many people were still out of work, the fledgling industry provided homeowners with an opportunity to use the only asset they owned to generate a welcome source of cash. 

In contrast, while the nursing home industry was becoming primarily a for-profit industry, hospitals continued to develop under government and non-profit sponsorship. By 1935, there were about 6,400 hospitals in the United States, and virtually all were either non-profit or government facilities. Most hospitals had always admitted a significant percentage of "charity" patients who could not pay their own way, whose care was heavily subsidized by the government or by the religious or charitable institutions that supported the hospitals. They also required more capital and operated on a scale that few private operators would have been able to finance. 

Federal and State Governments Share Welfare Costs

The OAA program established the precedent of splitting welfare expenditures between the federal and state governments, while allowing the states to retain a significant amount of authority and autonomy to set standards, eligibility, and payment levels as they desired. The states, in turn, continued to share welfare expenditures with local governments, which meant that at least two, and sometimes three or more, levels of government were involved in the provision of public assistance, a situation which continues to this day.

This division, and the conflicting goals of providing a service that the public considers valuable while guarding the purse of the taxpayers, created inter-governmental tensions and rewarded efforts to shift beneficiaries into programs where some other level of government would assume a greater share of the cost. At the same time, beneficiaries had their own incentives to use or avoid certain types of services, depending on what kind of help they would receive and how burdensome the requirements for receiving it were likely to be. The OAA program was about to demonstrate that "gamesmanship" could affect program costs and utilization.

1940-1949

Summary: World War II, OAA utilization and costs explode, Benefits change family living arrangements, National health insurance proposed but defeated, Hill-Burton creates healthcare licensing systems, Various buildings converted to nursing homes.

World War II

During World War II many seniors came out of retirement to help with the war effort. Their employment income probably kept many of them off the welfare rolls during the war, but they had to retire once again when the servicemen returned home and needed jobs. The war also added to the size of the disabled population who needed long term care, and created many new widows and orphans who needed financial assistance. In 1939, the Social Security Act had been expanded to include survivors and dependents benefits, and the war greatly increased the number of people covered under the system. After the war, the Veterans Administration added new benefits for newly-disabled veterans or surviving spouses. 

The size of the elderly and disabled population was growing, and many of them were now eligible for government payments of one kind or another, including veterans benefits, old-age assistance, Social Security, and unemployment assistance. Many of those payments could be used to pay for nursing home care, further encouraging the development of care facilities.

OAA Availability Expands, Federal Share Increases

A number of amendments to the Social Security Act increased both the cap on Old Age Assistance payments and the percentage of OAA that was paid for by the federal government. The cap on the total combined payment that was eligible for a federal match increased from $30 a month to $50 a month, and the maximum federal share of the payment increased from 50% to 60% from 1936 to 1948. (Advisory Council Report, 1948)

OAA Payments
Year Cap on Total Combined Payment Federal Share of Payment
1936 $30 50%
1939 $40 50%
1946 $45 2/3 of first $15, 1/2 of remainder (56% on maximum benefit)
1948 $50 3/4 of first $20, 1/2 of remainder (60% on maximum benefit)

The states welcomed the opportunity to share public assistance costs with the federal government and quickly jumped into the program. By 1940, every state had set up an Old Age Assistance program, and coverage increased until 22% of the age 65+ population were receiving OAA benefits averaging about $20 a month in 1940, where utilization leveled off. Somewhere between 2,000,000 and 2,200,000 people received OAA each year throughout the 1940's, representing about 23% of the age 65+ population by 1950. 

OAA Plagued by High Costs and Misconceptions

The public was confused about who OAA payments were intended for, partly because they were called "pensions" and partly because the Social Security welfare plan was introduced simultaneously with the Social Security insurance plan. Many people did not understand that OAA was only intended to provide cash payments to the needy, not to everyone age 65 or older. 

The law required states to ensure that payments only went to those who were truly indigent, so they had to investigate all other sources of income and deduct them from the maximum monthly allotment. "All sources of support had to be explored - even small stipends that children provided to help their parents and the potential yield of a vegetable garden belonging to applicants. Sometimes children were asked whether they could help their parents - even if they currently were not providing assistance." This meant that many beneficiaries got much less than the $30 a month payment they had initially heard about. In Texas, for instance, the average allotment was only $15 a month. (Texas DHS, 1991) This left some people feeling they had been misled or taken advantage of. Others resented the indignity of the probing questions they had to endure in order to receive benefits. 

Even the social workers employed by the states to determine eligibility were confused about whether they were supposed to protect the public purse by denying benefits or relieve the pain that they saw by helping people qualify for benefits. As one man said, "I have been advised to give my farm and everything away so I could draw the old age pension. If I was to do that I would be crazy--I'd wake up some morning and find myself in the asylum." Another man reported, "I could git me in old age pension, if I wanted to sign my life insurance away. Woman from the state come here some time ago I says, 'Nothin' doin'', I says. 'Think I'm goin' to sign away my chance for a decent burial?' I says 'That's all I got to look forward to.'"  (Federal Writer's Project, 1939) 

Although the number of people receiving OAA stayed fairly stable during the 1940's, benefits increased precipitously, even after accounting for inflation. Average benefits restated in 1940 dollars increased by nearly 20% from 1940 to 1950. (Friedberg, 1998) Gross OAA expenditures doubled from $474 million in 1940 to $960 million by 1947. (Advisory Council Report, 1948)

OAA Benefits in the 1940's
  Percent of 65+ Receiving Benefit Average Annual Benefit Average Monthly Benefit Gross Expenditures
1934 3% $174 $14.50 $31,200,000
1940 22% $241 $20.01 $474,000,000
1947 22% $420 $35.04 $960,000,000

The percentage of people age 65 and older receiving OAA would be high if most people in this age group were retired, as is true today. However, about half of all men age 65-74 were still working throughout this time period. (Friedberg, 1998) Either those who were employed earned so little that many still qualified for welfare benefits, or a very large percentage of those who were not working were receiving benefits. Whatever the reason, the percentage of the elderly who were receiving welfare benefits during the 1940's was extremely high.

The federal and state governments reacted in different ways to the exploding costs of the program. Some states just cut their appropriations. For example, Texas Department of Public Welfare Executive Director Adam J. Johnson sent the following letter to all program recipients in October 1939:

"Because there is not enough money coming into the Old Age Assistance Fund in Texas to pay all the old age assistance grants in full, we are forced to cut $6.00 off the grant of everybody on the rolls. This is to notify you that, beginning with this warrant, your grant must be cut by $6.00 below what the Investigator recommends for you and you have been receiving. We regret having to do this, but are powerless to prevent it. Please understand this is due entirely to lack of funds and is not our fault nor the fault of the Investigator, and that the Investigator cannot increase your grant just to take care of the cut. The revenue coming in is not sufficient to do this. Grants to those who are eligible will be increased again as soon as funds are provided." (Texas DHS, 1991)

The benefit levels had risen so much that by 1948 the average OAA benefit ($38.18 per month) greatly exceeded the average Social Security benefit ($25.13 per month), providing a perverse disincentive for people to provide for their own old age by working and saving. (Advisory Council Report, 1948) Amendments were proposed for the Social Security Old Age Insurance program to increase payment levels and expand coverage to more people. In 1939, Social Security OAI was amended to pay benefits to widows, widowers, and dependent children of workers who died, primarily to start moving this population off of the welfare rolls, but the most significant changes weren't made until 1950.  

Benefits Change Family Living Arrangements

One effect of the new federal benefits was on the living arrangements of the elderly. Dora Costa studied the relationship between income, marital status, and living arrangements on elderly women. She found that older women were only half as likely as older men to be married. In earlier eras, those women would have been living with their children, but Costa noted a significant reduction in the percentage of elderly unmarried women who were living with their children in the 1940's, which she was able to attribute directly to the new source of income from OAA. (Costa, 1997) This new independence was good news in many ways, but it also meant that it was less likely that a family member would be present in the same house if those older women needed supervision or medical care in the future.

National Health Insurance Proposed But Defeated

Public interest in national health insurance began to increase during the 1940's, although it would be another 20 years before the Medicare program would finally pass the legislature. The first salvo occurred during the administration of President Franklin Roosevelt. The Social Security Board drafted a bill which was introduced in 1943, by Senator Wagner and Senator James Murray of Montana and Representative John Dingell of Michigan. Historian Peter Corning says, 

"As its drafters and sponsors had expected, the Wagner-Murray-Dingell bill signaled the beginning of the political debate that would come to a climax in the postwar years...[It] was the most comprehensive social measure ever introduced in Congress. It envisioned a federally sponsored health insurance program, along with permanent and temporary disability, maternity and death benefits, full federalization of the existing Federal-State unemployment insurance, expansion of old-age and survivors' insurance, and enlargement of public assistance." (Corning, 1969)

After President Roosevelt died and the war ended, President Truman tried to revive the issue, but was blocked in large part because of the opposition of the American Medical Association (AMA), who mounted a massive campaign to defeat the bill. As Corning puts it, 

"On the heels of President Truman's election victory, an 'Armageddon' psychology set in within the AMA. In December 1948, the AMA's House of Delegates met, in an atmosphere of crisis and voted a special assessment of $25 per member to resist 'the enslavement of the medical profession.' A prominent public relations firm was hired and a $4.5 million fund was deployed to wage a 'national education campaign' against the Wagner-Murray-Dingell bill. The campaign included publicity through the mass media, nationwide distribution of pamphlets, a vast speechmaking effort, and a drive to win and publicize specific pledges of support for the AMA's position from the press and other private organizations." (Corning, 1969)

At the same time, labor unions and the insurance industry were encouraging employers to provide health insurance to their employees as an alternative to a government-sponsored program. Truman and the bill's supporters eventually conceded defeat and dropped the bill.

Hill-Burton Act Stimulates Licensing of Healthcare

World War II halted construction and development of every kind, and by the end of the war, many buildings were badly in need of replacement or modernization. The national health insurance program that was being discussed highlighted the poor quality of the nation's healthcare infrastructure, which could only be improved by devoting significant funds to the construction and modernization of hospitals. During the high-profile controversy over national health insurance, Senators Joseph Lister Hill of Alabama and Harold Burton of Ohio quietly carved out hospital construction financing into a separate bill, and introduced the Hospital Survey and Construction Act of 1946 (commonly called the Hill-Burton Act). Compared to the high cost of national healthcare insurance, the Hill-Burton Act seemed relatively risk-free and inexpensive, and it passed with little fanfare.

Hill-Burton created a system to provide federal financing for construction of new hospitals in rural and poor areas that did not already have them, and to modernize hospitals in metropolitan areas. The sponsors did not want to create an uncontrolled explosion of buildings that weren't needed, so the bill called for each state to develop an agency to organize and coordinate health planning for the state, and to determine where in the state hospitals ought to be built. These agencies were also charged with pre-approving the design of the buildings before they were built, a level of oversight and consistency in healthcare construction design that had never existed. The sponsors felt that wealthier areas would be able to build their own hospitals without federal assistance, so funding was to be directed primarily to areas that were poor or rural. One controversy that arose before the final text of the bill was approved was whether or not federal funding could be provided to hospitals that were not publicly owned. The concern was that it might not be appropriate to gift taxpayer money to non-public entities. There was never any consideration of including proprietary hospitals in the program, but ultimately a decision was made to allow funding for non-profit hospitals, not as gifts, but as loans which would be repaid by providing a certain amount of free care to people who otherwise would have ended up as the responsibility of the government.  (Perlstadt, 1995)

Hill-Burton financing lead to an explosion in public and non-profit hospital construction, and provided a model for federal and state standards for the design, regulation, and financing of healthcare institutions that was later used for nursing homes.

Many Buildings Converted to Nursing Homes

An unplanned result of the Hill-Burton legislation was that many of the old hospitals that were being replaced were converted to another "medical" use -- they became nursing homes. In the late 1940's, all kinds of residential and commercial construction resumed, after stopping completely during the war. The pent up demand for construction made it hard to find the resources to build new buildings, but older buildings were coming on the market as they were replaced, and the end of the war ushered in an era of nursing home conversions. Hundreds of hotels, homes, and other existing buildings of all kinds were converted to nursing homes.

Government Role in Paying for Chronic Care is Reconsidered

A 1948 Social Security Advisory Council report suggested that additional Old Age Assistance (OAA) payments should be made available for poor people who required medical care, since the amount they were receiving was insufficient to cover it. 

"Care for aged and chronically ill persons is a growing problem and in the opinion of the Council is a Federal concern. Today more than 350,000 recipients of old-age assistance are bedridden or are so infirm as to require considerable help in eating, dressing, and getting about indoors. Of them, about 50,000 are living in commercial boarding or nursing homes or private institutions. Some of these persons living in such homes or institutions are getting very unsatisfactory care. Of those living in their own homes or with others, many need prolonged treatment in medical institutions." (Advisory Council, 1948)

As an example of the problem, they reported that in Connecticut in 1946 the average cost of nursing-home care for the aged was $118 a month, far more than the maximum $50 a month OAA payment. 

1950-1959

Summary: Government has become the primary payor for nursing home care, Financing is made available for nursing home construction, There is a "boom" in for-profit nursing home construction, The quality of nursing home care becomes a national concern.

Home Care Drops in Popularity

Home care had never really received much consideration as an alternative to institutionalization. Private duty nurses had provided for wealthier individuals in their homes since the late 1800's, but served only those who could afford the cost of highly individual in-home care. The visiting nurse associations and public health nurses who were available to the poor had been focusing their efforts not on care for the elderly but on health education, disease prevention, and pregnancy. By the 1940's, infant mortality rates had dropped dramatically, hospital care had improved, and patients began to look to medical facilities as the preferred sites for receiving medical care and education. As the cost of salaries and medical technology increased, it was also more cost-effective to ask patients to come to the medical professionals rather than the other way around. Since that was where the jobs were, most nurses began working for hospitals or physicians. By 1952, Metropolitan Life discontinued the visiting nurse program they launched in 1909 and the home care industry floundered with little funding and no clear sense of direction.

Governments Pay Providers Directly for Services

The Advisory Council suggested that these additional payments should be made directly to medical providers, rather than to the recipients. At that time, federal matching for state expenditures was only allowed for payments made directly to the assistance recipient. (Advisory Council, 1948) 

Two years later, in 1950, amendments to the Social Security Act said, "[The] Federal Government will share in cost of payments made directly to medical practitioners and other suppliers of medical services, which when added to any money paid to the individual, does not exceed the monthly maximums on individual payments." This created a significant change in the way that welfare was delivered and paid for. Nursing home operators could now contract directly with the states for payment, providing nursing homes with a new and more reliable source of income. Individuals were more time-consuming to deal with, and they didn't always pay their bills. The check from the government was one a nursing home could count on. 

Initially, the payment to medical providers was capped so that it would not exceed the amount that would have been paid to the individual, but in 1956 the Social Security Act was again amended to eliminate that cap. This was extremely important because nursing home costs were much higher than the individual OAA payment. The elimination of the cap on payments meant that the government quickly became the primary purchaser of nursing home care.

States Create Nursing Home Licensing

Nursing homes were emerging all over the country, but there were no federal standards for their design or operation. They were not licensed, buildings were unsafe, there were allegations of abuse and neglect, and nursing care was sometimes non-existent. Most states licensed hospitals, because the Hill-Burton Act required it, but few licensed nursing homes. The 1950 SSA amendments for the first time demanded that states that received federal matching funds must create systems to licensing both nursing homes and hospitals. This provision was added to "raise the standards of those institutions that have been understaffed and underfinanced, that have been firetraps, and in which people have been badly treated." Effective in 1953, "If a State plan for old-age assistance, aid to the blind, or aid to the permanently and totally disabled provides for payments to individuals in private or public institutions, the State must have a State authority to establish and maintain standards for such institutions."

The law did not specify minimum state licensure standards or procedures, nor was there any way to ensure that the states enforced the standards, but it was the first attempt to consistently regulate the industry at the state level. As a result, a number of nursing homes which couldn't meet the new standards closed in the 1950's, while others demolished their old buildings and built new ones.

Government Inventories Nursing Homes

Now that the government was so involved in the provision of nursing home care, it was determined that a national survey of the facilities was needed to identify how many there were and other basic characteristics of the facilities. The names given to these surveys varied, but most of the early ones were called "Master Facility Inventory Surveys". One of the problems designers of the surveys had was in defining what constituted a "nursing home". They settled on four classifications: nursing care homes, personal care with nursing homes, personal care homes, and domiciliary homes, and decided to count all facilities with 3 or more beds.

The "personal care home" classification more nearly resembles what we today call "assisted living" and the "domiciliary care home" is more of a board and care home, neither of which are included in modern statistics about nursing homes. To make things even more confusing, in later reports, the term "nursing home" sometimes refers to the first two categories combined, and in other reports only homes in the first category are counted as "nursing homes" and all three of the lower categories are grouped together as "personal care and other homes". 

Another problem in early surveys was making sure that all facilities had been identified and counted. The federal government provided no certification or oversight to the industry, so there was no "master list" to refer to. The surveyors relied partly on information provided by the state licensing bureaus, but the states all had different standards for licensing homes, and some of them had little or no information in their own files. For several years after the surveys were initiated, reports analyzing the data emphasized that there was no way to be sure whether facilities that appeared for the first time on a new survey were actually new nursing homes, or whether they had just been omitted from earlier reports.

The first ever national inventory of nursing homes was done in 1954. When the first survey was tabulated, it was estimated that there were about 270,000 people living in 9,000 homes classified as "nursing care home" or "personal care home with nursing". Virtually all the homes were for-profit facilities -- 86% of all nursing homes were proprietary, 10% were voluntary, and only 4% were public. 

Government-Owned Nursing Homes Evolve

Another important aspect of the 1950 amendments to the Social Security Act was that federal matching funds were finally made available for the cost of providing for aged and blind persons in "public medical institutions other than those for mental disease and tuberculosis." This belatedly allowed governments to develop nursing homes, long after proprietary operators had dominated the market.  

The traditional role of the county poor farm had become increasingly irrelevant since the inception of Social Security and Old Age Assistance in 1935, although a certain number of poor elderly still remained as the responsibility of the counties. Many of the poorhouses closed or were sold, but a few continued to operate as homes for the indigent elderly. The 1935 law created financial problems for the counties running nursing homes, because the residents couldn't qualify for Social Security Old Age Assistance. In some cases, the 1950 Amendments created a new source of financing for both the operations and the cost of constructing or renovating buildings to meet new licensing standards, and the county poor farm became a nursing home. In other places, the tougher licensing standards were the last straw, and the county poor houses were shut down.

At the same time, by the middle of the 1950s new drugs to treat tuberculosis had been discovered, and they were far more effective than bedrest at curing the disease. OAA payments to patients in tuberculosis sanitariums were still prohibited in the new rules which allowed payments to patients in public institutions, and state and county tuberculosis sanitariums began to close or be converted to other uses. Some became hospitals and other became nursing homes in the early 1950's. 

Nursing Homes Treated as Healthcare Facilities

A consensus was building that facilities for the aged should focus on providing medical care, as well as residential care, and legislators decided to actively promote the development of skilled nursing homes. In 1954 the Hill-Burton Act was amended to provide funds to nonprofit organizations for the construction of skilled nursing facilities that met certain hospital-like building standards, if built "in conjunction with a hospital". 

The Hill-Burton amendments created a number of precedents. The changes represented the first time that legislation specifically included nursing homes as part of the health care system rather than the welfare system, and created an expectation that the physical design of nursing homes would be based on hospital design. The Hill-Burton regulations placed nursing homes under the jurisdiction of the National Health Service, ensuring that future regulatory oversight would be medical in nature, and they represented the first time that federal funding for nursing homes was tied to standards for construction and design, staffing patterns, and other medically-oriented concepts. 

If all nursing homes had been built under these standards after 1954, some of the quality problems that later emerged might not have occurred. But Hill-Burton financing was limited to a small group of non-profits affiliated with hospitals, so these standards had little impact on the vast majority of new nursing home construction. Ironically, restricting the funds to hospital-affiliated non-profits was intended to increase the quality of nursing homes, but it had the opposite effect. Developers who couldn't qualify for Hill-Burton funds continued to build thousands of new facilities with no reference to Hill-Burton standards. When regulators later decided that all nursing homes should meet the higher qualifications, it was too late. Trying to make the nursing homes fit the standards many years after they were built was nearly impossible.

Social Security is Expanded

Several amendments to the Social Security Act were made in the 1950's, creating millions of additional people who would have a reliable source of income in their old age. In 1950, domestic workers; farm workers; non-farm, non-professional self-employed persons; and federal civilian employees not in the federal retirement system were brought into Social Security. In 1951, railroad workers with less than 10 years of service were added. In 1954, homeworkers and all self-employed persons except lawyers and medical professionals became eligible. In 1956, members of the military and all remaining self-employed persons except doctors joined.

Government Becomes Primary Payor for Nursing Home Care

The government was totally enmeshed in the business of providing nursing home care by the end of the decade. Various studies in the 1950's found that about half of the residents in private nursing homes were public assistance recipients, and that the federal, state, and local governments were paying about half the total cost of all nursing home care in the country. Federal and state reimbursement for the cost of nursing home care continued to increase throughout the decade. 

"A 1953-54 survey of nursing homes found that 90 percent of the patients in proprietary nursing homes were aged 65 or over. Two-thirds of the aged patients were women. Only one-half could walk alone and one-fifth were completely bedfast. Public assistance financed, in whole or in part, the cost of care of one-half of all patients in proprietary nursing homes. Stated another way: The proprietary nursing homes of the United States are almost exclusively geared to caring for old people and to a great extent to old people on public-assistance." Charles M Schottland, Medical Care through Social Security: What Lies Ahead?, Journal of the American Public Welfare Association, Volume 18, Number 3, 1960.

In 1956, amendments to the Social Security Act created a new, and separate, matching program for medical services like nursing home services, a program which would prove to be far more expensive than first anticipated. In 1958, Federal grants to the states for public assistance were further liberalized. Up to that time, all grants were split 50/50 with the state paying half and the federal government paying half. In 1958, the amount the government provided was based on the per capita income in the state, so that the federal government paid more than half of the cost of OAA in the poor states, and continued to pay half of the cost in richer states.

Boom in For-Profit Nursing Home Construction

The FHA loans required only small downpayments, so the operators were very highly leveraged with weak balance sheets. The low downpayments and generous terms, "guaranteed" reimbursement from the government in payment for services, and income tax benefits available to real estate operators made nursing homes attractive tax shelters for physicians and other individuals with personal wealth, drawing more for-profit operators into the field. 

Not all the activity was in new construction. FHA funds could be used for remodeling as well as constructing new buildings. A number of nursing homes were created from buildings built for other purposes, like homes, motels, or old hospitals abandoned when newer hospital buildings were built with Hill-Burton financing. 

At the same time that all these new nursing homes were being added, older facilities were closing down, particularly the small home-based or "mom and pop" operations. Because of these closures, comparisons of the number of total facilities at the beginning and end of the decade understate the number of new facilities that were being added. 

There are really no statistics on how many facilities closed and opened in those years, but we can draw some very general conclusions about the level of activity by combining data from a few sources.  It is possible that about 3,000 nursing homes may have disappeared in the 1950's and about 4,000 additional facilities may have disappeared in the 1960's. If that is correct, the following table shows the high level of turnover that may have been taking place in the 1950's and 1960's: (IOM, NCHS)

Nursing Homes Opened and Closed During the 1950's and 1960's.
  Beginning   Closed   Opened   Ending
TOTAL 9,000 -7,000 13,000 15,000
1950's 9,000 -3,100 4,000 9,900
1960's 9,900 -3,900 9,000 15,000

New Construction Financing Available for Elderly Housing

New branches of the government got involved in the financing of long term care in the late 1950's, when legislation authorized the Small Business and Federal Housing administrations (SBA and FHA) to help finance construction and operation of proprietary nursing homes and nonprofit housing for the elderly. 

In 1959 The Housing Act was amended by creating several programs to be administered by the Department of Housing and Urban Development (HUD). One program provided federal mortgage insurance to enable private lenders to make low-interest loans for the construction or rehabilitation of nursing homes, which were available to private, public operators, and non-profit operators. This was the first time that the federal government had provided any financial assistance to proprietary nursing home operators for the significant cost of building new facilities, and they took full advantage of it, greatly increasing the number of for-profit nursing homes in the country in the next few years.

Another program, called Section 202, provided direct, low-interest loans only to non-profit operators for the construction of housing for the elderly. Section 202 units could provide congregate meals, housekeeping services, personal care, social work/counseling services, or transportation for medical or social activities to people who lived in their own apartments in these buildings. Many church and fraternal organizations used this funding to add "independent living" apartments near their old age homes, creating campuses they started calling "continuing care retirement communities" or CCRC's.

These programs were more than adequate to allow for the development of new facilities. Bruce Vladeck reports that a $100,000 loan from the SBA (the maximum offered) was enough to purchase a 25-bed nursing home at that time. (Vladeck, 1980) The new construction activity also raised awareness of the industry for both builders and lenders, drawing in new developers and providing additional financing from private sources, even for projects not covered by federal guarantees. 

This new activity was good for developers but may not have been so good for the public. The FHA was concerned with housing, not health care, and the medical criteria laid out in the Hill-Burton Act were not required for nursing homes built or remodeled using FHA or SBA funds. Worse yet, nursing homes built with private, non-government financing had no federal standards at all to adhere to. Many of these new facilities were designed for residential rather than medical needs, and many had no affiliation with hospitals or health care systems. 

A number of the developers had housing backgrounds, and they had no idea how ill many of their residents would be, nor did they know how to provide medical services to a chronically-ill population. It was a recipe for disaster for an industry caring for a very vulnerable, very ill population -- hundreds of nursing homes were being constructed that couldn't comply with federal safety or medical standards, and they were often run by people with no medical background. 

Quality of Nursing Home Care National Concern

Not surprisingly, with government financial spigots open wide and few restrictions on what nursing homes should look like or how they should operate, quality issues started to come to the forefront. Among other problems, the lack of standards and the old age of many of the converted buildings made nursing homes fire hazards. When they did burn, there were often many deaths because they were filled with frail elderly residents who were unable to get themselves out of danger. One of the most tragic events was a fire in a nursing home in Warrenton, Missouri on February 17, 1957. 

Although the headline says 71 died, the final death count was actually 72 residents from the Sunday morning fire. One of the articles in the St. Louis Post-Dispatch the following day reports, "Screams and cries of elderly patients trapped in the Katie Jane Memorial Home were quickly stilled by flames which engulfed the 2 1/2 story brick building within minutes...Rescuers worked frantically to assist as many as possible out of the doomed dormitory, but after the first several minutes they labored in an eerie silence broken only by the sounds of crackling flames, hissing streams of water and shouted orders of firefighters." Inspectors reported that they suspected that there was a problem with the wiring in the home which might have caused the blaze, and they had been in the process of reviewing the home's license. 

A 1952 nursing home fire in Hillsboro, Missouri had claimed the life of 20 nursing home residents, and the impact of two major nursing home fires in five years stimulated the Missouri legislature into action. They met the day after the Warrenton fire and immediately introduced a bill to require sprinkler systems in all nursing homes and other institutions in the state.

A 1955 study by the Council of State Governments reported that the majority of nursing homes had low standards of service and relatively untrained personnel. Various states began to report problems. In response, the chronic disease program of the Public Health Service began to study state licensing programs, and found that few states had adequate numbers of survey staff and that the qualifications of survey personnel varied widely. 

In spite of all the problems, there was still resistance to making changes. Many states said that strict enforcement of the regulations would close the majority of the homes and no one knew what they would do with the residents. Buildings had already been built and were full, and residents who were living in them had no place else to go. Putting in controls after the fact was going to cause massive disruption. In 1957 the Public Health Service began to work with the states to create the "Nursing Home Standards Guide", but it took six years to agree on what the standards should be, and the guide wasn't finished until 1963. In the meantime, hundreds, maybe thousands, of new nursing homes were built.

In 1959, a special Senate Subcommittee on "Problems of the Aged and Aging" was established. The subcommittee reported that few nursing homes were of high quality, and that most facilities were substandard, had poorly trained or untrained staff, and provided few services. But they concluded, "because of the shortage of nursing home beds, many states have not fully enforced the existing regulations, failure to do so reflecting the policy of the states to give ample time to the nursing home owners and operators to bring the facilities up to the standards."

1960-1969

Summary: Government payments escalate, Nursing home quality concerns escalate, Medicare and Medicaid are created and costs explode, Medicare/Medicaid statistics, Medicare slashes nursing home coverage, The "Fevered Fifty" soar and crash.

Welfare programs for nursing home care are expanded.

In 1959, Congress attempted to fill many gaps in health care coverage by amending the Old Age Assistance ("OAA") program. The amendment sought to increase medical assistance for welfare recipients through federal and state matching funds. In addition, Congress added a proposal to create the Medical Assistance for the Aged ("MAA") program which would make health care available to people age sixty-five and older with low or moderate incomes. The MAA program also required state matching funds. By 1960, both proposals became law.

An extremely important change was made in public assistance by what is known as the Kerr-Mills bill. A new section was added to the old-age assistance title of the Social Security Act which provided federal matching of the cost of medical care for persons over 65 years of age who were not sufficiently needy to qualify for cash assistance to cover their ordinary expenses but who were unable to pay their medical expenses. The percentage of the total cost met by the federal grant ranges from 50 to 80%, depending upon the per capita income of a state. The federal matching of cost of medical care provided for recipients of cash old-age assistance was correspondingly liberalized. (Altmeyer, 1963)

Nursing homes were so entrenched in the welfare system by 1960 that the surveys mandated by the licensure requirements of the Social Security Act were done by the state welfare departments, rather than the health care departments. 

Interest was growing in creating a national health insurance program to help Social Security beneficiaries pay their medical costs because medical costs were increasing far faster than other costs. Retired people were particularly at risk because many weren't covered under the employer health insurance plans which had become more widely available since the debate on national health insurance had begun in the 1940's. President John F. Kennedy strongly supported legislation to create such a program, but the debate was highly charged. (Kennedy's interest in the subject apparently grew after his father had a stroke which resulted in enormous medical bills which Kennedy realized most seniors would have been unable to pay.) The concept of national health insurance was opposed by the insurance industry, the American Medical Association, most members of the Republican party and some members of the Democratic party. As a compromise, opponents agreed to support a program to pay for more of the medical costs for the indigent elderly, and in 1960 the medical assistance component of the OAA program (the "vendor payment" program) was replaced with a new program called Medical Assistance for the Aged (MAA), or "Kerr-Mills"

Kerr-Mills provided that the federal government would share welfare costs with the states by paying 50%-85% of the cost of the program, with the higher percentage payments going to states with the lowest average income. The Kerr-Mills program established an additional category of welfare for aged people who were not on public assistance, but who could not pay for needed medical services, who were called "medically needy". These programs benefited thousands of older people who were not technically "poor" but whose incomes were inadequate to pay for expensive medical costs like nursing home care. The program also helped nursing home operators, since they now had a source of payment for a whole new group of people who otherwise would not have been able to pay for their care.

Government payments escalate.

Program costs had continued to escalate, and payments for OAA exploded from $36 million in 1950 to $280 million in 1960, a 680% increase. The new Kerr-Mills program didn't rein in any of the costs, it created new ones. Along with adding new classes of beneficiaries, the Kerr-Mills program had eliminated the only control on spending that existed up to that time -- the cap on payments set by OAA. From this point forward, states could set payments to nursing home providers as high as they wished, and the federal government, which had no control over rates, was mandated to pay its part of the cost. 

Costs of Kerr-Mills increased from $449 million in 1960 to $2.3 billion by 1965, and nursing home costs comprised one-third of that total. This didn't even represent the cost of providing these services all across the country, since many states didn't participate in the new program, and 62% of this spending was concentrated in only five states. These states, New York, California, Massachusetts, Minnesota, and Pennsylvania, experienced a glut of nursing home bed development, as speculators swooped in to benefit from a "guaranteed" return.   

More money is routed into home and community-based services.

In 1956, an amendment to SSA authorized federal matching for state funds devoted to providing social services, and in 1962 it was expanded to encourage the provision of social services programs for the elderly. These funds were used to provide services that would allow low-income elderly people to remain in their home. Most states used the money to provide homemaking and other domestic services to older adults still living at home.

In 1961, Congress approved a new medical facilities construction bill, the Community Health Services and Facilities Act. The bill increased federal grants to states for nursing homes, general public health services, hospital planning, and outpatient services for the aged and chronically ill by $40 million over five years.

Demand for nursing home beds increases.

Even with all the new construction, there seemed to be an unquenchable shortage of beds. No matter how many beds were built, there always seemed to be people available to fill them up. Some may have been transferred from the facilities for the mentally ill, but that couldn't explain all the new residents. It may have been caused by the "woodwork" effect -- lots of people who were getting along one way or another without government assistance kept coming out of the woodwork once there were services available that the government would pay for. 

Not all of the explosion in nursing home development was related to the availability of payments for welfare recipients. The number of people receiving Social Security increased throughout the 1950's and 1960's as new groups of employees were added to the program, and in 1961 when the retirement age was lowered from 65 to 62 and benefits to aged widows were increased. That enlarged the pool of people who had the financial wherewithal to pay privately for at least some part of their care needs.

Nursing home quality concerns escalate.

Questions about nursing home quality continued to dominate. By 1960 a U.S. Senate Special Committee on Aging report said that 44% of nursing home beds failed to meet Hill-Burton fire and health standards. This should not have been surprising because few had been held to those standards (or any standards!) when they were built.

One reason for concerns about quality was due to fatal nursing home fires, which were becoming all too common. Some of the largest and most publicized included:

Major Multi-Fatality Nursing Home Fires

Major Multi-Fatality Nursing Home Fires
Residents
Killed
Date Place
20 October 31, 1952 Hillsboro, MO
33 March 29, 1953 Largo, FL
21 January 30, 1957 Hogham, WA
72 February 17, 1957 Warrenton, MO
63 November 23, 1963 Fitchville, OH
20 December 18, 1964 Fountaintown, IN
31 January 9, 1970 Marietta, OH
23 January 30, 1976 Chicago, IL

The Senate created the Special Committee on Aging in 1961, chaired by Senator Frank Moss, and they began to hold hearings on nursing home problems. The Moss Committee hearings in 1965 documented a huge lack of consistency in state nursing home standards and enforcement efforts, but they expressed caution about increasing enforcement because that meant closing facilities, which were already in short supply. They were concerned that there would be no place to put the dispossessed patients.

Medicare is created.

Although President Kennedy had not been able to get majority support for a national health insurance program while he was alive, after he was assassinated the programs he had been espousing took on new life. Lyndon Johnson ran for President in 1964 promising to implement Kennedy's plans, and won by a landslide, convincing many opponents that Medicare had overwhelming public support.

There was still a lot of debate, and intense opposition from the American Medical Association (AMA). Some opponents were concerned that covering hospital costs would only take care of about 25% of the medical costs of the elderly, and others were concerned about providing more coverage for the poor elderly. Another concern was the need to get the support of Ways and Means chairman Wilbur Mills, who had co-sponsored the Kerr-Mills program for the poorest elderly, and the AMA, which had floated an a voluntary program called "Eldercare" as an alternative to Medicare.

To counter the opposition in order to get the bill passed, all these concepts were incorporated into the legislation, and the 1965 amendments to the Social Security Act established the Medicare and Medicaid programs. Medicare Part A covered hospital costs, Part B was a voluntary program partially financed by premiums which covered physician and other out-of-hospital costs, and Kerr-Mills was converted to a program called 'Medicaid' to cover the indigent elderly.

The Older Americans Act is enacted.

Another event that occurred in 1965 was the passage of the Older Americans Act. This Act created the Administration on Aging; authorized grants to states for aging-related community planning, services programs, research, demonstration and training projects; and called for the development of State Units on Aging. This created what is now called the "Aging Network", a web of federal, state, and local agencies linked together to focus on social services and other programs primarily targeted to older adults living in their homes. The mission of the Aging Network was expanded in numerous ways in subsequent years, to include advocacy, meal programs, and a number of other services. Because of a lack of funding, many of the services developed long waiting lists, which limited the benefits to a relatively small proportion of the poorest elderly. Although the program had the potential to save the government money by providing more supportive services to people who wanted to remain in the community as a substitute for some of the nursing home costs, it never had the visibility or legislative urgency of Medicare and Medicaid. 

Medicaid is created as an afterthought.

Unlike Medicare, the Medicaid program was almost an afterthought. There had been no national debate about what to include or how to design Medicaid as had happened with Medicare. Medicaid was added to the Medicare legislation late in the process, partly as a compromise for those who wanted to add assistance for low-income elderly to Medicare. Medicaid was created from the Kerr-Mills program, and it kept many of the aspects of Kerr-Mills, but added new categories of eligible beneficiaries, like the blind, the disabled, and families with children. Because Medicaid was to be a state-run program and no one had thought through what the federal government wanted to accomplish, Medicaid was just turned over to the states to develop and administer as they saw fit, and the states proceeded to create 50+ varieties of Medicaid.

Medicare coverage for nursing homes is limited.

There had been a huge debate about what costs should be covered by Medicare. Nursing home costs were deliberately carved out of Medicare because of a fear that nursing home care would be a bottomless pit that would financially devastate the program.

"I think that has other implications because it would be comparatively simple administratively to handle the problem of the institutional case, because if you attempt to handle on an insurance basis the problem of the chronic illness, the long-time illness cared for in the home and cover the cost of professional services and the other costs, such as medicine, a great deal of difficulty will result. The problem of not padding the costs, or extending the period of illness at the desire of the patient or at the desire of the physician, which in some cases might occur, the problem of supervision, of keeping the cost down, or of being compelled to set arbitrarily the number of visits that would be paid for over a given period, which is done in many of these schemes, would present very great difficulties. I think it would be very difficult to carry out the plan of covering the catastrophic illness in the home whereas I think it would be quite simple to cover the high cost illness in the hospital." (Dr. Davis, Unpublished CES Reports, 1935)

The 1965 Advisory Council said in their report "Since the proposed program is designed primarily to support efforts to cure and rehabilitate, and since 'nursing home' care, in many cases, is oriented not to curing or rehabilitating the patient but to giving him custodial care, the Council does not propose the coverage of care in nursing homes generally." (Advisory Council, 1965)

The Department of Health, Education and Welfare (HEW), under the leadership of Anthony Celebrezze, complied with that recommendation, and had written the bill to ensure that nursing home coverage would be limited. Department officials and legislators were worried about nursing home costs, but they were also feared ballooning hospital costs if demand exploded when the government started paying for hospital care. As a compromise, 60 days of "extended care" was included under Medicare, but only if that care would be a substitute for a more expensive hospital stay.

The bill said that Medicare would provide funding for beneficiaries who needed post-hospital convalescence in what was to be called an "extended care facility" (ECF). The ECF terminology was created instead of using any reference to "nursing homes" to make it clear that these stays were not regular nursing home stays and that they would not be provided in regular nursing homes. Originally, only hospital-based facilities were to be certified as ECFs, but a later decision was made to allow free-standing nursing homes to apply for ECF status. The standards for ECFs were set high, with an expectation that few nursing homes would be able to meet them, to put a cap on expenditures. The program also dictated that ECF coverage would only apply if there had been a previous 3-day hospital stay. This provision was intended to ensure that the ECF stay was really a substitute for a hospital stay by limiting care to those who had already been in the hospital for some acute episode.

While the bill's authors intended to exclude nursing home coverage from Medicare, the general public assumed that long term care costs would be paid for by Medicare, since much of the promotional material they were hearing said that Medicare would help the elderly "avoid dependence". Discussions in the U.S. Senate underscored the fact that legislators knew that there was a discrepancy between the public expectation and the bill that was being voted on. During 1965 Senate Finance Committee hearings, Chairman Russell Long asked HEW Chairman Celebrezze, "Why do you leave out the real catastrophes, the catastrophic illnesses?" Celebrezze replied that it was "not intended for those that are going to stay in institutions year-in and year-out." Senator Long responded, "Almost everybody I know of who comes in and says we ought to have medicare picks out the very kind of cases that you and I are talking about where a person is sick for a lot longer than 60 days and needs a lot more hospitalization." Senator Allen Ellender stated on the Senate floor that "many sons and daughters whose mothers and fathers are growing old are of the belief that under the pending bill they will be able to get the Government to take care of their older parents, in the event they become ill for long periods of time" (Twight, 1997).

In spite of the debates and discrepancies, the legislation was signed into law with only limited coverage for nursing home care. The only real compromise was to increase the limit from 60 to 100 days. The final "solution" was to provide unlimited coverage for nursing home services to the poorest of the elderly under the Medicaid program.

Medicaid provides coverage for nursing home care.

The question about how long term care services would be covered by the federal government was answered by requiring the states to provide both medical home health and nursing home services to their poor elderly in order to receive a federal match for the costs of their Medicaid program. States also could optionally include people who did not qualify as "poor" based on their income or assets if they could not afford to pay for the medical care they needed (the medically-needy), so long as the recipients "spent down" their assets to pay for as much as they could before receiving Medicaid payments. 

Medicare costs quickly exceed projections.

To help appease the AMA, Medicare reimbursement to providers would not be based on fixed "rate schedules". Instead, reimbursement for physicians and other providers would be based on their "reasonable costs". This was intended to provide assurance that the providers would not lose money to encourage them to support and participate in the program, but it also meant there was no cap on program costs, nor any incentive for providers to control the amount of money they were spending.

Nursing homes were anxious to tap into this new Medicare program, and about 6,000 nursing homes applied for the ECF program when they were able to do so, but only 740 could meet the tough standards. By that time, it seemed politically inadvisable to leave so many homes out of the program, so a decision was made to allow in the facilities that failed to meet the standards, but which were in "substantial compliance", and 3,000 additional homes were accepted into the program on that basis. "Substantial compliance" just meant that they intended to fix anything that didn't meet the standards, but many of them never got around to doing that, and once they were in the program they weren't decertified. 

Nothing about the ECF program went as projected. Medicare ECF costs in the first year of the program had been estimated at $25-$50 million, but they ended up being $275 million. This huge overage came about for several reasons: 

  • There were many more facilities in the program than had been budgeted for because of the admission of so many "substantially compliant" ECFs.
  • The daily cost ended up being 50% higher than was expected, because the program reimbursed operators for their cost, using "cost-based reimbursement", without knowing ahead of time what those costs were or putting any caps on those costs.
  • The 3-day hospital stay requirement did not end up reducing hospital costs or limiting the number of nursing home admissions. In fact, the 3-day hospital stay requirement may have actually increased costs when hospital discharges were postponed long enough to meet that requirement. 

Medicaid costs quickly exceed expectations.

Although no one had really thought through what the Medicaid program would cost, some features of the program guaranteed it would much more expensive than anyone had anticipated:

  1. Medicaid coverage of nursing home services created a perverse problem when Medicaid covered nursing home care but only provided limited coverage for home care. If someone needed help and was unable or unwilling to pay for it themselves, they could move to a nursing home to receive that assistance and have the cost covered by Medicaid. Once in a nursing home, the high nursing home bills allowed people to qualify for Medicaid at higher income levels because of the "medically needy" provisions, greatly increasing the number of people on Medicaid. At the same time, the program cost per beneficiary increased because Medicaid was now paying for housing, food, housekeeping, and laundry, services which would not have been covered for in-home services.
  2. The option of a federal match provided a huge incentive for states to try to shift other obligations into the Medicaid system so that the federal government would pick up part of those costs, as well. The states could, and did, move people from the community, where the state and local government covered 100% of the cost, to nursing homes, where the federal government would pick up half of the cost. This also meant that the states had an opportunity to greatly expand the services they provided, while paying little or none of the additional cost themselves.
  3. States could set rates wherever they wanted, with no caps or ceilings, but they would never have to pay more than 50% of the cost. That made it easier to increase rates, since they only had to pay part of the increase themselves. If they combined this with the transfers described above, they could actually increase the rates paid to providers while reducing the cost to the state!
  4. Fiscal control of the system at the federal level was virtually impossible. All of the data was maintained by the states in over 50 different, disconnected systems. The federal government found it difficult to identify costs or utilization statistics even for services that had already been rendered, let alone derive enough information to make accurate projections for the future.

The cost of Medicaid quickly overran all initial projections. As Ways and Means Chairman Wilber Mills remembers it, "We were told by Bob [Meyers], the actuary, that the cost of Medicaid over Kerr-Mills in the first year would be $250 million, nationwide. It was $250 million in New York State alone...They had 41 per cent of the people in the state of New York eligible for Medicaid, the legislature did, after we passed it. And of course, they'd upped the numbers and that upped the cost over and above what Bob Meyers ever anticipated." (Social Security Oral Histories)

Nursing Home Supply, Expenditures, and Utilization, Mid-Twentieth Century

The data in the following table comes from a variety of sources, and it's impossible to tell if all of them were referring to exactly the same facilities and residents, so it is imprecise. However, it probably is good enough to create a very general picture of nursing home utilization and expenditures in the mid-twentieth century. The explosion in utilization and costs that took place after FHA financial assistance for nursing home construction was made available in 1959 and again after Medicare and Medicaid were enacted in 1965 is obvious. Also note that the percentage of the cost borne by the federal government increased far more than that borne by state and local government. (IOM, NCHS, CMS)

Size of Total and Age 65+ Population 1950-1970
U.S. Population 1950 1960 1970
Total population 151,000,000 179,000,000 203,000,000
Population age 65+ 12,300,000 16,500,000 20,000,000
Age 65+ / total population 8.1% 9.2% 9.8%
Nursing Home Supply and Utilization in 1954, 1963, and 1969
Nursing Home Supply and Utilization 1954 1963 1969
Number of nursing homes 9,000 13,100 15,300
Number of beds 260,000 507,500 879,000
Number of residents 260,000 470,000 793,000
Nursing home residents / 65+ population 2.1% 2.8% 3.9%
National Nursing Home Expenditures in 1950, 1963, and 1969
National Nursing Home Expenditures 1950 1963 1969
National spending on nursing homes (millions) $187 $1,055 $3,567
Expenditures per resident $700 $1,800 $5,300
Federal/State/Individual Share of Expenditures in 1950, 1963, and 1969
Federal/State/Individual Share of Expenditures 1950 1963 1969
Federal direct payments for care 0% 18% 24%
State/local direct payments for care 10% 13% 14%
Non-government payments for care 
(includes government payments to individuals)
90% 69% 62%

Moss Amendments strengthen fire and nursing standards.

In 1967, the "Moss Amendments" were passed to authorize HEW to standardize the regulations for the Medicare and Medicaid programs, and to withhold funding from nursing homes that did not meet those standards. Regulations were added requiring nursing homes to meet the life safety code of the National Fire Protection Association, and requiring skilled nursing facilities to have at least one full-time Registered Nurse (RN) on staff. For the first time, nursing homes were compelled by federal law to disclose their ownership and all financial interests, to make it easier to identify fraud and abuse.

Intermediate Care Facilities create catch-all for non-compliant homes.

The 1967 amendments also created a new category of nursing home, called Intermediate Care Facilities (ICF) for facilities which cared for residents that did not need 24-hour-a-day nursing services, but who needed custodial care. The definition of an ICF was not clear, and states began using it as a catch-all for any nursing home unable to meet other standards, in order to get a federal match on their expenditures. HEW tried to create standards, but finally withdrew their proposed ICF regulations when the states protested, and the ICF category remained in limbo until 1971, when ICF standards were finally agreed on and included in Medicaid.

Hundreds of nursing homes close, but quality remains a concern.

In 1966, the Joint Commission on Health Care Organizations (JCAHO), an organization long known for accrediting hospitals, created their first accreditation program for nursing homes. 

The Moss Committee was back in business. They held 30 hearings from 1969 to 1970 on nursing home issues, and accumulated thousands of pages of testimony.

As standards were increased and Medicare funding was cut, older homes continued to close. A report by the National Center for Health Statistics determined that 1,445 facilities closed just between 1969 and 1971.

Medicare cuts nursing home coverage drastically.

By 1968, ECF costs were up to $500 million, and HEW decided drastic action was required to scale the program back. They distributed "Intermediary Letter 371," which listed a number of "required" services which had never before been required and warned the insurance companies that administered the program (the intermediaries) that they should err on the side of denying, rather than approving, Medicare claims. Since Medicare claims are not reviewed until some time after the services have been delivered, thousands of elderly people and their families suddenly found out that Medicare was not going to pay for services they had already received, and which they had believed Medicare would pay. Nursing homes had to issue bills to the families asking for payment long after the fact, and thousands of residents and families had to scramble to find the money to pay for it. Estates of deceased residents had liens or garnishments placed on them, and some residents were discharged for nonpayment. Many never did pay, and the nursing homes ended up with uncollectible accounts that had to be written off. To illustrate the drastic change that took place, Medicare denial rates shot up more than 600% between early 1968 and early 1970.

Stocks of the Fevered Fifty publicly-traded nursing home companies soar, then crash.

In spite of the looming problems with Medicare reimbursement, publicly-traded nursing home chains became one of the hottest things on Wall Street. Everyone viewed Medicare and Medicaid as a risk-free source of revenue that made this a business where no one could lose money. In 1966 there were only a few publicly-traded nursing home chains, by 1969 there were 58, and by 1970 there were 90. The best known were called the "Fevered Fifty", and they were promising investors returns of 20-25% a year. In many cases, they went public before they had even completed construction of their nursing homes, with prices at a huge premium to the rest of the market. The stock of the "Fevered Fifty" exploded in 1969 and 1970, then the bottom fell out by 1971, as reality set in.

In part, the precipitous fall in the stock price was due to was poor management and unrealistic expectations, but there were also some highly visible instances of fraud. The most notorious one was Four Seasons Nursing Centers. Four Seasons came public at $11, shot up to $181.50, then dropped to $.06 a share when the SEC suspended trading after indicting the company president, partners in their accounting firm (Arthur Andersen!), and two officers of a brokerage firm for securities violations. Four Seasons started out as a construction company, but investors didn't seem to care that the owners had no medical background as they pumped the stock higher before the fraud came to light.

Four Seasons entered bankruptcy and was reorganized as ANTA. ANTA's subsidiary, Four Seasons Nursing Centers, was later acquired by Manor Care, a much healthier publicly-traded nursing home chain that ultimately merged with Health Care Retirement to form HCR Manor Care.

Appendix

Narratives, data, and photos from the Library of Congress, the Social Security Administration History web site, and other sources.

1790-1990: Population Percentage by Region

Summary: The percentage of the population in each region from 1790-1990, when the population moved from the original 13 colonies to the South and Midwest, and then to the West.

The following graph illustrates the expansion of the country from 1790 to 1990. The population moved from the original 13 colonies to the South and Midwest, and then to the West.

The following table shows the percentage of the total U.S. population located in each region for each census year:

Year 13 Colonies Midwest South West
1790 97% - 3% -
1800 93% 1% 6% -
1810 85% 4% 11% -
1820 77% 9% 14% -
1830 71% 13% 16% -
1840 62% 20% 18% -
1850 57% 23% 19% 1%
1860 50% 29% 19% 2%
1870 47% 34% 17% 3%
1880 44% 35% 18% 4%
1890 41% 36% 18% 5%
1900 41% 35% 19% 6%
1910 40% 32% 19% 8%
1920 40% 32% 19% 9%
1930 40% 31% 19% 10%
1940 39% 30% 19% 11%
1950 38% 29% 19% 13%
1960 37% 29% 19% 16%
1970 36% 28% 19% 17%
1980 34% 26% 21% 19%
1990 33% 24% 22% 21%

The states have been grouped into regions according to the way the U.S. Census Bureau defines geographical regions, except that all states that include land that was a part of the original 13 colonies have been grouped together in the above table and graph. That group includes all of the "Northeast" U.S. Census group, plus a part of the "South" U.S. Census group.

13 Colonies

State Graph Region U.S. Census Bureau Region
Maine 13 Colonies Northeast
New Hampshire 13 Colonies Northeast
Vermont 13 Colonies Northeast
Massachusetts 13 Colonies Northeast
Rhode Island 13 Colonies Northeast
Connecticut 13 Colonies Northeast
New York 13 Colonies Northeast
Pennsylvania 13 Colonies Northeast
New Jersey 13 Colonies Northeast
Delaware 13 Colonies South
Maryland 13 Colonies South
DC 13 Colonies South
Virginia 13 Colonies South
North Carolina 13 Colonies South
South Carolina 13 Colonies South
Georgia 13 Colonies South

Midwest

State Graph Region U.S. Census Bureau Region
Ohio Midwest Midwest
Indiana Midwest Midwest
Illinois Midwest Midwest
Michigan Midwest Midwest
Wisconsin Midwest Midwest
Minnesota Midwest Midwest
Iowa Midwest Midwest
Missouri Midwest Midwest
North Dakota Midwest Midwest
South Dakota Midwest Midwest
Nebraska Midwest Midwest
Kansas Midwest Midwest

South

State Graph Region U.S. Census Bureau Region
Florida South South
Kentucky South South
Tennessee South South
Alabama South South
Mississippi South South
Arkansas South South
Louisiana South South
Oklahoma South South
Texas South South

West

State Graph Region U.S. Census Bureau Region
Montana West West
Idaho West West
Wyoming West West
Colorado West West
New Mexico West West
Arizona West West
Utah West West
Nevada West West
Washington West West
Oregon West West
California West West
Alaska West West
Hawaii West West

Source: U.S. Census Bureau

Section: 

1800-1990: Changes in Urban/Rural U.S. Population

Summary: Graph showing the change in the percentage of the rural and urban population.

Year Urban Rural
1800 6% 94%
1810 7% 93%
1820 7% 93%
1830 9% 91%
1840 11% 89%
1850 15% 85%
1860 20% 80%
1870 26% 74%
1880 28% 72%
1890 35% 65%
1900 40% 60%
1910 46% 54%
1920 51% 49%
1930 56% 44%
1940 57% 43%
1950 60% 40%
1960 63% 37%
1970 74% 26%
1980 74% 26%
1990 75% 25%

Source: U.S. Census Bureau

Section: 

1800-1990: Changes in White and Black Fertility Rates

Summary: A graph showing the sharp decline in fertility rates since 1800, reflecting the reduction in the average size of families over time.

This graph shows the dramatic decline in fertility rates since 1800, as demonstrated by data compiled in the American History Files (myhistory.org), an initiative of the National Endowment for the Humanities. This data reflects the decline in the size of families over time.

Section: 

1800-2000: Largest U.S. Cities, The Westward Migration

Summary: The 10 largest cities in the United States from 1800 to 2000, showing the westward migration of the country that contributed to the disbursement of families.

The following table shows where the population was moving as the country expanded and families became disbursed. In 1800, the largest cities were all in the original 13 colonies. By 1850, some of the "gateway" cities to the west, like Cincinnati, St. Louis, and New Orleans, overtook the eastern cities. By 1900, many people had moved to the Midwest and early settlement of the West centered in San Francisco. By the mid- to late-1900's, many of the largest cities were in the West and the South.

Top 10 Most Populous Cities in the U.S.
1800-2000

13 COLONIES
City 1800 1850 1900 1950 2000
New York, NY 60,515 515,547 3,437,202 7,891,957 8,008,278
Brooklyn, NY* - 115,435 - - -
Philadelphia, PA 41,220 121,376 1,293,697 2,071,605 1,517,550
Northern Liberties, PA** 10,718 - - - -
Southwark, PA** 9,621 - - - -
Spring Garden, PA** - 58,894 - - -
Boston, MA 24,937 136,881 560,892 801,444 -
Charleston, SC 18,824 - - - -
Baltimore, MD 26,514 169,054 508,957 949,708 -
Washington, DC - - - 802,178 -
Providence, RI 7,614 - - - -
Salem, MA 9,457 - - - -
Norfolk, VA 6,926 - - - -
Albany, NY - 50,763 - - -
Buffalo, NY - - 352,387 - -
MIDWEST
1800 1850 1900 1950 2000
Cincinnati, OH - 115,435 325,902 - -
St. Louis, MO - 77,860 575,238 856,796 -
Chicago, IL - - 1,698,575 3,620,962 2,896,016
Cleveland, OH - - 381,768 914,808 -
Detroit, MI - - - 1,849,568 951,270
WEST
1800 1850 1900 1950 2000
San Francisco, CA - - 342,782 - -
Los Angeles, CA - - - 1,970,358 3,694,820
San Diego, CA - - - - 1,223,400
Phoenix, AZ - - - - 1,321,045
SOUTH
1800 1850 1900 1950 2000
New Orleans, LA - 116,375 - - -
Houston, TX - - - - 1,953,631
Dallas, TX - - - - 1,188,580
San Antonio, TX - - - - 1,144,646

Source: U.S. Census Bureau.

* Annexed to New York in 1898
** Annexed to Philadelphia in 1854

Section: 

1809-1930: History of Hospitals in Michigan

Summary: The evolution of both hospitals and homes for the aged out of the county poorhouse system; the reasons why healthcare institutions were established and when that happened; and reasons for different ownership of various healthcare institutions.

Library of Congress: Pioneering the Upper Midwest: Books from Michigan, Minnesota, and Wisconsin, ca. 1820-1910

I have reproduced the following excerpt because it illustrates a number of things: the evolution of both hospitals and homes for the aged out of the county poorhouse system; the reasons why healthcare institutions were established and when that happened; and reasons for different ownership of various healthcare institutions. This account is also interesting because it shows what was happening before the federal government became involved in financing healthcare, since it pre-dates Social Security, Medicare, and Medicaid. 

The book in its entirety is online at:
Medical History of Michigan, Volume I. (Michigan State Medical Society, 1930).
Medical History of Michigan, Volume II. (Michigan State Medical Society, 1930)

History of Hospitals and Nursing in Michigan

By Richard R. Smith, M.D., Grand Rapids, Michigan

The hospital has not been a feature of the American frontier; nor has the professional nurse been a pioneer figure. The doctor, with his saddle bags, was in evidence early. For the bed-side care of his patients, he was obliged to rely upon mother or wife or good neighbors to keep the sick-watch. When the children were born, the doctor's wife, or the preacher's wife, held herself in readiness to "go in and help." And when a disease was known to be both dangerous and "catching," the possible other persons in the community that had already "had it" attended the sick ones in some improvised place apart.

Michigan, however, is unique in that it both lies on an international frontier and has a bi-peninsular shoreline. The Straits were fortified by a stockade and a blockhouse, as soon as frontier trading began, and the earliest semblance of a Michigan hospital appeared in some crude quarters for the sick men of the garrison. The log-book of Capt. Alex Harrison, of The Gage, a boat that was unloading at Detroit wharf, contains these stories: "October 11, 1785. One hand sent to the hospital October 14. Durett came on board in place of Butler, gone to the hospital." A report on barrack conditions at Detroit of 1790, June 24, describes the hospital as one room entered by two doors, equipped with twenty-one single berths and having one chimney. Something more spacious and better equipped must have been provided before 1812, when cholera visited Detroit as an incident of the war with England. Cantonment surgeons handled the scourge and the mortality was almost entirely among the soldiers.

County Houses

Sickness and poverty are akin; and the civic conscience, under primitive conditions, has provided for the two afflictions in one institution. A very early Act of Michigan Territory for the support of the poor, February 1, 1809, when William Hull was governor, provides that the overseers of the poor in the several districts within the Territory shall relieve and support all the poor, lame, blind, and sick, and shall provide for them houses, nurses, physicians, surgeons, in such cases as they shall judge necessary. Nothing more was contemplated by this than the letting out of cases to families that were willing to take them cheap. A poor law of twenty years later date, October 29, 1829, authorizes the proper officers to contract with a "competent physician" by the year, and to offer the contract at public auction to the lowest bidder. Seven years before Michigan arrived at statehood in 1837, a public Act authorized the establishment of county poorhouses with a superintendent. The seeds of the county infirmary, the home for the sick that civic charity provides for the poor, are found in this legislation; they, however, were seeds of slow germination.

Wayne County had been authorized to establish and operate a poorhouse two years before the General Law; although immediate action did not follow. And it was specified that the directors might admit lunatics and other diseased persons, if the disease were not contagious. A poor farm was purchased in 1832; and a shed-like building was erected the next year. A second visitation of the cholera, the same crisis that improvised places to house a pestilence in Detroit, speeded up the development of hospital features at the County House.

The borrow from the vivid language of Mr. George G. Catlin's "Story of Detroit":

"On June 7, 1834, Governor Porter, of Michigan Territory, died very suddenly. The circumstances of his death must have aroused suspicion of Asiatic cholera in the minds of the attending physicians, for his funeral was held on the day of his death. Between that time and August 1, several cases occurred with the unmistakable symptoms of cholera, and an alarm went through the city. There was a hurried cleaning of streets and alleys, but the plaque continued.

"Fr. Kundig, priest of Holy Trinity Church, was quick to realize the emergency, for so great was the general terror that sometimes when one person was attacked in a house, the rest of the family would flee, leaving the victim to the care of physicians and nurses. Many people hurriedly left town, but the people of surrounding towns were afraid of them. They built fences across the roads leading out of Detroit and tore up the bridges. Some Detroit people who went to a tavern in Rochester were turned into the street and had their baggage thrown out after them. Holy Trinity Church was situated on the north side of Cadillac Square, at the northwest corner of Bates Street. Fr. Kundig tore up the benches, built a partition across the middle to separate the men patients from the women, and organized it as a hospital. He induced about twenty-five of the young women of his congregation to enlist as nurses. He also enlisted an Irish ditch digger named John Canaan to act as official grave digger, and procured a horse and two-wheeled cart for him with which to gather up the sick and bring them to his church and to carry away the dead each morning from the improvised hospital and the homes about town. It is said that in the worst period of the plaque, the total deaths in one day numbered thirty-six.

"The Presbyterian Church, at the northeast corner of Woodward Avenue and Larned Street, was also utilized as a cholera hospital; and there Dr. Douglass Houghton and several other physicians ministered to the afflicted."

Telling how the results of the scourge reacted on the County House, Mr. Catlin says:

"Following the cholera, the city was burdened with many invalids, widows and orphans, and the poorhouse utilized to its capacity. In the lack of other provisions for their care, Bishop Resé placed the Sisters of St. Clare in charge of the inmates. Most of the inmates were brought to the institution by Fr. Kundig, who took pains to search out the needy, and, having assumed so many of the duties, he was appointed supervisor of the poor in the fall of 1934. The county allowed him 16 cents a day for the care of the inmates; but the actual cost was about double that amount, for provisions were hard to get, and labor was scarce, owing to the departure of many people from the city. There were more than 100 inmates of the poorhouse, and sixty of those were invalids.

"There were no nurses to keep up treatments after the doctors had left to hurry to the next sufferer, so Fr. Kundig organized a Catholic Female Association for nursing the sick and caring for children suddenly orphaned by the plague."

Of that association and the common necessity came the organization known as St. Vincent's Female Orphan Asylum.

Detroit Hospitals

From these primitive hospital endeavors undertaken by the commonwealth in connection with its early emergencies and charities, there followed the broader conception of better institutions with a wider purpose. Its gradual development is best pictured in a history of Detroit's several hospitals.

The earliest hospital in the city of Detroit to have a continuous existence is St. Mary's, dating from June 9, 1845. It is the earliest in the state of any operating under private management. Four Sisters of Charity, an order founded by St. Vincent de Paul, began this work in an old log building at the southwest corner of Larned and Randolph Streets, which the Sisters of St. Clare had used for a schoolhouse in the previous decade. St. Vincent's Hospital was the original name. Dr. Vlemcke superintended the medical and surgical work during the opening years. Sisters were the nurses, and operating expenses were met by popular subscription. The hospital made early provision for contagions cases, and cared for cholera victims in 1849. November 6, 1850, marked the first new era in its history when the hospital occupied a new building on Clinton Street near St. Antonie, which had been erected by popular subscription at a cost of ten thousand dollars. The lot, having a frontage of 87 feet and running through to Mullet Street, was the gift of Mrs. Antoine Beaubien, at whose request the institution changed its name to St. Mary's Hospital. It had accommodations for 150 patients and was a large establishment for its time. A hospital register, now in the Burton Historical Collection, show that the institution was receiving county patient in very considerable numbers over the period 1855 to 1873. A more faded order and account book shows that St. Mary's was serving from December, 1864, to April, 1865, as a United State General Hospital, W. H. Goimger, A. A. Surgeon, U. S. A. in charge. A second material advance is marked by the date November 21, 1879, when an additional building was occupied that had been erected at a cost on $50,000 on ground worth $15,000. This accommodated 130 inmates and the older building was reserved mainly for out-patient purposes. A free dispensary was by this time an important feature. While patients were received mainly on order from the director of the poor, others could secure board and attendance by the week at prices not greatly differing from present time hospital rates. In its present form St. Mary's Hospital has 330 beds, besides operating an out-patient department.

Other Roman Catholic homes for the sick at Detroit are less deeply rooted in the growth of the city than this pioneer, which goes back to Bishop Lefebre, the immediate successor of Bishop Resé, first incumbent of the Diocese of Detroit.

The beginnings of Providence Hospital, West Grand Boulevard, are inseparable from the House of Providence for destitute children and unfortunate women, opened by the Sister of Charity in 1869. This home was originally on Fourteenth Street, between Dazelle and Marantette. The institution was incorporated in 1872. Out of it has grown the largest Roman Catholic Hospital in the state. It has 475 beds, and compares favorably in equipment and service with the best hospitals of Detroit.

A third Roman Catholic home for the sick, St. Joseph's Mercy Hospital, on East Grand Boulevard, is as recent as 1922. This is under the control of the Sisters of Mercy, two branches of which order are operating hospitals in Michigan, one of them centered at Dubuque, Iowa, and the other at Grand Rapids. St. Joseph's has 185 beds and maintains an outpatient department.

St. Luke's Hospital and Church Home, operated by St. Paul's Protestant Episcopal Church, is interesting as the earliest continuous institution with hospital features set up in Michigan under Protestant auspices. It was made possible by bequest of Mrs. A. C. Caniff, 1861, amounting to $1500. After location, 1864, in Lafayette Street and in West Forth Street, 1868, modern Detroit knows it as situated in Highland Avenue, where it carries on a work for the aged, sick, and poor, under support of the Episcopalian church parishes.

The State of Michigan had its share in the hospital drama of the Civil War; and the principal scene was enacted at Detroit. The most important was staged on a plat of ground on the west side of Woodward Avenue, where Martin Place was later cut through to John R. Street. The federal government coöperated with the newly incorporated trustee of Harper Hospital in making provision for the soldier sick who were returning from the front wounded and invalided. The hospital corporation purchased this land, which had joined their holdings by gift of N. Martin. At the government expense a large wooden building, supported on either side by a line of cottages, was erected on the Woodward Avenue front for a military hospital. When hostilities were over, the government conveyed these building to the Harper trustees, on condition that invalided soldiers should be cared for at local expense. Arrangements were also made between the hospital management and the local United States Sanitary Commission, whereby that society, noble forerunner of the numerous relief agencies of the World War, paid over to the hospital its final fund amounting to about $6,000, and gave over the care of all sick and needy ex-soldiers who might come into its hands. Although the hospital opened for general patients on New Year's day, 1866, its first beneficiaries were twenty ex-service men received from the Soldiers Home in the Arsenal Building at the corner of Jefferson Avenue and Main Street. This initial work of Harper Hospital was protracted over the period of a generation. Among the soldiers' records preserved in the Burton Historical Library there are two massive volumes of medical prescriptions issued during the years 1864 to 1868 which probably throw upon present practice in medication the highlight of contrast.

The beginnings of Harper Hospital have a surpassing tinge of eccentric romance. In 1831, when the Jackson administration was furnishing names for counties and towns in Territorial Michigan, Walter Harper, in his boyhood an Irish immigrant, came from Philadelphia to Detroit. There came with him as an upper domestic servant Mrs. Ann Martin, a young widow. She had suffered a broken life and a distracted mind for the death of her little girl in a Roman Catholic convent; and seems to have come west along with her employer at the urge of her mother, who feared some active violence against those whom she held responsible. Both Harper and Mrs. Martin acquired land at Detroit and in the environs. The woman derived the small sums she had to invest from a huckstering trade in vegetables, poultry and game that she carried on in a stall at the old city market at the upper end of Woodward Avenue; also delivering her wares at certain business places where her epicurean patrons were employed. Walter Harper died in 1867, and "Nancy" Martin in 1875. Her crowning active philanthropy reveals her a noble soul, although in an exterior that classes her with the very rough diamonds. In the year 1859, by Walter Harper's deed bearing date of February 3, and Ann Martin's deed of March 10, their realty was conveyed to trustees to be used for the erection and maintenance of a Protestant charity hospital. Rev. George Duffield, Dr. George Russel, Alexander C. McGraw, Jacob S. Farrand, Buckminister White, Frederick Buhl and David Cooper were the parties of the second part. Rev. George Duffield, for thirty years pastor of the First Presbyterian Church at Detroit, had inspired Harper with the idea, and Mrs. Martin chose to supplement with all her wordly goods the philanthropy of her long standing benefactor. The hospital was named for the man; the trustees so incorporated May 4, 1863. "Nancy" Martin had been honored in the naming of the street cut from Woodward Avenue to John R. Street. The Civil War contact of the Harper trustees with the United States government had resulted in the conveyance of an outfit of cheaply erected wooden buildings. These served as the principal hospital plant until 1884. At that time a main building of red brick, erected at a cost of $115,000, was completed, and the Civil War structures were disposed of. A current of benefactions had now set in. The contributors' list includes many persons of local prominence over this middle period of the history of the city and some of national fame, as Zachariah Chandler and Russell A. Alger. Miss Jean L. Coyle's free bed endowment, rated at the time at $220,000, and in property of increasing value, was given in 1924 in memory of her father, William Kieft Coyle. It has meant much to this important philanthropy. Harper Hospital, for a number of years, operated a unit for the care of contagious diseases, housed in a small red brick building in the rear of the hospital plant. This discontinued when the Herman Kiefer Hospital was established. The Charles C. Case Cancer Research Fund is indicative of the forward stand for hospital on the scientific side. In its jubilee year, 1913, Harper Hospital experienced a notable expansion, to be surpassed in the aftermath of the World War. On the last day of that year, the J. L. Hudson Memorial Building and Theodore D. Buhl Memorial Building were opened. The second of these additions, a family gift, was a center for the out-patient and social service departments. The first had been projected by the hospital trustees and was completed as a monument to a leading benefactor of the City of Detroit, a gentleman high up in its business circles, who was president of the hospital board at the time of his death in 1912. The golden anniversary reports of Harper Hospital discovered that it had cared for 72,250 patients, totalling 933,390 hospital days, and that not over half of the patients had paid anything for their care or treatment.

During the World War, Harper Hospital furnished the staff of doctors and nurses for Base Hospital Unit No. 17 that served in France under command of one of Detroit's foremost surgeons, Colonel Angus McLean.

With the reconstruction time, the hospital entered upon another expansion commensurate with newer scientific and social ideas. Gray Pavilion, to house the operating rooms and x-ray department, was given by the children of John S. Gray in 1918. In 1926, the Harper trustees made a great appeal to the friends of hospital philanthropy, setting forth the fact that while Detroit had become, in numbers, the fourth city of the United States, it was lagging with its 4,723 hospital beds at ninth place in provisions for the sick. The appeal was for an approximate $2,500,000.00 for the erection of a 450-bed unit, for which sufficient ground was already owned, on Brush Street. The care of 650 patients at one time was declared to be the hospital's ideal, 275 beds to be devoted to surgical cases, 200 to medical, and 100 to obstetrical, and 75 to eye, ear, nose and throat patients.

With this splendid addition a reality, the history of Harper Hospital becomes a matter of current events. Among the doctors who have had their part in its story of service and growth are E. L. Shurly and David Inglis in internal medicine, Theodore McGraw, H. O. Walker, and J. Henry Carstens in surgery; Howard W. Longyear, Walter P. Manton, and Benjamin R. Schenck in gynecology, and Daniel LaFerte in orthopedics.

The first suggestion of a homeopathic hospital at Detroit seems to be the offer of a building site at the southeast corner of Willis Avenue and John R. Street, made by Amos Chaffee in 1869. The first homeopathic physician to locate at Detroit, Dr. S. S. Hall, entered upon his long practice there as early as 1843. In 1879 the Detroit Homeopathic Association was incorporated. But the hospital project lagged until 1886, when Mr. James MacMillan expressed to Dr. C. A. Walsh his purpose to sponsor a building that should cost $100,000. Mr. John S. Newberry soon afterwards proposed a gift of $50,000 as an endowment for operating costs. Mr. Chaffee then renewed the gift of the building site, which had reverted to him within the seventeen years since his first offer. Stipulations were made that the hospital be maintained forever free to all needing its services and unable to pay for them. Grace Hospital was opened in December, 1888. Constructed for 100 beds, it was equipped for thee care of only eighty-five patients. The MacMillan and Newberry families, reinforced by Mr. D. M. Ferry, and supplemented by others, continued to subscribe to the general endowment fund in sums from $1,000 to $50,000.

The twenty-first year of Grace Hospital, 1910, opened a period of much needed enlargement. Patients were being cared for to the number of 156 under sorely crowded conditions. An addition to front on Willis Avenue was projected, the Board of Trustees undertaking to raise $50,000 and appealing to friends to subscribe a like amount. An addition devoted to surgery was the result. Thereafter continuous expansion is discernable, although checked by the drain of the World War. The Merriam Memorial Branch, constructed in 1913 on West Grand Boulevard, added fifty beds to the 242 of the main hospital. An x-ray department was added in 1916; a radiotherapy department in 1922. Between 1917 and 1919, 163 of Grace Hospital personnel received leave of absence or resigned to answer the call of the government; seventy-seven physicians, seventy-four nurses and twelve employees, many of them serving overseas.

Following a survey of hospital capacity in Detroit after the World War, the trustees of Grace formulated a program of enlargement in terms of $1,000,000, contemplating three major units and two minor constructions. Two of the proposed additions have been realized, the larger one being a building for the out-patient department occupied in 1926, when the Board received its program as including a private patient's unit, home for nurses and home for staff and employees, all to be erected at the main hospital site; also a new main building on the west side to replace the Merriam Memorial Branch. Thanks to generous endowments, the charity work of Grace Hospital has kept pace with its general expenses. In 1925, of all the patients received, 24.2 per cent paid the full cost of care; 63.9 per cent were part pay patients; and 11.9 per cent were city, county and charity patients treated without personal charge to such patients. Eleven hundred and fifty-two were treated free; and in so doing the hospital expended $65,000. An increase was noted in the number of colored applicants for both out-patient and hospitalization. The most shining contribution of personal service to Grace Hospital is the long and distinguished career of Dr. Oscar LeSeure, for many years chairman both of the attending staff and of the executive committee.

The Woman's Hospital and Infants Home, suggesting by its name a social work that has always lain close to the heart of womankind, was established as early as 1869 by the Ladies Christian Union, a society that had organized in 1860 and had operated a Home for the Friendless, and had re-organized in 1868. First occupying rented quarters on Cass Avenue, the institution was established in its own building on Thirteenth Street in 1875; and in 1893 found a more permanent home in Ferris Avenue. At the turning into the new century 270 cases was the measure of the year's work. In 1922, 3,464 patients were cared for, 2,132 of them being mothers and babies. The imperative expansion took form in plans for a building to contain about 200 beds. The institution already enjoyed a Class A rating by the American College of Surgeons. The new plans drafted in the form of an X were determined by special concern for sunlight, retirement from street, and ease of operation. A drive for $600,000 was put on by trustees and other friends in 1923, and ground was broken shortly afterward. Some of Detroit's noblest women among the fortunately circumstanced have served as patronesses of this institution. Officers of the modern social service work have contributed much to its effective operation; especially the Women's Division of the Detroit Police.

The Children's Free Hospital of Detroit was established by charitable ladies in 1886. Nine years later, Mr. Hiram Walker, in memory of his daughter, Jennie Walker, erected a fine building at the corner of Farnsworth and St. Antoine Streets. Attending physicians donated their services, and everything was free. About sixty children of parents of less than ordinary income received care. Senator James Couzens, while mayor of the city, re-established this especially appealing charity on a munificent scale, with a donation of $5,000,000, made upon the condition that the Children's Free Hospital of Detroit and the Michigan Hospital School of Farmington be consolidated. The Children's Hospital of Michigan is the result. It has 250 beds and an out-patient department. Prominent Detroit men and women, including Senator and Mrs. Couzens, make up the executive committee and the board of trustees.

Henry Ford Hospital

The Henry Ford Hospital was visioned by a group of citizens and physicians who sensed the rapid growth that their city was passing through in the opening decade of the twentieth century, and foresaw the need for a larger hospital than any existing and one that should have the most up-to-date equipment. in 1909, a plat of twenty acres was purchased at West Grand Boulevard and Hamilton Avenue. Building operations began according to plans for a great general hospital, and two or three units were completed. Then the enterprise lagged under its own weight. Mr. Henry Ford took it over with some changes of plan, and the main building was ready for use not far from the time when the United States entered the World War. Mr. Ford handed it over to the government, and it became United States General Hospital in 1918. Thus it furnished a scene in the drama of nursing sick and wounded soldiers back to life, and of teaching disabled men some new way to earn a living. Fifteen hundred soldiers were care for. After their discharge, Mr. Ford resumed building operations. The hospital is remarked for its very complete equipment and for original features. It is a "closed hospital" in that the staff is attached to the institution and cares for all the patients. It has 548 beds and a high emergency capacity.

The year 1909 marked the beginning of a movement to establish a new hospital in rapidly growing Detroit. The Detroit General Hospital Association was organized to plan and build the Detroit General Hospital. With Mr. Henry Ford as chairman, the Finance Committee obtained subscriptions and purchased twenty acres of land bounded by West Grand Boulevard, Hamilton, Byron and Bethune Avenues. Plans of a pavilion type of hospital, drawn up after committees had studied hospitals in Europe and America, were accepted and the work of building began.

In 1911 ground was broken for the first building unit. As was the experience of many public enterprises at that time, enthusiasm lagged and subscriptions did not prove sufficient to carry the project through. The foundation of the building remained unfinished for eighteen months. In 1914 it was suggested that the City of Detroit take over the entire project. In June of the same year Mr. Henry Ford wrote to the trustees of the association as follows: 

Detroit General Hospital 
Detroit, Michigan 

Gentlemen: 

Learning that it is proposed to turn the assets of the Detroit General Hospital over to the City of Detroit, and believing that this would be a serious mistake, both for the city and from every other point of view. I hereby make you the following proposition: If you will make a good and sufficient deed to me or my assigns of the land and buildings now owned by you at the corner of West Grand Boulevard and Hamilton Boulevard, Detroit, Michigan, I will pay a sufficient sum of money on delivery of the deed to repay to each subscriber the moneys paid in by him or her to the hospital association, and I will assume the outstanding debts and contracts for buildings of the Detroit General Hospital, but you are to relive me of all other obligations such as continuing obligations to employ particular individuals and everything of that nature.

In conclusion I will state that It is my intention, if this proposition is accepted, to go forward with plans for a complete and creditable hospital for the benefit of Detroit.

Yours sincerely, 
Henry Ford.

His offer was accepted immediately and there was apparently great satisfaction of the solution of the difficult and embarrassing situation in which the Detroit General Hospital Association had remained for several years.

On June 26, 1914, the present site of the Henry Ford Hospital was deeded to Mr. and Mrs. Henry Ford. On September 15, 1915, the articles of incorporation for the Henry Ford Hospital were recorded with the Secretary of State at Lansing. Five days later Henry Ford and his wife deeded the property to the Henry Ford Hospital, Incorporated. The first meeting of the incorporators was held September 20, 1915, and a board of trustees was elected. Mr. Henry Ford was made president and Mr. Edsel Ford, his son, vice president.

On October 1, 1915, the first patients were admitted, a pavilion for seventy-five patients of the original plan having been completed, together with the operation rooms, laboratories and service buildings. Dr. Frank J. Sladen, formerly resident physician at the Johns Hopkins Hospital and associate in medicine in the University, had received the appointment as physician-in-chief.

In February, 1916, Dr. Roy D. McClure, resident surgeon of the Johns Hopkins Hospital and associate in surgery in the medical school, was appointed as surgeon-in-chief.

From the beginning, the plan had been for a full time staff, that is, a staff engaged to spend their full time at the hospital. Many physicians and surgeons who were desired as members of the staff of the Detroit General Hospital were unwilling to come on the full time service of the Henry Ford Hospital.

The hospital, comprising only a small pavilion of the original plan, with operating rooms and service plants, was run for two years while plans were being made for the large hospital and staff.

By August 1, 1918, the new buildings were well under way. At that time there was an acute demand for medical men and nurses for the army. The hospital was closed for the duration of the war and the entire staff volunteered and entered the army, a number of the staff being associated in France with Evacuation Hospital No. 33.

On October 27, 1918, the huge shell of the new hospital building was turned over to the United States Army at a rental of one dollar a year and used as U. S. Army General Hospital No. 36, with Lieutenant Colonel Alexander T. Cooper as commanding officer, and wounded overseas men were received as patients early in 1919. The hospital was returned to Mr. Ford by the government on January 1, 1920, and the original staff returned from their army service and again opened the hospital.

In January, 1920, the second influenza epidemic arrived, and 300 emergency beds were made available for the city. The main hospital was opened in December, 1921, with a completely equipped diagnostic clinic, staff and 450 bed capacity.

The Clara Ford School of Nursing and Hygiene was opened in 1925, being unique in having the first separate school building with class rooms, laboratories, gymnasium and swimming pool.

The staff of the hospital has been organized for accurate diagnosis and treatment of patients and for post graduate training of doctors in every division of medicine and surgery. The training consists of one year's rotating interneship, a second year consisting of six months in the diagnostic clinic and six months in general medicine or general surgery, or as an assistant in a division. Those making good then have the opportunity of three straight years in the division of their choice, if approved by the division head.

Seminars are held by the different division heads and weekly clinics by the department heads in medicine, surgery and pathology. Dr. Frank W. Hartman is chief pathologist and Dr. Joseph A. Johnston is head of the department of pediatrics.

Research work has been encouraged and ample facilities have been made for it. Two outstanding research problems have been accomplished by this hospital since the War. The use of tannic acid in the treatment of burns, now widely used, was beautifully worked out in a scientific way by Dr. Edward C. Davidson. This treatment has reduced very materially the death rate from burns as reported by a number of clinics, as well as reducing the suffering and deformities. The American Medical Association last year awarded its Gold Medal to Dr. Frank W. Hartman and Dr. Howard P. Doub for their work in the experimental production of chronic nephritis by deep X-ray therapy, not only demonstrating the far reaching harm which may result from an unwise use of deep therapy, but in opening up for laboratory study, in a way never before possible, the subject of chronic nephritis.

It is too early to tell of the influence of this hospital on medicine in Michigan. It has not only done the shop work of repairing wrecks, but it has also seriously tried to carry forward the torch of knowledge. Its ideal is not only the care of the sick, but the more important service of habituating its clientele to annual examinations to head off disease and to advise concerning diet and the type of daily living necessary to health.

One hundred and ninety-two papers have been published by the staff. A volume of collected papers was published in 1925.

On July 1, 1929, 132,700 patients had been registered and had received complete examinations. All patients reporting for even a trivial ailment are urged to have a complete examination.

The City of Detroit has large hospital institutions operating under the municipal authority. All of these are incidents of that rapid growth which the census of 1910 brought home to the consciousness of the people. The Detroit Board of Health dates back to an act of the state legislature of the session of 1895. The State Board of Health, for two decades, had been agitating for isolation hospitals, and had issued a notable statement at its meeting in 1893 as to the prevalence of communicable diseases in Detroit. Smallpox was epidemic at the time. This can scarcely have been the original urge to operating as a city pest house the small building in the woods out Hamilton Boulevard. The Detroit Board of Health is specifically charged under the city charter to suppress the spread of contagious diseases, and to provide for the care and treatment of all persons in the city having malignant or infectious diseases. The Board is now operating two notable isolation hospitals. In 1906, the city established on the site of the little old pest house a spacious hospital for contagious diseases, 865 beds; and named it after Dr. Herman Kiefer, long an outstanding physician of Detroit and member of the Board of University Regents. The other institution under the City Health Department is Springhill's Tuberculosis Sanatorium, at Northville. The Department of Public Welfare, formerly the Poor Commission, has authority under the city charter to establish and operate hospitals, infirmaries and farm colonies for the care of the sick, except persons afflicted with contagious or dangerous communicable diseases. The department has operated since 1915 the Receiving Hospital, a large institution located at St. Antoine and Macomb Streets. The report of the city physician to the Board of Poor Commissioners for the year next preceding the opening of this hospital shows a most interesting distribution of the city's poor-sick among private hospitals and remedial institutions. The total number of patients cared for at municipal expense during that year was 16,352. St. Mary's Hospital had 3,431; Grace Hospital, 1,097; Harper Hospital, 922; Providence Hospital, 493; Boulevard Sanatorium, 54; Harper Hospital, West Branch (afterwards Delray Industrial Hospital), 99; Samaritan Hospital, 63; Florence Crittenden Home, 80; Detroit Tuberculosis Sanatorium, 45; Woman's Hospital, 68. The cost of caring for the city's sick-poor by this system had mounted up to about $110,000 a year; and the change to a municipally operated hospital proved a substantial economy. The initial unit of the Receiving Hospital cost $250,000. At the expiration of five years the second unit was added, involving a much larger outlay. The hospital has beds for 560 patients and a staff of thirty-five doctors and 150 nurses. It has regular departments in medicine, general surgery, emergency work, psychiatry and orthopedic surgery; it has an out-patient department. The emergency department leads all the others combined in the numbers of patients. There is a considerable transfer from the Receiving Hospital to Eloise Infirmary. In the city budget of 1924-1925, a second enlargement was projected to cost $900,000. The architects followed the tower style that New York City has given to the country; a far cry from the little low log building in which St. Mary's Hospital started only eighty years earlier. High up are quarters for 200 nurses, below operating rooms with the most modern accessories, X-ray and bacteriological rooms, psychopathic wards, laundries and executive offices, in step with the magical growth of first class American cities.

The "History of the City of Detroit," 1701-1922, prepared under the distinguished editorship of Mr. Clarence M. Burton, gives space to seven hospitals and finds nineteen others to notice by name. It adds to this list, under the name of "Charitable Institutions," eight that receive the more extensive treatment and twenty-one called by name only. Some of the names are interesting indices to race and religion. There are the William Booth Memorial Home and Hospital and the Serbian-American Hospital Relief Association.

An appreciation of the extent of the hospital work done in Detroit may perhaps be obtained if one glances at this list. Lack of space forbids further mention.

1. Children's Free Hospital, 5224 St. Antoine. 
2. Cottage Hospital, 54 Oak, Grosse Point. 
3. Detroit Eye, Ear, Nose and Throat Hospital, 62 West Adams. 
4. Delray Industrial Hospital, 7125 W. Jefferson. 
5. Detroit Osteopathic Hospital, 
6. Dunbar Memorial Hospital, 576 Frederick. 
7. Evangelical Deaconess Hospital, 3245 E. Jefferson. 
8. Highland Park General Hospital, Glendale Avenue. 
9. Lincoln Hospital, 1051 25th. 
10. Michigan Mutual Hospital, 1366 W. Grand Blvd. 
11. Providence Hospital, 2500 W. Grand Blvd. 
12. St. Luke's Hospital, 228 Highland. 
13. Salvation Army Woman's Hospital, W. Grand Blvd. and W. Fort. 
14. Joseph Mercy Hospital. 

At Grosse Pointe Farms in Cottage Hospital, operated under Detroit Community Fund auspices. This was opened in an eight room house as a small nursing unit during the influenza epidemic of 1917. Later, another house was acquired, and a modernly equipped operating room and delivery room were built to join the other two. This was followed by adding emergency room and operating room, bringing the capacity to twenty-one beds. Added to this, a new fifty-bed hospital was occupied in the autumn of 1928. Cottage Hospital is standardized. Since the Detroit Community Fund makes up the annual deficit, amounting to one-fourth of operating expenses, patients are charged a very low rate. There is an endowment adequate to provide free service for the needy of the community.

Grand Rapids Hospitals

The settlement of Grand Rapids, on the west side of the state, dates from 1837; the municipal incorporation from 1850. Here it was Protestant philanthropy that developed the earliest hospital foundations. The details are of liveliest interest to lovers of local chronicles, and to those that despise not the day of small things. For the purpose of devising ways to care for the poor and sick independently of the town poor masters, a meeting was held in the fall of 1847, at Prospect Hills schoolhouse, on the site of the Ledyard Block. Thus began a Benevolent Association under the presidency of Mrs. Francis F. Cumming, wife of the rector of St. Mark's Church, which operated a house-to-house relief work through district visitors. On January 16, 1857, a charter was taken out under the name Grand Rapids Orphan Asylum, by a group bearing a close personal identity with the unincorporated workers of the ten years preceding. A double function was herein authorized, namely, to provide for orphans and destitute children, and to extend relief to sick and indigent persons. In less than five years a more stirring function than either had interrupted the ordinary activities of the society. The benevolent and patriotic citizens of Grand Rapids devoted their energies to the Civil War encampments in their midst.

The war hospital was located near the site of the Central High School. Fountain Street, 1863. The troops were for a short time located on low ground near the river on the West Side, but soon moved to the Prospect Hill, the land the Union Benevolent Association lately occupied being part of the ground. The actual encampment with its cavalry occupied a large territory. Between six and seven thousand troops rendezvoused here.

The hospital proper was in the house now occupied by C. Tanis, 216 Prospect Avenue, the third north from Lyon Street, having a center dormer window. There was much serious illness. The nurse in charge was Mrs. Lucia Johnson, the matron of the Grand Rapids Orphan Asylum, who took up with splendid bravery the care of the soldiers. She literally gave her life to the relief work; she died from pneumonia while on duty in the hospital. A fine, rare woman, is the verdict of a man who, as a youth, knew her at her hospital work. There were no stretchers for the sick. The men were placed in blankets and four soldiers carried a man to the hospital.

February 14, 1863, the following appeal was issued: Hospital 7th Michigan Cavalry.

To the Ladies: 

Feeling grateful for the many acts of kindness conferred upon the men entrusted to our care, we, the medical officers of the 7th Michigan Cavalry, feel encouraged to solicit from the Ladies of Grand Rapids further contributions in the way of bandages and lint and other suitable materials for the dressing of wounds. Experience has shown that large supplies of the above named are needed, etc.

William UpJohn Adna Sherman, Surgeons.

The hospital site at Camp Anderson, formerly the old fair grounds, is not known. One or two other places were certainly used for war hospitals, but the exact sites have not been located.

In 1873, January 18, the Benevolent Association reincorporated, with Union Benevolent Association for its official name. The Orphan Asylum had been closed in 1871, largely because state institutions for children at Coldwater were expected to take over a good share of its work. Its purpose now was to provide a home for infirm, aged, homeless persons, to care for and relieve temporarily any necessitous persons, and to erect and manage a general hospital for those suffering from disease or injuries. This two-fold work went on for twelve years at the old Gage place, on the west side of Bostwick Street, just south of Lyon. The first of two notable transformations was realized in the removal on February 23, 1886, to a new building at the southwest corner of College and Lyon Streets. The site was the gift of the Sarel Wood estate. The sale of the former property was a substantial contribution to the cash of the new one, $31,707.31; a final debt of $3,000 was cancelled by Hon. Thomas D. Gilbert. Local merchants contributed to the furnishing. Union Benevolent Association Hospital now developed along strictly professional lines. In 1890, the first medical staff was appointed, Dr. Charles Shepard being chief. When the third incorporation occurred, the articles taken in 1873 being limited to thirty years, the provisions for general philanthropy disappeared from the charter. The care of the aged had already been discontinued because other societies were competent to take it over. There are two noted names, Mrs. Wealthy M. Morrison and Mrs. Marion L. Withy, that appear in the charters of 1857, 1873 and 1903 respectively.

The latest and furthest step of Union Benevolent Association Hospital into the great things of medical science has been taken in its transformation into Blodgett Memorial Hospital, wrought by John W. Blodgett in memory of his mother, Jane Wood Blodgett. In November, 1914, the public was informed that Mr. Blodgett would tender a large gift to the trustees of the Union Benevolent Association. An architect from the New York firm of York & Sawyer had already been consulted. A plot of twenty-five acres situated between Wealthy and Sherman Streets, east of Plymouth Road and overlooking Fisk Lake, was purchased for a site. Ground was broken May 18, 1914, Mr. Blodgett turning the sod. A splendid hospital structure in Florentine style was erected without delay. On March 31, 1916, formal dedicatory exercises were held. The hospital, representing nearly fifty years of development of physical properties and institutional organization, is well adapted to the purposes and needs of the community. It has 150 beds and all the accessories that such a hospital should gave, and is at present one of the three general hospitals in Grand Rapids. Three persons intimately associated with its growth should be mentioned. Mrs. Marion L. Withey for many years devoted much of her time and effort to the institution. The training school bears her name. Miss Ida M. Barrett, a superintendent, devoted a large part of her life to the hospital and was largely responsible for the upgrowth of the service upon which the present hospital is founded. Miss Mary A. Welch, at present superintendent of the training school, has been identified with the hospital for more than a quarter of a century, and as an administrator has few equals. To her should be credited chiefly the fine spirit and ideals of nursing which are an outstanding feature of the institution.

In the winter of 1872-1873, St. Mark's Church in Grand Rapids had under its care two aged and infirm women. To provide a home for them and for others who might come to the same need, the rector appealed to the philanthropic women of the church. Prominent in the group which responded and effected the desired organization was Mrs. E. P. Fuller, who, with her husband, gave encouragement to the project by donating the use of a small house at what is now the corner of Bond Avenue and Crescent Street. Here on February 11, 1873, was held the first recorded meeting of St. Mark's Church Home, a voluntary association, in the modest inception of which lies the origin of Butterworth Hospital.

In 1875, the home was transferred to more commodious quarters at 144 Island Street, upon property belonging to Mr. and Mrs. E. P. Fuller, who generously donated its use rent-free for a number of years.

In June, 1876, the institution was incorporated under the name St. Mark's Home and Hospital.

About 1887, Mr. Richard Edward Emerson Butterworth, who for many years had been identified with the business interests of Grand Rapids, offered to the city the sum of $10,000 towards a hospital building, but the offer was not accepted by the city. The diversion of Mr. Butterworth's interest towards St. Mark's Home and Hospital is attributed to the effective intercession of Mrs. E. P. Fuller.

A site was secured on Bostwick Avenue and plans progressed for the erection of a fine large modern hospital. Mr. Butterworth gave a further gift of $30,000, but unfortunately he did not live to see the hospital completed.

The new building, under the name of St. Mark's Hospital, was opened in 1890, and was devoted exclusively to hospital purposes, which meant the discontinuance of what had been at first the primary object of the association, namely, the institutional care of homeless old people.

In 1894, the name was changed to Butterworth Hospital in memory of the man whose generous gifts had made possible the erection of the hospital.

A training school for nurses was established in 1890, and since that time 480 graduates have gone forth. Many of the graduate are filling important positions in institutions, public health, and every other nursing endeavor. The missionary spirit has taken our graduates to many of the foreign fields, as Arabia, Abyssinia, China, India, Korea, as well as the home missionary fields of Alaska, Kentucky, and New Mexico. Several Butterworth graduates served during the Spanish-American War, and many more had a part in the World War.

In 1925, the present beautiful well-equipped hospital of 270 beds was opened largely through the generous gifts and personal interest of Mr. and Mrs. Edward Lowe. Mr. Lowe was president of the Board of Trustees from 1898 to 1928, a period of thirty years. It is worthy of note that Mr. Lowe was a grandson of Mr. Butterworth.

To Mr. and Mrs. Lowe's subscription of $500,000 were added approximately $1,000,000 by the citizens of Grand Rapids. Mr. Robert W. Irwin headed the building committee which raised the funds, and to his untiring and well directed efforts should be chiefly credited the success of the movement. It made possible the erection of a hospital which was in keeping with the long and sound development of a philanthropic institution of this kind and the needs of a growing, prosperous industrial city.

St. Mary's Hospital, at Grand Rapids, is one of the enterprises of the Sisters of Mercy, an order founded in Dublin, Ireland, in 1831, by Mother Catherine McAuley. It is the largest of the system of hospitals conducted by this order in the State of Michigan. The bringer of the work of the Sisters of Mercy into the American Old Northwest was Mother Mary Joseph Lynch, a woman of rare personality and varied gifts. She came to Grand Rapids from Kinsale, Ireland, in 1873. Twenty years before she had done a nurse's service in the Crimean War, where she was intimately associated with Florence Nightingale. The Sisters of Mercy, coming to Grand Rapids at the request of Rev. J. P. McManus, opened an Academy on South Division Street, and members of their order were the first non-secular teachers of St. Andrew's School. But to Mother Joseph, influenced by her early contact with suffering in Ireland, the care of the sick and the relief of the poor made a more immediate appeal than education did. And she took her little community to Big Rapids, where they instituted a hospital for the care of men injured in the lumbering business, ministering to thousands of patients.

The Sisters of the Order of Mercy established their hospital at Grand Rapids in August, 1893, when Sister Mary Ignatius, accompanied by two or three others, arrived from Big Rapids. Their original property, donated by Mrs. Mary McNamara, was a dwelling house known as 145 South Lafayette Street. To this was attached a small house brought from the corner of Sheldon and Maple Streets. In 1898 and 1900, additions were made, at a cost of $10,000. The hospital association was incorporated March 23, 1901. The enlargement that greeted the new century was but a beginning. The old Coffinberry home adjoining the hospital on the south, was acquired by it in 1903; the Smiley residence at the southwest corner of Cherry and Lafayette Streets, in 1905. This became the site of a new building that was dedicated June 26, 1911, and received patients a month later. The Amberg property directly west was also acquired, and converted into a nurse's home.

Increase of hospital service is but poorly measured by statistics; yet the most beneficent institutions have no other way. In its first year St. Mary's Hospital treated sixty-nine patients; twenty-one years afterwards its annual report showed an increase of eighteen hundred over this. A number of Sisters Superior had filled the position of hospital superintendent.

Fifteen years after possessing its first new building, and almost simultaneously with the erection of the new Butterworth Hospital, 1926, St. Mary's Hospital enlarged its quarter and perfected its equipment on the scale that the social growth of the twentieth century demands. The realty know as The Elmwood, lying south of the main hospital building, was acquired. An addition was made to the main building, and a new unit was erected for maternity and children's cases. The extension was largely planned by Sister Superior Mary Bernard. A high Authority on nursing, who visited Grand Rapids shortly after it went into operation, declared that the unit for mothers and children was one of the most perfectly planned buildings for the purpose in the United States, and that some woman must have thought it out. St. Mary's Hospital in its new form is arranged according to the Bacon plan. The latest additions represent an outlay of $550,000 in buildings and of $50,000 in equipment and furniture. The architect were Berlin and Swern, of Chicago, with Harry L. Mead, of Grand Rapids.

Flint Hospitals

Hurley Hospital

Hurley Hospital was originally built through the generosity of James J. Hurley, pioneer Flint business and civic leader, who willed to the city an entire block of land at Begole and Sixth Avenue, and $50,000 in cash for the construction of a city hospital. The Stockdale estate added $34,000 to Mr. Hurley's bequest.

The old hospital was opened in 1908 and had a capacity of thirty-six beds. Arrangements was made for free patients, to be examined by the health department. Under the city charter at that time, there was provision for a one-mill levy for maintenance. This gave the hospital $20,000 a year with which to operate. Thus the city hospital came into existence.

Dr. J. C. Wilson, an early and accomplished physician of Flint, was chairman of the first hospital board.

In the month of April, 1928, a new million-dollar Hurley Hospital was opened for public inspection. Complete in every detail, with different color schemes carried out on every floor, the new building presents features of great interest. The Board of Health Clinics are quartered in the basement. The physicians are provided with a library, a large auditorium and amphitheatre operating rooms. The patients have advantage of the complete physiotherapy, X-ray and laboratory departments. The new Hurley Hospital takes high rank among the modern hospitals of this country.

A training school for nurses is maintained. A beautiful five-story nurses' home has been constructed.

The hospital is governed by a hospital board appointed by the mayor and a medical advisory board representing the different medical specialties. Chiefs of the different services are appointed annually by the medical advisory board.

Three hundred and ten patients can be cared for in the new building. The construction of the hospital in the shape of a Maltese cross provides for ample room for expansion.

On Wednesday evening, October 24, 1928, the Merliss Brown Auditorium of Hurley Hospital was officially dedicated and turned over to the Genesee County Medical Society. The Auditorium is built as an integral part of the hospital. Architecturally it conforms to the regular theater style, with a suitable for speakers and a seating capacity of three hundred. The acoustics are exceptionally good. Very infrequently does one find such perfect ventilation, the air remaining clear and fresh. The decorations are subdued and in excellent taste. The sidewalls are paneled in antique oak for a height of about eight feet; above this the walls are stippled in a warm brown; overhead the ceiling is beamed and richly decorated with conventional design done in blue, red, and gold. The lighting fixture are very decorative and unique, in that ample light has been provided without glare. Comfortable upholstered seats have been purchased with funds raised by voluntary subscriptions from members of the county medical society.

An auditorium such as this constituting a unit of a city hospital is rather unique, and it is the only one of its kind in the state. Visitors during the recent post-graduate conference at Flint were enthusiastic in their praises and Genesee County Medical Society may be very proud indeed of its new acquisition.

In accepting this gift from the Board of Hospital Managers and through them the citizens of Flint, the society assumes a moral obligation to make use of this splendid equipment in disseminating medical knowledge. The tax-payers will, we hope, quite fittingly benefit by receiving improved medical care.

J. B. Pengelly, as representative of the citizens of Flint, introduced Merliss Brown, member of the Board of Hospital Managers, after whom the auditorium was named. Mr. Brown, in an appropriate manner, turned the auditorium over to the medical society. Dr. W. H. Winchester, in his usual charming way, expressed the appreciation of the physicians to the Board and the citizens of Flint. A short talk was given by Dr. F. C. Warnshuis, of Grand Rapids, on "Organized Medicine." Following this, Dr. J. D. Bruce, of Ann Arbor, told of the effort being made to place post-graduate education on a suitable footing in Michigan. Our honored guest, Dr. M. L. Harris, of Chicago, president-elect of the A. M. A., spoke on "Doctors, Patients and the Community."

On October 24 and 25, 1928, at the new Merliss Brown Auditorium at Hurley Hospital, at Flint, was held a medical and surgical conference and clinic. Attendance each day was about one hundred. The subjects discussed were all very well received and appreciated by those in attendance. All felt that the bringing of these conferences is a big step forward in post-graduate work and as they are more appreciated by the medical profession, the attendance will increase. Men could spend much time and at greater expense visiting clinics hundreds of miles away and not received and valuable information given by these papers.

The Women's Hospital

The Women's Hospital, Flint, Michigan, was founded in 1917 by a woman physician, Dr. Lucy Elliott, whose life dream it was to provide special hospital services for women and children.

After two years the financial burden became too great for Dr. Elliott. Just as she was on the verge of giving up the work, Mrs. J. Guy Blackinton, with several friends, came to the aid of the hospital, securing support for five rooms for one year. Mrs. John M. Hammond, with several of her friends, sponsored the sixth. The nucleus for the present hospital auxiliary was formed on the suggestion of Mrs. Forrest Boswell, who had knowledge of a successful organization in another city for the support of its hospital. The first president of the auxiliary was Mrs. Van Meter. Mrs. N. Hammond was elected vice president, Mrs. I. E. McConnel, secretary, and Mrs. Charles Ballard, treasurer.

On April 28, 1919, the Flint Chamber of Commerce approved of the incorporation of the Women's Hospital Association, which took over the hospital and made plans for a new site and a larger building. Committee from the Rotary and Kiwanis Clubs, as well as from the Genesee County Medical Society, were active with the Chamber of Commerce in furthering the re-organization.

In 1912, five acres of land on Lapeer Street were purchased from Mr. and Mrs. D. P. Smith. A campaign to raise money to pay for the property and to remodel the house into a small hospital procured $76,000 by December, 1912.

The building was ready and occupied in April, 1923. With many improvements, and an addition of twelve private rooms made possible in 1926 by gifts totaling $41,000, the hospital now has forty beds for women and twenty-four cribs for infants. An active maternity and surgical service is maintained.

The staff is organized under the plan of the American College of Surgeons. Staff conferences are held on alternate months with the meeting of the medical advisory board. The advisory board, 24 in number, is appointed by the Board of Trustees from the general staff.

Between eighty-five and one hundred patients are admitted to the hospital each months; average number of births is fifty-three and about forty surgical cases are cared for each month.

The first board of trustees was A. E. Raab, chairman, Charles A. Cumings, secretary, and J. Guy Blackinton, treasurer, George A. Barnes, D.D., John L. Pierce, the late Horace E. Potter, Charles S. Mott, Forrest W. Boswell and Grant J. Brown. The same board still serves with three exceptions. George Simmons was appointed to succeed John L. Pierce, William S. Ballenger to succeed Rev. Dr. Barnes, and Samuel Morgan in place of the Rev. Horace J. Potter.

The hospital (May, 1928) is under the superintendency of Margaret E. McLaren, R.N.

St. Joseph's Hospital

St. Joseph's Hospital was founded in May of 1912, by four Sisters of the nursing order under the patronage of St. Joseph. One of the fine old residences of Flint, the Stockton home at 722 Ann Arbor Street, was remodeled, and an addition built, making room for forty beds for adults and a nursery with eleven cribs for infants.

Few hospitals in the state have done more with so little equipment. Last year 2,024 patients were cared for, which included 773 surgical, 661 medical and 590 maternity patients.

The hospital operating deficit is each year included in the Community Fund, as about 25 per cent of those cared for are charity patients.

The nursing order in charge of the hospital has been incorporated under the name of Burgess Hospital with headquarters at Kalamazoo.

The Sisters are soon the to be rewarded for their wonderful work, as a fine new hospital is at present (May, 1928) contemplated.

Private Hospitals

The Axford

The earliest hospital, for years a landmark in Flint, was the Axford, a building constructed in two parts, the one to serve as a residence for the family of Dr. S. M. Axford, a pioneer physician, the other as a hospital mainly for his surgical cases. He was useful, very energetic and competent, and had a large practice.

The Murray

Dr. W. P. Murray was an excellent surgeon and for years enjoyed a lucrative and extensive practice in Flint and its environs. His physiognomy, general appearance, intonation and manner of speaking were of the Yankee type, but nothing of the Puritan was displayed in close contact. Indeed, his interest in speedy horses and the race track contributed not a little, in the opinion of associates, to his financial undoing. He bred contestants for turf honors and aspired to high accomplishment in this field of activity, but ventures went wrong, and he often experienced disappointment.

At one time his surgical practice was so exigent that he secured a large centrally located colonial house and remodeled and refurnished it for his hospital purposes. From this, the second undertaking in private hospital lines in Flint, he realized, regrettably, nothing aside from augmentation of anxiety and care.

The American Medical Director for 1927 lists one hundred and seven cities and towns in the State of Michigan as having hospitals, sanatoriums and charitable institutions with hospital features, this not including State and Federal institutions. For Detroit, twenty-eight hospitals and other homes for the sick receive mention; for Grand Rapids, fourteen; and for Flint, four. These three center

Section: 

1850: Aged Women's Home, Baltimore, MD

Summary: Photos and description of the Aged Women's Home in Maryland, apparently a very nicely appointed home.

Aged Women's Home, 1400 W. Lexington Street, Baltimore, MD
Built 1850, demolished, July 1959.

From the Library of Congress American Memory Collection

The history of the organization responsible for the Aged Women's Home and the later adjacent Aged Men's Home is pertinent. "Several ladies" formed the Impartial Female Humane Society in 1802 for the purpose of assisting "the deserving widow and deserted wife" and to establish a "Male Free School, upon liberal principles." The Society was incorporated in 1811, and in 1849 the Society was reincorporated as "The Baltimore Humane Impartial Society and Aged Women's Home," for the express purpose of enlarging its sphere of activity to include the aged. In 1864, the charter was again changed to include a home for Aged Men. About this time the school was discontinued.

In December, 1848 the Society announced their determination to build an aged women's home on the present site. The lot measured 80 feet front by 150 feet depth. Fifty feet of the frontage was contributed to the Society by James Canby of Wilmington Delaware. Canby owned 33 acres of land in the vicinity, and was in the process of developing it for residences. The home was one of the first building to be erected in his development. In the same announcement, the Society urged merchants and artisans to contribute materials and labor to the building.

Sometime afterwards Thomas Dixon, architect, supplied general drawings. In July of 1840 a number of carpenters submitted bids for construction. L.G. Shipley estimated the total cost as $15,240, and was willing to do the carpenters work at a deduction of 55% from the standard measurement prices, and also donate $225 to the Society.

From an article in the Baltimore Sun, June 4, 1850:

The Widows Home -- This is the name of a really beautiful specimen of architecture, now rapidly approaching completion, and situated on West Lexington Street...[the first floor] contains fourteen single chambers, each containing a window, and with opening into a spacious hall...The second story likewise contains fourteen single chambers, as does the story above, all of which are nine feet wide and fifteen deep. The board room is an apartment in the second story, commanding the front, which will be finished in the most elegant manner; adjoining which is the apartment for the matron...Each story is supplied with bath rooms, water closets, and every convenience which a well constructed residence affords; and in the third is an apartment designed for an infirmary...The basement contains a kitchen, dining room, sewing apartment, pantries and cellar, and beneath the entrance is a fine arrangement for a refrigerator on a large scale.

Section: 

1870: Home for Aged and Infirm Colored Persons, Philadelphia, PA

Summary: Bylaws and excerpts from the Sixth Annual Meeting of the Home for Aged and Infirm Colored Persons which provide an outline of everyday life in the home.

Excerpts from the Sixth Annual Meeting of the Home for Aged and Infirm Colored Persons

Text from the Library of Congress American Memory Collection.

Home for Aged and Infirm Colored Persons
111 South 4th St., Philadelphia, PA
January 13, 1870

Appeal for Funds

As will be seen in the proceedings of the Annual Meeting, a lot of ground suitable as a building site has been donated to the "Home" by Stephen Smith, and it is very desirable that a building adapted to our wants be erected thereon without delay.

The number of applicants for admission is large, while our present building is very fully occupied.

Some worthy objects of our charity have been "called home" while waiting for admittance, and some have been compelled to enter the Almshouse. There are worthy aged men too for whom the Home is also intended, but who have not yet been benefited because of the need of larger accommodations.

Under these circumstances we earnestly appeal to the friends of the Home, and to the public, to aid us liberally, each according to his measure, in this effort to meet and relieve a most worthy class of our community.

Contributions may be sent to any of the Managers, or to the Treasurer
SAMUEL R. SHIPLEY,
111 South 4th St.
Philadelphia.

RULES AND REGULATIONS FOR THE GOVERNMENT OF THE HOME.

Rule 1.
The Matron shall have the entire charge of the Home, and keep it in neat order under the direction of the Committee of Management. She is to enforce the Rules, to be present at the meals, to see that they are properly served up, and every thing is on the table before the family are seated; that suitable nourishment is provided for the sick, and proper order is observed at the table. She must be respectful and kind to every one in the Home, and attentive (without partiality) as their circumstances require. She will promptly check any quarreling or other improper conduct in the inmates, and, if necessary, report the same to the Visiting Committee. She shall keep a record of all articles sent to the Home, whether purchased or otherwise, and an exact account of all expenditures, and furnish the Committee with a monthly account thereof. She will be expected to go through the house about 10 o'clock, P.M., and see that all unnecessary fires and lights are extinguished.
Rule 2.
No person will be admitted into the Home but such as bring satisfactory testimonials of the propriety of their conduct and the respectability of their character.
Rule 3.
Those received in the Home must be at least fifty years of age, and shall pay to the Treasurer the sum of fifty dollars. This Rule may be varied from if so directed by the Managers.
Rule 4.
Any property or personal effects which an applicant may be possessed of must be made over for the benefit of the Home prior to their admission therein; and if any inherit property whilst in the Home, and prefer remaining, the said property must likewise be transferred to the Managers for the use of the Institution; all such transfers being recorded in a book kept for the purpose.
Rule 5.
Colored persons over the age of fifty, of respectable character, and furnishing satisfactory references, may be boarded in the Institution, upon such terms as the Managers may decide; but shall be subject to the same rules, and have no privileges different from the other inmates. Satisfactory security must be given for the regular payment of the board previous to their admission.
Rule 6.
No boarder shall be received or continued in the Home to the exclusion of those entirely dependent. Two week's notice, however, must be given for the removal of any boarder.
Rule 7.
A register shall be kept of the names of all applicants, the persons by whom they are recommended, their place of residence, and the report of the Visiting Committee thereon, and any other information that may be deemed important.
Rule 8.
Those that are pensioners on any benevolent Institution or Society, it is expected will have their pensions continued to assist in their support, and that their funeral expenses shall be paid.
Rule 9.
Those received into the Home will be cared for without other expenses during their lives, provided the Managers have the funds.
Rule 10.
The inmates are prohibited from soliciting aid outside of the institution.
Rule 11.
None but the Physician of the institution or his substitute shall attend the inmates, unless he should request a consultation with another practitioner.
Rule 12.
After rising in the morning, and again before retiring at night, all who are of ability shall be assembled in a suitable room, and a chapter from the Bible read to them, after which an opportunity shall be afforded for silent or vocal worship.
Rule 13.
Religious meetings shall be held in the House on the first day of the week, at 10 1/2 o'clock, A.M., and 4 o'clock, P.M., for those unable or not desirous of attending elsewhere.
Rule 14.
Any one of the inmates may be visited (with their consent) for religious purposes at any suitable time, but if a religious opportunity is desired with all of the family, it must be first approved by at least two of the managers.
Rule 15.
A bell will be rung ten minutes before each meal, when all who are able will repair to the dining room. When seated, a suitable pause shall be observed before eating.
Rule 16.
The sick or infirm will be accommodated with meals in their own rooms, but all others will be expected to take them at the general table.
Rule 17.
It will be expected that all who are capable will make their own beds, and sweep their rooms, early every morning; such as are not will have it done for them.
Rule 18.
The inmates are expected to sew, knit or do any other services for the benefit of the Home of which they are capable.
Rule 19.
Any of the inmates desiring to visit their friends, must obtain permission from the Matron.
Rule 20.
If any of the friends of the inmates present articles for individual use or for general distribution, the same must be placed in charge of the Matron and furnished at her discretion.
Rule 21.
No stimulants or liquors to be used in the Home unless ordered by a physician, and then to be administered only by the Matron.
Rule 22.
No person will be permitted to interfere or find fault with the Matron. Any complaint should be made to the Managers for their action.
Rule 23.
All visitors shall be properly treated and shown through the Home, especially those visiting for religious purposes. Visitors will not be admitted before 10 A.M., or after 5 P.M., except in special cases.
Rule 24.
The strictest attention must be paid by each one of the family to these Rules. For the first and second offence, the Matron will admonish the offender; for a third, she will complain to the Visiting Committee; and for a fourth, removal from the Home, if so directed by the Board.
Section: 

1873: Sailor's Snug Harbor, Staten Island, NY

Summary: A very complete description of life in a self-supporting old-age campus in 1873 as described in an article written in Harpers Magazine.

Text from: Library of Congress: The Nineteenth Century in Print: Periodicals

The Sailor's Snug Harbor.
Harper's new monthly magazine.
Volume 46, Issue 272, January, 1873.

Drawing of old man sitting in align sunny corner

"THIS is rather a cold morning, isn't it?"

"Cold, Sir ~ She's a biter. Bless me if my toes ain't amost a-comm' off with cold!"

This was rather a curious remark, seeing that it came from a person whose lower extremities consisted of two wooden sticks from the knees down. I suppose that my countenance betrayed my astonishment at it, for the old sailor smiled, and, looking down at his sticks, continued, "You see, Sir, somehow or other the cold weather always loosens my straps, and I feel as if the pins were gem to shake me My old 'uns, of the real stuff, were left at San Juan d'Ulloa, in the Mexican war, and since then I have been hoppin' around on pedestals. But there's the Harhor now, Sir, and that's where I have been anchored these twenty years. Nice place, commodore. Was you ever there?"

I told the old man that it was just the object of my visit at the present time, and that I had come down on the boat for no other purpose. I also told him that I had a letter to Governor Melvill, and that I should be obliged to him if he could show me where to find that gentleman. Meanwhile the boat approached the landing, the gang-plank was drawn ashore, and heavy boxes, barrels, and bundles, containing provisions for the Harbor, were being carried on shore. Huge carcasses of beef and mutton came next, and after that came the living freight for the Harbor.

My friend seized his crutches, and coming up close to me, whispered into my ear: "Say, commodore, you are goin' to call upon the gov'nor, ain't you? Now, Sir, I will tell you how you could do a service to an old salt, if you wanted to There's Jack Stubbs; he rooms with me, and has got a wooden leg like me (but only one), and has been tabooed because he came home half-seas-over the other night. It was his old man's birthday, you see, and he had been celebratin' it up in the city. Now, Sir, if yen could lay in a good word for him with the gov'nor, saying that he didn't mean to do it, but that he was over-took suddenly, or somethin' of that sort, I think that the gov'nor would let 'im off cheap. Do what you can, commodore; Jack is a good boy, although he does love the bottle!"

I promised to do as asked, and we went together through the iron gate, and up the smooth walk leading to the centre or main building of the Sailors Sung Harbor. On our way thither I learned that the boy, Jack Stubbs, for whose benefit I had promised to interfere, was eighty-two years old, and that celebrating the birthday of the old man was only a slang term for getting a little the worse for liquor, which will, my friend with the wooden legs said, occasionally happen to some of 'em. Ascending the broad marble steps, we entered a large hall in the main building, lighted from above by a large oval window in the cupola, and occupied with chairs and benches placed across the floor, and leaving a narrow passage-way along the wall on either side. Just inside the door, and fronting the benches, was a reading-dcsk of oak with a red velvet cushion, and in the rear stood, on either side of the opposite door, two vases of terra cotta, filled with shrubs and flowers. A gallery went round the hall on all sides, at the height of the second floor, and above that was the cupola and sky-light. A large portrait of Captain John Whitten, who had once gone from Albany direct to China in a small sloop, and who subsequently was the first governor of the Harbor (from 1833 to 1844), faces the main entrance from the gallery; and above that is a well - executed bust, in marble, of the founder of this grand institution, Captain Robert Richard Randall.

"This way. Sir, to the gov'nors office!" and my friend hobbled round to the right, and knocked at a door facing the hall; "and don't forget to lay in a word for Jack Stubbs now, commodore, if you please", he had just time to repeat, in a whisper, when a loud "Come in!" summoned me to enter. It was a sung and comfortable office, seated in which, before a bright fire, was the genial governor of the Sailors Snug Harbor, Captain Thomas Melville.

After the usual salutations, I delivered my letters and credentials, and had at once cordial welcome extended to me. Feeling comfortable and at ease after my rough and cold trip down on tile boat, I did not forget my promise to my fellow-passenger with the wooden legs, but related to tile governor the promise that had been exacted from me. He laughed, and promised to forgive old Stubbs for this once, "although", he said, "he is one of the worst we have, On account of his intemperance, notwithstandiug his age. By making baskets he earns enough to go on a regular spree every fortnight, and if we put no restrictions upon him, the probability is that he would celebrate the old mans birthday some two dozen times year. By tabooing him is meant that he is not permitted, for a certain term, to go outside the iron railing. There is only about a week left of his term, and, as you desire it, I shall willingly forgive the old man that, and pat him upon his good behavior."

It must be said, however, in justice to the inmates of the harbor, that their conduct, with but very few exceptions, is irreproachable in every respect. It but seldom becomes necessary to taboo any body, and a still rarer occurrence is the expulsion of any. This last measure is only resorted to in cases where repeated drunkenness or disorderly and violent conduct renders it absolutely necessary. Out of a population in the Harbor of more than four hundred inmates, only five or six cases of expulsion occur in a year. There were, at the time of my visit, 396 inmates in the Harbor, of all ages and belonging to all nationalities.

Paragraph XI. of the by-laws of this institution declares: "All mariners, including captains and mates, if aged, decrepit, and worn-out sailors, are proper objects of this trust. But no person shall be admitted as an inmate of the institution (if a foreigner born) who can not furnish satisfactory proof of his having sailed for at least five years under the flag of the United States; and this further stipulation is made: No person shall be received for as a member of this institution who is a habitual drunkard, or whose character is immoral, or who labors under any contagious disease."

These are the only conditions regulating the admission of worn-out old mariners into the Sailors Snug Harbor. By the charity and generosity of the founder, Captain Randall, the gates of this snug harbor are open to every nationality and every creed. Of to the 396 inmates above mentioned, only 197 were native Americans, and these were of an average age of 57 years; the balance was mostly made up from the following nationalities:

England, 44, of an average age of 54 years.
Ireland, 33, "45 ".
Scotland, 14, "53 ".
Germany, 24,"55 ".
Sweden, 26,"51 ".
Norway, 10,"50 ".
Denmark, 10,"53 ".
France, 5,"41 1/2 ".

Then there were some from Poland, Malta, Cape de Verd, and the Cape of Good Hope. The average age of the inmates is 55 years; the youngest man in the institution was a young sailor of about 23, who had lost his rime sight by an accident, and the oldest was a colored man named Jacob Morris, who, at the time of my visit, had attained the ripe old age of 103 years.

Every morning at seven o'clock a bell calls all the inmates down to breakfast, which consists of a quart of excellent coffee each, and an abundant supply of home-made bread and butter. Dinner is on the table at twelve, and supper at half past five or six PM, according to the season. At nine in the evening all the lights must be put out, except the lamps in the halls and in the hospital, and the inmates are expected to retire to rest. Except when tabooed or on the sicklist, every inmate is at liberty to leave the institution, and visit his friends in the city or elsewhere. All he is required to do is to report to the governor before leaving and; upon his return. The gates are open for visitors every day during the week from nine in the morning till nine in the evening, except on Sundays, when no visitors are received.

The inmates were at their dinner in the large and attractive dining-hall when we entered it. This is situated on the ground-floor of a large building in the rear of the main or central building, with which it communicates by a wooden bridge, raised about tea feet above the ground. The largest dining-room contains twelve long tables, each of which can accommodate thirty-two diners. In another dining-room opposite there are four tables, each capable of accommodating the same number. The dinner on this particular day consisted of mutton-stew, which was served up in large tin tureens. The spoons and forks were of the best white metal, each bearing the stamp Sailors Snug Harbor, and the quality of the dinner was excellent. Each man had a tumbler of water in front of his plate, and of bread and meat as much as he desired. The table-linen was perfectly white and clean, and altogether the appearance of the dining-hall was more like that of a good substantial hotel than of a charitable institution.

Grace was said before dinner, and thanks were also offered after meals. Waiters, in long white aprons, were busily engaged among the tables in removing empty dishes and substituting filled and steaming ones in their places. Satisfaction and happiness shone in the face of every one; and I have no doubt that many an old sailor, at the bottom of his heart, on this cold and wintry day, silently blessed the memory of his benefactor.

There is nowhere another institution conceived in the same spirit of liberal and unlimited benevolence, the famous Greenwich Hospital not excepted; nowhere else does the old sailor, after having braved many a storm and frequently faced death, find so safe and snug a harbor. There, seated in a warm and comfortable room, he can through the window look out upon the scenes of his former life as a mariner; there is the deep blue sea, covered with numerous craft, reminding him of the time when he himself braved its dangers, and recalling adventures in foreign climes, that, sitting there by the window in his easy-chair, he is fond of relating.

Captain Robert Richard Randall, of the city of New York, by his last will and testament, dated June 1, 1801, after leaving certain specific legacies, bequeathed all the residue of his estate, real and personal, to the Chancellor of the State, the Mayor and Recorder of the city of New York, the president of the Chamber of Commerce, the president and vice-president of the Marine Society, the senior minister of the Episcopal Church, and the senior minister of the Presbyterian Church, in said city, and their successors in office respectively, to be received by them in trust, and applied to the erection of an asylum or marine hospital, to be called The Sailors Snug Harbor, for the maintenance and support of decrepit, aged, and worn-out sailors.

The institution was to be opened as soon as the income from the estate, in the judgment of the trustees, should seem sufficient to. support fifty seamen. But the persons thus designated as trustees being also the appointed executors of the will of Captain Randall, soon found themselves inconvenienced in the management of the estate by reason of the changes which took place in the ordinary course of elections and appointments to these offices, and therefore applied for, and in February, 1806, received, an act of incorporation from the Legislature. The first trustees were John Lansing, Jun., Chancellor of State; De Witt Clinton, Mayor; Maturin Livingston, Recorder of the city; John Murray, president of the Chamber of Commerce; James Farquar and Thomas Farmar, president and vice-president of the Marine Society the Rev. Benjamin Moore, senior minister of the Episcopal Church; and the Rev. John Rodgers, senior minister of the Presbyterian Church. At their first meeting they elected officers, adopted by-laws, and appointed a committee to prepare a suitable design for a seal for the corporation, the device of which, when subsequently adopted, represented a harbor formed by two points of land projecting into the sea, in which a ship appears riding safely at anchor, and on the shore, in the background, a view of the hospital, with the motto, Portum petimus fessi.

In October, 1806, the reported income of the whole estate was $4,243. Eight years later the annual income had increased to about $6,000; and in the same year the New York Legislature, owing to some difficulties which had arisen in determining who were the senior ministers of the Episcopal and Presbyterian churches, decided that the rector of Trinity Church and the minister of the Presbyterian church then located in Wall Street were of the trustees of said corporation. An act also was appended requiring the trustees to make an annual report of the state of the funds held by them to the Legislature of the State, and to the Common Council of the city. Thus the State and the city of New York were constituted the guardians of the trust. In 1817 the total income of the estate was $6,659.92; and during that year the trustees petitioned the Legislature for permission to change the site of the hospital. Instead of erecting it on the twenty-one acres of ground in the upper part of the city, as had been contemplated by the testator, which plan would absorb a large portion of their revenues, depreciate the value of the adjoining lots, and necessarily confine the inmates to narrow limits, they asked to be authorized to purchase ground for the hospital at the entrance to, or in sight of, the harbor of New York. A short time previous they had been tendered the liberal offer of a conveyance gratuitously of a lot of land, not less than ten acres, on Staten Island, situated on the bay between Point Diamond and the quarantine grounds, then belonging to, and offered by, Daniel D. Tompkins.

This permission was, however, not granted by the Legislature until 1828, after a delay of eleven years, the result of numerous lawsuits against the trustees by various parties that claimed to be the legal heirs of Captain Randall. Troubles and suits seemed to involve the estate upon all sides, and large sums of money were expended in disposing of them. It was not until March, 1830, that a final decision in this matter, by the Supreme Court of the United States, in favor of the trustees, set at rest all doubts as to the validity of the disputed will.

In May of the following year (1831) the trustees purchased their present site upon Staten Island, consisting of a farm containing 130 acres of land, for the sum (Of $10,000. Subsequently they purchased 21 acres more, with a water-privilege, which had been originally a part of this farm, but had been sold, and was used for manufacturing purposes, the price paid for this part of the property being $6000. These two parcels of land now constitute the farm and grounds of the Sail ors Snug Harbor At a still later period the trustees added to the farm, by lease, 36 acres of excellent woodland. In October, 1831, was laid the corner-stone of the main building, which, over a marble foundation, was built of brick, two stories high, with a portico supported by eight Doric pillars in Vermont marble. A broad flight of marble steps leads to the main entrance, and the centre of the roof supports a low cupola of an oval shape. This building, embracing all of what was then the Sailors Snug Harbor, was completed in 1833, and formally opened on the 1st of August of that year with great festivities, furnishing a home for thirty aged and worn-out sailors, Subsequently two wings were added to the main building, and connected with this by two covered corridors of one story each. These wings are built of the same material, and are of the same height as the main building, and are wholly occupied by sleeping apartments. The centre or main building has a frontage of 65 feet, with a depth of 100 feet; each of the two wings is 51 feet by 100; and the connecting corridors are each 39 feet 6 inches in length. Later yet the rear building was erected, of dimensions nearly similar to those of the main building, but three stories in height, the two upper stories being partitioned off into lodging and sleeping rooms.

In front of the main building is the marble monument erected over the remains of the founder, which were, in August, 1834, removed hither from their original place of internment.

After the successful termination of the numerous lawsuits and intrigues that had for such a long time embarrassed the trustees, the revenues of the estate increased at an extraordinary ratio; and as at the same time the value of the real estate owned by the corporation in the upper part of New York had more than trebled in value, it is not surprising that the income of the estate in 1855 amounted to the handsome sum of nearly $75,000, while the institution at that time supported three hundred inmates. And since then the animal income has kept on increasing, making for 1870 a total amount of about $127,000.

The greater part of the ground-floor in the main building is occupied by the hall already described, which is used in the winter months for religious services every morning and night, thus obviating the necessity of heating the chapel except on Sundays. All the buildings are heated by hot air from furnaces in the basements. To the left of hall is the reading-room, where all the leading dailies, weeklies, and magazines can be found; and behind that is the library, well stocked with books, mostly consisting of narratives of travel and adventure and a books of voyages and exploring expeditions. On the opposite side, to the right of the entrance, are the office and private room of the governor, and up stairs are time sleeping apartments, facing on the gallery. In the basement are long airy corridors and workrooms, where a great part of the inmates are occupied in basket-making. This industry is carried on to a very great extent in this institution, as it is easy work, requiring no strength or special skill, and a pursuit in line which the blind can also engage. The importance of this industry may be estimated from the fact that during a single year baskets were made by the inmates that sold in the market for nearly $30,000, averaging an income of about $75 for each inmate. These baskets are bought up mostly by two large New York houses, and a considerable proportion of them, as also of the mats made there, are shipped to and sold in Boston. The materials used in the manufacture of mats and baskets (Spanish palm leaf and rattan) are bought by the inmates themselves, and the whole profit belongs to them individually, and is for the greater part spent for tobacco and in the purchase of minor comforts. One old salt from New Hampshire had acquired a private library, numbering some forty odd volumes, which he had in his room, nicely arranged in a bookcase of his own manufacture, with glass doors. His latest acquisition was the History of Julius Caesar, by the ex-Emperor Napoleon, bound in green and gold.

In the basement are also some of the washrooms, furnished with iron basins and large towels on rollers, where the old sailors perform their daily ablutions and make their toilet, as washing in the rooms is prohibited. Passing through the wide and airy corridors, we found about sixty old men, some of them blind, engaged in basket-making, while at one end of the hall sat a blind man preparing the palm leaf for use, by splitting it and drawing it between two sharp knives fastened into a block of wood before him, by which it is cut into a uniform thickness and width. At the foot of the stairs sat a man, apparently not very old, and in good health busily engaged in finishing the centre piece of a knife-basket.

"Hallo, Davy!" Governor Melville hailed him, "how are baskets to-day?"

Davy, turning his lustreless eyes upon us, answered, "Dull, gov'nor, amighty dull; haven't sold a basket this fortnight. Think I will leave the basket business and go into mats."

This man, whose name was David James, was, I learned, the oldest inmate in the institution (though not by any means the oldest man), he being one of the thirty original inmates. He was then twenty-seven years old, and has been an inmate of the Harbor for thirty-seven years.

Here we also found, engaged in basket-making like the rest, a veteran from the war of 1812, named Daniel Collins, who had been twice captured in American merchantmen by the English cruisers. Nearly opposite him, with a large mat upon his knees, with which he was busily engaged, sat Cornelius Rose, an old white-haired and white-bearded sailor, who joined the American navy in 1812, belonged to the schooner Enterprise when she was captured by the English brig Boxer, and was one of the crew of time frigate President when, under the command of Decatur, that gallant ship fought three English frigates. He belonged to the old Constitution for nine years, and took an active part in the Mexican and Florida wars. His records and papers show that he has participated in no less than twenty-seven conflicts.

Besides basket-making the old sailors have other means of making money, one of the most common of which is fishing. A large proportion of the money which they accumulate, as we have already said, goes for tobacco. Of course no sailor can he tabooed for smoking.

On our way up stairs again the governor pointed out to me the Swedish lawyer, se called from his nationality, and the fact of his being, or considering himself as being, the bright particular star, concentrating within himself the erudition of the whole community. He seemed to be not unlike our friend Jack Bunshy, and at the very time when we passed him he was engaged in laying down his opinion to another sailor and I seemed to hear the familiar words, "Whereby if so, why not? The bearings of the observation lies in the application of it. Awast, then!"

Crossing the bridge, we again entered the rear building, the basement of which is occupied by the kitchen, the store-room, stewards office, colored men's mess, and blind men's mess. Here, also, are the apartments in which the assistants and employees of the institution take their meals. The blind men have two waiters to attend to their wants and assist them; but beyond some help at table, they require no aid, but navigate the whole building, up stairs and down stairs, assisted only by a cane, with which they feel their way. Here we meet one of the most interesting of the blind men just coming from his dinner. It is Captain John Mewen, who in 1813, while belonging to the privateer Vengeance, of New York, assisted at the capture of twenty-one British vessels. Afterward he became the captain of an East Indiaman, and was for many years a prominent, successful, and well-known master of ships in the East India trade. But misfortunes overtook him; he lost his sight, and consequently became unable to follow his profession, and he is now a much-esteemed inmate of the Harbor. Passing from this building, we cross the grounds to the hospital, stopping on the way to have a look at the steam-laundry and bakery.

The hospital is a magnificent and solid building of gray sandstone, built in the same style as the main building, with massive pillars supporting a portico over the entrance. In the basement are the kitchen and work-rooms for the convalescent patients who desire to work at their usual occupation -- basket-making. On the first floor is a large hall with a gallery or promenade overhead, and also the mess-rooms; and the upper story is occupied by the wards, which are all large, light, and airy, and have five or six iron bedsteads in each. On entering we were met at once by old Webster, who is now in the ninety-fourth year of his age. He was admitted an inmate of the Sailors Snug Harbor in 1844, then sixty-seven years old. It must be confessed that age has, as he said himself, "rather brought him down." His mouth is toothless, his eyes watery and dim; but his white hair and long white beard give him a venerable appearance. He speaks with difficulty, and is perfectly helpless at table.

"Well, Webster, how goes it?" the governor said, approaching him and wiping off his beard, full of crumbs of bread with his pocket-handkerchief.

"A-a-all ri-ght, gov-nor; b-but why don't the d-doctor c-come to see m-me?"

"Why, Webster, are you sick? If so, the doctor shall, of course, come to see you, and I will send for him at once."

"N-no, gov-nor, I a-ain't sick; but I'm a-getting old!"

"Well, the doctor cant help that, you know; but if you feel sick or need the doctor's assistance, why, then, of course, you shall have it at once."

"No, gov-nor, I d-don't want the d-doctor, if you will let me g-go out alone; I c-can t-tr-travel without a p-pilot!"

To this, however, the governor would not assent, much to the mortification of old Webster, who insisted that he was well enough to travel over to New York and come back again without an escort. He is remained at liberty to go out whenever he pleases if the weather is fair and nothing particularly is the matter with him; but he has always an assistant or a reliable brother inmate to accompany him and take care of him. This old man is, however, notwithstanding his age, of a very belligerent disposition; thus, a short time ago it became necessary to taboo him for a month because he knocked one of the patients on the head with his cane, getting excited during an argument over some small matter; and it was but a week previous to my visit that he challenged one of the younger boys of seventy-five outside to a personal combat as a means of settling a little difficulty between them.

We found lying in bed, in one of the wards, with a bowl of chicken soup on a small table beside him, a invalid, Charles Risby, Norwegian by birth, and seventy-seven years old. He arrived in this country at Boston on the day that the long embargo went into operation. During the war of 1812 he belonged to the Constitution, on board of which he participated in the fight with the Guerriere. In the same ward was Ebenezer Lakemann, who, while serving in the American privateer Buckskin, of Salem, Massachusetts, in 1813, captured the English schooner Marianne, which was recaptured, with him on board as prize-master, by the English frigate Maidstone. He was taken to England and imprisoned there, and afterward exchanged for one of the crew of the Guerriere.

In a ward on the opposite side of the hail, looking bright and cheerful, and ornamented with several bird-cages containing chirping and twirling canaries, we found old Jacob Morris (colored), who entered the Sailors Snug Harbor in the year 1848, then at the age of eighty. He was now in the 104th year of his age, and had, until very lately, been well and up every day, walking around the grounds as one of the youngest. "But, gov'nor," he said, "me getting feeble, sah; bery feeble! Me can not now leave bed, dinner, sah, bery weak in de joints, sah; and bosom pangs here--here!" and he pressed his hands against the left side of his breast. It was evident that he could not live long.

The wards for the sick were all well lighted by windows reaching from the ceiling to the floor, and well heated and ventilated. Nearly every room had bird-cages and flowers in it, and the walls were painted a delicate lavender, pleasant to the eye, and imparting a soft and cheerful appearance to the room.

Leaving the hospital we proceeded to visit the farm belonging to this institution, and were accompanied thither by another old veteran, John Strain. The products of the farm in 1870 amounted to $9,067.60. Allowing for expenses for conducting and stocking it $3,768.87 there a net profit of $5298.73, which is a very handsome exhibit. Among the articles raised may be named 5,465 eggs, 20,662 quarts of milk, 1,722 bushels of potatoes, 5,627 heads of cabbage, 2,990 heads of lettuce, 16,410 cucumbers, besides great quantities of carrots, radishes, beets, corn, onions, sweet-potatoes, squashes, watermelons, string-beans, etc., etc. The live stock consisted of 12 milch cows, 4 young heifers, 1 Albany bull, and 90 hogs, besides oxen and horses. Of poultry there are kept about 70 chickens, mostly for the use of the hospital. An ice-house is also erected here, in which is stored away the ice for the use of the Harbor, which is obtained from a pond situated on their property.

Away back, south of these buildings, lies a fine stone building, belonging to a society of ladies in New York and on Staten Island, but erected upon ground belonging to the Sailors Snug Harbor, which is occupied as a "Home for Destitute Seamen's Children." These ladies work in silence; there is no ostentation about the distribution of their charities. But they labor earnestly, and in a good cause.

The chaplain belonging to the Sailors Snug Harbor lives with his family in a large and comfortable house situated on the premises, in the rear of the chapel, which was erected in 1855. Here services are held every Sunday during the winter, and every day, morning and night, during summer. The chapel is a plain but handsome brick building, without any cupola or belfry, but with large stained windows. The interior is plain, but scrupulously neat and taste- fully decorated; and upon two long tablets, one on each side of the altar, are inscribed the names of all the trustees and officers that have been connected with the Harbor since its first opening.

The doctor also lives upon the premises, in a fine house situated near the road and facing the Kills, far in advance and to the right of the main buildings. The governors house occupies a similar position on the opposite side, to the left of the main buildings, and from both of these dwellings a flagged walk leads to the main entrance of the centre building. Directly in front of this, surrounded by an iron railing, is the plain marble monument that covers the remains of the founder of this noble charity.

The old sailors are not allowed to keep dogs. To some of them this is a great deprivation. These lovers of the canine species are obliged to gratify their peculiar tastes outside the limits of the institution. With one of them, known as the bone man, the passion for dogs amounts to a monomania. In order to render himself attractive to his favorites he fills his pockets with bones and wanders off into obscure haunts and by-ways, where he may often be seen surrounded and followed by his not entirely disinterested clients.

That the revenues of the Sailors Snug Harbor in the course of time will be largely increased when the long leases shall have expired, and their up-town property be released on more favorable terms than at present, there can be no doubt; and this will, of course, admit of a still further extension of the institution, and the accommodation of a still greater number of aged, decrepit, and worn-out sailors. The greater part of Mr. Stewarts store, situated on Broadway and Tenth Street, in New York, is erect- ed upon leased ground owned by the Sail- ors Snug Harbor, as are also many other costly stores and buildings in the upper part of ~he city. The resources of the institution are very ample, and they are honestly and judiciously applied in accordance with the design of the testator, being in the hands of gentlemen well known for their integrity, and of the highest social standing.

As I left I was accompaied to the gate by an old veteran, who told me that his, name was John Perz, and that he had been captured and taken to England a prisoner in 1814 by the British ship of the line Elizabeth, of seventy-four guns; and just us I got outside the gate somebody seized my hand and said, "Thank you, Sir, thank you; much obliged, Sir!" and turning round I beheld my friend of the morning on his two stumps, in company with the delinquent Jack Stubbs, who held his hat in his hand, looking somewhat sheep-faced, and staring at the knob at the end of his wooden leg. The governor had kept his promise: he was outside the iron railing, and consequently no longer tabooed.

Section: 

1880-1990: Living Arrangements and Marital Status of Elderly Women

Summary: Research by Dora Costa shows that older women were more likely than men to be unmarried even back in 1880, but the percentage living with their children has declined significantly since then.

Dora Costa has collected statistics on the marital status of elderly men and women from 1880 to today. She discovered that the percentage of older men and women who are married has hardly changed in the last century, and that throughout that period older women are only half as likely as older men to be married. She points out that the increased life expectancy of women is partly responsible for that difference in the later years. In earlier years, when there was not as much difference in life expectancy, women were more likely to marry men who were much older than themselves, so they often outlived their husbands. In later years, the percentage of women who were widowed began to decline, but it was compensated for by an increase in the percentage of divorced and never married women, while the percentage of age 65+ women who were married remained fairly constant.

This information is important in the study of long term care because married people are often able to provide and care for each other, while unmarried people have no partner to help them.

Marital Status of Men and Women Age 65+, 1880-1990

Year Men Women
Married Widowed Other Married Widowed Other
1880 72% 22% 6% 35% 58% 7%
1890 71% 23% 6% 35% 59% 6%
1900 65% 29% 6% 34% 61% 6%
1910 65% 28% 7% 34% 59% 7%
1920 65% 27% 9% 34% 59% 7%
1930 64% 27% 10% 35% 57% 9%
1940 64% 25% 11% 35% 55% 10%
1950 64% 24% 12% 35% 55% 11%
1960 69% 19% 12% 37% 52% 11%
1970 71% 17% 12% 35% 52% 12%
1980 75% 15% 11% 36% 52% 12%
1990 75% 14% 11% 39% 50% 12%

Source: Dora L. Costa, A House of Her Own: Old Age Assistance and the Living Arrangements of Older Nonmarried Women. (NBER Working Paper No. 6217, 1997)

Dora Costa uncovered some interesting statistics about the percentage of women who lived with family members as dependents from 1890 to today. She found that unmarried women, whether they were widowed, divorced, or never married, were far more likely to be living with family members than married women throughout this period. However, she also determined that all women, regardless of marital status, have become less likely to live with family members than they were 100 years ago, and that they have become much more likely to be living independently in their own homes as the head of household or the spouse of the head of household. Her study found that this change was strongly related to the availability of income from pensions and old-age assistance programs in the latter part of the century.

Dependency and Living Arrangements of Women Age 65 or Older, 1890-1990

Married Women

Year Head of Household or Wife of Head Living With Family as Dependent Boarder or Other
1890 89% 10% 1%
1900 87% 12% 1%
1910 88% 11% 1%
1920 89% 9% 2%
1930 - - -
1940 91% 7% 2%
1950 92% 6% 2%
1960 96% 3% 1%
1970 97% 2% 1%
1980 98% 2% 0%
1990 98% 2% 0%

Widowed Women

Year Head of Household or Wife of Head Living With Family as Dependent Boarder or Other
1890 36% 57% 7%
1900 40% 54% 6%
1910 42% 53% 5%
1920 42% 53% 5%
1930 - - -
1940 51% 43% 6%
1950 52% 41% 7%
1960 65% 29% 6%
1970 72% 26% 2%
1980 83% 16% 1%
1990 85% 14% 1%

Other Women

Year Head of Household or Wife of Head Living With Family as Dependent Boarder or Other
1890 21% 59% 20%
1900 29% 51% 20%
1910 25% 56% 19%
1920 32% 51% 17%
1930 - - -
1940 41% 41% 18%
1950 45% 39% 16%
1960 65% 25% 10%
1970 64% 28% 8%
1980 81% 18% 1%
1990 78% 16% 6%

Source: Dora L. Costa, A House of Her Own: Old Age Assistance and the Living Arrangements of Older Nonmarried Women. (NBER Working Paper No. 6217, 1997)

Section: 

1881-1930: History of Nursing in Michigan

Summary: A chapter from the Medical History of Michigan that illustrates the way that nurses were involved in both home and institutional care.

Library of Congress: Pioneering the Upper Midwest: Books from Michigan, Minnesota, and Wisconsin, ca. 1820-1910

A chapter from the Medical History of Michigan. The book in its entirety is online at:
Medical History of Michigan, Volume I. (Michigan State Medical Society, 1930).
Medical History of Michigan, Volume II. (Michigan State Medical Society, 1930)

History of Nursing in Michigan

To Miss Marie Belle McCabe, of Grand Rapids, should go the credit for the portion of this chapter on nursing.
She bestowed many months of hard, painstaking work upon the gathering of the material, and has selected, arranged and drafted it. My part has been merely to give a certain direction to the project, to add a bit here and there, and to edit the manuscript. Some of the items, particularly her descriptions of nurses' uniforms, reflect clearly a feminine viewpoint and could not have been readily conceived by the masculine mind. We believe that they will be appreciated by our women readers.

We think that the facts contained in the chapter are essentially correct, although necessarily Miss McCabe was obliged often to rely on the personal recollections of those who have been devoting their lives to this field of endeavor. For lack of space and because our sources of information were to a considerable extent limited, much that would have been of interest has been omitted or passed over with brief mention. We regret that questionnaires remained sometimes unanswered and that we thus have not had access to data upon which an adequate account might have been given of certain nursing institutions and the work of individual contributors to this field.
We believe that our readers will find in this chapter not only a brief history of nursing in Michigan, but also a short, reliable account of the present state of many of its institutions. (R. R. S.)

The basis for all nursing was the care that the mother bestowed upon the members of her household in time of illness. Her anxiety for her loved ones, along with her desire to give aid and relief to the suffering, made her gentle and painstaking in the methods she used. At first, the mother was concerned with her own family, but as settlements grew larger, she would offer her services to a neighbor in time of trouble. Apparently there was no need for greater skill than that acquired by experience within the family and the neighborhood. Certain women, however, were handier in caring for the sick than their neighbors; naturally they would be called into service very often. Gradually, women, because of their natural inclination and repeated experience, were set aside by the neighborhood to minister to the sick. These women were called nurses.

As communities grew, the limits of friendship were less observed and women skilled in giving aid to the suffering were called into homes of strangers and would receive remuneration for their services. This was the beginning of the practical nurse for hire, and for decades she was sufficient for the needs of the people.

A curious transformation occurred. The gentlewoman retired from nursing, leaving this service for the menial to perform. Then we find the Grace Pools and the Sairey Gamps of literature, with their slovenliness, drunkenness, and immorality. When hospitals were first established, the nursing was done by these untaught hirelings. Since these nurses were also the scrub women, the scullions and the cooks, and all this for a very small wage, they were usually of inferior mental capacity and desirability. They were often morally vile and incompetent. As a reaction to these distressing conditions, arose the ideals that brought into being the nursing profession as it is known today.

Florence Nightingale, back in the first half of the nineteenth century, had the vision of what type of person should be entrusted with the care of the sick. She knew that intelligence, cleanliness and morality were fundamental characteristics. When she established her training school for nurses in England, the pupils nurses were selected with these qualities in mind. With the rise of scientific medicine and surgery, physicians recognized that the care the patient required was too complicated and exacting to be entrusted to the untrained, old type nurse, and they were ready to help usher in a new order of nurses. Nurses of high ideals of service had a difficult task, however, in obtaining recognition. Doctors and the public were accustomed to the unskilled and ignorant nurse, and were slow to accept the intelligent, educated woman whose training made it possible for her to follow orders accurately in the scientific care of the sick and whose presence in the sick room added so much to the mental comfort of the patient.

Michigan felt the need of the nurse many years before she arrived. In a history of Detroit published in 1834, the lack of a sufficient number of nurses to care for the sick and for orphans was mentioned with regret. And later in that year, when the whole vicinity was suffering with cholera, Father Kundig organized a Catholic Female Association, whose members would devote their time to nursing as long as the community needed them. Even at the time of the Civil War, there were no trained nurses. There were a few hospitals in the state, but the care of the patients was intrusted to convalescents and hired men and women. The first University Hospital at Ann Arbor was built in 1869. The early records show that the male patients were cared for by the handy man about the hospital. Two practical nurses were employed to attend the women patients. Another hospital, at an early date, recorded that it was difficult to have all patients cared for properly. The hospital paid wages varying from $3.00 to $10.00 a week for practical nurses, but there was never any assurance that the new day would find a complete corps. The women employed were very unreliable and would resign their positions without notice. It is also recorded that the hired nurses were likely to neglect the disagreeable patients when caring for the kindly disposed was more congenial to them.

The Michigan hospitals were not unique; these conditions prevailed all over the country. The way out of the difficulty was met by Bellevue Hospital in New York, by establishing a training school for nurses in 1873. Sister Helen, a Roman Catholic nun, who had been associated with Florence Nightingale, was secured to open the school. Within six years from the date of the establishment of this first nursing school, nine other schools were started; most of them in the East.

When the Sisters of Charity and the Sisters of Mercy began to come into Michigan, they established asylums for the sick and the friendless. They could not pay for the nursing of their charges, therefore they started training women who could help them in this needed work. At first, the training was offered to sisters and novices of the particulars order, but after a time, the need for trained nurses who could go out into the community was so great that the privilege was extended to the laity.

Many physicians associated with the early Michigan hospitals realized that the way to have trustworthy nursing for their patients was to provide some sort of training. Dr. John Harvey Kellogg, a young physician coming into Michigan from New York City to take charge of the Battle Creek Sanitarium in 1874, found that if he was to have skillful nurses for his surgical and medical patients, he would have to train them himself. He was a student in Bellevue Hospital Medical College when the training school for nurses was established. Since he knew what might be accomplished, he began giving short courses for nurses and attendants. The course increased to six months and included technic in hydrotherapy and massage. Gradually the course was extended and a formal training school for nurses was opened in 1883. At the time Dr. Kellogg was teaching men and women how to give skilled care to his critical cases, the doctors of Harper Hospital in Detroit were feeling keenly the need for trained nurses. The result was the opening of the Farrand Training School for Nurses in 1883. The school was named in honor of Dr. David Osborne Farrand. The idea upon which this school was founded was, "That it should be a school open to women of culture and stability, who would become pupils with a view of making nursing a life work, and it should be so well established that eventually it would furnish trained nurses not only for Harper Hospital, but for the community at large." In the establishment of each training school in Michigan, the purpose was evidenced by some such expression as "in response to the community's growing need for graduate nurses."

Up to 1890, Michigan had four training schools for nurses; one in Battle Creek, one in Detroit, one in Grand Rapids, and one in Saginaw. The next decade saw twelve more schools established, and, strange to say, all twelve were in the immediate neighborhoods of the early ones. However, from 1900 through 1910, twenty other training schools were founded. These were distributed over the state, three being in the upper peninsula. There were a number of schools which, for one reason or another, ceased to thrive and went out of existence. At the present time, there are forty-nine accredited schools of nursing in Michigan, all endeavoring to give careful training to their students.

During the infancy of the early schools, there was little uniformity in class instruction or in subject matter. The degree of proficiency of the training was in direct proportion to the vision of the superintendent of nurses and her advisory board. There also was wide variation in the age requirement for entrance. Some of the training schools would enter any adult, while some limited the age, as did Blodgett Memorial Hospital, to women between the ages of 25 and 35. Little attention was paid to preliminary education. Marked attention however was paid to high moral character, good disposition, and good health. The candidates were obliged to qualify in these three attributes. One early school deemed proficiency in house work before entrance a very desirable accomplishment.

Since the organization of the Michigan State Board of Registration of Nurses in 1910, there has been a greater uniformity in the courses offered in the choice of subject matter in the training schools throughout the state. The entrance age limit is now defined to be eighteen by law, but there are still training schools that refuse entrance to those so young. The Farrand Training School of Harper Hospital requires that the applicant be at least nineteen. Michigan law also demands that the applicant shall have completed the tenth grade before entering a training school. In this respect, again, Michigan training schools show some variation. Although no accredited school enters a student with less than two years of high school, several schools expect three and four years. The training schools in connection with the following hospitals demand the completion of high school before a pupil is accepted: University Hospital, Ann Arbor; St. Joseph's Hospital, Ann Arbor; Harper Hospital, Detroit; Children's Free Hospital Detroit; Henry Ford Hospital, Detroit; Battle Creek Sanitarium and Hospital, Battle Creek; Mercy Hospital, Grayling; St. Luke's Hospital, Marquette; Hackley Hospital, Muskegon; Edward W. Sparrow Hospital, Lansing; Blodgett Memorial Hospital, Grand Rapids; and St. Mary's Hospital, Grand Rapids. At the present time, regardless of the legal requirements, student nurses themselves realize the value of good preparation, and most of them enter the training school only after the completion of a high school course. The State Board of Registration of Nurses, in going over its files for 1929, found that 79.8 per cent of the nurses applying for registration had a high school diploma. Only 15.6 per cent of the nurses seeking registration were adhering to the minimum requirements. The State Board, also, finds that each year shows an increasing number of graduate nurses who have had a partial or complete college course.

The length of time spent in training has increased. At first some of the courses were but six months long, others as long as eighteen months. But by 1900 all of the better schools of nursing gave a training of at least two years. The law limits the course to a minimum of two years; at present, all but five of the schools offer three year courses. Three of these schools affiliated with the State University or colleges combine in five year courses, and graduates obtain a Bachelor of Science degree. The five training schools with courses less than three years exceed the minimum two years by six months.

Class work in the early training schools did not occupy the important place it does today. Staff doctors did much in the instruction of student nurses. Naturally it was done in a rather haphazard way, for it was difficult for the physician to fit the work of instruction into his daily routine and classes were held with too little regularity. The superintendent of nurses was, of course, held responsible for the instruction of the pupil nurses and she helped them in nursing procedures. She, also, with many other duties to fulfill, was likely to find her day too full for formal class periods. One school records that for the first three years of its existence it averaged eight lectures a month to student nurses. A report of the superintendent of another pioneer hospital states that no lectures had been given to the nurses that year. She hastens to say that the fault did not lie entirely with the doctors. The work was too heavy for the number of workers, and the nurses had no time to attend classes. But the elaborate course of study outlined by the National League of Nursing Education in 1927 shows how far nursing education has advanced since its inception in 1880.

Not only has the course of study become more inclusive and technical, but also the instruction has become more regular and assured. Getting away from the early days in which physicians and superintendents of nurses assumed the entire responsibility of educating the young nurses, every training school today employs a registered nurse for this purpose. Some of the larger schools employ several such instructors. Many of the training schools are augmenting this teaching with that of experienced teachers outside the medical and nursing professions. In 1912, the Children's Free Hospital of Detroit enrolled their students for a course in chemistry given by the Cass Technical High School. Soon other training schools began sending their probationers to Cass for instruction in the basis sciences: Chemistry, anatomy and physiology, bacteriology, dietetics, psychology, materia medica, and dietotherapy. The plan gave the students the opportunity of receiving instruction from specialists in each of the sciences. Moreover, the instructors of nurses are given more time for following up the practical procedures in nursing technic. Making use of the public schools was next tried in Grand Rapids. Two of the hospitals, Butterworth and St. Mary's, sent their beginning students to the junior college for the basic sciences in September, 1918. The following fall, Blodgett Memorial joined them in the movement. With the rise of junior colleges throughout the state, other schools for nursing have followed this example and are sending their student nurses to the college for class work, or by having the college teachers meet the classes in the hospital. Many hospitals give their dietitians to teach dietetics and dietotherapy to the nurses. Some hospitals employ registered pharmacists to hold the classes in materia medica. Two of the hospitals founded by the Sisters of Mercy have engaged priests to teach the nurses psychology and ethics. It is interesting to note that in both cases the priests hold Ph.D. degrees in psychology. It is not to be questioned that nursing procedure and clinical instruction must be given by nurses and doctors, since they are expert in these fields. More and more our hospitals are arranging with doctors, as well as with instructor nurses, to carry on this work. The present directors of training schools are putting forth a painstaking effort to secure an expert teaching force.

Three of the Michigan schools for nursing are affiliated with institutions of higher learning. They permit their students to take academic work leading to a Bachelor of Science degree and to have the hospital training at the same time. These schools offer a three-year course as well. The University of Michigan grants a B.S. degree to students in the University Hospital School for Nurses who complete the five-year course. The Edward W. Sparrow Hospital for Nurses is affiliated with the Michigan State College at East Lansing for the five-year course. Battle Creek College receives the nurses from the Battle Creek Sanitarium and Hospital School for Nurses when then enroll for the five-year course. Nurses receiving degrees from these three institutions must have met all entrance requirements of their college. Those graduating after the five-year course must be examined by the State Board before they are permitted to use the title of R. N.

Michigan schools for nurses not only offer a very excellent opportunity for training in their own hospitals, but they sponsor scholarships and loan funds that enable their graduates to study further. The Farrand Training School of Harper Hospital, Detroit, offers an annual scholarship from the Lystra Gretter fund that may be used for advanced study. The Foster Foundation of Grand Rapids grants $1,000.00 each year to a nurse graduating from any one of the three local hospitals. It is awarded to the nurse who passes with the highest mark a competitive examination which is given to representatives from the three training schools. The Michigan State Nurses Association now maintains a fund from which two loan scholarships may be granted each year. One scholarship may go to the graduate nurse who wishes to enter a Class A college. The other scholarship may go to a graduate nurse desiring to study public health nursing, provided the nurse selects a school with a well organized public health department. The Michigan State Nurses Association scholarships are granted to nurses who are between 23 and 45 years of age. All of these scholarships are granted to those who have had at least one year's experience. More and more the graduate nurse is encouraged, either by her own training school, or by other agencies, to do advanced study which will help her grow in her profession. It is recognized that the further development of the nursing profession depends upon graduates of unusual ability. With all other conditions equal, the nurse with the best training can make the most valuable contribution.

Nurses far removed from the conditions that controlled their lack of fitness in the early nineteenth century, and ever inspired by such leaders as Florence Nightingale to carry on against all odds, have developed into a glorious band of intelligent, expert workers, with ideals that are commensurate with the dignity of their service. The Michigan nurse has not been slow to fill her rightful place in the nursing activities of the world, and in many instances she has taken a leading part.

The Florence Nightingale Pledge

† Pledge administered first to Farrand Training School, now adopted by many training schools throughout the state.

"I solemnly pledge myself before God and in the presence of this assembly, to pas my life in purity and to practice my profession faithfully. I will abstain from whatever is deleterious and mischevious, and will not take or knowingly administer any harmful drug. I will do all in my power to maintain and elevate the standard of my profession, and will hold in confidence all personal matters committed to my keeping, and all family affairs coming to my knowledge in the practice of my calling. With loyalty will I endeavor to aid the physician in his work, and devote myself to the welfare of those committed to my care.--(Mrs.) Lystra E. Gretter, Farrand Training School for Nurses, Detroit."

The number of young persons who at present select nursing for their life work has increased since the latter part of the nineteenth century. Up to the year 1890, there were less than fifty students enrolled in the training schools for nurses in Michigan. In 1921, 1,575 men and women were studying nursing. In making this comparison, it is only fair to state that by 1921 the number of training schools had so increased that any locality of the state was within a reasonable distance of at least one of them. The proximity of such schools possibly had something to do with the increased interest in nursing. Of course, the population of the state had increased. While these factors all contributed, there is no question but that the ideal of service and the glory of the profession made a very strong appeal to the young person of character. The nurse played such an unselfish and heroic part during the World War, that she won respect from all observers. Her growing interest in the social conditions of her own locality and of the world was making her an outstanding citizen. Young girls were attracted by the nurses and nursing activities, and so it is not surprising that many of them elected the profession. It is pre-eminently a woman's work.

Again, a nurse's training may be gained with comparatively little expense to the student. Usually no fee from the student is asked, and hospitals occasionally pay the student nurse a small sum to cover the expense of uniforms and books. This money is not considered a remuneration for what work she may do in the hospital. The cost of the training for each student is much greater than the actual money value of the service each girl can perform for the hospital. Training for no other profession can be gained at so little expense. Hospital boards feel that the service the trained nurse can give to the community more than pays for the training. 

Years ago, when hospitals were less certain as to what should comprise a suitable training for the nurse, and the question was being debated as to what a nurse might owe the hospital for this training, the student performed heavy labors and worked long hours. It was a Michigan hospital, Harper Hospital of Detroit, that first established the eight-hour day for nurses. This standard day for women was not only accepted by other hospitals throughout our country, but also laws were passed to protect women in industry from a day too long to maintain good health. While Harper observed the eight-hour day for its students as early as 1891, some of the hospitals have only recently limited the nurse's working time to a fifty-six-hour week.

The purpose of many training schools today is not only to train the young nurse in the care of the sick, but to supply a carefully controlled social background as well. The "house mother," "social directors," and superintendents of nurses are awake to the needs for recreation and social contacts. The homes of the student nurses are more than housing quarters. They are homelike, have artistic living rooms, libraries supplied with books other than texts, and music rooms furnished with pianos, phonographs and radios. The well equipped kitchenette offers facilities for teas and suppers. Nurses are frequently given the opportunity for choral singing, public speaking, and dramatics. If the school has no gymnasium, it often rents one, and students may thus take part in basketball, folk dancing, and other indoor sports. Life in the nurses' home offers the same social advantages as that in the college dormitory. Thus the student nurse learns to balance her day with work and play.

Since 1880, when some kind of training was first offered in Michigan to persons who wished to care for the sick, many training schools have sprung into existence, some to weather the difficulties that beset them and others to fall by the wayside. Every hospital that offered a nurse's training contributed to the rise of the nursing profession in Michigan. When a hospital discontinued its training school, either because of the force of circumstances or for other reasons that seemed desirable, it did not withdraw from active its graduates who were already raising the standards in the field of nursing. Nor was the influence which the school initiated during its existence completely lost when it no longer accepted students. Such a training school as the one connected with the Homeopathic Hospital of the State University was a pioneer in advancing nursing education. The Lockwood Hospital and Deaconess Home in Petoskey offered one of the first training schools in that section of Michigan. The nursing school at the Ann Arbor Private Hospital was disbanded when progress in the educational program and the facilities of the University Hospital School for Nurses made it possible for it to care for all the student nurses in the vicinity of Ann Arbor. Dr. Reuben Peterson and Miss Fantine Pemberton, the two persons who organized the Ann Arbor Private Hospital Training School for Nurses, were very active in developing a program for nursing education for the University training school. The training schools connected with the Paulina Stearns Hospital in Ludington, St. Joseph's Hospital in Menominee, and the Samaritan Hospital in Detroit were discontinued in 1923, after years of successful teaching. Unstable economic conditions caused the Calumet and Hecla Hospital of Calumet to dispense with its training school. The Newberry State Hospital stopped giving nurses' training after 1921. Today, along with six other hospitals, it offers a course for the training of attendants. This brief mention of those schools which have gone out of existence as such, and not live only in the lives of the nurses who were influenced by them, does not begin to evaluate their service. No more will be said of them, however. In the following pages only schools recognized by the State Board of Registration of Nurses and Trained Attendants in 1929 will be included. The schools will be considered in chronological order. Whenever possible, the oldest schools will receive special mention because they "blazed the trail" for the training schools that followed.

Michigan College of Medicine Training School for Nurses, 1881

In 1881, the Michigan Medical News reports, "It gives us pleasure to announce the establishment in this city [Detroit] of a training school for nurses. The work has been undertaken by the Michigan College of Medicine, and the coöperation of a number of prominent citizens and ladies has already insured its success. The Michigan College of Medicine is entitled to credit for the innovation. For $25.00 and two years study and practice of their profession, they [the nurses] will receive $216.00 and be prepared to earn at least $10.00 a week in this remunerative and useful field of work for women." This notice is the only record of the training school which has been found. How long the school existed and how many nurses it trained are undetermined. Nevertheless, this school has the honor of being the first formal training school for nurses to be mentioned in print in Michigan.

Farrand Training School for Nurses, Harper Hospital, 1883

Two schools for nurses were organized in the year 1883. These schools are outstanding today because of the breadth of their work and because of their influence in the development of nursing. Certainly a pioneer in nursing education in the middle West, as well as in Michigan, was the Farrand Training School honoring Dr. David Osborne Farrand. It was established in connection with Harper Hospital, Detroit. The only trained nurses this section of the country had known up to that time were from one of the very few training schools in the East or Chicago. There was also a dearth of physicians. Dr. Farrand, as well as other doctors, felt that medical service could be extended over a greater field if the physician could leave at the bedside of a critical case a reliable, skilled nurse. The Farrand Training School was opened with the ideal of training women of culture and stability who were willing to make nursing a life work and who would care for the sick not only in Harper Hospital, but in the community as well.

The first principal was Miss Emma Hodkinson, a graduate of the Bellevue Hospital Training School for Nurses in New York City. The early entrance requirements were credentials of good health and character and a good education. Entrance was limited to women between 24 and 35 years of age. The length of training was eighteen months. While the curriculum was made up of but few subject, the records show that from the beginning the program was systematically and carefully observed. The classes were taught by the principal. The subject matter for each course was very carefully selected to fit the needs of the nurse.

If not from the first, at least at a very early date, the Harper nurse's uniform was made from a distinctive checked gingham manufactured in England exclusively for the Farrand School. The good is now woven in this country, but the design has never been changed. Needless to say, the style of the uniform has been changed from time to time, as fashion dictates.

Mrs. Lystra Gretter, of the Buffalo General Hospital, became the principal within the first five years of its beginning. She guided its destiny for a period of twenty years. The purpose of the school has always been to keep pace with the demands of the community. Mrs. Gretter rearranged, lengthened, and added to the curriculum that these needs might be met. The eighteen months of training was extended to two years. This satisfied only for a time and in 1891 a three-years course was developed. The year 1891 was an important one for the nurses of Harper, as well as other hospitals, and for women in industry everywhere. Harper adopted the eight-hour day for its nurses. It was the first hospital in American to take such reform measures, and for several years it stood alone in this idea. The result of that radical step has been harvested by women in employment around the world.

The course of study has often been revised to meet the increasing demands upon the nurse. When Harper joined other Detroit hospitals in sending their beginning nurses to Cass High School for instruction in the basis sciences, the total corps of the school's instructors was maintained. This made a teaching force to give adequate supervision to the nurses on duty. Now the training school has its own class room unit, including a well equipped laboratory.

The Farrand Training School opened with a registration of seventeen pupils. Now the enrollment is two hundred. The entrance requirements have changed somewhat. Graduation from a high school is considered the minimum educational background and an applicant may be accepted if she is as young as nineteen.

During the forty-six years that Farrand has been training nurses, it has always stood for excellency and proficiency in nursing technic. The able women who have served as principals have left their stamp not on students alone, but on the nursing profession in the state. Many illustrious names in the field of nursing social welfare are to be found among the 1200 graduates from this school.

Mrs. Gretter was interested in every progressive movement in nursing. She contributed in a large way to many branches of the service. Her ideals for the nurse are expressed in the Florence Nightingale Pledge, which was written by her and her Committee on Nursing Education for the class of 1893. Because it expresses superior ideals for women entering the nursing profession, the pledge has been adopted by other training schools. Hundreds of young nurses have agreed to the covenants of the pledge on commencement days.

Miss Matilda Krueger, of the class of 1907, followed Mrs. Gretter as principal of the training school. Miss Krueger was called from this post to take a very important place in the nursing service of the American Red Cross in Serbia. She died while serving her country.

Miss Emily McLaughlin, 1896, then took charge of the training school for the next nine years. Miss McLaughlin had served during the Spanish American War. When her country needed her again, she organized the nursing force for Unite 17 which did such faithful work during the World War.

Miss Margaret McDermid was left in charge of the school when Miss McLaughlin went overseas. She was followed by Miss Lula B. Durkee, 1894. Miss Durkee had also seen service in the Spanish-American War.

Other alumnæ that have become prominent in nursing circles are Miss Alice Bowen, 1889, who established the Visiting Nurse Association of Detroit; Miss Agnes Deans, 1895, who organized the Central Directory for Nurses and who became an executive in public health work under Miss Delano; Mrs. Elsbeth Vaughn, 1904, who assisted Miss Delano during the war and is now with the American Red Cross in St. Louis, Missouri; Miss Elizabeth Parker, 1888, who held important positions in nursing work in the state, especially in the tuberculosis crusade, the State Nurses Association, and on the State Board of Registration of Nurses.

These are but a few of them. There is, unfortunately, no space in which to mention all of the graduates who served in times of disaster and in wars, nor those who are serving in hospitals and private homes, and in community work.

Battle Creek Sanitarium and Hospital School for Nurses, 1883

When Dr. John Harvey Kellogg, a recent graduate from Bellevue Hospital Medical School in New York, took charge of the Health Reform Institute in Battle Creek in 1874, he found that he needed men and women with some scientific understanding of the care of sick to assist him in his work. From time to time, he organized the "family of helpers" into classes, in order to give demonstrations of technic in nursing procedure. He augmented these demonstrations with lectures on physiology and hygiene. Dr. Kellogg was so interested in spreading the gospel of healthful living that, when time permitted, he taught classes in the community the value of sufficient rest, proper foods, and wholesome exercise for the maintenance of health. Out of these classes grew three schools; the school of nursing, the school of dietetics, and the school of physical education.

Dr. Kellogg was still a student in Bellevue when the first American training school for nurses was opened. It was in 1883, however, when he and his associate, Dr. Kate Lindsay, organized the three months' course for the instruction of nurses in connection with the sanitarium. Within the year they increased the curriculum so that a two years' training was established. The first class, with a membership of seven, was graduated in 1886.

Both Dr. Kellogg and Dr. Lindsay were vitally interested in scholarship and learning. They taught the first class themselves. Dr. Kellogg would give the theory and Dr. Lindsay followed up with the practice. After Dr. Lindsay's time, the records show that when a class did not exhibit proficiency in a certain procedure that Dr. Kellogg deemed necessary, he would take over the instruction of that class. No doubt, the success of this school through the years is due, in part, to the constant seeking after knowledge by its founders and the incorporation of the findings into the course of study given to student nurses; and also, in part, to the careful way of teaching.

A report of this school of nursing published in 1896 stated that for several years the course of study had included anatomy and physiology, hygiene, surgical nursing, practical nursing, hydrotherapy, and cookery for the first year students. The second year students studied massage, manual Swedish movements, cookery, and disease. The young women were given procedures in obstetrics and gynecology. A knowledge of general housework was considered important.

The student girls shared in the ironing, while the men cleaned the carpets. Both men and women students acquired skill in caring for the patients' room and in setting trays. Young men and women would sometimes attempt to take the training without a sufficient educational background. Under the circumstances, the sanitarium maintained them while they learned the rudiments of an "English" education. Consequently, the date of graduation for these nurses was delayed.

Nurses in training constantly had the ideal of service for others held before them. Among the first students, Christian Health Bands were organized. These bands of nurses would use their leisure time visiting the lonesome and the sick. They gave bedside care whenever it was needed. They always tried to leave some message of cheer and helpfulness, either in words or by gifts. From this practice has grown the out-patient department that today offers community nursing to Battle Creek and vicinity. The benefit is not felt by the community alone, because the nurses are getting excellent training in public health service.

The Christian Health Bands aroused such a desire to help others by caring for the sick and by teaching healthful living that many of the members volunteered for mission work. This spirit so permeated the school that the name was changed to the Battle Creek Sanitarium Missionary Training School for Nurses. The students volunteers felt the need for a more extensive and intensive training before they entered into such responsible work, and a five-year course was given to them. This course included religious training as well as a ramified nurses' training. From this course, several of the young men entered medical school and are practicing physicians today. The five-year course was discontinued after several years.

The year 1888 was noted not only for the beginning of this five-year course, but it also marked the introduction of scientific cooking into the training course. Mrs. C. E. Kellogg, a scientifically trained women, converted her kitchen into a nutrition laboratory, and after thorough experimentation, she brought her findings to the cookery classes for the nurses.

The student nurses were not receiving as complete a training as Dr. Kellogg and his staff wished, and so a general hospital was added to the sanitarium in 1887. This made it possible for the nurses to have experience in all nursing services except in contagion and mental cases. The name of the school was again changed to Battle Creek Sanitarium and Hospital School for Nurses.

An important change took place in 1923, when the management of the Battle Creek Sanitarium and Hospital bought the buildings of the old Battle Creek College and housed the three schools, School of Nursing, School of Physical Education, School of Home Economics under one roof. These three schools became the nucleus for the present Battle Creek College. Two years later, the College of Liberal Arts and Sciences was added. Battle Creek College wan then granted full recognition as a four-year college worthy to grant the baccalaureate degrees by the North Central Association of College and Secondary Schools.

Mrs. Mary Staines Foy, who has been the director of nurses since 1899, and who was ever watching for opportunities for expanding the curriculum of the training school that it might become of still greater service to the students, saw her chance. She and Mrs. Louise Gleim-Fischer assumed the task of reorganizing the nursing school so that two courses might be offered. One course was for three years. It prepared the student to take the examination for registration. The other course was for five years and led to a scientific degree, as well as giving an adequate training in nursing. The subjects required of all the student nurses were put in three consecutive years, during which time hospital training was given. Five-year students spend the other two years in the literary college, preferably before entering the school for nursing. The three-year course was planned for a curriculum which totals 1,025 hours of class work. This is 200 hours more than that suggested by the standard curriculum; 196 of these hours are devoted to hydrotherapy, electrotherapy, and massage. Mrs. Gleim-Fischer was made dean of the school of nursing and remained in that position for three years.

The educational requirements for entrance were raised to meet the college requirements. This school of nursing, along with other schools in the state, is finding that applicants for admission are presenting ever higher educational attainments. The later classes have had a sprinkling of students with some college training. The classes of 1927 and 1928 each had seven college graduates among their number.

The school attracts students from all over the world. No doubt this is true because of the wide distribution of the graduates. Several races have sent representatives here for training. In former years men were accepted. This practice, however, has been discontinued since the World War.

The uniform of the Battle Creek Sanitarium and Hospital School for Nursing has undergone an interesting revolution. The long, tight woolen sleeves gave way to elbow length when the nurse found that it was difficult to manage the sleeves and give a bath at the same time. The dark woolen dress was replaced by brown striped gingham. A lovely blue and white followed the brown tripes. The large full apron acquired a bib. The cap, after caps were introduced, was roomy and frilled and of remote kin to the trim head dress crowns today's uniform. Of course, waist lines have been competing with skirt lengths to see which would change most often. The recent skirts, however, have not swept the floor as the nineteenth century ones did.

Nineteen hundred and twenty-eight young men and young women have graduated from his school of nursing and have gone "into all the world," where they are holding positions of trust and responsibility. Mrs. Mary Staines Foy, a member of the first class, then again of the class of 1890, has been intimately and constructive associated wit the Battle Creek Sanitarium for fifty-one years. For the past thirty she has been the director of nurses. Miss Charlotte Hoffman, also an early graduate, went to Honolulu to be chief nurse in the sanitarium there. She worked in several missions in California and in 1913 she returned to Battle Creek to take charge of t he nursing service for the obstetric and out-patient departments of the sanitarium. Miss Lenna Cooper, 1900, was selected by the United States government to be the chief dietitian during the World War. At present she is food director of the University of Michigan and professor of institutional administration of Battle Creek College. Miss Leone Sweet, 1903, Miss Jessie Midgley, 1903, Miss Fern Sheick, 1924, as well as other alumnæ, are teaching or supervising in their own school.

Graduates of Battle Creek Sanitarium and Hospital School of Nursing are found in hospitals all over the country as administrators, supervisors, or instructors. Many more are in foreign hospitals.

One of the first industrial nurses in the country came from this school. In In 1904, Miss Jennie Williams was employed by the National Cash Register Company in Dayton, Ohio, to do first aid among the employees.

Thirty-nine graduates served their country during the World War; eighteen of the number were men. Nine nurses went to France with Base Hospital 114 and one is buried there. Numbers of nurses were sent to Camp Custer. During the influenza epidemic, student nurses were sent to relieve the Red Cross nurses at Camp Custer

Marion L. Whithey School of Nursing, Blodgett Memorial Hospital, Grand Rapids, 1886

When the Union Benevolent Association of Grand Rapids began to admit the sick as well as the aged into their home, a need for nurses was felt. It is true that women could be hired to care for patients, but this was more or less unsatisfactory. They were untrained, and their unfitness for the responsible work of a nurse was soon recognized. The advisability of opening a training school for nurses was discussed for over a year, with the result that two members of the Womans's Board were sent to England to study the conditions under which the nurses' schools organized by Florence Nightingale were conducted. Finally, in 1886, at a meeting attended by the Union Benevolent Association Hospital Committee and a number of interested physicians, the plans were formulated for the establishment of a "nursing academy." The proposed course of study was to be so thorough and so complete that any one taking it might receive a certificate on graduation that would entitle her to do nursing in the hospital and in private families.

The school was opened in 1886. It was named the Marian Louise Withey School of Nursing. Entrance was granted to young women who could furnish references as to excellent health and good character, who were between 25 and 35, and who had had a common school education. Preference was shown to applicants with experience in general house work. Five candidates could meet all of these, qualifications, and were accepted for the first class. During the first year, however, the number was raised to nine. From the very beginning of the Marian L. Withey School, more applications for entrance have been made each year than could be accepted, and the school has always been able to choose its students.

The first course was for eighteen months, with the training divided among the medical, surgical, obstetrical, and children's wards. Occasionally student nurses were permitted to go into homes as an accommodation to citizens, as well as for further experience for the nurse. The remuneration the nurse received for such service was paid to the hospital. Some of the Grand Rapids doctors were much interested in the experiment of training nurses, and they willing coöperated by teaching them. The doctors gave the lectures in anatomy, physiology, hygiene, disinfectants, as well as the clinical instruction. The arrangement of classes and the supervision of the nurses were in the hands of Miss Stephenson, a graduate nurse from Harper Hospital. She planned a course of eight lectures a month for the first year. This number of lectures was found not to be sufficient to acquaint the student with all she needed to know, and the number was raised to ten a month for the second year.

The early classes were asked to supply themselves with suitable dresses and aprons. This permitted an interesting assortment. One young lady appeared for duty in a lovely Paisley-patterned calico gown with a modish train. By 1893, a uniform was adopted that controlled the personal tastes somewhat, leaving the individuality to assert itself only in the matter of the size of the bow on the apron. It developed that the larger the bow, the more confidence the nurse felt in her own appearance. The detailed regularity of the trim uniform of today leaves no chance for the display of rivalry among the wearers.

The community has been interested in its own first school for nursing from its very inception. This interest has asserted itself in many ways. The graduating exercises for the first class was a social event attended by a large audience. The stage was beautifully decorated with flowers. The class was dressed in striped seersucker with white caps and aprons. Each graduate received exquisite floral tributes from friends. Mrs. Withey, a member of the Hospital Committee, when she handed their diplomas to them, admonished the class to be discreet and above gossip; to be brave, to be patient, gentle and faithful. In fact, she summarized the community's ideal for the nurse when she said, "Keep a high standard constantly in view." She also offered them the protection and comfort of the Home if ever sickness or misfortune should overtake them. It was not alone such glorious occasions as commencement exercises that friends of the school showed interest. Dr. Frances Hillyer, Dr. Frances Rutherford, and Dr. Elizabeth Earle were actively concerned for the school and for each individual student. When it was difficult to secure a suitable superintendent for the hospital, Dr. Earle gave half of her time to the hospital and actually held the school together. Dr. Earle was courageous enough to make the public see just what it owed to the young women who were taking the training. She plead for reasonable housing quarters. Her efforts were rewarded in 1889, when a modern lodge, tastefully furnished, was opened for the student nurses. Dr. Earle has told of some of the idiosyncrasies of the patrons of the school. The school charged $10.00 per week for a nurse's service in a private home. One woman refused to pay. She felt that $7.50 a week was enough to ask for the services of an undergraduate, especially since the student nurse was required to do so little. The patron pointed out that the nurse allowed two hours a day for rest and she was seldom called after midnight. In a remarkably short time, the school was excellently organized, and it has been serving a grateful public for forty-four years.

It was made evident that the type of training the Hospital Committee had in mind when the school was opened could not be given in eighteen months. In 1890, the course was extended to two years. Again in 1902, the curriculum was reorganized and the period of training lengthened to three years. The school has ever faithfully studied the nursing situation, and has sympathetically accepted any change that will better the service of its nurses. In 1919, soon after the Union Benevolent Association Hospital moved to a new site and was re-named Blodgett Memorial, the first year students joined the nurses from the other hospitals, St. Mary's and Butterworth, for class work in the academic subjects in the junior college. Three years ago, instruction in elementary nursing procedures was added to that part of the nursing curriculum given at the college. Consequently, the hospital instructor of nurses has had more time to devote to advanced students, and for supervision of beginning students in their duties on the floors.

For the last three years, the senior nurses of the three hospitals of Grand Rapids have entered competitive examinations for the $1,000 award from the Foster Foundation, which goes to the student making the best record. The money is to be used for further study. Two of these three awards have gone to Blodgett seniors, Miss Lucille Broersman and Miss Nellie Westvcer.

Five hundred and seventy women have graduated from this school. Among these alumnae may be found many individuals who have made outstanding contributions to the nursing profession. Miss Ida M. Barrett, an early graduate, became the superintendent of the hospital and school of nursing in 1893. She remained in this position for twenty-five years and served both hospital and school with intense devotion and remarkable success. Miss Mary Welsh, also an early graduate, became assistant superintendent and dietitian under Miss Barrett. After serving the hospital in this capacity for eighteen years, she became the superintendent of nurses and assistant superintendent of the hospital. Beyond question, when two fine women of such remarkable character are each willing to devote twenty-five years to the growth and development of a school, that school is destined to become a splendid influence in the development of nursing in that community. Miss Welsh, after a number of years of service elsewhere, returned to Blodgett to resume her work as superintendent of nurses and now occupies that position there. Her remarkable character and intelligent direction of the school commands universal respect and the love and devotion of every nurse who has ever been so fortunate as to serve under her.

Among the graduates of the Marian Louise Withey Training School for Nurses should be mentioned Miss Kate Merrill, who was the first visiting nurse in Grand Rapids. To her must be given the credit for establishing public health nursing. Miss Alice Hall, in the tuberculosis clinic, has contributed in no small way to the welfare of the citizens of Grand Rapids and Kent County. Miss Adah L. Hershey established public health nursing in Des Moines, Iowa. Miss Helen A. Farnsworth is head of the Central School of Nursing in Kansas City, Missouri. Miss Christine Hendrie also has been prominent in educational work. Many of its graduates have taken up private duty nursing. Miss Margaret Stekel, Miss Elizabeth Brice and Miss Edith Wilson are among the nurses who have served especially well in this capacity.

Dr. Abbott, in charge of the woman's department of the State Hospital in Anna, Illinois, is a Blodgett alumna. Miss Vera Ingerson has been in charge of hospital in Korea for years.

Miss Mary Fletcher, Miss Mary Welsh and Miss Christine Bauer enlisted in the Spanish-American War and each saw service in Southern army camps. Eighty-eight stars are on the Blodgett Alumnæ service flag for the recent war. One of these stars is gold. Miss Grace Meyers not only represented her school during the World War, but she served as assistant superintendent of nurses at Blodgett Hospital for four years, and after the war became superintendent for two years.

Among the many women of the Hospital Board who have served the institution for many years and with marked devotion, two at least, deserve special mention, Mrs. Marian Louise Withey, a woman of strong character, great intelligence and energy, was a hard working and most loyal supporter of school and hospital during all of their earlier years of struggle. With equal loyalty and with remarkable ability for the many duties which she has assumed, Mrs. Dudley E. Waters has, for very many years, helped in the upbuilding of the school and contributed to the comfort and attractiveness of the hospital.

Grace Hospital School for Nurses, Detroit, 1889

The Newberry Training School for Nurses--now the Grace Hospital School for Nurses--was established in 1889, in connection with Grace Hospital, Dr. W. L. Babcock and Dr. Stephen H. Knight were active in these early days in stimulating interest in the project. A committee composed of Mrs. Helen Handy Newberry, Mrs. Helen Joy, Mr. Truman H. Newberry, Mr. John S. Newberry and Mr. Eldridge M. Fowler made it possible for the school to be instituted.

Miss Eugenia Hibbard was the first principal of the school. During the nine years of her supervision, the school passed from its infancy to a well organized training school. A course of two years was first offered; later one of thirty months. Now post-graduate courses are given in surgical anesthesia, operating-room technic. X-ray technic, laboratory technic, dietetics, and physiotheraphy. Seven hospitals from over the state send their students, to Grace so that they may gain experience in nursing service which smaller hospitals do not offer. The number of resident students has increased from fourteen in the first class to two hundred sixteen.

The curriculum follows the plan presented by the State Board, but many of the courses are ramified to increase the subject-matter. The first year students go to Cass High School for the basic sciences. The instructors of nurses and the staff doctors give instruction in the remaining courses.

Grace Hospital School has had five superintendents since Miss Hibbard resigned to do nursing during the Spanish-American War. Miss L. J. Gross was superintendent until she resigned to become superintendent of nurses in Buffalo General Hospital, Buffalo, New York. Miss L. A. Chambers next held the position, to be followed by Miss C. P. Van Der Water. Miss Van Der Water was principal for seven years. Miss Harriet Leek was principal during the World War. Miss Laura Meader served ably for eight years. She died while she was director of the training school on June 1, 1928. Miss M. Delta Long is director of the school at the present time. The six nurses who have held this post have instilled into their students their own ideals for the nurse and her service to mankind.

The alumnæ from Grace have gone into every branch of nursing service. Seventy of them served their county in the time of war. Four area now in missionary work in foreign fields. Twenty others are in public health nursing and fifty are holding administrative positions in hospitals. Hospital nursing has made a strong appeal to the present senior class; one-half of them elected the administrative course. The alumnæ who have chosen private duty are serving their communities efficiently, too. This in too brief form is the history of a Michigan school that has always occupied a prominent and enviable place among our best institutions for training nurses.

Women's Hospital School for Nurses, Saginaw, 1889

The School of Nursing connected with the Woman's Hospital of Saginaw was established in 1889. The need for trained women to carry on the work of the hospital was recognized by the altruistic women who founded the Woman's Hospital Association under the presidency of Mr. J. W. Freeman. The association found that it was impossible to supply this need. They decided to answer the difficulty by establishing their own training school for nurses. The school first offered two-year course. This grew into a three-year course. At the present time, in order that the student nurses may receive training in all the services, the school has formed an affiliation with larger hospitals. The class work is organized to meet the requirements of the standard curriculum which the State Board of Registration of Nurses and Trained Attendants recommends.

The entrance requirements are eighteen years of age, two years of high school, good health and a good moral character. At present, nineteen young women are studying nursing in this school. The records of the early classes have been lost in moving from one hospital site to another, therefore, no accurate information has been gleaned concerning the activities of the graduates.

Butterworth Hospital School for Nurses, 1890

The Women's Board of St. Mark's Hospital held a meeting one summer day in 1890, and received, as its guest, Dr. Reuben Peterson, the first superintendent of the institution. Dr. Peterson, on that occasion, told the good women assemble about the great need for a training school for nurses in connection with the hospital. If the hospital would train its own nurses, it could not only supply the deficiency then existing, but it might also supervise the instruction and mold the student to the hospital's standards. Dr. Peterson was granted the authority to establish a training school, and he accepted three probationers that first summer. Miss Koler, of St. Luke's Hospital, Chicago, was secured as superintendent of the hospital while the school was yet in its infancy. She proved to be an able and sympathetic supervisor, inspiring the confidence of the students, the medical staff and the public. To her must be given much of the credit for the early success of the school.

The length of the training was to be two years, but for some reason the first class was not graduated until 1893. The commencement of the first class was a dignified and charming service. The six young women, in uniforms of blue chambray, white aprons, white caps, cuffs, and collars, with mulls ties, seated under their motto of "Nil Desperandum," took the vows of unselfish and untiring service in carrying for the sick. Dr. G. K. Johnson delivered the graduating address. He advised the nurses always to be scrupulously neat, to maintain control of tongue and temper, to think clearly and to keep command of themselves in the performance of their duties.

The school soon assumed a very important place in the community. It became a leader in the education of the nurse in Grand Rapids and throughout the state. Mrs. Susan Fisher Apted, a woman of superb ideals, untiring energy and great personal magnetism, was among its earlier superintendents. She exerted a very great influence over the school and inspired in her students a marked sense of devotion to duty and of the dignity of a nurse's work. Miss Elizabeth Flaws came to the hospital in 1905. She was a woman of remarkable executive ability and a strict disciplinarian. Those were the days when the duties of hospital superintendent and that of the training school were often combined in one. The hospital flourished as never before and the standards of the nurse's training were made more exacting and advanced steadily. During her regime, she raised the course from two to two and a half years. This was still inadequate, and the training was later increased to three years.

Miss Flaws was deeply concerned with the subject matter and the teaching of the academic portion of the curriculum. She brought in teachers to lecture to the student nurses. The probationers were sent to Central High School for a course in chemistry in 1912. Miss Gertrude M. Smith, and interested citizen, conducted classes in dietetics in her home for the seniors. Every efforts was made to give the students a careful training, in order that they might be able to meet any situation in the field of nursing.

Miss Flaws realized that a school can do better work if its graduates feel a sincere interest in its welfare. She also knew that graduates felt more responsible when the school kept in touch with them; consequently the Butterworth (the hospital was renamed in 1894) Alumnæ Association was organized. Miss Flaw's resignation in 1912 was a severe loss to hospital and school. The seven years of her service were momentous ones in the history of the institution.

No history of the hospital training school should neglect to mention Mrs. Eugene Boise, who, was president of the Lady Board of Managers, directed their affairs for so many years. A large part of their success is due to her who so loyally and intelligently led the way, always toward higher standards.

In 1917, the conditions of war were making such a drain on the trained nurse supply that the problem arose as to how the sick were to be cared for in the home hospital and student nurses continue their training at the same time. Grand Rapids, under the influence of the public health supervising nurses and the superintendents of the hospitals, agitated the sending of the probationers from the three local hospitals to the Grand Rapids Junior College for instruction in the basic sciences. Such a departure in nursing education was not without precedence since the Central School of Nursing was already established in the Kansas City Junior College and Vassar was offering a nursing curriculum. Miss Elizabeth Seldon, the superintendent of Butterworth, was deeply interested in the project and evolved a practical working plan for its operation. The difficulties were overcome and matters went forward. Since 1918, Butterworth has sent it first year nurses to junior college. Miss Grace F. Ellis was appointed by the Board of Education to be the director of this Central of Nursing.

The next progressive steps to be taken by the Butterworth Hospital School for Nurses were under the direction of Miss S. Belle MacCallum, a former student and associate of Miss Flaws, an alumna of the school, and its superintendent of nurses since 1925. The student nurses have been placed on an eight-hour schedule. A system of electives is offered the seniors. The nurse who wishes to enter into private duty service is permitted to go on twelve-hour special duty and so gain experien

Section: 

1881: The Indoor Pauper: A Study

Summary: An article from The Atlantic Monthly written by the Secretary of the Board of Charities describing in great detail the poorhouse system at that time.

The Indoor Pauper: A Study
By Octave Thanet, Secretary of the Board of Charities
The Atlantic Monthly. (Volume 47, Issue 284, June 1881)

Text from: Library of Congress American Memory Collection

This is an article from The Atlantic Monthly written by the Secretary of the Board of Charities describing in great detail the poorhouse system at that time.

PAUPERISM with us is not the grim menace which it is in Europe. True, the vagabond pauper otherwise the tramp has given us a vast deal of trouble; but lie is as much outlaw as pauper, and, such as he is, he is a distinctly novel figure in American life. The normal, quiet, legally supported pauper has never taken enough money from us to startle us out of our apathy. This is peculiarly the case with the pauper whom the State supports entirely, the indoor pauper, as the reports style him. Commonly, his misfortunes or his vices are stowed away in a remote farm-house on a muddy road. Politicians do not concern themselves with his fate, for he has no vote; benevolent people have their hands full helping the poor who are not yet sunk into paupers; the very newspapers seek him out only when his woeful lot has acquired the lurid attraction of a horror. Yet this neglected and repulsive being has claims upon our attention, because upon our fears. Pauperism has increased rapidly within the last decade. Few people realize how much money is spent annually for the support of our almshouses, to say nothing of what we spend upon our other paupers, partially supported outside, or wholly supported in hospitals, insane asylums, and asylums for orphan children. The State of New York spent, during the year ending November 30, 1879, the sum of $1,618,867.63 for the keeping of 57,925 persons in almshouses and poorhouses. These same almshouses and poorhouses gave temporary aid to 79,852 persons, at an expense of $692,465.77. Pennsylvania last year supported 20,310 persons in her almshouses, at a net cost of $1,515,290. Massachusetts paid $1,776,778 for pauper support and relief. The whole number entirely supported was 13,989, and the number of the partially supported was 72,881. Ohio, which is not especially afflicted with pauperism, pays more than half the money obtained by the state taxation for the welfare of her criminals and paupers; and the estimate does not include the public charities of her cities, or any township aid. She has an almshouse population of 13,599 during the year. The Michigan paupers, in 1878 (when the last biennial report was published), showed a rate of increase four times greater than the percentage of increase in the population. Such statistics could be multiplied indefinitely. It should be stated, however, that there has been a great lessening in the number of out-door paupers aided, since the business of the country has improved; the number of almshouse inmates remaining about the same. Undoubtedly, many of the indoor paupers came to the almshouses during the hard times, but the better times fail to draw them away. Indeed, once a pauper, always a pauper, has become an almshouse axiom. The pauper being thus expensive and pertinacious, we must needs be interested in our manner of dealing with him, however unpleasant he himself may be. In this article I shall try to describe, as fully as my space will permit, the Indoor Pauper, what he is, and how we treat him. I shall not discuss here any question of the necessity of poor-laws; whatever their defects, however tragical their unforeseen results, the argument in their favor has been reinforced by the kindly sentiment of generations, until now the popular heart makes the legal care of the poor a part of our Christianity, and assaults upon such care excite overwhelming opposition. Yet, granting the necessity of poor-laws, their warmest friend will admit that they may be so framed and so administered as to do grievous wrong. To tempt the poor into pauperism is a bad business; but it is the business of every State which is unwisely lavish with its poor-fund. To brutalize men, and ruin women, and corrupt children, are acts usually called by harsh names; but they are the acts of every State which gives over the management of its almshouses to ignorant officials To load with chains helpless creatures, proven guilty of no crime; to beat them, starve them, shut them up in underground dungeons, cold and damp, with mouldy straw for furniture and rats for company, and there leave them for months and years untended, save for the daily pushing of their coarse food through a hole in the door, this conduct, when we read of it in the history of the Inquisition or the Bastile, we say is wicked cruelty; but it is cruelty which has been practiced by every State that has abandoned its insane paupers to almshouse tending.

Moreover, it is quite possible to imagine a system which shall combine all these evils; attracting unthrift and vice by its profuse gifts, while it exposes the old and feeble, and all those stricken with disease of mind or body, to intolerable sufferings, a system, in short, which shall be at once costly, barbarous, and useless. Most intelligent poor men would pronounce such a system worse than none. Is there any resemblance between such a system and our own? This question I shall try to answer by a study of the character of our paupers, and the conditions of their almshouse life. Our almshouse system is not properly a system at all; it is a congregation of systems, each State having its own. The oldest States have copied, or rather imitated, the English methods, the new States have imitated the methods of the old States, and all have improvised alterations and additions as circumstances seemed to call for them. Most of the States have what is termed the county system. Each county cares for its own poor in whatsoever manner it may prefer. The counties elect officials having charge of the poor: county supervisors, commissioners, infirmary directors, directors of the poor, ordinaries, superintendents of the poor, and the like. These send those of the poor who are, or are supposed to be, incapable of supporting themselves to houses built and conducted at the expense of the taxpayers. The houses are variously called poorhouses, almshouses, county infirmaries, and county homes. The county officials elected to care for the poor generally appoint the almshouse keeper; sometimes, however, he is elected; and sometimes the almshouse is under the control of a superintendent of the poor, who selects the keeper. The keepers are appointed or elected annually; their superiors hold office for periods of from one to three years. In some States the township is the local unit, instead of the county; some States have both the township and the county system. Massachusetts, Rhode Island, Connecticut, and New York make a distinction between state and local poor; the State caring for the former, and the counties or towns for the latter. A number of the States have no poorhouses. The paupers are boarded out, at the expense of the counties, often with their own relatives. Sometimes a number of paupers are cared for by a farmer, whom the counties pay. Usually, they select the farmer willing to take the lowest price per pauper. In Tennessee, there are public auctions held in the counties, at which the poor are set off to the lowest bidder. Nine of the States have central boards, called Boards of Charities, which inspect and to some extent control their almshouses. The nine are Massachusetts, New York, Rhode Island, Pennsylvania, Illinois, Ohio, Michigan, Wisconsin, and Kansas.

(Footnote: The Massachusetts board was organized first in 1863 (the different departments of health, lunacy, and charity were consolidated in 1879); the first New York board was organized in 1867; Illinois, Rhode Island, Pennsylvania, and Ohio organized boards in 1869, Wisconsin and Michigan in 1871, and Kansas in 1875.)

The duties and powers of the boards differ in the different States, but, in the main, their duties are to investigate, and their powers are to advise. Settlement laws, which have played so important a part in England, make but a small figure among us, save in the New England States. New York gives a settlement to any one who has resided in the State for a year; but the owner of the settlement loses it if he leave the State and remain for a period longer than one year. Sixty day's residence in a county gives a county settlement to the citizen of New York.

(Footnote: Laws of New York, 1873, chapter 661, contains an act to provide for the support of state paupers. All blind, lame, old, impotent, or decrepit persons, who have not resided sixty days in any county of the State are deemed state paupers, and provision is made for their care by the Board of Charities.)

A year's residence gives a settlement in any Pennsylvania district to any householder, taxpayer, servant, apprentice, holder of public office, or to any mariner or other healthy person coming directly from a foreign country into the district. Married women take their husband's settlements, and children their parent's. A years residence, indeed, seems to be the favorite limit, although in the West even a shorter period will secure a settlement. The New England States are more rigid. Massachusetts requires five years residence; but a settlement in Massachusetts can never be alienated; once obtained, it belongs to its owner to the end of his days, wherever he may go, however long he may stay away; it is his and his descendants after him. Every drop of Massachusetts blood, says a Massachusetts commissioner, with a touch of poetry, carries a settlement with it. It is never reversed. Massachusetts requires the payment of taxes during these five years, save in a few cases, such as soldiers, unmarried women, public officers, and the like. Vermont, New Hampshire, Rhode Island, Connecticut, New Jersey, and Delaware, likewise, make the payment of taxes requisite to the acquiring of a settlement; the other States merely ask that the person shall live for so many months or years within their borders.

There is as much difference in the views taken by the various States as to what makes a pauper, and as to who shall decide whether or no a poor person shall be considered a pauper, as there is in their settlement laws. Some States leave the local authorities no discretion in the matter. New York, on the one hand, does not recognize any able-bodied person as a pauper; Massachusetts, on the other, expressly holds that any able-bodied person without visible means of support, when he comes to the local authorities, is entitled to support. No matter how strong a man is, says Mr.Wrightington, the Massachusetts superintendent of the outdoor poor, if he is as strong as Samson, if the authorities of one town send him to us, we must either keep him, or send him beyond the state line. Of course, presuming Mr. Samson to have a settlement, he cannot be sent beyond the state line, and the commonwealth has no choice but to take care of him as long as he may choose. Other States and they are the majority leave the whole matter in the hands of the county officials. Generally, the county officials lean to the side of mercy; the quality is not strained, since it costs them nothing; for, be it noted, there are two sets of principals in the business, the county directors or supervisors, who manage the almshouses, and are responsible for their expenses, and the justices of the peace and poor overseers, who commit paupers to the almshouses, and have nothing more to do with them. It is for the interest of the poor directors and supervisors to have as few paupers in the almshouse as possible; it is for the interest of justices, who are paid for each order they write, and of overseers, who depend for reelection upon the suffrages of the poor but warm hearted populace, to show a liberal spirit. And, as Sydney Smith has observed, everybody is full of humanity and good nature when he can relieve misfortune by putting his hand into his neighbors pocket. Who can bear to see a fellow-creature suffering pain and poverty, when he can order other fellow-creatures to relieve him? The result of all this is that, practically, most States give almshouse lodging to any one having a settlement who can bring himself to ask it. What, then, are these almshouse lodgings, and what manner of men desire them?

Perhaps as easy a way as any to answer the question will be to describe a visit made by the writer, a few months ago, to a large rural almshouse in Illinois. I select this particular house because it is not the best, and is a long way from being the worst, within my knowledge. The house stands in the centre of a great coal district, thirteen miles from the county seat, but only two from a little mining hamlet. The road is fairly good in dry summers; when the weather is wet, and through most of the winter, it is almost impassable. My companion was a clever young physician, of considerable experience among the insane. After a long drive we stopped before a cluster of buildings, to which a tall windmill gave something of a picturesque and foreign air. There was a neat brown cottage; a large, bare brown house, without blinds, and seeming to have a disproportionate number of windows; along, two-storied building, shining with new paint; and a number of out-buildings, in appearance much like those to be seen on any large farm, even to the detail of a brick-red barn. The yard in front of the house had a number of trees, and a little to the right was a large garden. We saw no flowers, except the great white snowballs weighing down a half dozen huge bushes; but green things were sprouting and springing up all over the garden beds, and the foliage and the short scant grass had the fresh beauty of May. A man opened the gate. for us. He was a short, squarely built fellow, in dingy yellowish garments; and he had chains on his feet, making him take queer, short steps. His face was pale and sodden, with blear eyes and shapeless features; somehow, he seemed all of a color, hair, skin, eyes, and clothes. Several other men, also in chains, and more or less of a color like him, were hobbling about the yard; and one young man, in a long blue jean gown, was sitting chained to a post. Those must be the insane, said the doctor. Mingling with these men were others without chains, men and women, some of whom were painfully deformed. No one appeared to pay them any attention. The superintendent was away; but his daughter, a rather pretty, slim girl of eighteen, offered to show us through the house. The brown cottage was the keepers house; this we did not visit, but passed directly into the large frame building, the home of the sane paupers and of the harmless insane. At the time of our visit the house contained ninety-seven paupers, including some thirty-seven insane people and nine children. The first room we saw was a small store-room. Besides stores, there was a shelf filled with medicine bottles. The almshouse being so far from the county-seat, the almshouse keeper acts as resident physician.

'Oh, pa's quite a good doctor!" said the girl; at which my doctor smiled grimly. From the store-room we passed through a chamber crowded with beds and cradles into the women's sitting-room. Both apartments were rather untidy. The bedding in the first was shabby, and made one think of Dandie Dinmonts speech in the Portanferry jail. The sitting-room had a stove, and some pine benches for furniture. On one of these was stretched a hideous old woman, very stout and red, wearing a single blue garment; she seemed to be asleep." That woman got the dropsy, and she's crazy, too," said our guide. We asked if any one took care of her. The girl said, "No, she takes care of herself." Entering the next room, we were greeted by a tremendous clamor. We had the curiosity to go out on a small porch, where the quarrelers were. They were two: an old blind woman and a middle-aged man, who were abusing each other at the top of their voices. Two younger women stood by, and flung occasional interjections into the uproar. The first was a broad-faced German, with yellow hair; she held a child in her arms. The second woman must have come from a New England village; no other place on earth could have sent into the world that lank form and long sallow visage. Just as we came upon the scene, the New Englanders shrill voice rose above the others: "Every body as knows me knows that I'd never lay a finger on nobody, except they druv me to it!"

"You tink me got nobody help me!" screamed the old woman. "Me got God; he give it to you!" We mustered enough German to speak to her. She was not a bad-looking woman: tall and thin, with a mobile dark face of the Bavarian type. Our question met instant response; with vehement gestures and quick-changing expression she told her story. They had come to the almshouse, her husband and she, because he had been ill for years, and she was blind, and they had no living children. They had been decent people in the old country, and they did not take kindly to almshouse ways. Her husband soon died. After his death, she was put in the charge of these two women. They had treated her most cruelly; they had robbed her of her little property of clothes; they beat her and persecuted her; and, with tears rolling down her cheeks, she begged us, for the love of God, to take her away. "What's she sayin?" whispered the New England woman to the German. The latter rapidly translated the charges: "She say we steal her tings, we beat her and blague her." "Me!" cried the New Englander, "me tech her! Why, I do her washing!" as though that settled the question. She then gave us to understand, confidentially, that Mrs. Jens (the old woman's name) was "dretful queer", and that nothing she said could be believed. A little money pacified the group, and enabled us to get upstairs. All the rooms there were sleeping rooms. They were not scrupulously clean, but the time being Saturday morning, we made allowance for their looking their worst. Many of the inmates were in their rooms; a few sewing, the most doing nothing. They were careless in their dress, and all the faces had a listless, vacant look. Here, also, we saw a number of cradles. We asked our guide what was done with the children. She said they tried to get homes for them among the neighboring farmers, when the mothers consented. But when the mothers don't consent? said the doctor. Well, you know, we wouldn't want to take them away without, said she. Then we went into the men's department, which was much like the women's. In one bare chamber, through which we passed (as must every one going upstairs), a man lay on a comfortless bed, turning so white and haggard a face to the wall that at first glance I thought him dead. He had bad spells, the girl said; at such times he went on awfully, but most of the time he was quiet enough. There was no one in the room; but a burly Irishman, shaving himself in the hall, was said to keep an eye on him. In another apartment we came upon a cheerful, clean old man, who was mending a pile of men's clothing, being a tailor by trade. Ill health and partial blindness had brought him to the almshouse. He was the only sane pauper we saw who showed any sign of pleasant animation, either in face or speech. Our guide was warm in his praise. "He's a real nice old man; works all the time," said she, "mends all the men's clothes." We passed from the men's side into the yard. There was a partition separating the two departments, but the yard seemed to be in common. The German woman who took care of Mrs. Jens came up to us while we were looking at the various groups. She was leading a little girl by the hand, and still carrying her baby. "This is my Annie," she said, giving the girl a push forward. "She looks like you," said the doctor. The woman held up the baby for inspection. "Do you tink he look like me, too?" We said No; perhaps he resembled her husband. She gave the abrupt giggle which in her class sometimes does duty for a blush and said, "Oh, yell my husband You see, I leff my husband. He's not my husbands; he's Irish." She jerked her thumb over her shoulder at a bench where a gray-bearded, moody-looking Irishman was sitting, with his head sunk on his breast. "He's his fader," said she, with another giggle. The doctor asked her how long she had been in the house. "Oh, so long I can't remember," she answered. "I had little girl born here, but she die; I'm so fraid dis one die, too, but I take just so good care of him I can." There was an ugly halfhealed scar on this woman's forehead; after some further conversation, the doctor asked her how it came there. "She said a crazy girl got mad, and hit her with a tin cup. Oh, they're always jawing and lighting," said our guide coolly. "I can't keep count of the rows. Would you like to see the kitchen?" As we passed through the basement, something bumped against us. I turned, and saw a twisted creature who had lost both legs, and was shuffling himself along on his back with his hands. The kitchen was crowded, and not clean; but the bread just going into the oven looked light and white. The dining-room was near the kitchen. It was in better order. Some long pine tables, not covered even with the favorite almshouse oilcloth, were set with tin cups and the heavy white ware called stone china. Our guide told us that the paupers had meat twice a day, tea and coffee, and plenty of vegetables and bread; and tobacco was given to the men.

We had time for only a hurried inspection of the insane department. It is a separate building of wood, with a brick basement, and cost the county something over five thousand dollars. It is heated by a furnace in the basement, and water is supplied from a tank in the attic filled by a wind-pump and force-pumps. There are twenty-four cells in the building. The lower story has the cells built back to back, each having a front of wooden bars opening out on the hall, which is well lighted. The upper story has a central hall, with cells on each side. The cells were very small; but they were clean. Only two of the lunatics were in their cells, and them we did not see; the others were out in their airing courts (two small spaces enclosed with a high fence), or in the yard. The girl said that there were but two attendants. They had a comparatively easy time in summer, but when winter came, it was awful! The doctor inquired what the attendant did when the insane were violent. "I don't know what he does," said the girl, shrugging her shoulders; "knocks 'em down, gives 'em a good thrashing." "That's bad," said the doctor." What would you have him do?" cried she, "stand still and be killed? There's hardly a day in winter that some of 'em don't try to do him a mischief. Every once in a while the man comes in with his linger chawed up, or his face scalded with the hot coffee they ye throwed at him." Then she showed us the marks on the cells where the insane had beaten their heads against the walls, or gnawed at their bars like wild beasts. Respecting the general condition of the house, the girl said that the men worked in the fields during the warm weather, but there was a lack of work through winter.

We did not see a book or newspaper, nor indeed the slightest means of diverting the mind, not so much as the customary pack of greasy cards. There was no hospital, and the bathing arrangements were most primitive; but, judging from the paupers aspect, they did not bathe often enough to be troubled by any deficiencies. The keeper, himself, would gladly have had both bath rooms and a hospital, but the supervisors thought them too expensive. I have no reason to suppose that any cruelty was shown to the sane paupers, or any wanton cruelty to the insane. The keepers wife and daughters, whom we saw afterward, were neatly dressed, and gave every token of being of a kindly disposition. I believe that they tried hard to make their charges comfortable, and that whatever abuses were apparent were caused in the main by the construction of the house, which made cleanliness difficult and discipline impossible.

I have entered thus minutely into the details of this picture because it is the picture of the average large rural almshouse through the country; because, moreover, its population is the typical almshouse population everywhere. The popular impression about the pauper class is a queer mixture of indifference and sentimental pity. While not one in a thousand has ever taken the pains to see the inside of an almshouse, there is yet a prevalent idea that almshouses, for the most part, shelter the unhappy and guiltless poor, whom unmerciful disaster has followed fast and followed faster until it has chased them to this last refuge, people who have come from vine-covered cottages, or tidy rooms up one flight of stairs in tenement houses, with a big Bible on the table and a pot of flowers in the window, or even from luxurious homes desolated by commercial panics. As a matter of fact, the great majority of American indoor paupers belong to what are called the lowest classes, and seek the almshouse not because of unmerciful disaster, but because of very common vices. Between half and two thirds of them are of foreign birth. The best authority, if one wishes to study the habits, ancestry, and history of the indoor pauper, is the report of the New York hoard upon the subject. Sixty questions, most carefully framed and selected to cover the whole ground, were drawn up for the board, and were (by them or their agents) asked of every adult sane pauper in every almshouse in the State. All possible information, at the same time, was obtained from superintendents, keepers, and records. The report says on this point, The examination has made it clear that by far the is greater number of paupers have reached that condition by idleness, improvidence, drunkenness, or some form of vicious indulgence. It is equally clear that these vices and weaknesses are very frequently, if not universally, the result of tendencies which are to a greater or less degree hereditary. The number of persons in our poorhouses who have been reduced to poverty by causes outside of their own acts is, contrary to the general impression, surprisingly small.

(Footnote: Extract from Report of New York Board relating to Causes of Pauperism, page 190. The meaning of these words may he gathered from a. few figures: 2,453 of the paupers examined were in families; from these families there were known (during three generations) 14,901 dependent on public charity, 4,968 insane people, 844 idiots, and 8,863 drunkards.)

Any one who has visited many almshouses or talked with the men who know most of paupers will recognize the same old story. Paupers, said a plainspoken almshouse keeper to a convention of Pennsylvania directors of the poor, paupers, though not criminals, are, so far as my knowledge extends, largely from the lower classes of society; most of them being ignorant, and many of them possessed of all the low and mean instincts of human nature, with scarcely a redeeming quality. The writer once asked the steward of a large city almshouse if he had many persons come to him who had formerly been prosperous, and had, through disease or some other cause not their own fault, been reduced to seek public help. He said, "Never"; then added, "Well, yes, there was one man: he had seven horses, and he was taken sick, and sold one horse after another. And there was another man who was said to have had considerable property, but he drank." I asked him if he had many applicants who had been decent, industrious, laboring people, and had come there from any other cause than disease or old age. He answered, emphatically, "Not one." This man spoke from an experience of nineteen years.

Probably, it is a liberal estimate to put down one tenth of the paupers as to have come people deserving of sympathy; the other nine tenths are in the almshouse because they have not wit enough or energy enough to get into prison. Such people do not have a hard life in the almshouses. The squalor does not disturb men and women who have known nothing else; the immorality is a temptation; and even in the worst kept houses there is usually plenty to eat and little to do; in any case, they have not the heavy and irksome task of thinking for themselves.

The class which suffers at all our almshouses is the class for whom almshouses are presumed to be maintained, the unfortunate and self-respecting poor. A more horrible existence than a modest woman must endure at very many of our almshouses it is impossible to imagine. She lives amid unclean disorder and constant bickering; she is always hearing oaths and vile talk, the ravings of madmen and the uncouth gibberings of idiots; she is always seeing scarred and blotched faces and distorted limbs, hideous shapes such as one encounters in the narrow streets of Italian towns, but which, here, we hide in our almshouses. She is exposed to a hundred petty wrongs; Mrs. Jens's case, already described, may give the reader an inkling of their nature. Often she is treated with absolute cruelty; in some almshouses she cannot protect herself from the grossest insults. It is only fair to say that the best almshouses classify their inmates as much as they can, and have hospitals for their sick and infirm. So far as food, lodging, and medical care go, the inmates are comparatively comfortable. Nevertheless, in the best almshouses the worthy poor have to submit to most degrading and irritating associations. Many of the aged have grown old in almshouses, and most of the invalids owe their unhappy fate to their own vices. Such people are neither pleasant nor edifying companions, but they are the companions with whom the inmates of almshouse hospitals have to live, however spotless their own lives may have been. This difficulty, almshouses being constructed as they are, must baffle the efforts of the wisest and kindest keepers.

Two other classes of paupers were noticeable in the almshouse which I have described, the insane and the children. With the insane I group the feeble-minded and the epileptic. It is difficult to describe the way in which we treat our insane paupers, because the plainest recital of facts would seem to accuse almshouse officers of revolting barbarity. Yet, in most cases, ignorance and fear are their worst faults. Often the almshouse keeper is forced to use harsh measures, because he has not enough assistants to be gentle. "I don't want to shut them up," is the keepers indignant plea, "I don't want to chain them; but I cant have them running round the yard naked, or tearing things to pieces, or pitching into people! I don't want to be killed, and I don't want anybody else killed!" Meanwhile, his superiors, the superintendents, or, more often, the county supervisors, have plenty of other work, and take his word for the necessity of chains and dungeons. No public interest spurs the wits of either keeper or superintendent into devising better methods. And thus, within the present century, as almshouses multiplied, there grew up a tradition of torture, if one may so phrase it, a belief that the only proper treatment of a lunatic was restraint, and that the one indispensable quality of restraint was completeness; so clubs, whips, straps, darkness, and starvation supplemented chains and bolts as means to keep lunatics quiet. The rough-and-ready modes of dealing with the insane practiced in the Illinois almshouse which I have mentioned are but mild expressions of the average almshouse theory. The Boards of Charities, at the outset, found a state of things which belong to the Middle Ages. Let me give a few extracts from the early reports, dating back, however, no farther than 1873 :

The condition of those [of the insane] in the county poorhouses and jails, says the first Michigan Report, is wretched in the extreme. . . . They are generally confined in miserable cells. In many cases they are chained in pens without light or ventilation. In the Eaton County poorhouse we found a woman fastened in a pen of this kind, made in one corner of the cellar. She was put there, not from inhumanity on the part of the officers, but simply because they had no other place to keep her. Inmates are often whipped. In the Lenawee County poorhouse a crazy young man was regularly flogged as a punishment. The sentences which follow, regarding the unprotected condition of insane women, I will not quote; it is enough to say that, at the time of the boards visit, there was in the St. Clair poorhouse an insane woman with two children, both born in the house, the fathers of both being inmates. Nor was this case uncommon. One miserable woman told the board her shocking story in the presence of the keeper. He merely said, That's so; but I see no means to separate them. Idiots and epileptics fared little better. They seem to have been chained, beaten, imprisoned, and utterly neglected. An epileptic woman in the Lenawee County poorhouse fell into the fire during a fit, and burned her eyes nearly out. The Ohio board found the entire system of infirmary management [almshouses are infirmaries in Ohio] involved in very general neglect, abuse, and cruelty. The Illinois Reports tell the same repulsive story. Lunatics chained, beaten, starved, shut in dark cells and left there to die, exposed to shameful and nameless cruelties, these are the headings of the chapters in the confessions which every State, speaking at all, has made regarding her dealings with the pauper insane. The Wisconsin Board of Charities talk of boxes built in the cellar, without light or ventilation; and say that when the board began their visits the almshouses were gradually becoming public nuisances and a disgrace to the State. New York confesses her sins in a score of dreary pamphlets. Even Massachusetts and Rhode Island, the first States to take pity on their insane poor, could show a large collection of chains, handcuffs, straps, and the like quieting instruments used in their town and city almshouses. I am speaking of a period scarcely more than ten years ago. Since then the different Boards of Charities have wrought a marvelous change in some States, and done good work in all. But they have had to fight against the system itself; and even yet the lot of an insane pauper is a very dismal one. The last Michigan Report says, The way the insane are cared for at the county houses, without judgment, without knowledge, . . is simply shocking. It would be an act of mercy, in many cases, says the secretary bitterly, to leave these poor people to starve, rather than keep them alive to drag out an existence which is a living death. The late Mr. Wines, of the Illinois board, discusses the subject at length: "On this point there is a word to be said on both sides. The amount of personal liberty allowed to insane inmates of most almshouses is worthy of serious attention. They are allowed in all suitable weather to live in the open air; they wander over the farm, unrestricted, and if they are able to work in the field they have useful employment, the want of which is the bane of hospital life. . In many almshouses no restraint is employed. . So much in favor of the almshouses; but it must now be admitted that these very almshouses are fatally deficient in other conditions, also essential to the treatment of insanity, namely, proper supervision by personal attendants, and proper medical care. It must also be said that many keepers are afraid of insane persons, and this fear begets restraint, often of a cruel sort, chains, whips, and even the firing of pistols, to intimidate the patients. . These extreme measures are not common, but what is common . . is the building of so-called receptacles for the insane, or insane departments, in which, when there are a number of insane to be cared for, many of them are imprisoned, some even for life, in solitary cells. Many of these insane departments are unfit physically for the occupancy of sane men: imperfectly heated, or not heated at all; not ventilated, often dark, destitute of furniture, sometimes in an outrageously dirty state, filled with foul odors. . . . In a few of the almshouses we have seen cells for the insane in the form of cages, without doors, where the victims are immured beyond the possibility of any entrance of the keeper himself, without tearing down or removing the bars. Even the best Illinois houses cannot give their insane much personal care." That sentence has a harmless sound; this is what it may imply: In a respectable Illinois almshouse there is a woman who occupies a large wooden box filled with straw; she will not wear clothes, but is covered with a canvas cloth; is in constant motion; has bruised herself from head to foot, and put out her own eyes. 

Ohio seems to treat her insane rather worse than Illinois. Looking through her last report, one finds such cases as these: A man becomes a violent maniac; his neighbors, scared, bind him with cords, put him on a sled, and draw him over the snow to the infirmary. There he is taken to a room without fire, and left through a bitter-cold night; in consequence, he freezes both feet, and one has to be amputated. A doctor writes a pathetic letter to the superintendent of an insane asylum, imploring him to admit an epileptic girl, whom her parents dare not send to the infirmary, because of its known immorality. The family; are in a sorrowful condition, he says, and if this distress is not alleviated it is my opinion that the mother will be an inmate of an asylum before six months. An old man, whose habits are troublesome, falls ill; he is taken to an out-building, and left there; he grows worse, but no doctor is called; at last, one of the paupers informs the county physician, who finds the old man dying; a few hours later he is dead. A hundred and fifty-six Ohio lunatics and fifty-six epileptics are reported as secluded, which rather poetical term means that they are kept in narrow stalls or iron cribs in small outer buildings, usually dark, almost uniformly without drainage or ventilation; and that they are untended, save as meals are carried to them. Others, not in seclusion, are restrained with handcuffs, chains, and hobbles. But the reader recognizes the old story; there is no need to repeat it. These three States, the most wealthy and populous in the West, may serve as examples of the treatment accorded the pauper insane by the Western States, which have central boards of inspection.

Coming East, one finds a degree of improvement. Yet even Massachusetts cannot show a blameless record. A few hundred crazy people are still kept in her town and city almshouses, and these do not always receive the best of care. Tewksbury almshouse is not without reproach, as the investigation of 1876 showed; and, although improved since then, it has the faults inseparable from large institutions. In comparison with most almshouses it shines like the just. This is the testimony of a man intimately acquainted with Pennsylvania almshouses. "There are some persons," he says, "foolish enough to assert that the insane are just as comfortable and well cared for in an almshouse as in a hospital. Experience proves just the reverse. . . . In some of the very best of institutions there is a lamentable display of ignorance in connection with the management of the insane. . . Patients are seen confined in narrow corridors, or perhaps exercising in a small yard bounded by high walls. You are struck with the hopeless look which their faces wear. Every now and again you note some poor maniacs face, and wonder how he or she could have inflicted such a variety of .cuts and bruises. . . . Patients under restraint are noted everywhere. Upon inquiring, you are told that the bruises, etc., are the result of falls, the patient being subject to fits, and that the restraints are necessary in order to keep the unfortunates from destroying their clothing, injuring themselves or others. All this may be true; but how is it that the same things are conspicuous by their absence in hospitals properly arranged?" He speaks of their meagre diet and scant clothing, of the slender attendance, of the gloomy surroundings, but most of all complains of the almost total absence of employment. The picture is of another sort than those drawn in the Western reports, yet it is hardly less dreary. The Western lunatic is unkempt and neglected, sometimes he is harshly used, but unless he is violent he has the free air and sunshine one half the year; he has, too, the chance of resting his wandering wits by tiring his muscles. Covert for open abuse, Utica cribs, muffs and strait-jackets for chains, after all, these are not such great gains. Order and cleanliness are great gains, yet they are dearly bought when the patient pays for them with air and sunshine and work. Neither are chains and filthy dungeons quite gone out of fashion in Pennsylvania. Many almshouses still employ them.

What has been said of Pennsylvania applies also to New York. No State has struggled more valorously to provide for her insane poor; but in spite of Willard Asylum, there remain 6456 insane, idiotic, and epileptic paupers, under county and city care. Their condition is often very melancholy. To support this statement I shall not make any quotations from the horrible disclosures published periodically in the New York papers; such testimony is always received with suspicion by the sober mind; moreover, it is not needed; official reports, indictments of grand juries, and coroners verdicts contain proof in plenty. The late reports of the Boards of Charities show that the best county and city almshouses care for their insane in the manner already described; the worst have the familiar dungeon and chain, and the pauper attendants keep order with their whips and their fists. The institutions managed by New York city are as bad as any. Overcrowding; poor food served cold; insufficient clothing; neglect and abuse by the overworked and underpaid attendants; patients dying of scurvy; patients eating rat poison; patients strapped to their beds for days and weeks, until the bones started through the skin, these are some of the grim facts told of the asylums on Blackwell's, Randall's, and Hart's Island. The almshouse of Onandago County may serve for an example of the rural ill-treatment of the insane. A newspaper reporter visited the house, and saw and heard enough to furnish materials for a startling article, which roused the public indignation so effectually that the supervisors asked the Board of Charities to help them investigate his charges. I have their report before me. Besides the customary cells, there were some underground dungeons of solid masonry, with concrete floors, without windows, but having a hole in each door large enough for a man to thrust his head through; both cells and dungeons being cold and damp. In summer the supply of water used to give out, although the almshouse authorities wasted very little on the paupers. The keeper of the insane department, O'Connel by name, had been a drunken pauper; he worked very cheap, and was considered a faithful fellow. To keep his patients quiet he used muffs, chains, dark cells, starvation, blows, and other straightforward arguments of force. His wife was matron. She was accustomed to mop the women; once she seized a crazy woman by her hair and flung her to the ground; but the matron of the almshouse testified that she never was particularly harsh. All the attendants were paupers; they swore at the patients, and talked loudly; it was a way they had, said the witnesses. Lunatics were shut up in the dark cells for weeks and months at a time. Two men died in these cells; one of them in a dungeon without window or bed. He wore himself out, said the keeper; he did not want to live, and I closed him in there, and he died comfortably. The attendant testified that the man was a harmless man, not ugly or vicious. The other cell had a window and a bed. Why he was put in the cell at all is not plain; he could not have excited much fear, since he had lost both arms, and was a mere skeleton, dying of consumption. But, in the language of the attendant, he was a violent man, did not appear to know nothing, which is the sole explanation given. There is no need of considering the darker charges made against O'Connel; they rest, for the most part, upon the evidence of pauper women, likely enough to avenge his blows by a cunning lie. However, no one who heard the testimony seems to have doubted that the insane suffered cruel hardships. It is only fair to add that the board of supervisors at once discharged the old attendants, and now employ paid attendants and a resident physician. The dungeons have been demolished, the building is heated by steam, and other improvements have been introduced. It is now the declared policy of the county . . . to retain only the quiet and harmless chronic insane under county care. Onandago County is not a sinner above all others. In 1878 Washington County poorhouse had a woman chained to a bar. Clinton County kept seventeen lunatics in dark, hot cells, filthy beyond description; four of the seventeen being restrained further with chains and muffs. Alleghany and Cattaraugus counties used cells very similar; and all over the State chains and handcuffs were found in the almshouses. Since then there has been a gradual improvement, or, rather, I should say a gradual abandonment of open violence; but, substantially, the situation remains unchanged. The foregoing descriptions all apply to the States having Boards of Charities, whose particular vocation is to discover abuses. Naturally, the States where the counties have had their will unchecked do not make so good a showing, when they make any showing whatever. No longer ago than 1877, a commission, appointed by the governor of Connecticut to inquire into the administration of the various charitable appropriations of the State, reported that they had found the insane at Tariffville in a condition which should shame a savage. At the New Haven almshouse there were fifty-four insane persons, some of them lying upon loose hay, without much clothing, and sorely in need of care. I have some local New Hampshire reports, all very complacent in tone, praising the county system, praising the commissioners, praising the almshouse officers, in fine, praising everything and everybody except the paupers themselves. One finds, however, that the insane are secluded and restrained in New Hampshire, just as they are in other States. Nor is the attendance more numerous or better trained than elsewhere. When a New Hampshire poorhouse burns down, no one seems to know where the keys to the cells are. This was the case at the Strafford County fire, where thirteen paupers and lunatics perished.

The Middle States, Delaware and New Jersey, have always had a tarnished fame as regards their almshouses. The almshouse at Snake Hill (Hudson County, New Jersey) is periodically abused in the newspapers. The Camden County almshouse is at present being investigated, on charges of cruelty to the insane, resulting in several deaths. A single instance of the barbarities alleged to have been committed will suffice. One patient became violent, and was strung up in a strait-jacket, and left without any attendant. A patient named Barney got a club, and beat him so terribly that he died.

The West probably treats her pauper lunatics decently, so far as food and clothing go; otherwise, the States without Boards of Charities seem to be doing much as the States with boards were doing ten years ago. The South does no better. In the States where the paupers are boarded out, and auctioned off to the lowest bidder, the insane, as may be supposed, are not desired at any price. Their place is not the almshouse, but the jail. Of their fate I say nothing; but it is sufficiently dreadful. The others lie and die in corners, tended or untended by the few private families willing to have them about. Where there are almshouses, these miserable beings go to them. What the almshouses are we can only judge from the reports of the State of Maryland, the single Southern State which has systematically investigated the matter. In 1877 John Lee Carroll, then governor, ordered an inspection of the Maryland public institutions, particularly with reference to their sanitary condition and treatment of the inmates, and the number of the pauper insane who are confined therein at the public expense. The man selected for this arduous and delicate task was the secretary of the Board of Health, Dr. C. W. Chancellor, and he seems to have performed his duties thoroughly and fearlessly. His report revealed a state of things in the almshouses which appalled the very county supervisors. Most of his pages cannot be quoted. I shall try only to give a feeble notion of what he saw, leaving the rest to the readers imagination. He saw everywhere men and women handcuffed, bound, and chained to the floor; he saw rooms filled with lunatics, weeping, howling, and dancing, unrestrained; he saw the sane and insane men and women all crowded together in the same noisome den; he saw their children deformed in mind and body; he saw, by the light of a candle which, in the broad daylight, he was obliged to use in order to see at all, a haggard, half-clothed woman crouching in the corner of a room so filthy that when the door was opened he staggered back, half fainting. Speaking of the almshouses as a whole, Dr. Chancellor said, In most of these places cleanliness is an unknown luxury; all is filth and misery, and the most degrading, unrelieved suffering. The inmates, sane and insane, were found, in many instances, huddled together without discrimination of age, sex, or condition, . . . with results shocking to all sense of humanity. And he thus described the condition of the insane: "There are now within the almshouses and jails of our State five hundred insane and idiotic people, who are utterly cast down, neglected, half fed, and ghastly in their wretchedness. A few figures will speak more plainly than words. Maryland has twenty almshouses. Only six of these, in 1877, appeared to be kept with any regard to cleanliness; and two of the six had colored departments, in disgraceful order. More than three fourths of the almshouses were old, dilapidated, and so constructed that any classification of the inmates was out of the question. Thirteen houses kept children whose parents were insane, and whose birth was directly owing to the States neglect; indeed, there were only three almshouses quite free from abuses of this shameful character."

The publication of this report was attended with marked results. The supervisors tore down some of their worst almshouses, and built new ones; they repaired and cleaned the others; they turned away the old keepers, and gave the new ones stringent instructions; in short, the almshouses, to use Dr. Chancellor's own words in his last report, became as good as those of any other State where the same unregenerate system prevails. In a few houses the insane are still subject to the same shame and torment; in none can they receive adequate care. What the Maryland almshouses were there is reason to fear most Southern almshouses are. Nor is this unfortunate state of things without great excuse in the poverty of the South, and in the more pressing social problems thrust upon her by the war. North and South alike, our treatment of our pauper insane is open to grave condemnation, quite as much upon economical grounds as any. Even the States having the best public insane asylums send many of their acute cases to the almshouses. The consequence is that they have these patients to support through their lives; for the vast majority of almshouses have no facilities for curing insanity. Furthermore, only a few almshouses make any account of insane labor, except in the West, and there only during the summer months, and among the milder chronic lunatics. English and French experience shows that insane labor may be used to a much greater extent than most almshouse keepers dream. The difference between the amount of labor which we might and which we do get out of our insane paupers is just so much wasted. The expense of keeping a pauper lunatic is commonly reckoned at a dollar and a half a week, or seventy-eight dollars a year; it is not a high estimate to call the properly directed labor of a lunatic worth half this sum, and the States not getting this labor lose thirty-nine dollars a year for every lunatic not employed, yet capable of employment. Assume, for instance, that three thousand of New York's six thousand paupers of impaired intellect can work if they may; the State then pays $117,000 every year which is worse than thrown away, since it is paid for the deliberate and well-meaning torture of the most miserable class of human beings. A general survey of the whole field makes it appear that our system of caring for the insane is equally cruel, senseless, and wasteful.

Another class of paupers was noticeable in the almshouse which I described in the beginning of my article, I mean the children. They suffer as deeply as the insane, although in a different way. The best institution is a poor home for a child, and most candid men admit that almshouses are among the worst institutions which we have. Rude and blurred as are the foregoing portrayals of almshouse life, I think they show its entire unfitness for any child. None speak more strongly on this subject than the almshouse keepers themselves; and the very mothers of almshouse children realize its degrading influence. I remember the language of a matron of an Iowa almshouse. We were standing together before a feeble-minded girl with her baby in her arms. "Seven of 'em has been born in this house since I come," said the matron. "I thank God they was all born dead but this one and one other, and I pray God this one may die, too." Then she spoke of a proposed law to take the children out of the almshouses. The girl interrupted her with an eager inquiry: "Will they take my baby away?" "You would not want him brought up here, yourself, would you?" I asked. She looked up, with a sharp change of expression. "I? she repeated, passionately. God knows I would not! Anywhere else!"

I have thus roughly indicated the general character of the various classes of indoor paupers, and the way in which we treat them. To paint this sorrowful picture in detail would require a wider canvas than I have taken.

Section: 

1883: The Pauper Question

Summary: An article from The Atlantic Monthly that examines current attitudes about poverty and public assistance in the late 1880's in the U.S., France, Germany, and England.

The Pauper Question
by D. 0. Kellogg
The Atlantic Monthly. (Volume 51, Issue 307, May 1883)

Text from: Library of Congress American Memory Collection

An article from The Atlantic Monthly that examines current attitudes about poverty and public assistance in the late 1880's in the U.S., France, Germany, and England.

THE labors of Henry Ozanam in Paris, of Edward Denison and Octavia Hill in London, of Daniel von der Heydt in Elberfeld, of Charles L. Brace and Mrs. Charles R. Lowell in New York, embracing diverse fields of action, have aroused a new interest in social problems, because they have animated the benevolent with the hope that the evils of pauperism and crime are not ineradicable. These names are but representative of a long list of persons, whose disinterested zeal and intelligence have adorned the age with examples of the noblest humanity. By a law of compensation which seems always to work in human affairs, as the industrial reconstruction of society, consequent upon discoveries in science and their application in arts, went on, invading and overturning old relations and habits, there sprang up a race of philanthropists to meet this moral confusion by reknitting the ties which hold all parts of the community in healthful social order. 

A characteristic of modern benevolence is its recognition of the solidarity of human society. By virtue of this fact, man can no longer be regarded as a self-poised, isolated unit, whose character is the result of his own determination, but as the creature of his environment. Two fruitful inferences proceed from this principle: first, the inadequacy of mere physical instrumentalities to work a change in the condition of the debased, since these do not reach their fellowships; and secondly, the complicity of society in the evils of its wretched classes. Outlawry is a fiction; the word of the magistrate cannot undo the deed of God. For weal or harm, every living soul is an integral part of society; his deterioration is a disorder in the whole body. Probably these conclusions have not been formulated in the minds of many wise and effective disciples of charity, but they emerge none the less from all careful investigations into the situation and requirements of the miserable, and they are disclosed in the strenuous efforts of thoughtful philanthropists to reform the institutions and methods of the community, as an indispensable prerequisite to the reformation of persons. Let this contrast serve for an illustration: Professor Fawcett, in his work on Pauperism, tells us that an English landlord, desirous of improving the character of his agricultural tenants, whose bestiality was attributed to overcrowding, enlarged his cottages by adding rooms, so that the family could separate into decent privacy. Instead of doing this, however, his tenants sublet the new rooms, and thus increased the evils. These laborers were not conscious of any wants which could not be satisfied by herding in a single room. Their character was unchanged, and a mere mechanical improvement in their surroundings could not alter their habits. If Miss Octavia Hill met with better results in Barrett's Court, she was not less convinced than the landlord mentioned that no reformation was practicable among the objects of her solicitude, until their habitations were suited to good manners, and reflected upon them the standards of respectable society. But she knew equally well that her presence must enforce a decent discipline, and link her wards to a higher order of feeling and motive, or her tenants would go on as of old, turning the passage-ways into receptacles of garbage, and hewing the staircases into fire-wood. Miss Hill's success grew out of the recognition of two facts: the complicity of society in the degradation of her wards, and their capacity to respond to moral influences. They were the victims of neglect, and hence worse sufferers in character than in circumstances; but they were also human souls, susceptible to the order and beauty of discipline, when it was presented by one whose trained faculties attached her in a hundred joyous, honorable ways to that society which discipline unites and regally endows. 

The proper mode of dealing with pauperism is involved with various propositions for remodeling existing systems of charity. Were poverty and misfortune identical with pauperism, no vexatious question would arise to perplex a conscientious benevolence. Technically, the pauper is simply a person who has become dependent on the community. But a vast deal more is attached to the terra in every mind. There is a type of character implied in it. A grave change, indeed, must have gone on in individual character before a persons private trials can become subjects of public concern. Mere poverty does not dissolve those ties of kindred and acquaintance which avail for even the severest misfortunes of life. A man loses his place in society, with its kindly ministries of goodwill, and becomes an object of public relief by the decay of those finer qualities which render man a social being and not a brute, and the community a society and not a herd. Pauperism is an anti-social condition, and that is a moral state. It is the nearest approach to actual outlawry that human nature can exhibit. If we may pronounce the judgment which Mr. R. L. Dugdale only suggests in his pamphlet, The Jukes, which is a study of hereditary pauperism pursued through six generations, embracing several hundreds of descendants of the same stock, pauperism involves a deeper incapacity to sustain social relations than crime. It is a lower abyss of physical and mental inaptitude, and, consequently, it is more incorrigible. It is doubtful if any class of unfortunates, whether reduced by the hand of God, as the old phrase ran, or by vice, can escape the taint of spiritual debasement, when they become objects of public and official relief. 

Inasmuch as a frightful chasm lies between that position where a man is sustained by those resources of industry, thrift, affection, and esteem which centre legitimately in himself, and that wherein these are all dried up and public relief takes their place, the attention of social economists has long been directed towards the danger of offering facilities for crossing the chasm to those who are tempted to take the step by the pressure of poverty, a danger which is enhanced by the fact that the temptation appeals to those who have the fewest safeguards of intelligence and self respect. It is widely felt that public charity does present such facilities, and that it is a source of corruption, unless accompanied by provisions for restricting it to unavoidable suffering. Some of the humanest spirits, who have sacrificed themselves without reservation to charitable labors, even sympathetic women, through the secret chambers of whose heart the cry of pain went vibrating like a trumpet-blast from heaven, summoning them to duty, have regarded the prodigal relief of the present day as a source of no less mischief than intemperance. This opinion stands on record in a most emphatic way. Lord Grey's reform of the English poor law in 1834 was preceded by the most thorough scrutiny ever made of the pauper system of that country, by a parliamentary commission. It resulted in the creation of a national board of commissioners, who were to give effect to the changes deemed necessary. After several years experience, in the midst of a succession of bad harvests, and when the accompanying pressure of disordered markets had spread distress over the whole realm, the commissioners said, in their report to Parliament in 1839, all poor laws are in their essence impolitic and uncalled for, and that, consequently, their abolition ought to he the ultimate object of any changes that may be made, an object, however, that cannot be attained without being preceded by several years of careful preparation for it. 

For the reasons now alleged, much criticism has turned upon the system of legal relief practiced in England and America. One feature of it is generally reprobated by thoughtful men, and that is the out-door relief administered by overseers or guardians of the poor. The suppression of this form of assistance is the first step urged, but it is only a first step. Still further measures would undoubtedly follow, and indeed they are already set on foot, but their efficiency is hindered by the distribution of public doles. Little reflection is needed to perceive that this simple reform aims at a vast deal more than the relief of the taxpayer from an insufficient burden; at more even than a withdrawal of a limited amount of temptation from the poor. It is designed to be the entering wedge of a system of effective action. The corner stone of that system is the discrimination between real and simulated destitution, with a practical control of those who become the wards of charity. Should outdoor legal relief be abolished, it would then be possible to erect an English system which should incorporate the best features of French and German charity.

A comparison of the three systems will go far to show what amendments the administration of poor relief in America requires. For this purpose European experience is especially valuable for us, since nearly all the States of our Union have imported the English plan and theory of official charity, without much scrutiny, and with all their defects. Besides this, the information concerning pauperism in Europe is much more thorough and systematic than with us.

The English scheme of poor relief lies in confusion. Until Lord Grey's government, the justices of the peace had authority to order pauper relief at their discretion. There was no uniformity of method observed in the realm, but each parish was at liberty to pursue its own counsels. The local officers had some ground for prodigality in the standard set up by a statute of 1796, which directed the public pauper to be maintained in a state of comfort. Poor-houses, built under the Elizabethan statute of 1601, existed in most parishes, but they were designed only for impotent folk. At the beginning of the present century pauperism increased with great rapidity, and in some seventeen years the ratepayers burden was doubled, a tax that in some instances amounted to a confiscation of ratable property. Whether as a consequence or a cause of this increase, the justices of the peace had adopted the expedient of making allowances from the parish treasury for insufficient wages, and bad fixed a standard to which the weekly income of paupers should be raised out of the rates. They justified this course by the argument that it was cheaper to provide a partial than an entire maintenance for the dependents upon the parish. The effect was disastrous, for it appeared in the genera1 reduction of wages, which brought the most industrious to the brink of starvation, and destroyed the motive of self-support.

When the ruinous nature of this method was brought to light by a parliamentary investigation which occupied four years, Lord Grey carried an amendment to the poor law through the legislature, which stripped the local justices of the power to order relief, created a national board of commissioners, with district commissioners under them, and ordered the erection of work-houses in every parish, or authorized union of parishes. It was the intention of the framers of this amendment to confine all relief to inmates of the work-house, except in cases of peculiar emergency. The parish officers were to see that work was provided for and secured from all the inmates who were capable of performing it, especially able-bodied dependents. Those who would not accept this mode of relief were to be held as not sufficiently pinched by want to be objects of official aid. This is the famous but neglected work-house test of England. Its character and issue were tersely stated by Mr. Edward Denison in 1869, the year previous to his death: The framers of the poor law of 1834 never seriously considered how they could find work for the destitute. They only wanted a disagreeable and deterrent occupation. Their principle was to offer board and lodging in the work-house to all who would take it; the only further consideration being how to make the recipients condition so uncomfortable that he would avoid it as long as he could, and get out of it on the first opportunity. Possibly this system, thoroughly and universally enforced by able administrators, would have stamped out pauperism altogether, to the infinite advantage of the whole laboring class. But the law never was in harmony with public opinion; it was very partially and negligently executed, and of course broke down. The poor law of 1834 has practically been repealed long ago. Four causes wrecked the plans of Lord Grey's government: the recalcitrancy of the parish authorities, who would not follow the instructions of the board of commissioners; the distress consequent upon the bad harvests of 1837-39, and upon the commercial depression of that period; the sundering of families in the work-house; and the lack of proper discrimination between helpless and able-bodied inmates. One building and one administration were offered to the infant and the idle, to the aged and the vagabond, to the deserted mother and the penniless inebriate, to the blind or maimed and the street beggar. Two incompatible designs were to be pursued under one roof. The same institution was to be a hospital for the helpless and ah agency for repressing importunity. Humanity lay behind one part of the scheme, and suspicion behind the other. Occupation meant to be deterrent in one ward could not he regarded as honorable in another. The work-house dress and discipline confounded the impotent with the vagabond. Misfortune wore the badge of vice. Of course, in such an institution, the natural associations of the family must be broken up by artificial classifications. Parents are sundered from children, husbands from wives, brothers from sisters, a separation which is the bane of institutional life. The one cause rendered the workhouse unpopular, while the other rendered its repressive design fruitless. The general commissioners were not clothed with authority over the parish guardians, whose administration still managed the tax-rate, and distributed its proceeds. Local self-sufficiency and usage met the intervention of a national committee with jealousy and obstinacy, as if it were an impertinence. Then, the quick succession of general distress compelled the commissioners to relax their instructions, and in three or four years after the poor law was amended there were in England seven out-door beneficiaries of the parish-rate to one inmate of the work-houses, a proportion which has been maintained ever since with disheartening monotony. The sequel is thus narrated by Edward Denison : The guardians, with short-sighted economy, knowing that the fewer the inmates of the work-house the smaller their expenses, neglected to offer the work-house when they ought to have offered it, and got into a way of giving small doles of out-door relief to those whom they knew they ought to have admitted. Once embarked on the system of giving out-door relief, without the application of either work-house or labor test, there was naturally no end to it. They had taken the lock off the door; they had no means of discriminating the applicants. These, of course, became more and more numerous, as it became evident that any one might get relief, if he were lucky, deserving or undeserving. Then, having voluntarily pulled down the barrier which excluded only the unworthy, they were at length, in self-defense, compelled to put up another of some sort, and they put up one which excluded all alike, or, at least, let no more than half in. They gave so little relief that it was a mere mockery. Then in comes public benevolence, says the poor law has broken down, and does its best to make a real break-down of it. That, in my view, is the history of the matter. To this statement he adds his opinion, formed when he was living in Philpot Street, at the East End of London, whither he went to obtain by daily contact with it some clear insight into the nature of pauperism: The remedy is to bring back the poor law to the spirit of its institution.? The same conclusion had been reached by Sir Charles Trevelyan, a coadjutor of Denisons in philanthropic endeavor, and one of the most patient students of this social problem in England. It is shared by Professor Fawcett, the present postmaster general of the realm. And it has also recently been proposed by Mr. Seth Low, the mayor of Brooklyn, before a conference of charities held in Boston; and his intelligent devotion to the cause of the poor in his native city attracted to him that attention which raised him to civi5 honors, usually reserved, not for riper, but for more protracted years.

How exactly this brief account is paralleled by our American States! New York, for example, by a statute which Mr. Low thinks to be as nearly perfect as can be, but which, unhappily, has been much disregarded, restricts out-door relief, to quote Mr. Lows words again, to persons not in a condition to be removed to the poor-house, and in cases where the disability is likely to be temporary. So distinct is this provision that the city of Brooklyn was impelled in 1878 to withhold its customary appropriations for out-door relief, and with what results will be told further on. Here, then, is English experience repeated. An excellent repressive law is neglected; an unlawful system of inadequate doles to the lucky is set up ; in self-defence a barrier is erected against the depletion of the public treasury by excluding, without discrimination between need and mere greedy clamor, half the claimants of relief. Then voluntary charity steps in, and creates a confusion amenable to no method or discipline. Divided among a hundred practically irresponsible organizations, and flowing from thousands of hands, guided by neither experience nor information, the generosity of men, conscientious enough to give but not to befriend, engulfs the poor in stronger temptations to pauper life.

In one respect Mr. Denisons representation may fairly be controverted. They gave, he says of the guardians, so little relief that it was a mere mockery. Probably lie would himself have consented to change this sentence, and make it read, They gave so unsuitably that it was a mere mockery; for his published letters show that he deplored the lavishness of English relief, and that he commended the Paris scale of relief, which is so small that one may wonder whether there is any use of dispensing it at all. The Parisian allowance for a paralytic or blind person is one dollar per month. This is the scale of relief for a pauper in his seventieth year. From this sum it rises slowly to $2.40 for one in his eighty-fifth year. Septuagenarian and octogenarians entitled to hospital relief may have $4.80 on each of the five wintry months, and $3.80 on each of the remaining months of the year. These are the largest allowances authorized, and comprise nearly all that are made in money. Relief in kind is on a still smaller scale, and is denied to able-bodied men except in extraordinary cases.

A few years since the city of Leipsic had a standard of maximum relief to cover clothing, rental, fuel, light, and food. It was about sixty-two cents per week of our money for able-bodied men; women, children, and the aged were deemed to require less. This standard has been abolished, but the actual subsequent distribution of relief has averaged below it. The old Leipsic standard does not differ materially from that of Elberfeld, in Rhenish Prussia, a city notable in the charitable world for the excellence, thoroughness, and efficiency of its relief system. Now these low standards are not to be accounted for by the parsimonious spirit of the communities where they exist, nor by the cheapness of the necessaries of life there. They are found to be adequate, while under our prodigality and disorder society constantly presents the aspect of unsatisfied pauperism. Beggars are never absent from our streets; the child's whine for cold pieces is heard almost daily at our back doors; the stoves of the poor are never sufficiently replenished with charity coal; the dispensaries are crowded; the soup-kettles are draining all winter into the messengers pails; the sick are constantly waiting for the hospital bed to become vacant; the merciful man walks all his life among supplicating hands. There is no such appearance of mendicancy in France, nor in the better organized German towns; not even in Belgium, the classic land of pauperism, as it has been called. The penuriousness of France or Prussia avails to do what the strenuous lavishing of England and America cannot accomplish.

It is time to ask the reason of this difference. We have mentioned France and some German cities as examples of economy. In them there are two systems, conceived in exactly opposite political theories ; but notwithstanding this, their administration of relief quite as exactly corresponds in principle and in method. Under each the entire control of relief is substantially held by one management; therefore the pauper is practically in the custody of a single authority; the work-house test is fully compensated for by a system of investigation which makes relief at the homes of the poor quite safe; and two great remedial influences are kept in constant action upon the pauper, namely, employment and the constant pressure of friendship. How these things are accomplished we are now briefly to inquire.

Louis XIV. invited the great charitable foundations of France, in terms that could not be resisted, to confide their trusts to the government. The movement thus begun was completed by Napoleon I., when he sequestered the revenues of the church, and made the priesthood directly dependent upon the treasury of the empire. But while Louis XIV. was thus enlarging the functions of the French government, his troops were ravaging Germany. At the peace of Westphalia, a generation earlier, the population of Germany was found to be reduced to one fourth its former number; its cities were in ruins, its finances in disorder; its institutions had to be created afresh. Thus Germany was one of the latest of modern European nations to establish order and accumulate trusts. There are fewer institutions originating in private, self controlled charitable foundations in that country than in any European country west of Russia and the Balkan peninsula. Her hospitals and asylums are largely the creation of civic munificence, and therefore amenable to authority. There are exceptions to this statement, hut they are not serious enough to hinder the application of coordinated charity to the best systems of German relief.

The theoretical divergence of the French and German schemes of public charity is this: in France the state absorbs private benevolence into its official organization; in Germany the state abstains from official action, but authorizes private organization, and clothes it with needful powers. It must be understood, however, that in speaking of a German system of poor relief reference is made to the successful methods employed in typical German cities, as in Hamburg, Berlin, Leipsic, Elberfeld, Barmell, and Crefeld. Of the North German Confederation, and of nearly every German state, it may be said there is no system. Their legislation has thus far been confined to laying down the principles upon which the liability of each state, or each community, for the relief of the poor is to be determined, and to prescribing the Ames within which each poor district may exercise authority. As in England and America, the details of administration are left to each locality.

A rapid survey of the French and German schemes will elicit their common features. Paris may be taken as the completest illustration of the practice throughout the country, a practice followed in Belgium in all. its respects. We have already seen that the ancient and valuable charity foundations of France passed into government control. Under the civil code, private generosity is forbidden to erect any new eleemosynary institutions without the permission of the chief executive of the state, a permission which is very rarely accorded. Individuals may endow government institutions as much as they please, but the state is strictly averse to independent, self-regulated charity organizations, and will not incorporate them. From these old trusts there accrues an income, not only for the maintenance of hospitals, but for distribution in alms. To this resource are added the contributions of the benevolent, the proceeds of certain fines, and, when occasion requires, a subvention from the public treasury. Here we reach the first principle of French relief. Although administered by the state, this relief is charity. The funds are supplied by the voluntary acts of the people; the official is but the almoner of them. Consequently, the pauper can set up no claim to aid. This principle is in direct contrast to the English theory. Under the latter, applicants for aid have brought the poor guardians into court to compel them to give relief; and it has been held that, although the pauper could not recover damages, the guardian was liable to penalty for a denial of statutory relief. Probably the same doctrine would be held in the American courts notwithstanding the difference of method between Great Britain and America in levying the poor tax.

The agency for dispensing the money entrusted to the state for charitable distribution in France is called the Bureau de Bienfaisance. There is one for each commune, or borough, in Paris, as it is intended there shall be one for each commune throughout the land. Of this bureau the maire is hereditary president, and his aids are hereditary or exofficio vice-presidents. Twelve administrators are appointed in each bureau, and assigned each to one division of the commune. Their appointment proceeds from the Prefect of the Seine, who, in turn, is the creature of the interior secretary of the national government. The functions of the administrator are those of an overseer of the poor, with a voice and vote in the business of the bureau. In addition to these, the Prefect of the Seine appoints a secretary-treasurer of each bureau, in whose hands are the registers and the money, and who is in subordination to the Director-General of Public Relief, another agent of the general government. The bureau employs a staff of doctors, midwives, and Sisters of Charity, but all paid employees hold office from the Prefect of the Seine. So far everything is official. The provision for voluntary effort is this: Each administrator may nominate as many assistants in his division as he can persuade the board of direction to accept. They are described as commissioners and charitable ladies, and their duties are thus prescribed: They second the administrators in their care of households inscribed in the registers; they are specially charged with the duty of obtaining all possible information of the poor to be entered on the books; they propose their admission; they distribute at each dwelling the ordinary and extraordinary contributions; they visit the persons assisted by the bureau, to learn their position, the resources of the family, arid all other facts which may enlighten the board.

Let it also be considered that this system of administration is closely supported by the police; that every person must be inscribed upon the register before relief can be obtained; that a pauper must prove a residence of twelve months in Paris, and give notice of any change of lodging; that he is dependent on the administrator for the certificates required for unusual surgical appliances, for pensions from the war department, for legal papers affecting inheritance or exemption from taxes and fines, and for admission to hospital relief; that the separate bureaux are all hound in one administration by means of conferences held under the Director-General of Public Relief, and of reports made to his office; and it will be seen that very little opportunity is left to voluntary and private effort. The whole plan is summed up in the words of Mr. Edward Denison:

"Whoever desires to understand the French system of dealing with destitution must constantly bear in mind these two facts :

"(1.) That in France the state makes no special provision for the poor.
"(2.) That in France no one can do anything at all except through state machinery.

"The result of the joint operation of these two circumstances is that private charity supplies the funds, and state machinery administers them."

One point remains to be noticed. All in-door or institutional relief is restricted to the smallest limits possible. Even in the case of a septuagenarian applying for extraordinary hospital relief, every inducement is held out to him to remain with his relatives . There is no workhouse in France; no almshouse, even, in our sense of the word. The Depots de Mendicite, which may be thought to correspond with the work-house, are not tests of destitution, nor relieving agencies at all. They are the receptacles of persons convicted before a magistrate of some petty misdemeanor, as begging, vagrancy, drunkenness, and such offenses as with us consign the perpetrator to the house of correction. A system like this assumes the practical custody of the pauper from the moment he begins to receive aid. He is placed in subordination to an authority, which controls every avenue of relief; he is under the constant supervision of visitors, who not only deliver to him his allowance, but who befriend and counsel him, who seek employment for him, and teach him the best use of his own resources. Except in cases of nearly complete impotency, from age or defect, he is never maintained, but only assisted, by public relief.

On the other hand, the bureau takes every precaution that no form of distress shall need to apply elsewhere. While the profligate has little opportunity to take refuge among strangers, and to ply the arts of mendicancy on disconnected and discordant societies, the needy is not forced to go from office to office, to obtain fuel here, medicine there, and food elsewhere. Provision is made for every form of exposure to suffering from birth to the tomb. Even bedclothes are loaned, dresses for the first communion are supplied, and studious apprentices are encouraged with small annual gifts of money. And all this apparatus is directed by a single management, in the decisions of which the judgments of men actually engaged in the work unite.

It has sometimes been disputed whether there was less suffering from want in Paris than in other large cities, but it is not questioned that France is remarkably free from mendicants. Should it be said that this may be attributed to the proverbial habits of economy and thrift which characterize the French poor, it might well be retorted that their independence is not assailed by the temptations of unwise and cruel charity.

An examination of the system practiced in Elberfeld will show that the same results are aimed at by very similar means. The Elberfeld plan has been adopted in the neighboring cities of Barmen and Crefeld; it is analogous to that of Hamburg, Leipsic, and Berlin. We shall state the features common to those cities. In the original conception of these relief agencies, the care of the poor is wholly entrusted to a society of patriotic men, authorized by the municipal council to administer poor relief, as the constitution of the Leipsic Directory phrases it. These societies are self-perpetuating and self-regulated, though liable to be overruled by the civil authority. They connect themselves with the municipal authority by assigning seats in their boards of direction to some municipal councilors, burgomeisters, and financial officers. They coordinate their enterprise with hospitals and like foundations, as in Hamburg and Berlin, by giving them a representation in the board, or, as in Leipsic, by a municipal ordinance requiring voluntary societies to divulge the nature and amount of relief which they grant to the beneficiaries of the directory. In Hamburg, at one time, a police regulation went so far as to forbid almsgiving on the street. The voluntary society is authorized to collect subscriptions from the citizens, and to disburse them at its discretion. The funds so procured are augmented in some instances by police fines and licenses for places of amusement. In Prussia, a citizen chosen to act as an agent of a municipal relief society is liable to a penalty if he refuses his unpaid services. At Elberfeld he loses his communal vote, and has his taxes raised. Usually, the service is cheerfully rendered as an honorable trust.

The Armen Directory, or whatever the society may be called, divides the city into numerous wards or divisions, each under one or two overseers. Each overseer has associated with him a number of private citizens as visitors, chosen from the division under his charge. At Leipsic, a few years since, there were sixty visitors for a population of ninety thousand. This proportion was thought too small, and together with the fact that the different overseers did not meet sufficiently often for conference, and consequently carried diverse methods and vigilance into the work, was believed to impair the efficiency of the system. Elberfeld had two hundred and fifty-two visitors for a population of seventy-one thousand, or one visitor for every eight cases of registered paupers. A point is made, in this city, that no visitor shall have more than four cases in charge at one time, and it is rigidly observed; for it will be noticed that eight cases annually would hardly furnish four at one time. Berlin must come very close to the Elberfeld standard, since this capital is divided into one hundred and sixteen districts, each under a subcommittee of from fifteen to thirty visitors. Did each sub-committee average twenty members, there would have been eight cases of pauperism annually to each visitor, when the population was seven hundred and twenty thousand.

The English type of the work-house is almost unknown in Germany, though in some states, as Saxony and Bavaria, for example, legal provision is made for it. The attempt was twice made to introduce it into Leipsic, but in 1846 the institution was finally abandoned. The German work-house is a convict place. Its doors open only to the mandate of the magistrate. The Armenhaus, or almshouse, is usually an asylum for impotent folk; and while these are employed as their capacity will allow, the institution does not aim at being a test of destitution. In Berlin, the great influx of population since the city became an imperial capital has forced the workhouse into a new and probably temporary use. As building has not kept pace with the increase of population, rents have risen rapidly, forcing the poorer tenants to seek for cheaper apartments. These are not easily found, and dislodged families obtain a refuge in the work-house while in quest of new homes.

But the prevailing sentiment of Germany is averse to in-door relief, on account of the separation of families which it involves. The Prussian law makes husbands and wives, parents and children, liable for each others maintenance, if they have the means therefore. This requirement is extended in some instances by communal law to half brothers and sisters, to grandparents and grandchildren. Where so much emphasis is laid upon the natural duties of relationship, no plan which sunders families or weakens their sense of responsibility one for another can receive much countenance.

Another feature of German law is that relating to settlements. Formerly, each state, to avoid the expense of pauper support, erected barriers to immigration from other states. The North German Confederation has now provided that any German may receive assistance from the commune where his necessity arises, but that the cost of it may be recovered from the commune where he has a legal residence. In Prussia, arbitration courts are established, with jurisdiction over this question. The practical result is that a record of pauperism is kept, almost as strict as that of France. The pauper cannot escape from the environment of kindred and acquaintance, a fact which in itself is a great obstacle to imposture.

When a destitute person wishes to be aided, under either the Leipsic or the Elberfeld plan, he must apply to the visitor in the locality where he resides. Thus his petition is brought before the overseer and the directory. He is then subjected to a most rigid inquisition, which is called the Fragebogen in Leipsic, the instruction in Elberfeld. He is informed that if he accepts relief he immediately parts with his civic rights, and that he must observe a courteous and perfect subordination to the relieving officers. Any willful untruth in his declarations subjects him to the custody of the police. He is then required to furnish a correct statement, and a record is made of his kindred in ascending and descending lines; of his occupation and the means of earning of each member of his family; of his previous history, particularly if he has ever been in the hands of the police; of his furniture, jewelry, goods in pawn, loans, debts, membership of any beneficial club, and his claims therein; of his rental, and whether it includes furniture, fuel, and light, and whether he sublets any of his apartments. He is questioned as to his efforts to obtain work, and idleness for a certain number of months without an effort to get employment is a misdmeanor punishable with imprisonment. While he is receiving relief, he must not keep a dog, or frequent places of amusement, or refuse the labor that may be assigned to him, or use the aid granted him for any purpose but his own immediate and personal wants. This may seem an impertinent, despotic regimen, but it is not without valuable advantages. Above all, it furnishes the information so essential to a proper management of the case, and it enables his guardians to protect him from enticements to sink into a dissembling vagabond.

The pauper, once registered, is placed in the care of a visitor, who is not only unpaid, but a reputable citizen, and who is enjoined to be a faithful, vigilant friend. The visitor is to seek employment for his wards; to visit them weekly; to observe any changes in their circumstances; to help them make the best use of their own resources, and leave the charity lists as soon as possible. The relief accorded is determined at a meeting of the directory, at which the overseers assist, and to which the visitors may come. It is to be in kind, when possible, and is not to be called for, but regularly carried to the paupers home. At Elberfeld, every month the lists are revised in the board meeting, reports are received of any change of circumstances in the condition of the beneficiaries, and all whose necessities have ceased are dismissed.

The result of Von der Heydts Elberfeld plan was so remarkable as to attract attention from all parts of Europe and America. In 1852, the year before Von der Heydts society was formed, the city, with a population of fifty thousand, had four thousand paupers. In 1869 the population was seventy one thousand, and the paupers one thousand and sixtytwo, while the expense had dwindled one half. In Leipsic, the ratio of paupers in 1832 was 9.2 per cent., in 1870 it was 3.26 per cent. In Berlin, the ratio of out-door paupers is about 2.5 per cent., and it is not materially different in Hamburg.

In these European systems, the French scheme is that of official relief, the German that of organized private charity. Both are alike in the following principles: unity of action; the practical and exclusive control of the beneficiary; aid rather than maintenance; out-door rather than in-door relief; assistance based upon thorough information as to the paupers disposition, resources, and needs, administered by experienced hands, and adequate in character and duration of time to prevent all suffering; and the earliest possible restoration to independence of the pauper. The remedial features of these systems arc dependent upon a complete acquaintance with each case, and the absence of interference with its management. Can these two features be grafted on our Anglo-American system? Or rather, since we have no system, can these two principles be rooted in our free soil, so that our rank growths of prodigality and caprice may on this stock bear wholesome fruit?

This is what our benevolent economists seem to aim at. If legal relief can be restrained to the inmates of public institutions, at once a coordination of work will ensue. Private charity takes up the out-door poor; the state assumes the care of the in-door paupers. Those who are in public institutions pass under the discipline of a single authority, and in that custody are removed from the interference of inexperienced, undiscriminating hands, and from the opportunity to practice the dishonorable shifts of the professional mendicant. Moreover, these public institutions are in turn more amenable to the best opinions of the community. Mistakes here soon become obvious, and are more easily remedied. Then, too, public relief comes into orderly relation with private benevolence. The state alone can restrain and coerce. That power is needed when the persuasions of free society fail. Those whom voluntary charity finds incorrigible, or beyond its influences, will gravitate into public institutions. Thus, private efforts for the good of the depressed will be accompanied with the alternative of the discipline of official oversight, when immoral forces prove insufficient.

But is it safe to trust private hands with the whole control of out-door pauperism ? In view of the fitfulness, caprice, sentimentality, and corrupting lavishness of ignorant benevolence, students of social science have long been deprecating the disorders of spontaneous charity. Well, it exists as a very momentous part of our social machinery. Nor is there any trace of the slightest disposition on the part of the free-born American or Englishman to surrender his inalienable right to give away his money just as he chooses. He is neither a German nor a Frenchman. We must deal, therefore, with private charity as hest we can, appealing to the good sense of the community, and to that genuine humanity which, in every generous breast, is deeper than the desire to gratify a mere sentiment for improved methods of working.

The attempt to organize the charitable forces of society on a basis of voluntary adhesion, which began in London more than a dozen years ago, not uninfluenced by the example of Elberfeld, has already made encouraging progress in England, and is rapidly taking root in our chief cities. Those economists who have most earnestly advocated the abolition of public out-door relief, like Sir Charles Trevelyan, Edward Denison, Octavia Hill, Professor Fawcett, and Seth Low, who have been already mentioned, with a host of others who might be named, have been warm friends of the charity organization movement. In its essential idea, charity organization aims to establish a bureau, through which every established institution and society formed for the assistance of the poor and every private citizen may act in cooperation. It renounces the pleasure of giving any relief which can he procured from agencies already existing. In pursuit of this idea, it schedules and classifies all the discoverable resources of charity, and says to the generous and to the destitute, here is where you can best accomplish your aims; here are the means appropriate to your desire or your need.

Charity organization, drawing its agents from workers already in the field, or from fresh volunteers, distributes them through every precinct of the city, to discover what forms of human misery are hidden there; to probe the social wounds, and ascertain how far they penetrate through the flesh into the character; to search out the cause they know not; to be discreet friends to the weak and incompetent; to open to them the sources, of help, and first of all those which place them upon their feet, and put a brave, hopeful, self-respecting heart in their breasts. Its purpose is that not an outcast soul, however dislodged from society, shall go misunderstood and unbefriended.

Holding this purpose, it comes to the community and says, We will accept the responsibility of every case of real or simulated distress which you may throw upon us. We will not relieve it ourselves unless it be so exceptional an instance that no other resource is at hand; for our aim is not to create a new organization, but to systematize and bring to the highest efficiency the hundreds of agencies already available, and so put an end to their disorder and waste. It is an agency for investigation, and as such it becomes a bureau of registration, at which relief societies may detect the overlapping of their work, the concealed assistance of their beneficiaries, and the impostures practiced upon them. There they may find the means to discriminate between meritorious and dissembling want.

Charity organization is a scheme of conference. Workers fresh from the field come together, that a hundred experiences may converge into some luminous ray of guidance, that the dispirited and perplexed may he encouraged, that the one sidedness of individual sympathy and observation may he corrected, that the wisdom of the many may coalesce into the wisdom of each one.

A plan like this has in it the meritorious points of the Elberfeld system; or, at least, it will have them as soon as private and public relief shall he separated and put in supplementary relations. It has the virtue of being a voluntary society of patriotic citizens; it furnishes friendly visitors, allotting the field among them, so that they do not cover the same cases, nor become overburdened with duty; it acquires that information which makes imposture difficult, and suffers no destitute person to he neglected ; it elicits and brings into order the resources of benevolence, so that no form of want goes unprovided for; by checking waste and distributing applicants systematically, it reduces relief from maintenance to assistance, from the prop of idleness to the crutch of the lame, and it can prolong well-adjusted aid while the necessity for it lasts finally, being a system of unity and thus gaining in a large measure control over the wards of charity, it can terminate relief when the occasion for it passes, and the dependent upon it is ready to graduate into the great world of industrial, social, and moral order. Such is the significance of the attempt to curtail legal relief to the limits of institutions. It is an important, if not an essential, step to systematized work, and until pauperism is confronted with system there is no hope of eradicating it. This paper, already long, ought not to pass over certain facts which illustrate and support its argument. Chalmers's experiment in one of the poorest and most populous parishes of Glasgow is a case in point, and is freshly appealed to as an example of wise administration. He abolished all legal relief in his parish, and charged every new case of pauparism that arose upon an evening penny collection, which amounted to $400 a year. In a population of ten thousand hut twenty new cases arose in four years, of which five were the results of illegitimate births or family desertion, and two of disease. The cost of their relief was but $175 a year. In a few years the established pauperism of the parish sank from 164 to 99, and Dr. Chalmers had to find new educational methods for employing his superfluous poor funds.

Mr. Low, in a paper to be found in the published proceedings of the National Conference of Charities and Correction of 1881, brings forward three instances of the sudden curtailment of public official out-door relief which were attended by no discoverable distress. In 1876, the town ship in which Indianapolis is, by a change in the trusteeship of poor relief, reduced its expense from $90,000 a year to $8000. In 1878, the city of Brooklyn ceased to give out-door relief, in which $141,207 had been expended the previous year. The sudden withdrawal of this large sum found no compensations elsewhere that could be detected. There was no increase in the population of the almshouse or hospital, no augmented demand upon the treasury of the General Relief Society of the city, no police reports of unusual mendicancy or want. On the contrary, since the cutting-or of public out-door relief, with the exception of 1879, when the inmates of the hospital and almshouse were increased by only eleven, this in-door population and the expenditures of the Society for Improving the Condition of the Poor have diminished. Like statements may he made concerning Philadelphia, where the municipal councils in 1879 declined any further appropriations for out-door relief, although they had voted $66,000 to this purpose the previous year. No new strain was put upon either the public institutions or the resources of charitable societies.

For some years the East End Union of London, within whose limits lies one of the most poverty-stricken districts of that city, has abolished all official outdoor relief, with a most encouraging gain upon the pauperism of its territory.

One of the best informed writers on the subject of Italian pauperism writes, When Napoleon abolished the religious orders and the convent alms at Rome, out of thirty thousand beggars, thus left without assistance, only fifteen thousand had themselves registered and taken into St. John Laterans. The same thing happened in Lombardy in the time of Joseph II. When the workhouses of Pizzighettone, Abbiategrasso, and Milan were opened for beggars, the greater part of them disappeared.

These instances are taken from widely different countries, times, and circumstances, yet they concur to show that no small part of the apparent pauperism of the community is only simulated, in order to share in the spoils of charity. They sustain with uniformity the oft-repeated proposition that mendicancy grows by the provision made for it.

Probably few would object to the expansion of their comfort which even mendicants may gain by their vulgar cunning, if this were all that should be taken into account. We might well say with Charles Lamb, Rake not into the bowels of unwelcome truth to save a half-penny. But the half-penny is not the consideration at all. It is the saving of a human being. And the corrupting influence of professional, or mechanical, or official charity is beyond all denial. In it the element of personal sympathy is almost, wholly obscured. The fountain of beneficence is concealed. Paupers do not drink at the clear spring. The almoner of a public fund does not give his own away, but simply distributes among clamorous claimants what they regard as morally their own. They can recognize but little more ground of gratitude to the mechanism of distribution than to the hydrant which brings the water that it taints into their dwellings. There is little in this perfunctoriness to reinstate the poor in the consciousness of social ties. Rather, the official agency of relief is a bar to the avenues of society. It is a gate where those stand, to use Longfellow's graphic words,

Who amid their wants and woes
Hear the sound of doors that close,
And of feet that pass them by;
Grown familiar with disfavor,
Grown familiar with the favor
Of the bread by which men die.

Whatever scheme of dealing with pauperism may be pressed upon our notice, one truth will doubtless emerge from every experiment, clad in repulsiveness until society recognizes it, transfigured with divine radiance when obeyed. It is the truth that man is not an animal, but a moral and social being. The system must be simply the method 0 by which the noblest spirit acts, not a labor-saving mechanism. The English work-house, with all its discriminating rules, has lapsed again and again into a winters refuge of vagabonds, a recuperating asylum of the inebriate and licentious, a source of infection to its hapless innocent inmates, and a prop to prolong the career of profligacy. Under the elaborate and splendidly adjusted organization of the Bureaux de Bienfaisance, Napoleon III. thought it necessary, during his reign, to expend more than $360,000,000 on the public improvements of Paris, in order to furnish employment to the people, while Belgium is the classic land of pauperism. The severe Fragebogen of Leipsic cannot remedy the faithlessness or indifference of the overseer, nor the lack of moral influences attaching to the paucity of visitors. Under all systems, everything depends on the manner of administration, and the spiritual wealth of the community at their command. While the scope of relief extends to no greater wants than an intelligent farmer considers in his herd, the pauper cannot hut feel that he is placed among the cattle outside, and excluded from all participation in the life of these households. The closing of the doors to high human fellowships, with their moral basis of order and concord, with their bright conventions of courtesy and refinement, with their rich play of responsive sympathies, with their hope exciting vistas of still ampler and purer prospects, this is the saddest element in the situation of those whom adversity, ignorance, or vice has depressed. The poor wretch, who, lapsed from the pale of cosmic life, is sinking into the debasement of animalism, where intelligence turns to predatory instincts, the voice of conscience is quiet, the faculties for fellowship wither up, and the hope of better things does not stir the heart, needs to be environed by the friendships of the capable and strong. Without this higher and harder charity, organization is not method, but mechanism. The hand without the mind is but a tool. Together they are the artist. The mechanisms of charity can never shape the hard rock of pauperism into the features and forms of beauty. For that undertaking society must become an inspired artist. May not this persuasion have led the apostle Paul to couple the principle and exhortation together? He that soweth to his flesh shall of the flesh reap corruption ; but he that soweth to the spirit, shall of the spirit reap life everlasting. And let us not be weary in well-doing; for in due season we shall reap if we faint not.

Section: 

1884-1910: Provision for Old Age

Summary: This excerpt from Henry Seager's classic book provides great insight into early 20th century views around the world on old age and public assistance, family and employer responsibility, and the role of private insurance.

Social Insurance: A Program of Social Reform
Henry Seager, 1910

A chapter from this classic book provides a lot of insight into early twentieth century views on old age and public assistance, both in the United States and around the world. It also provides a commentary on a number of relevant issues, like the responsibility of family members for the elderly parents, the responsibility of employers to provide financial assistance to their retired employees, and the role of private insurance and annuities in preparing the elderly to provide for their own needs.

The full text of the book is available in PDF format at http://www.ssa.gov/history/seager.html, but I have converted the most pertinent chapter into HTML to make it more easily accessible.

CHAPTER V - PROVISION FOR OLD AGE

THE last of the evils that I propose to discuss in these lectures is impecunious old age. Happily, old-age poverty is less conspicuous in the United States than it has become in European countries, but it is already sufficiently common to present a problem.1 Numerous as are the old men's homes, old ladies' homes, and homes for aged couples that are supported by private charity, they are yet, as every worker among the poor knows, too few to meet the demand. Our almshouses are also practically homes for the aged poor. Some almshouse inmates became paupers before they were aged, but many of them led independent and self-respecting lives, and even put by something for the future while physically able to earn wages. When wages ceased, savings, if any were made, were used up or else lost in unwise investments, and at the end almshouse relief and the pauper's grave were preferred to exposure and starvation.

Whatever preconceptions we may have in regard to the duty of thrift and the importance of making every one suffer the consequences of his own lack of forethought, me must all agree that the lot of the aged pauper is a hard one. Other countries are trying to ameliorate this lot by substituting for pauper relief compulsory or assisted insurance or old age pensions of various kinds. Their need is greater than ours, but this makes it more important that we study the problem and decide as to the merits and demerits of different plans for providing for old age, before an aroused public opinion, brought to bear on our state legislatures or on Congress, forces unwise legislation.

Old-age poverty is, of course, not a new problem. There is every evidence, however, that it is a problem of growing seriousness. In the country household there is a place for the aged parent or grandparent. The family has a settled abode, and economic interest re-enforces filial regard in securing to old people proper cart and consideration. So long as any strength remains, there is useful work about the house or farm which they may do. Moreover, the cost of maintaining an aged relative in the country is so small as to seem an insignificant burden. In the crowded tenement houses of modern cities the situation is very different. Here, as industry is now organized, there is little for an aged person to do. The positions for which men or women over sixty-five years of age are suited are few, and there is always an excess of old men and women looking for such positions. Furthermore, the cost of maintaining an aged relative in the city is an appreciable item in a wage earner's budget, and even when the burden is cheerfully borne, it means so much less for other necessary family expenditures.

As changing economic conditions are rendering the dependence of old people on their descendants for support increasingly precarious, so, on the other hand, new obstacles are arising to providing for old age through voluntary saving. I have already spoken of the tendency of expanding wants and of city conditions of property ownership to discourage saving on the part of wage earners. The call of the savings bank and of the insurance company is weak in comparison with the old-time call of free land and a home of one's own. As the typical American is changing from the farmer to the factory employee, the likelihood that old-age poverty will be provided against by voluntary saving is decreasing. We have not yet seen the normal consequences: of this development in the United States, because we are still in a transition stage. European experience, however, should leave us in no doubt that a great increase in old-age poverty lies before us, unless we are prompt in taking measures against it.

The proper method of safeguarding old age is clearly through some plan of insurance. Old age is a risk to which all are liable, but which many never live to experience. Thus, according to American lift tables, nearly two thirds of those who survive the age of ten die before the age of seventy. Under these circumstances, for every wage earner to attempt to save enough by himself to provide for his old age is needlessly costly. The intelligent course is for him to combine with other wage earners to accumulate a common fund out of which old-age annuities may be paid to those who live long enough to need them. There is little evidence that wage earners have thus far made much use of such machinery as is available for procuring old-age annuities. This is partly because of a lack of prudence and forethought on their part, but partly, also, because until quite recently the machinery itself has been unsatisfactory. Trade-union and fraternal insurance have done something to meet this need, but neither is on a very secure basis from the actuarial standpoint, and the number of individuals benefited has been small.

Much more significant in its promise for the future is the introduction of old-age pension plans by some of the railroad and industrial corporations. The pioneer in this field was the Baltimore and Ohio Railroad, which inaugurated its pension policy in 1884. Its example has already been followed by twenty-four other railroads, including such important systems as the Chicago and Northwestern, the Delaware, Lackawanna, and Western, the Illinois Central, the Pennsylvania, the Philadelphia and Reading, the Southern and Union Pacific, and the New York Central. Needless to say, these pension systems, though they require, often, no contribution whatever from the employees who benefit from them, have not been introduced on grounds of philanthropy. They are frankly intended for the good of the service. As Mr. Burlon Hendrick puts the matter in an article on "The Superannuated Man": 2 "The most effective way of securing the right kind of force is obviously to adopt a broad general policy that will attract the most ambitious men, and secure from them the most efficient work of their productive years. The law of gravitation affect wage earners as well as other objects in nature; the best inevitably gravitate toward the most satisfactory terms of employment. The corporation that can insure its employees a reasonable permanency of employment, promotion in order of precedence and fitness, and a satisfactory provision for old age, will inevitably attract the highest grade of men and obtain from them the most efficient work."

From the point of view of the railroad companies which have been so enlightened as to introduce them, these pension systems are admirable. A study of their detailed provisions leaves one a little less certain that they are entirely satisfactory from the point of view of the men. Their primary object is to insure continuity of service. Thus, all of them limit their benefits to employees who have been in the service of the corporation for a considerable period of years, ten, fifteen, twenty, twenty-five, and in one case thirty years being prescribed. Again, all of them base the amount of pension on the period of service, a usual plan being to pay one per cent of the average wages during the last ten years for each year of service. Their whole tendency is thus to tie the employee to the single corporation for life. As regards railroad corporations, continuity of service is so important to the safety of the traveling public, and the relations between employer and employee are on the whole so satisfactory, that this is perhaps not a serious objection.

The same system, however, is being widely adopted by industrial corporations. Already twenty or more such corporations, including the American Steel and Wire Company, the International Harvester Company, the Standard Oil Company, the Metropolitan Street Railway Company, and the Western Electric Company, have such plans in operation, and many more are contemplating their introduction. In the opinion of employees in competitive industries, any plan which ties a man to his job by discouraging him from changing from one employer to another, when by so doing he may better his condition, is undesirable. All economists recognize that the mobility of labor is an important factor in securing for wage earners higher earnings and better conditions. These pension plans are intended to and do oppose the free mobility of labor. No fault is to be found with the employer for desiring to insure the stability of his labor force. On the other hand, we must recognize that these plans which make enjoyment of an old-age annuity contingent on devotion to a single employer over a long period of years may seriously hamper wage earners in their efforts to improve their lot.

I mention this drawback not because it seems to me an insurmountable obstacle in the way of solving, or largely solving, the problem of provision for old age through corporate initiative, but because I think it ought to receive more sympathetic consideration than corporate managers have yet accorded to it. These corporation systems in their present form may be compared with the old-age pension systems that were maintained by some of our universities before Mr. Carnegie came forward to provide old-age pensions for college professors through the Carnegie Foundation. Under the old plan, a professor at Columbia, for example, was entitled to a pension after a certain number of years' service, if he remained at Columbia until he attained the age of sixty-five. This was a good system for Columbia, but it cannot be denied that it had a tendency to keep men in New York when it might have been better for them and better for the country if they had felt freer to go to other universities to which they were called. By Mr. Carnegie's benefaction a national system of pensions for college professors was substituted for the local systems that were previously established. The Columbia professor today is no better off, if he prefers to remain at Columbia, than he was before the Carnegie Foundation was established. He is freer, however, to consider on its merits any invitation to take his Columbia training and his Columbia experience to another institution which may require his services. By his benefaction, Mr. Carnegie increased the mobility of the teaching staff of our American colleges, and I believe the country is the better for the change.

It would be entirely possible for the great corporations that have taken the initiative in supplying old-age annuities for their employees to substitute for their establishment plans some system by which the employee who could better himself by changing to another employer might do so without forfeiting his right to the annuity. To explain how this might be done, I must first describe two other important recent developments in the field of old-age insurance in the United States, the Massachusetts Savings Bank Insurance plan, and the offer of new types of old-age annuity policies by the commercial insurance companies.

The Massachusetts Savings Bank Insurance system was introduced three years ago, for the purpose of bringing cheap life and old-age insurance within the reach of all wage carriers who patronize the savings banks. No paid agents or collectors are employed by the banks, and consequently the cost of administering the system is kept at a minimum. It is expected that business will come to the banks not only from wage earners who wish policies for themselves, but from trade unions, mutual benefit associations, and employers who wish politics for their members or employees. The banks insure not only individuals but groups of individuals, and their initial rates, which are themselves low, are made even more attractive by the payment of substantial dividends. Thus, the dividend last year, the first year during which the system was in full operation, was 8 1/3 per cent to all policy holders. The system has not yet been in operation long enough to justify confident assertions in regard to its success. Its promoters claim that it has already forced the commercial companies materially to reduce their rates, and that still further reductions are probable. On the other hand, the commercial companies assert that they were about to reduce their rates any way, and that, if they were given the same privileges as the savings banks in regard to the issue of group politics, they could offer better service at lower terms than their new competitors.

That an important change in the policy of the industrial insurance companies was made, at about the same time that Massachusetts introduced her interesting experiment, is generally admitted. The premium rates on workmen's insurance policies have been materially reduced, and numerous new forms of policies designed to meet more exactly the real requirements of wage earners have been put out. Thus, the Metropolitan Insurance Company has recently offered a combined life and old-age annuity policy at rates that bring it within the reach of all wage earners, except the very poorest, who have the forethought to provide against these contingencies. The Metropolitan Company has also sought to have the insurance laws of the various states amended to enable it to offer group policies. Such amendments have been made in Maine, New Jersey, and Minnesota, and though bills having this end in view were defeated in Massachusetts, and, through the governor's veto, in New York, it seems probable that such a desirable change will soon be made in the insurance laws of all of the states.

The plan by which well-disposed employers might free their offer of old-age annuities to their employees of the objection that such old-age annuities tie them to their jobs, is, briefly, as follows: Taking advantage of the low rates for insuring groups of men, employers might secure old-age annuity policies for their employees as they are added to their force. The premiums on these policies might be paid wholly by the employer, as an addition to wages designed to attract a higher type of workmen; wholly by the employee, as a deduction from his wages voluntarily agreed to at the time he enters the employment; or, partly by the employer and partly by the employee. In any event, the employee should be given a property right in the policy taken out for his benefit. If he decided at any time to change to another employer, the policy should be freely surrendered to him, or its cash value paid over to him. On entering the employment of a new employer who had a similar system, he should be required to deposit his policy with the employer, and the premiums on it would be paid by the new employer, in accordance with whatever plan he was pursuing with reference to his other employees.

Along these lines it would be possible, if broadminded employers would take the initiative and look at the problem from the point of view of the deep social interests at stake, for the United States to go far toward securing the benefits of the compulsory old-age insurance system of Germany, or the old-age pension system of the United Kingdom, while avoiding the serious disadvantages of both plans. It is perhaps visionary to expect that American employers will do this, but there is good ground for maintaining that, unless they will carry out some such plan, old-age pensions paid by corporations to the employees who have been long and faithful in their service will fail to solve the serious social problem presented by old-age poverty.

Another important development in the lint of provision for old age is the growing agitation for old-age annuities for civil service employees. Aside from humanitarian considerations, there can be no question that the efficiency of the public service requires sonic arrangement for the enforced retirement of civil service employees at a stated age. The United States is the only important country which has not introduced retiring allowances for public employees. The authorities at Washington are so impressed with the importance of the question that President Taft, the Secretary of the Treasury, and the Secretary of the Interior have united in urging Congress to pass a civil service old-age pension law during the present session. The same considerations that apply to old-age pensions for federal employees apply to state, county, and municipal employees. It is a significant indication of the trend of the times that the Report of the Commission on old-age Pensions, Annuities, and Insurance, which has just been submitted to the Massachusetts legislature, while highly conservative in most of its recommendations, comes out strongly in favor of retiring allowances for public employees. In this connection it says : "The fundamental consideration is one of economy and efficiency. The retirement system will stop the waste and demoralization now involved by the continuance of worn-out workers in the public service." To supplement this recommendation, it has introduced bills into the legislature providing retiring allowances for state, county, city, and town employees based on the contributory principle.

So much for the situation as regards provision for old age in the United States. Other countries, as already stated, have gone much further in developing policies to cope with this problem than we have.3 In this, as in so many fields, Germany was the pioneer. Following the successful establishment of compulsory illness and compulsory accident insurance through the acts passed in 1883 and 1854, the imperial government introduced compulsory old-age and invalidity insurance in 1889. Under this system, employers in Germany are required to insure their employees sixteen years of age and over, by paying the prescribed premiums to the local insurance offices.4 One half of these premiums is deducted from the wages of the employee; the other half is contributed by the employer. The government itself contributes 50 marks ($12.50) per annum to each annuitant, and also bears most of the expense of administering the system. The annuities are paid to any insured person who is completely disabled from earning wages, or who has attained his seventieth year, whether incapacitated from earning wages or not. The amount of annuity depends on the wage class to which the insured belongs, but is, in any event, quite small according to American standards, the highest pension being only 230 marks ($57.50) a year.5

There can be no question but that Germany's system has succeeded in ameliorating old-age poverty in that country. The opposition to it, which was at first bitter on the part of employers, has disappeared, and it is now looked upon as reasonable and desirable social legislation. Nevertheless, this feature of Germany's compulsory insurance system has not been imitated by other countries. Among the objections urged against it are:

(1) [lost text] which it is not easy to justify. Old age is not the result of employment, but entirely distinct and independent of it. If a comprehensive plan for providing maintenance for the aged is to be adopted, why should employers be singled out to make a special contribution to it? On what ground can it be maintained that they are any more responsible for the solution of this social problem than any other class in the community? In Germany, employers submit to it because, between the landed aristocracy on the one hand and the social democrats on the other, they are politically weak. It would be difficult to make them submit to it in a country where their political influence was greater.

(2) The administration of the system requiring, as it does, so many small contributions collected over such a long period of years is both cumbrous and costly.6 Unless it can be clearly shown that this method of providing old-age annuities fosters thrift on the part of those who benefit from it, as the method of old-age pensions paid directly from the public treasury fails to do, the greater costliness of administering it is a serious objection.

(3) It is questioned whether compulsory insurance does tend to foster thrift. Compulsory: thrift is almost a contradiction in terms. It is not through being compelled to save that people develop the habit of looking forward and the spirit of enterprise which will lead them voluntarily to make provision for future needs. This is a psychological question, and those who have studied the reaction of Germany's system on the habits of Germany's wage earners hold diverse views in regard to it. There certainly appears to be some evidence that now that the discussion of the system has largely ceased, wage earners think of their wages as what is left after employers have made the deductions which the law requires, and look upon those deductions as taxes to which they are subject, without giving much thought to the fact that the proceeds may ultimately be expended for their benefit.

The same general social conditions which led Germany to introduce compulsory old-age insurance, led Denmark, two years later (1891), to introduce her system of old-age pensions. This was part of a comprehensive reform of the Poor Law, which was designed to deal even more rigorously with what we may call the "undeserving" poor, and at the same time to treat more generously and considerately the victims of misfortune. To be entitled to a pension under the Danish law, the applicant must satisfy the following conditions:

  1. He must not have been convicted of a crime or of a dishonorable transaction.
  2. His income from other sources must be insufficient to provide the necessaries of life, or proper treatment in case of sickness for himself or those dependent upon him.
  3. His poverty must not be a consequence of any action by which he has deprived himself of the means of subsistence for the benefit of his children or others.
  4. During the ten years preceding his application he must have had a fixed residence in the country, and not have applied for pauper relief or have been found guilty of vagrancy or begging.
  5. Finally, according to a provision added in 1902, he must not have led a life such as to cause scandal nor have been convicted of drunkenness or immorality.

Any person who has completed his sixtieth year, and satisfies these requirements, may apply for an old-age pension to be paid entirely out of the public treasury. The amount of the pension depends upon the cost of living in the locality, and is determined by local officials. That it is not excessive may be inferred from the fact that in 1904 the maximum pension paid was only $54 a year (in Copenhagen), and the average was less than $40. For pensioners who have no relatives or friends with whom they may lodge, old-age homes are provided of which Miss Sellers draws quite an idyllic picture I in her interesting account of the Danish Poor Relief System. They are managed more as small inns or boarding houses than as charitable institutions, and the residents are treated as voluntary guests rather than as inmates.

Students of the Danish system say that that country, by making a sharp distinction between paupers and pensioners, has succeeded in providing for the victims of misfortune in their old age without discouraging thrift and prudence on the part of the wage-earning classes. The very fact that to secure an old-age pension the applicant must not have been in receipt of public relief or been convicted of begging or vagrancy during the 10 preceding ten years necessitates a self-supporting existence up to the time when wage-earning capacity begins to wane.

Germany's and Denmark's systems were introduced by conservative leaders who were alarmed by the progress of radical thought as typified in the social democratic party. From this point of view, the adoption of old-age pensions by New Zealand and the states of Australia, which came next in chronological order, is highly suggestive. New Zealand's system, which was introduced in 1898, was the policy of the labor party itself. This system was copied within the next few years by New South Wales and Victoria, and in 1908 introduced for the whole Commonwealth of Australia through a federal law which has just come into operation.

The spirit of this legislation is indicated by the preambles to the statutes introducing it. The laws of New Zealand and New South Wales declare that "it is equitable that deserving persons who, during the term of life, have helped to bear the public burden of the Commonwealth by the payment of taxes, and by opening up its resources by their labor and skill, should receive from the colony pensions in their old age." The law of Victoria goes even further, asserting that "it is the duty of the state to make provision for its aged and helpless poor." As the main features of these systems are reproduced in the recently adopted system of Australia, a brief description of the latter will suffice. In order to secure a pension in Australia, the applicant must have attained the age of sixty-five, must have resided in the country for twenty-five years continuously prior to the date of application, must be of good character (that is, have led a temperate and reputable life during the five years immediately preceding the date of application), must not have deserted husband, wife, or children, and must be in need of the assistance, the test being the amount of income from other sources (not more than £52) or the amount of property owned (not more than £310). The persons satisfying these requirements are entitled to pensions of not more than £86 ($130) a year. If the income from other sources amounts to more than £26, the pension is reduced correspondingly, the total income being kept down to £52 a year ($250). It is too early to judge of the effect of this federal old-age pension policy in Australia. The New Zealand system, however, has now been in operation for more than ten years, and some notion of its tendencies may be formed. The total number of pensioners in 1908, out of a population of about one million, was 13,569. The expenditure for pensions in that year was $1,626,000, or approximately $1.70 per capita of the population.7 Since the system was introduced, the number of pensionaires has increased year by year, but not with alarming rapidity. The amount paid in pensions has trebled during the ten years from 1899 to 1908, but this fact was due in large measure to changes in the law which increased the maximum pension from £18 to £26. As an offset to this expenditure, the pension policy has reduced the amount expended on outdoor relief; there has been, on the other hand, an increase in the amount spent in indoor relief, but that is explained chiefly by more liberal provision for indoor paupers.

The pension system that has attracted most attention, and that for obvious reasons is most interesting to us in the United States, is that introduced into the United Kingdom by the act passed August 1, 1908, and which came into operation January 1 of last year. This act follows the laws of Denmark, New Zealand, and Australia in limiting rigidly the persons who are entitled to this form of public assistance. To receive a pension in the United Kingdom, a person must have attained the age of seventy, must have been a resident in the country during the twenty years preceding the application for the pension, must satisfy the pension authorities that his yearly income from other sources does not exceed £31 10s. ($157.50), that he has not failed to work according to his ability, opportunity, and need, for the maintenance of himself and family, and that he has not within ten years been convicted of any offense for which the punishment is imprisonment without the option of a fine. The amount of the pension for persons whose income from other sources does not exceed £21 ($105), is 5s. or $1.25 a week;. From this maximum the pension declines with the amount of the income from other sources. Persons whose outside income exceeds £31 10s. a year may not claim a pension. Under this law, some 667,000 persons qualified for pensions during the first year, and the resulting expenditure amounted in round figures to $40,000,000. These 667,000 persons constitute somewhat more than one half of the population of the United Kingdom seventy years of age and over.

As is well known, the United Kingdom did not adopt an old-age pension policy without having devoted many years to the consideration of the subject. As long ago as 1878, Canon Blackley proposed a contributory old-age pension policy. From that year until the enactment of the old-age pension law thirty years later, a great variety of pension plans were proposed and considered by royal commissions, parliamentary committees, and successive cabinets. On the eve of the Boer War the Conservative Ministry of the day was on the point of introducing an old-age pension bill into Parliament. The state of the public treasury during and immediately after that war made the adoption of any pension policy impossible. How favorably English public opinion is disposed to this method of caring for the aged poor is attested by the fact that when the Liberal government came into power three years ago this was one of the policies which it put into effect. Its attitude was no doubt influenced by the growing strength of the Labor party, but there is every indication that even had the Labor party failed to return fifty-two members to the last Parliament, some sort of old-age pension system would have been adopted.

Though it is too early to form a confident opinion as to the effect of the new policy on the habits of wage earners, there is certainly little ground for some of the arguments often heard in this country against this and similar old-age pension systems.

Few people appear to have given adequate thought to the circumstances which narrowly limit the problem of providing pensions for the aged poor. The payment of such pensions clearly has no tendency to increase the number of persons who pass the age of seventy. Old-age poverty is too remote from the calculations of youths and maidens to have any effect on marriage or birth rates. At most, assuring to old people bare maintenance after they pass a certain age can affect their number only by extending somewhat the length of life. No one can be so inhumane as to urge this as an objection to the policy.

But provision of old-age pensions may tend to increase the number of aged poor, that is, may discourage thrift on the part of the wage-earning masses. This thought leads many intelligent people, who appreciate the desirability of collective provision for old age, to favor the system of compulsory insurance, while opposing strenuously gratuitous old-age pensions. In my opinion, the idea that compulsory insurance against such a remote contingency as old age fosters thrift is illusory. As already suggested, providence and forethought are not developed through compulsion; are, in fact, almost inconsistent with compulsion. On the other hand, old age is only one and not a very important one, of the contingencies that put a high premium, as society is now organized, on a saving disposition. It is desirable to save and acquire property to get on in the world, to give children a better start than their parents enjoyed, to be assured more than bare necessaries as old age comes on, etc. These, the strongest motives leading to saving, are unaffected by the guarantee of a small annuity out of the public treasury after a certain age has been reached, especially if one condition to securing the annuity is that the applicant should not have received poor relief up to the time when the application is made. The smallness of the pension in all the countries having old-age pension laws (the maximum being only $2.50 a week in Australia and New Zealand) and insistence that during the years immediately preceding application for a pension the candidate should have lived a respectable and self-supporting existence, makes any discouragement of thrift in consequence of the policy quite improbable.

It is no doubt a deplorable fact that in the United Kingdom more than half of the persons who have passed the age of seventy should be entitled to pensions under the by no means excessively liberal provisions of the law, but this fact was not the result of the pension policy; the large amount of old-age poverty which it reflects was rather the cause of the pension policy. It was because statistics showed that one-fifth of the population from seventy to seventy-five, one fourth of that from seventy-five to eighty, and quite one-third of that over eighty, was actually dependent on pauper relief that a more humane way of caring for the aged poor was introduced. In my opinion, there is quite as much reason for anticipating that the new policy will encourage thrift as for the contrary view. The guarantee of five shillings a week may encourage persons of advancing years, who before had nothing to look forward to but the workhouse, to make some savings to supplement this very small income. There is some truth in the view that people will make sacrifices for tea and tobacco that they will not make for bread and meat. Moreover, whatever the fact as regards saving for old age, there can be no doubt that the new policy will add to the incomes of families who feel the care of parents and grandparents a serious, even though not unwelcome, burden. The better provision for children that may result from this enlargement of family incomes should have a favorable effect on the rising generation. Finally, this and every other change which makes for confidence and certainty on the part of wage earners should tend to encourage prudence and forethought and to discourage recklessness and indifference.

For these and other reasons, that is, that the number of old persons in the country cannot well be increased by an old-age pension policy, that the number of the aged poor is not likely to be increased, and that the influence on prudence and forethought is as likely to prove favorable as unfavorable, the dismal forebodings and head-shakings which the adoption of old-age pension policies by Australia and the United Kingdom has caused in philanthropic circles in the United States, seem to me quite uncalled for.8

Whether it will prove desirable in the United States at some future time for us to adopt an old-age pension policy is a question the answer to which must depend on the direction taken by the corporation pension systems that are already so common and that seem destined to become very general. If corporation managers can be persuaded to substitute for their establishment pension plans systems that do not interfere with the mobility of labor, such full provision may be made through these systems and through special pension arrangements for public servants of all sorts, college professors, etc., that governmental action, except to provide for public employees, will be unnecessary. If, however, corporate pension plans continue to require those who benefit from them to serve for long years the corporate employer promising the pension, this method of providing for old age will prove inadequate. Wage earners will have little enthusiasm for it; they will continue to change from employer to employer to better their condition, and a large, in the aggregate a very large, number will fail to secure such pensions because they will not have complied with the conditions.

Our experience with national military pensions has not predisposed us to favor national pensions of any description. Giving full weight to the fact that the number of aged persons is strictly limited, there is still danger that, if we were once embarked on the policy of granting annuities out of the public treasury to private citizens, pressure would be brought to bear on Congress to lower the age limit and increase the annuity, and that this might lead to unwise extensions of the policy in both directions. For these reasons it is all the more to be hoped that those intrusted with responsibility for directing the great corporate interests of the country will not only continue to introduce such wise provisions for their employees as old-age pensions, but will do so on terms that will not interfere with the mobility of labor.

1 We have no trustworthy information in regard to the amount of old-age poverty, as distinguished from pauperism, in the United States. Statistics of pauperism clearly indicate, however, our more favorable situation. Thus, according to the Massachusetts Commission on Old Age Pensions, Annuities, and Insurance, there were in that state in 1908 8.5 paupers for every 1000 of the population as compared with 24.2 per thousand in the United Kingdom, and 31.7 paupers over 65 years of age for every 1000 of the population in that age class as compared with 173 per thousand in the United Kingdom.

2 McClure's Magazine, December, 1908.

3 Admirable brief descriptions of foreign systems of caring for old age are given in the Preliminary Report of the [Massachusetts] Commission on old-age Pensions, etc., submitted to the legislature in January, 1909.

4 The method of payment is through the purchase of insurance stamps which the employer is required to affix each week to the insurance cards carried by his workmen. The pensions themselves are paid through the post offices.

5 Though the average pension paid in 1906 was only $39.52, the system called for a total expenditure in that year of $32,845,000.

6 The weekly premiums now required range from 14 pfennigs (3 1/2 cents) for the lowest grade of wage earners to 36 pfennigs (9 cents) for the highest. As the insurance begins at 16 and continues to 70, it would be necessary, in the normal case, to affix the stamps 2508 times.

7 If a similar policy were adopted by the United States, and the per capita expense entailed was the same as in New Zealand, the cost of living there being as high as the cost here, the resulting addition to national expenditures would be somewhat less than the present cost of our military pensions ($161,710,367 for year ending Juno 30, 1909). This is a very large item, but as our military pensions are assuming more and more every year the character of old-ago pensions, and should from now on decrease, it cannot be said to be larger than the country could bear, if the policy were deemed wise.

8 The Massachusetts Old Age Pension Commission goes so far as to say that: " A noncontributory pension system is simply a counsel of despair. If such a scheme be defensible or excusable in this country, then the whole economic and social system is a failure. The adoption of such a system would be a confession of its breakdown." One can only regret that the members of this Commission did not visit progressive and prosperous New Zealand and Australia before they committed themselves to such extreme views. Such opinions in those countries, whose "economic and social system" is fundamentally like our own, would excite only amused surprise.

Section: 

1888: Berkshire Home for Aged Women, Pittsfield, MA

Summary: One of the oldest continually-operating nursing homes in America.

Text from: National Register of Historic Places

(See 1888: Berkshire Home for Aged Women, Pittsfield, MA.)

Since its construction in 1888, the Berkshire Home for Aged Women has provided a retirement home for elderly, retired, and widowed women. The original money to construct this handsome Richardsonian Romanesque building came from an $18,000 bequest from Pittsfield's Crane family to be used as a home for "the elderly ladies of Berkshire County." Over the years, this building has reflected the changes in attitudes and ideas regarding care of the elderly. In 1891, the home only had two requirements--that applicants pay an entrance fee of $300, and that they own a black silk dress. For many years, the citizens of Berkshire County and Pittsfield contributed generously to the upkeep and support of the home--gifts of fruits, vegetables, and even one $50,000 donation made the Berkshire Home for Aged Women one of Western Massachusetts' finest retirement homes. In the 1930s, the home enjoyed the patronage of a wealthy local woman--Catherine Cary--who eventually donated well over $500,000 dollars to the home. The rising costs of home care depleted the Berkshire Home's resources, however, and by the 1950s, the home's chief problem revolved around finances. With a capacity of only 29 women, the home's waiting list rose to 9 years. In the 1960s, the Federal government's Social Security program allowed the elderly to stay in their own homes longer, but depleted the number of women applying and staying at Berkshire Place. The Berkshire Home for Aged Women continued to struggle financially in the 1970s and early 1980s, and in 1989, when a report indicated that most retirees had no desire to live in a gender-segregated environment, the Berkshire Home for Aged Women began to accept male applicants, 101 years after its establishment.

Today, Berkshire Retirement Home, Inc. continues to administer the property, one of the oldest continually operating nursing homes in Massachusetts. The Berkshire Place Home for Aged Women is located at 89 South Street, Pittsfield, MA. The property is a retirement home and not open to the public.

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1889: William Enston Home, Charleston, SC

Summary: One of the first planned communities for the elderly.

Text from: National Register of Historic Places

(See 1889: William Enston Home, Charleston, SC.)

The William Enston Home is an early example of a planned community for the elderly. Developed in the late 19th century, the home is comprised of 24 residential cottages; Memorial Hall, a community building; an infirmary; an engine house; a water tower and an entrance gate. Designed in 1889, the water tower served as the centerpiece of a model waterworks system, and the spacious, landscaped grounds exemplified suburban planning ideals of the 19th century. The buildings also constitute a significant collection of Romanesque Revival architecture, a style rare in Charleston.

William Enston was the Home's philanthropic benefactor. An English immigrant to Charleston, Enston made his fortune in trade. Upon his death, he bequeathed the majority of his estate to the City of Charleston to establish a benevolent home for the city's aged and infirm residents which would "make old age comfortable." The Home was to be modeled on similar British institutions, specifically one Enston was familiar with in his native Canterbury. Enston specified that the complex be comprised of neat and convenient two-story brick cottages with at least eight acres of land. He also stipulated that potential residents be the old and sick, from 45 to 75 years old, of "good honest character," and not suffering from "lunacy."

Enston's estate at his death in 1860 was valued at $1 million, but reduced by half after losses from the Civil War. The project was delayed until after Mrs. Enston's death in 1886, when the City received the whole of the estate. Charleston Mayor William A. Courtenay corresponded with the mayor of Canterbury to develop the concept for the "model village."

The majority of the cottages were built in 1889 on 12 acres with shaded and stone-paved roadways, named after various English sites and historical figures. The remaining buildings were all added by the 1930s. Today the complex is owned by the Housing Authority of Charleston, and the restored cottages are home to persons of low to moderate income.

Section: 

1890: Civil War Veterans Pensions

Summary: From The Atlantic Monthly, a description of possible abuses of the Civil War Veterans pensions.

The United States Pension Office
by Gaillard Hunt
The Atlantic Monthly. (Volume 65, Issue 387, January 1890).

Text from: Library of Congress American Memory Collection

From The Atlantic Monthly, a description of possible abuses of the Civil War Veterans pensions.

As the United States was the outcome of the Revolutionary War, one of the first duties of the government was the care of the soldiers of that war. Almost as soon as there was any Congress of the United States, and some years before the adoption of the Constitution, pension claims were presented for payment. The general government was not prepared, however, to assume the whole responsibility, and, by a resolution of June 7, 1785, Congress referred to the different States the right of judging who of their citizens were entitled to be placed on the list of invalid pensioners. The States refused to take any action, and the very next Congress found itself confronted with the whole subject again. The general government has assumed the burden of adjudication and payment of pension claims ever since. The appropriations were made for individual cases until 1790, when the first general appropriation of $96,979.72 was made. There was no general pension law until 1792, when it was enacted that, if any person, whether officer or soldier, belonging to the militia of any State, and called out in the service of the United States, be wounded or disabled while in actual service, he shall be taken care of at public expense. This law is the foundation stone upon which our general pension system has been built. The yearly appropriations under it averaged about $90,800 up to 1800. It was not until 1818 that a service pension was granted to the veterans of the Revolution, and then only to those who had served for nine consecutive months, and who were, from reduced circumstances, in need of assistance from the country for support. Under this act, up to 1858, over $22,320,000 had been disbursed, and a subsequent law, removing the property qualification, cost $2,601,000.

In 1814, after the close of the War of 1812, the whole amount paid to army pensioners was $90,164.36. There is no tabulated statement attainable, showing the actual sum paid in pensions on account of this war, until the year 1871, when pensions were granted to all who had served sixty days. From that date up to 1888, 60,670 claims had been allowed. The disbursements have decreased from $2,313,409.47 in 1872 to $1,670,264.44 in 1888.

The Mexican War has not proved an expensive one. A service pension was not granted until 1887. About 8000 claims were allowed under this act last year, the payment being eight dollars per month in each case.

The foregoing facts are interesting merely as history. They relate to res adjudicata, and pension legislation may be considered as completed so far as our old wars are concerned. But in the enormous expenditure for pensions which the Civil War has involved, the increasing demands of its survivors, the apparent willingness of Congress to comply with their most extravagant proposals, here, indeed, we have a question which demands earnest attention.

It is estimated that there were 289,715 men engaged in the Revolutionary War, 527,654 in the War of 1812, 100,460 in the Mexican War, and 2,780,176 in the War of the Rebellion.

It was, therefore, only natural that the business of the Pension Bureau should increase enormously after the close of the Civil War. In 1865, 72,684 claims were allowed, the disbursements being $8,525,123.11. There was a diminution after this, until the passage of the notorious Arrears Act, in 1879, when 141,466 claims were filed. The appropriation was insufficient, but the disbursements were $57,240,540.14. The law granting pensions has been substantially the same ever since the provisions of the Arrears Act ceased to be operative, June 30, 1880; the only changes of consequence having been made in the ratings of certain specific disabilities. The number of claims filed has, however, increased. From the last report of the Commissioner of Pensions we learn that 75,726 claims were fi1ed in the year ending June 30, 1888, as against 72,465 in 1887, and 31,116 in 1881. For the past few years the number of claims filed by survivors of the War of 1812 has been insignificant, and need not be taken into account. For the Mexican War, 7853 claims were filed in 1888, and 18,718 in 1887. This would make the number of claims filed in 1887 on account of the Civil War 53,747, and in 1888, 67,873, as against less than 30,000 filed in 1881.

The causes which operate to produce the filing of such a large number of. claims so many years after the war are several. First among them is the activity of the claim agent.

"The country," said Commissioner Bentley, in his annual report, over ten years ago, "is being constantly advertised and drummed, from one end to the other, by claim agents in pursuit of persons who have honest claims, or those who are willing, in consideration of the fact that it will cost them nothing unless they win their pension, to file claims which have no merit, leaving it to the ingenuity or cupidity of their agent to 'work' the case through."

The numbers and the activity of the claim agents have materially increased since Mr. Bentleys time, and so has the number of claims filed increased also.

A second cause is the belief, based upon party platforms and bills introduced at each session of Congress, that the benefits of the Arrears Act will be extended. As the new act may contain a limitation against claims filed after a certain date, and as it is impossible to say when that date may be, the soldiers, or their widows, argue that it is safest to send in their applications as soon as possible. This condition of affairs is carefully fostered by the claim agents.

Nor must the large number of meritorious claims be overlooked. There are many bodily infirmities peculiar to military life which cause little inconvenience to a man in the prime of life, but which break forth more or less violently in old age. Application for a pension is then made, and the fact that it has not been made before is no reason for suspecting its honesty.

The number of claims allowed in 1887 on account of the Civil War was 46,380, and in 1888, 46,750, as against about 25,000 in 1881. There is no part of the Commissioner of Pensions report more significant than the table which shows the number of invalid claims filed each year, and the percentage allowed of each years filing:

Years in which the claims were filed Number of invalid claims filed each year Percent of claims allowed of each years filing
1862 1,362 80.1
1863 26,380 74.8
1864 20,263 79.9
1865 27,299 88.7
1866 35,799 87.2
1867 15,905 82.5
1868 7,292 84.7
1869 11,035 81.6
1870 12,991 80.9
1871 8,837 77
1872 8,857 76.3
1873 8,728 82.7
1874 9,302 75.7
1875 11,926 75.4
1876 17,030 70.9
1877 16,532 74.7
1878 18,812 74.2
1879 36,835 78.8
1880 110,673 67.8
1881 18,455 48.4
1882 29,004 46.2
1883 35,039 42.4
1884 28,962 39.8
1885 27,959 38.8
1886 35,202 34.2
1887 36,204 21.7
1888 47,349 4.7

"Invalid" claims are those of soldiers who apply in their own behalf. The claims of widows of soldiers, and of relatives who were dependent upon soldiers for support, are generally more difficult to prove and require a longer time in their adjudication than the invalid claims. It is a pity, therefore, that the table does not include these claims. It is also to be regretted that the table does include claims on account of wars previous to the Civil War, which are based upon mere service and are easily and quickly established. If the former were included, and the latter excluded, the result would be even more noteworthy than it now is.

From this statement of facts, it is evident that there must be something wrong in the method of proving claims. The labors of the Pension Office, at this rate, would seem to be interminable. The force of clerks employed is as large as it ever was, and consists of 1500 employees, at a cost of over $2,000,000 a year. The number of claims filed, as we have seen, increases annually, and the delay involved in their adjudication increases patri passu with the increase of claims. The fault lies in the system followed in proving claims under the law.

There is a volume published by the government, entitled A Digest of the Pension Laws, Rulings, Decisions, etc., and in the first edition of this work is to be found a treatise on the practice of the Pension Office. This practice is based upon the orders, rulings, and decisions of the Secretaries of the Interior and the Commissioners of Pensions for many years back. New decisions rescind old decisions, new points are being constantly ruled upon, and the system has become elaborate and complex. Under it, all the facts necessary to establish a claim, which are not shown by the official record in the War Department, are proved by the exparte documentary evidence submitted by the claimant, or his attorney, to the Pension Office. Whether this evidence is good or bad, truthful or untruthful, the Pension Office must find out as best it can. It sees neither the claimant nor his witnesses. The whole case is conducted in writing. The United States Pension Office.

To prove a pension claim under the law, it must be shown, in the first place, that the disability alleged originated in the service and in the line of the soldiers duty. Not in one case out of twenty is there any record at the War Department showing this. In the absence of such record, the Pension Office requires the testimony of the regimental surgeon who treated the soldier, and of the commissioned officer whose business it was to have cognizance of his condition. If the testimony of neither can be procured, and this is generally the case, after the claimant has shown why he cannot procure their testimony, the evidence of two of his comrades is considered.

If the claim is on account of disease, as most of the claims are, it must next be shown that the claimant was disabled by the disease at the time he left the army, and that it has continued to disable him up to the present time. This must be proved by physicians who have treated the claimant. If physicians testimony cannot be procured, the testimony of employers and neighbors is considered. If he satisfies these demands, and if the United States Examining Surgeon declares he is disabled for performance of manual labor by the ailment he claims for, his claim is proved, and his name is added to the pension roll.

A claim filed shortly after the war was not hard to prove, under these requirements. The witnesses who had served with the soldier in the army were easily found, and their recollection of events was fresh. Similarly, the continued existence of a disease after service could be shown for a short period of years without a long and arduous search for the necessary proof. But with the passage of years the obstacles in the way of proving a claim have largely increased. Regimental officers and surgeons have died, or have forgotten; fellow-soldiers, when any can be found, testify indefinitely and unsatisfactorily. To show that a particular disease has existed continuously for twenty-five years is a task of ever-increasing difficulty.

In considering the testimony produced in accordance with its requirements, the Pension Office has no direct means of ascertaining when an imposition is being attempted. The claimant is not likely to give information against himself, nor are the witnesses whom he selects likely to do so. It is his business to collect evidence to further his interests, and it is nobody's business to discover evidence on the other side. The temptation to perpetrate fraud is strong. The probability of detection is slight. The fear of local public opinion is no restraint upon a dishonest claimant, because his neighbors need never know what proof he has procured. Sometimes a volunteer informer sends word to the Pension Office that the claim is fraudulent; sometimes the postmaster of the town, when written to by the Department, pronounces the character of the witnesses to be bad. But informers are not popular in a community, and postmasters are in no hurry to declare their fellow-townsmen untruthful. The public opinion that would restrain a soldier from openly attempting to defraud the government operates with equal strength in preventing any one from officiously standing in the light of his neighbors interests.

The delays which inevitably follow the endeavor of the Pension Office to discover the truth are endless. Witnesses are slow to answer the written questions sent them, and sometimes entirely neglect to do so; and to explain to the claimant, or his lawyer, wherein the proof is lacking requires. a correspondence covering a long period of time, and in the end attended by unsatisfactory results. In cases of exceptional complications, or where fraud is suspected, a clerk is sent by the Pension Office to the residence of the claimant and his witnesses to examine them. This special examination is provided for by law, and but few of the claims adjudicated have had the benefit of it. Even when it is instituted, the truth is not always reached. A solitary government clerk, with an extremely limited knowledge of law, is not always a match for the claimant and his sharp attorney. It is hardly necessary to point out the disadvantages of the present system of proving claims to an honest applicant, or its advantages to a dishonest one. The latter, secure from the probability of detection, gets witnesses of the same character as himself, willing to swear to anything, while the honest mans witnesses can testify only to the limited knowledge they possess.

Mr. J. A. Bentley, Commissioner of Pensions under Presidents Grant and Hayes, was certainly the most disinterested, if not the ablest, commissioner who has held the office since the Civil War. He, and he alone, seems to have appreciated the evils of the practice of the Pension Office. As a remedy, he advocated the establishment of numerous local commissions, each one to consist of a lawyer and a surgeon. The commission was to examine claimants and their witnesses openly, in the community in which they lived, and pass upon the merits of the claims; the surgeon attending to the medical aspects of the case, and the lawyer to the points of law involved. Since Mr. Bentleys suggestion, there have been established, under congressional enactment, many local medical boards, each composed of three competent surgeons, for the purpose of making a medical examination of all applicants for invalid pensions. Their examinations have been found to be thorough, and it is difficult to devise any better method for dealing with the medical side of the claim.

No material change has, however, been made in the system followed in proving the legal side of the case. A single legal officer would not be competent to attend to this satisfactorily. He would have to act as attorney for the government and as a judge; and, moreover, the matter is too important to be placed in the hands of one man, for, while the sum of money involved in each case may be small, the aggregate sum is enormous. A better plan would seem to be time establishment of local pension courts, holding their sessions publicly at the points most convenient for the parties concerned. The court, having been furnished with the soldiers army record by the War Department, and the certificate of medical examination by the Board of Surgeons, should notify the claimant to appear with his witnesses, when ready to try the case, and should have power to summon witnesses on its own account, and to punish for contempt. The interests of the government should be protected by the proper legal officer, whose duties should consist, not in a causeless opposition to the claim presented, but in a careful vigilance to discover fraud. The claimants attorney would attend to his clients interests, and the judge could easily decide in a few hours upon the merits of a claim thus presented.

The nature of the testimony required to prove a claim should remain substantially the same as it now is, but the court should be allowed a certain latitude in accepting less proof. A decision having been reached in a case, the findings and proceedings should be forwarded to the Commissioner of Pensions for his review and approval.

The grounds upon which are based a majority of the special pension acts passed by Congress are that, while the claimant has not been able to obtain the proof necessary to establish his claim under the rules of the Pension Office, it is, nevertheless, a just claim. This is the theory of special pension legislation. The abuses to which it has been carried in practice are too familiar to require any comment. The establishment of pension courts would do away with the excuse for this species of legislation, since the proof necessary to establish a claim would be subject to modification in special instances.

The fact that the proceedings would be open and among the claimants neighbors would cause a dishonest man to hesitate before attempting a fraud on the government; and if a fraud were attempted, the probability would be strong that it would be discovered, neither of which guarantees of honesty now exists. On the other hand, the fact that the applicant would have speedy justice, and that the court would have power to pass favorably on his claim on less evidence than is now required, would accrue largely to the benefit of the honest claimant.

The details of the plan I have proposed cannot be discussed here. The number of courts necessary would depend upon the soldier population of the States. They would be numerous in the North and West; for the whole South two or three would suffice. After the large accumulation of old claims had been disposed of, the number of courts might be materially lessened. The Pension Office at Washington would consist of a mere handful of clerks, and the most liberal calculation in the number of courts and their expenses hardly results in so large a sum as the present gigantic Pension Office costs; and while this cost cannot be lessened materially for years to come, it would, under the new method, become less and less each year. The appropriations for payment of pensions, now so enormous, would, under the stimulus of quick justice and detection of fraud, also decrease materially.

Section: 

1890: Life for Nurses and Patients in Charity Hospital, NY

Summary: Some excerpts from an article in Scribner Magazine that focus on life in Charity Hospital, the poorhouse hospital on Blackwell's Island (now Roosevelt Island), New York City.

Source: The Nineteenth Century in Print: Periodicals

The Training Of A Nurse
Scribner's magazine (Volume 8, Issue 5, November, 1890)

Following are some excerpts that focus on life in Charity Hospital, the poorhouse hospital located on Blackwell's Island, New York City (renamed Roosevelt Island in 1973).

Charity Hospital Patients

The patients in Charity Hospital are the very poor of the city; some of them are only morally sick and needing a home; they puzzle the doctors to make a diagnosis. Most of their sickness, as we nurses know, has been brought on by over-work, poverty, drunkenness, laziness, and the like, but some are worthy and deserving persons.

Often when a patient comes into the hospital she enters a moral atmosphere which is new to her. She is cleaned and made fairly comfortable; she has to drop many of her old habits of speech, and be a decent member of the hospital for the time being. If she is not too degraded she can see what is expected of her at once. We seldom have any trouble with the patients and rarely hear an improper word. A nurse never need submit to insubordination; on her complaint the patient is dismissed, but a very sick patient is seldom beyond endurance. They are often very witty, and if we are in the mood we can get lots of fun out of them. They are also very religious. They thank God for everything; everything is the will of God -- their sickness, their troubles, their death; it never seems to occur to them that they might have a will of their own. In one way they have not much variety; they usually object to soap and water. As a rule the nurses are as good to the patients as they can be. Many of them remain in the hospital for a long time, and a nurse has the opportunity of showing them small kindnesses, perhaps writing a letter or giving them a garment or a few cents to pay their car fare. In those tedious cases of phthisis where the treatment is only palliative a nurse can be much to the patient.

Charity Hospital Staff

The helpers spoken of in this sketch are women sentenced to the workhouse on Blackwell's Island for terms varying from three days to six months, and for such offences as drunkenness, vagrancy, and fighting in the streets. From the workhouse they are sent to do the scrubbing, laundry work, etc., in the institutions controlled by the Commissioners of Charities and Correction, who are obliged by law to use their labor.

Nurse Training in a Charity Hospital

We begin our duties in a large ward of Charity Hospital. The probationer will have charge of one side of the ward, with the care of from ten to fifteen patients and all belonging to them. The head or senior nurse will go round with her and work in with her for the first time. She is shown how to make the beds, to change all soiled linen; how to remove a very sick patient from one bed to another; how to cover a patient and save her from fatigue while sitting up to have her bed made; the best way for her to get in and out of bed ; to keep an eye on the beds that the patients are able to make themselves, and so on throughout the details of the mornings work. The latter part of the day is taken up with waiting on the patients and keeping her side in order all the time. The probation month is especially a time of learning something new; a good deal has to be got into that month; afterward things come more by degrees.

Should the probationer be accepted, she becomes a junior nurse and has the same kind of work for about three months.

Night Duty

She then goes on night duty; she is on the landing as we call it, that is, has charge of the two or three of the wards opening on to that landing. The junior nurse is feeling somewhat independent and consequential by this time. She does not have to act by herself; there is always an experienced nurse on the top floor to whom she can refer in case of emergency or otherwise. A nurse may never have been up all night in her life before, so the first night is rather exciting and anxious; she is very wide awake until about two or three o'clock in the morning when the effort to keep awake is really painful.

A night nurse does not sleep, that goes without saying, and should she doze when all is quiet she has always one ear open. Imagine a rather young nurse peering around the large ward with the aid of an antiquated lantern. Shall I ever forget that lantern? It would throw all shadow and the least possible ray of light and anywhere but where it was wanted. Sometimes its miserable little light would go out and the wick have to be pricked up and relit, then it would spit and splutter as though it meant to burn well, but somehow it never would, and the gas burnt low on the landing. When I think of that lantern I can go all through my night duty over again. We have a helper to fetch and carry for us, and she can be very useful in many ways. She may be as good as a nurse or she may have a fancy for gossiping with her friends during the day and so prefer to sleep at night, and such a lady is rather a trial. The patients have a way of dying at night, in spite of the very best efforts of the nurse to keep them alive until morning. Some helpers never could go anigh a dead body, but they don't mind fetching the things and standing outside of the screen. It requires considerable nerve on the part of the nurse to lay out a patient in the small hours of the morning; when the wards are silent and gloomy there is something uncanny about it; there is not much of the beauty of death in these cases, but we get used to it after a time.

An Average Day in Charity Hospital

Here follows the journal of an ordinary day at Charity Hospital, by one of the head-nurses:

Time: 7.30 A.M.

Scene: Ward 3, Medical.

Beds all unmade, a few patients up, these have faces washed and hair combed the majority in bed with this duty still to be performed for them. A part of the floor at the front of the ward has been scrubbed. Mary, one of my prison helpers, is washing dishes at the table, and Bridget, the other, is taking soiled clothes from a large can and sorting them for the wash.

The atmosphere contains none too much oxygen; this can be explained by saying that the night-nurse is finishing her work in one of the other wards, and the patients in her absence have taken the precaution to close all of the windows for fear of taking cold. After giving an order for the windows to be let down, I take up the night notes and read:

     Murphy Died at 3 AM.
     Ryan Temperature, 1080; pulse, 120; respiration, 30. Antifebrine, grains iii., and other medicines given as ordered. Poultice applied last at 6 AM.
     Patient passed a very restless night.

And so on, through the other cases in the ward. These notes are signed by the night nurse, who now comes in with the keys, looking pretty well fagged.

"Good-morning; I am sorry I have kept you waiting for the keys, but I have been so busy I could not get down sooner. Had a death in Ward 4, as well as the one here, and a patient in Ward 6 suffering from delirium tremens, besides the ordinary work."

I now go over to where my assistants are putting on their caps and aprons and getting together the things necessary for work. Miss W. and Miss A. are here, but where is Miss H.?

Miss W. answers: "She was called up last night to go on the maternity service. The superintendent missed you, and asked me to tell you that another nurse could not be spared to-day."

Oh, dear, thirty-two patients in the ward, and five of them so helpless that they have to be fed and cared for like babies, two pneumonia cases, and the usual number of phthisical and rheumatic subjects. Well, well, grumbling won't do the work, so well have to make the best of it.

Each of my assistants, armed with a pile of clean sheets and pillow-cases, proceeds to the lower end of the ward and commences the task of getting beds made, while I go to write the list of clothes for the laundry. Bridget counts the clothes while I stand by and take down the number of each of the different articles. This done, they are tied in large bundles and sent to the wash-house.

Now the medicines are to be given out. I measure and prepare them, while a convalescent patient carries them round to those in bed. My list is a long one, and it takes fully thirty-five minutes before they are all distributed, the bottles wiped off, and the medicine closet put in order. My next move is to take a list of medicines which need to be renewed, and leave it ready for the doctors signature. It is now twenty- five minutes past eight, and Miss A. and Miss W. are making as good progress as possible at their respective sides; for it must be remembered that a nurse has often to stop what she is doing to attend to the wants of some particular patient, or to carry out an order if the time is due.

The "railroad beds"* are still unmade. Occasionally we have a convalescent patient who can do this part of the work very well. We had one in this ward last week, but alas, for the frailty of human nature, she showed a disposition to quarrel with the other patients on very small pretexts, so she was dismissed. With a rueful thought of what might have been, I go to work at the beds. A patient goes ahead and strips them for me. We work with all our might, and they are finished at ten minutes past nine. The side beds, too, are nearly finished. This part of the work necessarily takes much longer, as sick patients have to be placed in chairs and wrapped up in blankets, or, if they are too weak, lifted into other beds, so that their own can be made.

* A railroad bed is one that is unoccupied during the day, and therefore, as it were, "shunted" and rolled out at night. They stand close together in the middle of the ward.

My next work is to take morning temperatures; when I have finished this I see a large tin can standing near my table. It contains crackers, butter, eggs, and sugar. These have to be put away in their proper place, and the quantity noted. Now, I must write my diet-sheet, and order the supplies necessary for to-morrow. It is twenty-five minutes past nine, the beds are all made, the stands in order, the floor swept, and the table scrubbed. The junior nurses are about through with washing faces and combing heads, and it is now high time that I should make a round of the ward and find out if there is any change in the patients condition to which the doctors attention should be called.

While this has been going on the gruel and milk have been standing on the table, and the distribution of this falls to my share to-day also, as I have no senior nurse. Each bed-patient who cares for it is served with a portion on a tray; afterward the walking patients seat themselves at the table and take theirs. Now the doctors come in to make their morning visit, the house- doctor is told of any special complaints; he examines these patients, also any new ones who may not yet be under treatment, and leaves the new orders on my book.

While doing this work all morning, I have been trying to keep an eye on what my helpers are doing, and now take this time to make a thorough inspection of all parts of the ward, bathroom included. In the meantime the special diet has been divided among the patients needing it most. At eleven o'clock tonics are given out, afterward eggnogs and milk-punches are made and distributed.

We now begin to breathe freely, the worst pressure is over if we get no new patients. Our hopes along that line are doomed to disappointment, for the helpers from the women's bath-room now announce the arrival of two new patients, and Miss W. disappears to super- intend their bathing.

I am congratulating myself on not having a "stretcher case" at any rate, when two men come in with one. Miss A. quickly places screens round a bed, and a rubber sheet over the clean bedclothes. The woman is lifted on the bed, and her temperature, pulse, etc., taken. Her own clothes are soon removed, and a warm sponge-bath given and hair combed. These operations have effected a wonderful change in her appearance, and she now looks a little more like a Caucasian, whereas, before the bath, she might have belonged to one of the darker races of mankind.

The doctor is notified that there are three new patients in the ward. It is twelve o'clock ; Miss A. and I go to dinner, and leave Miss W. to superintend the patients noonday meal, and give out medicines afterward. We return at one o'clock, and Miss W. goes, with the right to remain off duty till four o'clock.

The ward is now to be swept again and put in order for the afternoon. This is hardly accomplished when two huge bundles of clothes are carried in, and in ten minutes time two more. These have to be sorted and counted. Before we proceed to the folding of them the afternoon milk and other extras are given out. That done and the table cleared, we fold the clothes as quickly as we can. In due time this is finished, Miss A. is making a poultice in the bath-room, and I am putting the clothes in the closet, when someone calls "Nurse, nurse!" I turn to see where the sound comes from, and notice several patients pointing to a bed in the far corner of the ward. I hurry down and find the patients clothes saturated with blood, a hemorrhage from the lungs. Screens are immediately placed around the bed, cracked ice given, and the doctor summoned. He comes at once, the flow of blood seems to have ceased, medicine is ordered, and the doctor goes. The patients clothes are now changed very carefully, and she is made as comfortable as possible. The screens are just put away when another stretcher is brought in, and Miss W., who has now returned, gives the usual treatment.

It is time for the afternoon tonics, and eggnogs and punches are again distributed; after this I take advantage of a few spare minutes to enter the names and addresses of patients in a book kept for the purpose. Discharged patients are also marked off.

The patients have supper between half- past four and five. At hall-past five Miss A. retires from the ward, the remaining time till half-past seven being hers to rest. In the meantime the doctor has been in and left a few orders.

The giving out of the evening medicines falls to me, while Miss W. attends to the patients needs in other ways. If I had a fourth nurse I might be relieved from duty; but it cannot be thought of now. This is the evening for carbolizing the side beds; the helpers do this, while we follow and restore things to order. The rest of the time till hall-past seven is spent in making patients comfortable for the night, and writing down new orders and notes on the patients condition for the night nurse. We are quite willing to deliver her the keys when she comes in, and bid her good-night, while we go home tired enough to sleep soundly.

Nursing Pay

At private nursing a woman receives from $15 to $25 a week, which would pay her well if she were always busy; but she is subject to be overworked for some months and idle for several more, and an excellent nurse said recently that she should be satisfied to be sure of making $600 a year.

Nursing Supply and Demand

There are signs that the market is beginning to be overstocked. The four large schools which I have already spoken of have already 911 graduates, and every hospital of whatever size must now have its training - school, so that each year brings a new crop of certificated nurses, more or less trained, according to their capacity and opportunities. Some of the schools announce that they have many more applicants than they can take

Section: 

1891-1969: Nursing Home Conversions

Summary: Photos of historical structures that were old age homes at some time to illustrate the variety of buildings that were converted to nursing homes.

From the Library of Congress American Memory Collection: Historic Buildings Survey (HABS)

Section: 

1893: Pensions, The Law and Its Administration

Summary: An article from Harpers magazine that provides an overview of the history of Veterans Pensions from the Revolutionary War to the Civil War

Pensions: The Law and Its Administration
Harper's new monthly magazine (Volume 86, Issue 512, January, 1893)

Text from: Library of Congress American Memory Collection

The pension system of the United States, which, including the appropriation for the current year, has taken from the Treasury more than a billion and a half of dollars (over 94 per cent. having been paid out since 1861), had its rise August 26, 1776, in a resolution of the Continental Congress providing that every commissioned officer, non-commissioned officer and private soldier who shall lose a limb in any engagement, or be so disabled in the service of the United States of America as to render him incapable of afterwards getting a livelihood, shall receive during his life or the continuance of such disability the one-half of his monthly pay from and after the time that his pay as an officer [or soldier] ceases. The monthly pay of a captain of infantry in active service was $26, and that of a private was $6. The benefits of the resolution were also extended to officers, marines, and seamen serving upon armed vessels. Claims were to be adjusted through the legislative bodies of the States where the applicants resided, which were authorized to make proportionate allowances in cases of less than total disability. In 1782 a maximum pension of $5 per month was granted to disabled privates and non-commissioned officers in lieu of half-pay. On account of the inability of Congress to raise money by taxation, the States, in 1785, undertook the payment of pensions, until the adoption of the Constitution made it possible for the general government to perform this function.

Since the original resolution of 1776 pension legislation has been voluminous, and down to the revision of the pension laws in 1873 may be justly termed chaotic. This paper will attempt only to out- line some of the general features. In order to do this the more clearly the various grants of pensions may be divided into four classes, viz.:

I. Pensions based upon disability incurred in service, or the death of the soldier from such cause.
II. Pensions based upon service and indigence, without regard to the origin of existing disability, or the cause of the soldiers death.
III. Pensions based upon service only.
IV. Pensions based upon disability, without regard to the origin of such disability or the pecuniary circumstances of the beneficiary.

Disability, within the meaning of the pension laws, may be defined as the effect of any disease, wound, or injury, by reason of which a person is at a disadvantage in the performance of ordinary un- skilled manual labor, as compared with a perfectly sound person; or would be, if compelled thus to earn a living.

Laws granting pensions of the first class have, as a rule, antedated the service in which the pensionable disability might be incurred, and have been designed to encourage enlistments; while with a partial exception in 1780, hereafter referred to, those providing for the other classes have always followed the service on which the right to pension is predicated. Although the Supreme Court has held that the first did not constitute a contract, it is evident that so far as they offered inducements to voluntary enlistment, they are of a quasi contractual character; while pensions of the other classes are, in their legal aspect, pure gratuities.

Class I.

The resolve of August 26, 1776, remained the basis of the pension rights of Revolutionary soldiers until the act of April 10, 1806, which repealed all previous legislation on the subject, and pensioned all persons unable to procure a subsistence by manual labor on account of known wounds received during service in the Revolution, granting half-pay to commissioned officers, and $5 per month to others.

Invalid pensions on account of disability incurred after the Revolution, began with the act of April 30, 1790, creating The Military Establishment of the United States, and promising pensions to officers and enlisted men who should be wounded or disabled in the regular service, at rates fixed under rules to be established by the President, not to exceed half-pay for commissioned officers, and $5 per month for others. This provision was extended by subsequent enactments to volunteer troops raised for special purposes, including the war of 1812, the Florida and Mexican wars, and the late rebellion. In 1816, rates for disabilities of the highest degree were graduated from $17 per month for first lieutenants, down to $8 for non-commissioned officers and privates. By appropriate legislation, officers and enlisted men in the navy and marine corps were kept on a substantial equality, with respect to pension, with those who served in the army.

No important changes were made in the invalid pension laws until the act of July 14, 1862, which provided that all officers and enlisted men disabled since March 4, 1861, by reason of any wound received, or disease contracted while in the service of the United States and in the line of duty, should receive pension proportionate to the degree of their disabilities, the highest rate for total disability being fixed at $30 per month for lieutenant-colonels and all officers of higher rank in the army and marine corps, and captains and other officers of corresponding degree in the navy; and at gradually decreasing sums for lesser officers, down to $8 per month for enlisted men.

A few years later pensioners for disability incurred prior to March 4, 1861, were placed on the same footing as to rates with pensioners under the act of 1862. The rates established in the latter act have continued to be the totals of the respective ranks. But the term is misleading; it has never been restricted to cases of total inability to perform manual labor, though for a few years the rates of 1862 were the highest granted in any instance.

A class of specific disabilities i.e., disabilities of fixed degree for which special rates are expressly provided by law arose under the act of July 4, 1864, which granted $25 per month for loss of both hands, or the sight of both eyes, and $20 for loss of both feet, in cases where the total of the pensioners rank was a less sum.

Since 1864 a great number of laws have been enacted affecting rates of pension, all in the direction of increased liberality; and many additions have been made to the specific class. The lowest strictly specific rate now allowed is $30 per mouth for total deafness, or loss of a hand or foot; and the highest is $100, for loss of both hands. By Pension Office usage the total rates prescribed in 1862 are given for anchylosis of the wrist and equivalent disabilities. There is obvious difficulty in comparing a gunshot wound in the head, or a case of heart-disease, or partial loss of sight, with a stiff wrist, yet this is precisely the sort of problem presented in the rating of the great majority of disabilities. For non-specific disabilities greater than total, there are allowed rates varying from $10 to $24.

On June 30, 1891, invalid pensioners under laws prior to the act of June 27, 1890, and under special acts of Congress, were drawing 134 different rates, varying from $1 to $100. Of 419,046 such pensioners, 20 were drawing $1 per month; 17,036, $2; 62,318, $4; 83,- 299, $8; 46,097, $12; 20,246, $24; 14,834, $30; 3210, $36; 3161, $72; and 36, $100. The average monthly rate was $15 16; while among 676,160 pensioners of all classes it was $11.

(Footnote: The total number of pensioners on the roll June 30,1892, was 876,604. It will doubtless exceed a million at the close of the present fiscal year.)

In 1780 the Continental Congress granted half-pay for seven years to the widows of officers dying in the Revolutionary service.

But the system of pensions to widows and orphans really began under the act of June 7,1794, which gave a half-pay pension for five years to widows, or, if no widow survived, to the children under sixteen years of age of officers who should thereafter die of wounds while still in the service.

The act of April 16, 1816, extended this allowance to widows and minor children (under sixteen, which has remained the limit of pensionable age) of officers and enlisted men dying, after discharge, of wounds received in action.

No provision was made for cases where the soldier died of disease until 1848, when a five-years half-pay pension was granted to widows and minor children of officers and enlisted men who died, of either wounds or disease, during service in the Mexican war. By later statutes there were included cases where the soldiers died at any time after discharge by reason of disabilities incurred in the war, and the pensions were continued for a term of five years.

In 1858 they were confirmed to widows for life or until re-marriage. In 1866 and 1868 widows whose right to pension accrued after the Revolution and prior to the rebellion were granted equal rates with those pensioned under acts passed since March 4, 1861.

It will be observed that the early pensions to widows and orphans were confined to cases in which the soldier held an officers commission. Half-pay pensions to widows of enlisted men began during the war of 1812, when special inducements were needed to secure enlistments. Legislation of this sort was restricted to widows of volunteers and militia-men until 1848, when it was extended to widows of regular army soldiers who died of disabilities incurred in the Mexican war. Its benefits did not embrace the regular army equally with. volunteers until 1853, in which year the soldiers of all wars since 1790 were placed on the same footing with respect to the pensioning of their widows.

The act of July 14, 1862, above referred to, was the foundation of the colossal pension system of the last thirty years. The rebellion had been in progress more than a year, and the end was not yet in sight. Troops were needed, and it had become evident that if citizens were to be induced to voluntarily leave their homes and expose themselves to the perils of active service, more liberal provision must be made for the families to which they might never return. It was accordingly enacted that if any officer or enlisted man had died since March 4, 1861, or should thereafter die, by reason of any wound received or disease contracted while in the service of the United States and in the line of duty, his widow should receive the total pension of his rank, to continue during life or until re-marriage; and if no widow survived, or in case of her remarriage, a like pension was granted to his minor children.

In 1868 these pensions were increased by two dollars per month for each minor child; and in 1886 the eight-dollar rate of widows, minors, and other pensionable dependents of enlisted men was increased to twelve dollars. Dependent relatives of soldiers, other than widows and children, were first pensioned under the act of July 14, 1862, which gave the mother, in case no widow or minor child survived, the same pension which a widow, had there been one, would have received; and a like provision was made for orphan minor sisters. Fathers and orphan brothers were included in similar legislation in 1866 and 1868. The dependence contemplated by these statutes might be partial only, but must have existed at the date of the soldiers death. Under the act of June 27, 1890, it is sufficient that a parent shall be in dependent circumstances at the time of applying for pension, without regard to his condition when the son died; but pension under this act begins at the date of filing the application, instead of from the soldiers death, as in cases established under former laws.

Class II.

Pensions of the second class were first granted nearly thirty-five years after the close of the Revolution, by the act of March 18, 1818, which provided that every officer, soldier, sailor, and marine who served nine months in the Revolution, and who was or should become in need of assistance from his country for support, should be pensioned for life, officers at *20 per month, and enlisted men at $8. There was no further legislation of this general character until the act of June 27, 1890, which grants to the widow of every officer and enlisted man who served ninety days or more in the war of the rebellion a pension of $8 per month, with *2 additional for each child of the soldier under sixteen years of age, in case she is without other means of support than her daily labor. When the widow dies or remarries, the right survives to the minor children, as under former laws, and pension is continued during life to children who are insane, idiotic, or otherwise permanently helpless.

Class III.

On October 21, 1780, the Continental Congress resolved that the officers who shall continue in the service to the end of the war shall..., be entitled to half-pay during life, to commence from the time of their reduction.

In 1783, at the instance of the officers of General Washington's army, this half-pay for life was commuted to full pay for five years.

In 1828, officers who served in the Revolutionary army as provided in the resolution of 1780, and enlisted men who performed like service, were granted their full monthly pay, no officer, however, being entitled to higher pay than that of captain.

By the act of June 7, 1832, equal benefits were extended to those who had served two years in the Revolution; and one who served a term or terms in the whole less than the above period, but not less than six months, was authorized to receive out of any unappropriated money in the treasury, during his natural life, each according to his term of service an amount bearing such proportion to the annuity granted to the same rank for the service of two years, as his term of service did to the term aforesaid. This latter provision is interesting as embodying the principle contended for by the advocates of the cent-a-day bill which was introduced in the Fifty-first Congress.

An additional stipend of $100 a year, granted in 1864, completed the measure of the nation's bounty to the boys of 76. The last Revolutionary soldier borne upon the pension roll died in 1869.

A service pension was first granted to widows in 1836, by legislation which gave to the widows of persons entitled under the act of June 7, 1832, the same pensions which the husbands drew or might have drawn, provided marriage took place before the expiration of the last period of service. This was the first allowance of pension of any sort to the widows of Revolutionary soldiers after the seven years half-pay of 1780 to the widows of officers, nor were children of these soldiers ever pensioned in their own right except by special acts of Congress. The limitation as to marriage was from time to time moved forward, and repealed altogether in 1853.

In 1867 the additional annuity of $100 given to Revolutionary veterans in 1864 was extended to their widows, and in 1878 all widows of soldiers who served fourteen days in the Revolution or were in any engagement were pensioned at $8 per month. Twenty widows of this class were still on the roll at the close of the last fiscal year.

In 1871 pensions of $8 per month were granted to surviving soldiers of the war of 1812, without regard to rank, who served sixty days in that war or had been honorably mentioned in a resolution of Congress for service therein, and who had not espoused the cause of the late rebellion, and to their widows in cases where marriage occurred prior to the end of the war.

In 1878 the requisite term of service was reduced to fourteen days or participation in an engagement, and the limitation as to the date of marriage was removed.

In 1887 a like provision was made for survivors of the war with Mexico and their widows, sixty days service being required, or engagement in a battle, or honorable mention in a resolution of Congress. This was made applicable, however, only to persons who were or should become sixty-two years of age, or subject to any disability [not incurred while voluntarily abetting the late rebellion] or dependency equivalent to some cause prescribed or recognized by the pension laws of the United States as a sufficient cause for the allowance of a pension. This apparent restriction may seem to bring the law within our second class; but when it is remembered that persons who were twenty-three years old at the close of the Mexican war were sixty-two in 1887, it will be seen that the act granted practically a mere service pension. At any rate, such has been its effect in its administration.

Class IV.

The only pensions of this class, for disability without regard to its origin or the pecuniary circumstances of the applicant, are granted by the act of June 27, 1890, which provides that all persons who served ninety days or more in the military or naval service of the United States during the late war of the rebellion, and who have been honorably discharged therefrom, and who are now or may hereafter be suffering from a mental or physical disability of a permanent character, not the result of their own vicious habits, which incapacitates them for the performance of manual labor in such a degree as to render them unable to earn a support, shall..., be placed upon the list of invalid pensioners of the United States, and be entitled to receive a pension not exceeding twelve dollars per month, and not less than six dollars per month, proportioned to the degree of inability to earn a support. This act is substantially the same as the so - called dependent bill, vetoed by President Cleveland in 1887, save in three particulars: the earlier bill provided for a uniform rate of $12 per month, excepted cases where the disability was due to the soldiers gross carelessness, as well as those where it resulted from his vicious habits, and extended its benefits only to those who were dependent upon their daily labor for support. In his veto message Mr. Cleveland construed this last provision as requiring not that the applicant should be wholly dependent upon his daily labor, but only that labor should be necessary to his support in some degree. This construction was fully warranted by that which had been given to the Revolutionary dependent act of 1818, and by the existing practice of the Pension Bureau in the claims of dependent relatives. In the administration of the act of June 27, 1890, actual dependence on manual labor for support, in any degree, is not deemed a requisite. To all pensions granted prior to the rebellion, it was essential that the soldier should have been honorably discharged from the service. Under post-rebellion laws this has been necessary for pensions of our second, third, and fourth classes, but not for those of the first class. A soldier who deserted during the late war in the face of the enemy and was drummed out of the service, or an officer who was cashiered for embezzlement or cowardice, stands on an equal footing, with respect to pension for disability incurred in the service, with his comrades who served honorably from Bull Run to Appomattox. Early legislation fixed the commencement of pensions at the date of the termination of service, and a limitation of two years for the filing of claims was established. This limitation was soon removed, and the pension was made to commence at the date of the completion of the proof.

This was the law until the act of July 14, 1862, which dated pensions of the first class from the discharge of the soldier when the claim should be filed within a year after discharge; otherwise from the filing of the application. The limitation was afterwards extended to three years, and later to five; and it was provided that no claim not prosecuted to a successful issue within five years after the date of filing should be allowed except upon record evidence from the War or Navy Department of the disability on which it was based.

All these checks were swept away by the arrears acts of 1879, which granted pension from the discharge or death of the soldier in all late war claims of the first class which had been or should thereafter be allowed, provided that application should be filed prior to July 1, 1880; otherwise, from the date of the application. This limitation was in turn removed with respect to the claims of widows in 1888. Service pensions, requiring little or no proof beyond that furnished by the official records, have been made to commence from the dates of the several acts by which they have been granted.

In 1887 Commissioner Black thus summarized the results of an inquiry into the pension systems of the European governments: Two bases have been recognized out of which a claim for pension might rightfully arise in the case of almost every civilized power. The first is the mere fact of service of the state in a military capacity, and the second is disablement in that service. The service to be the basis of pension must have been of a very great length, rarely less than ten, and oftener of twenty-five and thirty years. A noticeable feature in all of these pension systems is that they were manifestly prepared only for regular service troops, although no discrimination is made between the regular service troops and the war levies.... No instance can be found where pension is allowed for services dishonorably terminated or marked by a dishonorable record.... The foreign pension codes are based upon this idea of. .. . the right of the state to demand the service of every man capable of bearing arms, without regard to any other than a disability pension, and that the pension itself is a mark of extreme honor, reward of long service, or distinguished ability.

The foreign systems have but one class of pensions in common with our own, those for disability incurred in the service. In its other branches our system is unique. Our service pensions do not at all correspond to the service pensions of other governments, ours being for brief and often merely nominal service, while theirs are for long and actual service. Our retirement on pay of officers and enlisted men of the regular army is more closely analogous to the foreign service pension than are the pensions grouped above in the third class. The principle which is the basis of pensions for disability incurred during service and in the line of duty is too plain to need statement here, and justifies itself at once to all right-thinking minds. Such pensions honor both the nation and the beneficiary. Annuities after long and faithful service are obviously wise in countries where standing armies are required, as furnishing an incentive to such service.

But the sentiment of gratitude affords the only legitimate reason that can be urged for any of our service pension laws since the resolution of October 21, 1780. To this sentiment has been added as a ground for our pensions of the second class, in which the indigence of the beneficiary is a requisite, the consideration that the nations defenders and their dependents ought not to be abandoned to want, or the humiliation of alms, from whatever cause their need may have arisen.

But the principle upon which pensions of the fourth class were granted by the act of June 27, 1890, is not so clear. So far as relief is given under this law to needy persons, or to those who are suffering from disabilities probably due to military service, but not provable to be so, and it was the existence of. many such cases that furnished the chief argument for the measure, the principles above cited apply.

But another group of pensioners is being added to the rolls under this act, those who are not in needy circumstances, and whose disabilities are not even colorably due to military service. On what principle are these pensioned for their disabilities? If from gratitude, why discriminate in rates ac- cording to the degree of the disability? Would not length or character of service be the proper criterion? If the well-to-do business man, who served ninety days in the commissary department, sustains today a serious and permanent injury while exercising his favorite horses, why should he receive an expression of public gratitude, if he choose to ask for it, to which he would have had no title yesterday? And why should he have $12 per month, while his coachman, who served four years at the front, injured in the same accident, but only half so severely, can get but $6? One year after the passage of the act of June 27, 1890, 391,431 invalid claims had been filed under its provisions, of which 236,362 were in lieu of pensions or applications under previous laws, the remaining 155,069 coming from new claimants. How many of these claims have been made by men who are far from indigent, and whose disabilities are in no wise due to service in the army or navy, let the reader judge from his own observation.

Some curious anomalies have arisen under this latest experiment in pension legislation. Men who, after serving under the stars and bars, enlisted in the Union army, are rewarded by a grateful nation for wounds received while bearing arms against her. The thrifty bounty-jumper who entered the service with a concealed disability, which, after three months of wearing the blue, he used to secure his discharge, may, upon a full showing of the facts, receive a pension for that very disability. A woman who served a term in a penitentiary for poisoning her husband now claims a pension on account of his military service and death, and no reason is known why she may not have it.

The current of ever-increasing liberality which has flowed through our pension legislation may also be traced in the administration of the laws. In the earlier years there were some attempts to throw about the adjudication of claims certain judicial safeguards, which gradually fell into disuse. An act of 1792 provided for the attendance of each applicant and the production of his evidence before the United States Circuit Court of his district, and the court was required to make a personal examination of the disability, and forward the papers to the Secretary of War with a report and recommendation.

The following year it was enacted that whereas the act last referred to was found by experience inadequate to prevent the admission of improper claims to invalid pension, and not to contain a sufficient facility for the allowance of such as may be well founded, therefore all evidence relative to invalids (the requisite evidence being minutely prescribed) should be taken upon oath or affirmation before the judge of the district in which such invalids reside, or before any three persons specially authorized by commission from said judge; and this evidence was to be transmitted to the Secretary of War for final action. This office of the courts came to be discharged in a perfunctory way, and by degrees evidence submitted in pension claims assumed a wholly ex parte character.

Proceedings of this sort always open the door to fraud, and it is only saying that citizens of the pensionable classes have not maintained among themselves a higher level of integrity than prevails among their fellows, to say that fraud and imposition have here found a peculiarly inviting and profitable field. In the debate on the Revolutionary service pension act of 1832 the extensive frauds committed under former acts were referred to as matters of common knowledge. The compiler of the first digest of pension laws, in 1854, a late chief clerk of the Pension Office, attributed to the chaotic state of pension legislation, and to the ex parte system of adjudicating claims, the perpetration of innumerable frauds against the government.

In 1872 Commissioner J. H. Baker said, in his annual report: . So long as pensions are to be granted upon evidence which (except record evidence) is purely ex parte, so long frauds will continue to exist.... In our system the record of the soldier is too meagre at best, and during the late war the hospital records were illy kept, very frequently, as the experience of the office daily shows, so indefinite as to be utterly worthless in determining the origin and character of the alleged pensionable disability; hence the law authorizes a resort to parol evidence.... in which the government has not exercised the right of cross-examination, and upon which a decision could not be had in any court of justice. General Baker suggested that a special pension court should be established in each congressional district, in which there should be opportunity for open cross-examination of witnesses.

In his report for the fiscal year ending June 30, 1875, Commissioner H. M. Atkinson said: The development of frauds of every character in pension claims has assumed such a magnitude as to require the serious attention of Congress... From the nature of the system under which the right to pension is determined under existing laws, viz., upon ex parte evidence, the successful prosecution of many fraudulent claims cannot be prevented, even though the utmost caution be exercised. The lapse of time since the war, and the consequent unreliability of parol proof relating to facts at this remote date from their occurrence, afford the most forcible argument for the adoption of a more thoroughly organized system of adjudicating these claims. By actual test in cases taken from the files of this office it is shown that a large percentage of the affidavits filed in support of claims for pension are signed and sworn to without being read over to affiants, and without their having a full and proper knowledge of the contents, though accompanied by a certificate of the magistrate before whom they are executed that the witnesses have been fully informed of the purport.

In his report of 1876 Commissioner John A. Bentley presented a forcible indictment of the ex parte system, and recommended a plan by which testimony should be taken viva voce in all cases, and subjected to proper tests. A measure known as the sixty surgeons bill, embodying this recommendation, was introduced in Congress, but failed of passage. In 1878 he said, I am convinced that a great number of persons have been pensioned who have no just title, and that the number of that class is being constantly increased in the settlements which are now going on. In 1879 he presented a table showing that in 500 cases dropped from the rolls since July 1, 1876, there were 3084 false affidavits out of 4397 affidavits in all, and 92 forgeries. More than half a million dollars had been paid to these pensioners before the frauds were discovered. He said in 1880, The number of frauds discovered year after year, when it is considered that the attention of the office was attracted to them through accident or some suspicious circumstance, or by the statement of a volunteer informer, is very great, and renders it certain that but a very small percentage of the frauds committed come to the knowledge of the office.

In 1862 the Commissioner of Pensions was authorized to detail a clerk, with power to administer oaths, for the personal investigation of cases of suspected fraud. Such special investigation was found necessary and effective in a growing number of cases, and additions to the force of employees assigned to this duty were made from time to time.

In 1882 it was greatly augmented, and the special agents or examiners instead of making their headquarters in Washington, as before, were stationed in different parts of the country, each with a definite district. A marked increase in the quantity and thoroughness of the work performed by this branch of the Pension Bureau was thus effected. Commissioner Dudley said, in his report of 1883: The means taken to prevent the successful consummation of fraud are reasonably efficient to that end, and it may be easily demonstrated, I think, that such claims [i.e., claims without merit] are, to be found mostly in our rejected files. If it be doubted whether the rejected files have gathered in so large a proportion of the unworthy claims as this opinion would indicate, it is at least safe to say that instances of gross fraud have become comparatively rare. The ratio of the cases specially investigated in any year to the whole number of pending claims is always very small. Of those that are tested in this way, it is probable that few dishonest ones pass the ordeal successfully; and it is certain that the presence throughout the country of agents of the government charged with the detection of violations of the pension laws has a deterrent effect upon those who would otherwise resort to fraudulent practices.

On June 30, 1891, there were 110 special examiners in the field. Not only are cases of suspected fraud referred to them, but also many cases of probable merit in which the evidence filed by the applicant does not warrant allowance, and there is reason to believe that a more explicit showing of the facts would establish their merit, the government thus practically undertaking to supply the deficiencies in the prosecution of the case by the claimant and his agents. The benefit of this procedure to worthy claimants is apparent from the fact that during the last fiscal year over two thousand claims were admitted after special investigation, most of which must have been rejected if settled upon the original ex parte evidence. And it is a fact indicative of either a high average of merit in the pension claims of the present day, or great liberality on the part of the Bureau, or both, that the proportion of specially investigated cases finally allowed during the last two years to those rejected was eight to one.

The question of the sufficiency of evidence is obviously an individual one in every claim, but this general statement may be ventured, that the requirements of the Pension Bureau have since the late war undergone a steady reduction. That this Bureau has been, on the whole, as honestly and intelligently conducted as any administrative branch of the government, no one who is conversant with the facts will deny; but an effective public sentiment has demanded a constant liberalization of the process of adjudicating claims, just as it has by legislation increased rates, removed limitations, and created new groups of pensioners. No course has been open to the officials of the Bureau but compliance, and though all safeguards that the people will tolerate are still retained, thousands of pension claims are annually allowed upon evidence which would not draw one dollar from the pocket of a prudent business man, however anxious to satisfy all just demands. A prima facie case is made out in every instance, to be sure; but there is generally a very high degree of probability that the affidavits exceed the real knowledge of the witnesses concerning the facts in question. It is notorious that a great proportion of the ex parte affidavits in pension cases, even when made by men who in ordinary business are distinguished for strict integrity, are made with shameful lack of care and scruple. Statements are drawn up by the agents of applicants containing such averments as the exigencies of the case demand, and in numberless instances these are signed by persons who not only have no knowledge of the facts recited, but are not even aware of the contents of the writing; while many magistrates habitually take acknowledgments of pension affidavits without administration of the oath. If this prevailing laxity could have any excuse, it would lie in the fact that some of the matters * required to be proved, especially those elating to symptoms of disease shown by the applicant in the service, or from time to time since discharge, are such that an ordinary memory cannot retain them with certainty; and witnesses, fearing that a just claim may fail through their forgetfulness, are ready to blindly assent to the averments of the parties in interest, or at best assume as an original and positive recollection what they should know to be a mere untrustworthy impression. But there is no excuse. The sanction of an oath should be no less in an ex parte pension affidavit than in a court. proceeding. It must not be supposed that reckless swearing in pension claims is more prevalent among ex-soldiers than other classes of citizens. The average comrade or officer is neither a more scrupulous nor a more unscrupulous witness than the average neighbor or family physician.

If pension legislation has been too lavish, and the administration of the laws too loose, the responsibility lies upon the whole country. In the solicitude with which they have regarded the soldier vote our law-makers have but reflected the sentiments of their constituents; and the tendency toward a wide-open policy in the adjudication of claims has been in accordance with the manifest will of the people. In numerous communities throughout the land respectable citizens believe that they have among them some flagrant instance of dishonest pension; and yet information of supposed fraud is rarely volunteered except when prompted by motives of personal hostility, and even when sought is denied or given with reluctance. There is a growing conviction that the government is being shamefully plundered through the pension system; and the existence of this belief, whatever the fact, with acquiescence in the supposed abuse, cannot but have a most demoralizing influence on the public conscience. It is all too easy at best to regard the national Treasury as a public grab-bag; and the sight of A. drawing with impunity, year after year, a stipend from the government known or even believed to be obtained by dishonest means, is a most potent incentive to B. to try his hand at the same trick. Hardly less deplorable is the gradual lowering in the general esteem of the veterans of the late war as a class. The suspicion is abroad that a mercenary spirit, incompatible with that lofty sense of honor which the popular imagination would fain attribute to its military heroes, is spreading among them. This suspicion may be unjust, but its increasing prevalence is no less sure than it is unfortunate.

For years to come our pension system must be an impressive object-lesson to rising generations of Americans, and to those who come to us from other lands. Should they learn from it that here the citizen owes no duty to the state for which he may not demand compensation in hard cash? Or, scattering abroad its bounty with a generous but discriminating hand, should it teach that while the nation will not forsake her true defenders in their time of need, nor look on with cold indifference when they are handicapped in the race of life by the lasting infirmities of camp and field, her real debt to them is not to be reckoned in dollars, but in boundless gratitude and honor?

It is not probable that any backward step will ever be taken in pension legislation, nor that in the administration of the laws the lines will ever be more closely drawn than public sentiment shall require. If in the unparalleled munificence of our pension system there lurk serious evils, there seems to be no remedy save through an awakening of the public conscience and a shaking off of that easy-going acquiescence in abuses which is one of the most conspicuous vices of the American character. Reckless legislation may thus be prevented in the future, and a more just and honest distribution of the nations bounty under present laws may be secured. Let the great and rich Republic be liberal even lavish, in comparison with less-favored nations with her deserving veterans; she will never do too much for them. But let her not forget that if she is blind to the plain distinctions between truth and falsehood, need and greed, genuine military service and holiday campaigning, this is not liberality, but prodigality, which brings reproach upon herself and unmerited discredit upon every worthy soldier who accepts her aid.

Section: 

1898-1987: History of the Odd Fellows Home of Springfield Ohio

Summary: Illustrates how the benevolent societies got into the business of caring for the elderly, how they financed their projects, and how they changed over time as federal and state governments began providing welfare and regulating care.

Odd Fellows Home of Ohio
Springfield, OH

Data and photos from Historic American Buildings Survey.

This information illustrates how the benevolent societies got into the business of caring for the elderly, how they financed their projects, and how they changed over time as the federal and state governments got into the business of providing welfare and regulating nursing home care.

Background

Text from Historic American Buildings Survey, written in 1987:

The fraternal organization known as the Independent Order of Odd Fellow was founded in England and established in America in Baltimore, Maryland in 1819. The order burgeoned in America and dedicated itself to worldwide relief efforts stemming from its governing principals: "the strong support the weak, the well nurse the sick, the learned instruct the unlearned, and the rich help the poor." By 1897, there were 11, 569 lodges in the United States with over 2,197,196 men having been initiated. The women's counterpart, the Daughter's of Rebekah, number 4,808 chapters with 298,263 members at that time.

Odd Fellows was established in Ohio prior to 1845 and grew rapidly throughout the 19th century. As of 1989, there were 721 lodges in Ohio with 61,328 members and 362 Rebekah lodges with 29,989 members.

Odd Fellows were pioneers in providing for orphans and aging, indigent, and infirm citizens. The first Odd Fellows home in the country was founded at Meadville, Pennsylvania in 1872. Ohio lodges first began considering the need for an Ohio home in 1864, when the Ironten lodge formed a committee to urge the Grand Lodge of Ohio to establish a home and school for orphans in the state. Not until 1882 however, was formal action taken when a separate Odd Fellows Association was incorporated to build a "Home for Indigent Brothers." After years of deliberation, the first home in Ohio was opened near Mildale, Ohio in Hamilton County in 1890. It was known as the Rossmoyne Home and served aged and infirm Odd Fellows as well as some of their wives and widows. This home was operated by the Odd Fellows and Rebekah Lodges of Cincinnati and Hamilton County, and subsequently was taken over by the Grand Lodge of Ohio later in the 1890's. It was the seventh such Odd Fellows Home to be opened in the nation.

Even before Rossmoyne was officially opened, Ohio Odd Fellows began to investigate erecting an orphanage in the state. At the Grand Lodge session in Toledo, Ohio, in 1889 a special committee was appointed "for the purpose of considering the advisability of erecting a Home for deceased Odd Fellow's Children..." this "action by the Grand Lodge is in the nature of the excavation for the foundation upon which the Springfield Home was built." It was not until 1896 although, that formal action was taken toward establishing the home at Springfield, Ohio. During the Grand Lodge session in May at Lima, Ohio, $45,000 was allotted and plans drawn by Columbus architects Tost and Packard were accepted for erection of the home. In August the contract for construction was let with F.J. Evans and Son of Zanesville, Ohio at a cost of $57,187 (including alterations to the original cost and plans.) The official name was the "Odd Fellows Home of Ohio" and it was financed through assessments on all Ohio Lodges for construction and maintenance. By the time of its completion in May 1898, it had been decided that the home would admit aged Odd Fellows, their widows, and orphans. The Rosemoyne Home was put up for sale at this time. The grand dedication of the Odd Fellows Home at Springfield was held on October 27, 1898 following a parade through the city and march to the home then on the northern edge of the town. The site was on a hill overlooking Springfield and consisted of approximately 73 acres, most of which was used eventually for farming and activities associated with providing the home with fresh produce, dairy products and meat.

Chronology

1898
The main building is constructed for a cost of $57,187.

1901 - IOOF brother Arthur G. Bobcox, a landscape architect of Cleveland, prepared a landscape plan for the grounds around the house. A subscription plan of selling coin-tokens among the various lodges to raise money to implement the plan was not successful. It is not recorded if any of the original plan was carried out, but in 1902, the Wade Park Lodge of Cleveland did plant trees and flower beds on the grounds.

1902
The home was full with approximately 250 residents and discussions began concerning an addition. In that same year, the home was electrified at a cost of $841 per year, and a dairy was installed in an adjacent barn.
1906
A separate building to house a laundry and power plant was erected behind the main building for $9,962.
1907
Two, 3-story story wings were added to either side of the original structure, extending from the rear of the east and west sections of the original home at 45 degree angles. Also added were a kitchen at the rear of the dining room, tunnels for a new steam heating system, automatic fire doors, fire walls, and interior finishing. The total cost of these additions was $66,481.
1916
A 2-story hospital building was constructed at the northwest corner of the property approximately 30 feet from the end of the western wing. The hospital building was "H" shaped in plan. It eventually became the "Intermediate Care Facility."
1925
Another building, a nursery, was added to the northeast of the eastern wing in about the same location as the hospital on the west.
1936
The nursery becomes the offices of the Ohio I.O.O.F. Grand Lodge.
1950-1955
The eastern and western wings were connected to the nursery and hospital by brick buildings, and two side porches on the original central block were enclosed and utilized as sitting rooms for the residents. Sometime after that one wing became part of the "Intermediate Care Facility" and the other became the "Ladies Rest Home."
1962
State regulations forced the home to close its orphanage facilities and to accept only elderly residents.
Sometime between 1960 and 1987
A swimming pool was filled in and one bathhouse was removed (there is no mention about when they were built).
1987
"With a mortgage guarantee from the U.S. Department of Housing and Urban development new nursing care wings will be added to the east and west of the original main building and the original building will be renovated. This project was necessitated by the need to meet state and federal requirements for nursing care facilities and in order to 'take full advantage of advances in modern research in the study of aging needs.' Part of the rear wings of the original building, as well as both 1907 wings and the hospital building will be demolished. The dining room/kitchen and chapel/auditorium section of the main building, the Grand Lodge Office, the boiler plant, and the garage will remain. The new intermediate care wings will serve 100 residents, while the original building will serve 100 self-care (board and care) residents. The cost of the project is estimated at $3.1 million. The Odd Fellows' will sell bonds to finance the project."

Photographs

Section: 

1898: Boston's Pauper Institutions

Summary: Text and pictures from an article in New England Magazine describing every day life in the poorhouses, including a facility designated just for elderly couples.

Boston's Pauper Institutions

The New England Magazine
Volume 24, Issue 2, April 1898

By William I. Cole.

THREE of Boston's public institutions are on islands in the harbor. One of the Houses of Correction is on Deer Island, the House of Reformation for boys, on Rainsford Island, and the principal Almshouse, on Long Island. A city boat, the J. Putnam Bradlee, serves as transport between these and the city proper, making two round trips a day, a morning trip for carrying more especially mails and freight, and an afternoon trip for passengers. Different parts of this boat are assigned to the different grades of passengers from the institution's point of view. The commissioner of Penal Institutions, in whose hands is the control of the House of Correction, has a cabin of his own on the upper deck and the exclusive use of the hurricane deck the trustees of the Children's and of the Pauper Institutions, the governing bodies of the House of Reformation and of the Almshouse respectively, have their cabin on the main deck; superintendents and their deputies, the chaplain, and members of 233 the city office force enjoy the privileges of the pilot house; ordinary passengers have the freedom of the upper deck and a small saloon opening from it; while prisoners for Deer and Rainsford Islands and paupers for Long Island find accommodations on the deck below, the former in rooms where they are placed under lock and key. The presence of the Commissioner on board is announced by the display at the masthead of the institution's flag, a blue field with white ball containing an anchor surrounded by the words, City of Boston, Institutions Dept. in blue; that of the Trustees, by a plain blue flag.

The House of Correction and the House of Reformation, of the harbor institutions, have been described in other articles of this series; the Almshouse remains to be described.

Long Island is slightly less than a mile from Deer Island and somewhat more than half a mile from Rainsford Island. It is about a mile and three quarters long and a quarter of a mile wide, and in shape resembles a high military boot with toe pointed downward. It derives its name from its great length when compared with its breadth; or, as Wood says in his "New Englands Prospect," written in 1635: "The next Island of note is Long Island, so called from his longitude." The outer end of the island, or the top of the boot, rises abruptly to a height of seventy feet above the level of high water, and is known as Long Island Head. Here a lighthouse has been maintained since 1819; and at the present time fortifications for the defence of the harbor are in process of construction.

With the exception of this head, which is the property of the United States Government, the island was purchased by the city thirteen years ago for the site of an almshouse. Before possession could be entered upon, however, it had to be cleared of a colony of Portuguese lobstermen, who without any titular rights had established here their homes. After the time for vacating allowed these squatters by the city had expired, most of them persisted in staying on and met with some show of resistance all efforts to remove them. They were dislodged finally by eviction and the burning of their houses. A few of the colony still remain on the government side of the island, their row of shanties, near the dividing line, showing picturesquely where the city ownership ends and that of the government begins.

In 1887, a large brick building, the present "institution", having been erected, the female paupers were brought here from Austin Farm, whither they had been removed from Deer Island ten years before. But these were not destined to remain here a great while at this time. Within two years of their arrival they were transferred to Rainsford Island, where the male paupers had stayed their wanderings since leaving Deer Island in 1872, to take the places of the male paupers who in turn took their places at Long Island. The reason for this change was that on Long Island the men could be set to work, while on Rainsford they had little or nothing to do. When the hospital on Long Island was ready for occupancy, in 1893, however, the inmates of the Rainsford Island hospital were removed to it; and on the completion of the women's building, two years later, all the women were brought back.

The abandoned almshouse on Rainsford Island was taken possession of, in the same year, by the juvenile offenders, who were brought over from Deer Island, and became the present House of Reformation for boys.

In point of buildings, the Long Island Almshouse ranks among the best of the city institutions. Besides the "institution" already referred to, a well-built and commodious building, there is a model women's dormitory, an excellent hospital on the pavilion plan, a neat Gothic chapel with an attractive interior, and a fine superintendent's house.

The "institution," in which are the offices of the institution and the accommodations for the male paupers, is rectangular in shape, two hundred feet long and forty-five feet wide, three stories high, with a large extension leading back from the middle of the rear. The entrance hall runs through the centre of the main building. From either side of this opens a suite of offices and a great dormitory, and from the rear, into the extension, the general dining room. Back of this dining room come the officer's dining room, the kitchen and the general laundry of the island. On the two floors above are officers quarters, additional dormitories, of which there are four, a hall, and a sewing room in which clothing for the men is made and repaired. The basement contains the receiving room, where newcomers are entered, storerooms, the lavatory, and a large brick-paved room, lighted by half windows and furnished with rude tables and benches, known as "loafer's hall," where the men may spend their leisure time. The entire building is heated by steam and lighted by electricity.

The "institution" is supposed to have accommodations for three hundred men, fifty in each of the six wards. At the present time, though, it is housing four hundred and eighty, overcrowding four of the wards and pressing into service a large room never intended to be used as a ward.

Of a different plan and style of construction is the women's building. This is irregular in shape, with a frontage of one hundred and thirty feet and an extreme depth of one hundred and four feet. It consists of a central section and two wings or ward pavilions, each two stories in height. The entrance is from a vestibule into the main ball and day room, where there is a large fireplace and double staircases to the floor above. At the rear of this hall is the main dining room, and on either side are the wards, each thirty-seven by one hundred and three feet, which can be divided into two when necessary. These wards are airy, well-lighted, supplied with fireplaces, and have room each for eighty beds. The bath and toilet rooms are separated from the wards by a "shutoff" corridor and occupy bays. The floor above is arranged on practically the same plan. Here is the matrons' and attendants' dining room. In the basement are the office, receiving room, kitchen, and storerooms. As in the "institution" the heating is by steam and the lighting by electricity.

In construction, the women's dormitory is of the "open-timber work" style. Its exterior walls are filled with terra-cotta blocks, the outside of which is covered with cement, the whole forming panels between the timbers of the frame. This style of construction has the advantage over the ordinary in respect to cheapness and incombustibility. Unfortunately, however, it is not as damp-proof as fire-proof.

The largest of the buildings in ground area is the hospital, which has a frontage of two hundred and eleven feet and a depth of three hundred and fifteen feet. It is divided into three parallel ward pavilions, connected across the front by a corridor, in the centre of which is the administration building and at either end a "head-house." The administration building is three stories high, all the others being one story. The wings are divided into two or three continuous wards and together have room for three hundred beds. Two of the wings are for women and one for men. Between the middle wing or pavilion and those on either side are great courts for light and air. Connected with each ward are sun rooms and toilet and bath rooms. The "head houses" have the offices of administration for the wards, the nurses dining room, the diet kitchen, and rooms for special patients. The general offices of the hospital together with quarters for the physicians. nurses and attendants are in the administration building. Ventilation throughout the hospital is by the aid of fans. In style of construction the hospital is identical with the women's building; as is also the chapel. The superintendents house is of wood.

Permits to Boston's Almshouses are obtained of the Institutions Registration Bureau, one of the five departments into which the Institutions Department was divided by the legislation of last year. The applicant fills out a form with name, date and place of birth, occupation, habits, residence, and other like data. On these representations, supplemented by an investigation into his antecedents and circumstances, the Bureau decides as to the applicants pauperism and legal settlement, the two points on which a permit is issued. The character and past record of the applicant, whatever they may be, while noted by the Bureau, are not taken by it into the consideration of his case, since they affect in no way his status as regards the almshouse. That rests solely on the questions of legal settlement and need. He may have done time at the house of correction or the state prison, he may have been in and out of one and another poorhouse innumerable times, he may be a common drunkard but if he has a settlement in Boston and cannot support himself, he can go to the almshouse, according to the law.

Neither are the circumstances of his relatives taken into the consideration of his case; since however well-to-do any of these may be, they cannot be compelled to maintain him outside of the almshouse. Children ,grandchildren, parents or grandparents, however, could be required to pay his board in the almshouse, if able to do so, with the exception of a married daughter whose husband is living. Other relatives would not be liable, whatever their circumstances. As a matter of fact, however, this law of liability is practically a dead letter on account of the difficulty of enforcing it.

Should the applicant have no settlement, he can be sent to the state almshouse; or if his settlement is in some other city or town than Boston, he can be sent to the city almshouse on the understanding that the place of his settlement will pay his board.

Naturally the number of inmates at Long Island varies with the season, reaching its lowest point in summer and its highest in winter. On the first of July last there were in the men's building 184; in the women's building 167, and in the hospital 144; on the first of the following January there were in the same buildings 397, 208 and 149 respectively. It will be observed that the variation in the case of the men outside the hospital was much greater than in that of the women, while in the case of the sick it was practically nothing. As a rule the male population is about twice as great in winter as in summer and the hospital population remains about constant. The following table shows the movement of the population during 1897:

Status Males. Fem. Total.
Remaining Jan. 31, 1897 488 327 815
Admissions, including births 625 395 1,020
Discharged, including deaths 1,113 722 1,835
Whole number supported 612 364 976
Absent on leave 5 1 6
Whole number of removals 617 365 982
Remaining Jan. 31, 1898 496 357 853
Deaths 62 83 145
Births 10 7 17
Largest number present 512 363 875
Smallest number present 247 305 552
Average, daily 363 326 689

Ten of the seventeen children born were illegitimate.

Some of the occupations of those admitted last year were: Laborers, 230; printers, stone masons, 8; teamsters, 52; painters, 24; cooks (women), 32 ; seamstresses, 13; housework, 275; laundresses, 23; no occupation (women), 30; carpenters, 5; firemen, 7; clerks, 8; plumbers, 4; book agent and variety actor, 1 each. It is a motley and shifting population at Long Island, representing every age from 20 to 90, every physical condition from robust health to all varieties of infirmity and disease, every grade of mental ability from fair intelligence to feeble mindedness mild dementia, and every type of the unfortunate, the vagrant, and the vicious.

Of the 1,020 received last year, 39 were under 20 years, 101 between 20 and 40, 280 and 30, 228 between 30 between 40 and 50, 165 between 50 and 6o, 127 between 60 and 70, 63 between 70 and 80, and 17 between 80 and 90.

A glimpse of some of the types may be had from the following "settlement histories", selected almost at random from those on which permits were granted as recently as last January. Of course the correct names are not given.

Peter Doherty. Age 78. Born in Ireland but has lived in Boston since 1842 with the exception of the period between time 1859 and 1872, when he was in California. Before 1859 he had built and owned two houses. On his return from California he was robbed of a considerable sum of money. Since 1883 he has been in the almshouse 30 times. Is intemperate occasionally.

John J. ORourke. Born in Charlestown, 1863. His father at one time paid taxes on real estate. Is a teamster, intemperate. Left his wife about eight years ago on account of her intemperate habits. Has never had to be aided before. Was at Deer Island in September, 1897. Needs medical treatment.

Edward Miller. Born in Halifax in 1866 but has been thirty years in the United States. Is a carriage smith, intemperate. IHas received no public aid. Does not know his wife's present whereabouts. Has two children in the Mareella Street Home. Needs medical treatment. His father and stepmother unable to aid him on account of their own sickness.

Sarah Gallagher. Age 62. Is by occupation a domestic, intemperate. Has been, under an assumed name, at Deer Island 20 or more times. In and out of the almshouse 36 times since 1883.

William J. Downey. Age 44. Is a peddler, intemperate. At one time well-to-do but in a freak sold his business for almost nothing. On the death of his wife in the Massachusetts General Hospital of consumption, her mother took the three children. Later, a sister adopted the youngest. The man probably has a record in House of Correction. Has been in and out of the almshouse 41 times since 1885. Makes a paralyzed arm an excuse for not working. Met at Long Island a pauper woman whom he married for his second wife. The two children of this marriage are now in institutions. Two brothers of the man are at Long Island with consumption.

Mary Griffin. Age 69. Born in Scotland. Very intemperate. Has been in House of Correction 24 times for drunkenness and vagrancy. Last time in June, 1897, In and out of the almshouse 15 times in past 15 years. Extremely troublesome wherever she is.

Not only do these sample "settlement histories" give us glimpses of the variegated characters at Long Island; they suggest how many of these must have been criminal offenders at some time. Out of the 872 different individuals admitted in 1876, 244 men or 48 percent, and 184 women or 60 percent had been recent inmates of penal institutions. Long Island and Deer Island are not far apart literally or figuratively. Inmates of the latter as recently as last June and one as recently as last November are now inmates of the the former.

Again these "histories" hint, in the case of Downey, whose children by his pauper wife are public charges, at what undoubtedly would be found true could the facts be got at, namely, that Boston, and presumably other cities as well, is carrying along in its various institutions, a tolerably permanent pauper and criminal class. Not a few of the present inmates at Long Island are known to have been born in some institution, and in one institution or another, pauper or penal, to have passed most of their days. One of the children born at the island this winter was the fourteenth child born of the same mother in a city institution.

This heterogeneous population is constantly changing. The aged and infirm stay on, of course, from year to year, but the younger and more active elements grow restless after a time and drop away, to return perhaps in a few weeks or even a few days. As a matter of fact, during 1896 there were admitted once, 724, twice, 175, three times, 38, four times, 18, five times, 5, nine times, 2. To put some check on this free and easy going and coming the following order was issued about a year ago:

"Any person admitted to any almshouse of this city shall be so admitted only upon signing an agreement that he will remain in the house to which he will be sent until the last Saturday of the month next succeeding his admission, and, if he does not apply for his discharge at least five days prior to said last Saturday, that he will remain until the last Saturday of the month in which he shall so apply, unless sooner released by order of the Commissioner; and that he will comply with all the regulations of the house, and the directions of the officers thereof."

While this rule regulates to some extent the going and coming, it does not prevent an exodus from the island from the first signs of spring to midsummer and a return procession after the early frosts. As has been pointed out, the number of male inmates outside the hospital is much more variable than that of the female, being in summer about half what it is in winter, while the number of the latter is quite uniform the year round. The men and women at Long Island occupy different buildings, and, of course, different wards in the hospital; but they attend chapel together, the men sitting on one side and the women on the other, and come into contact with one another in the common laundry and on the grounds. One of the rules of the Island forbids communication, either written or oral, between male and female inmates, except by permission of the superintendent. Another rule aims to prevent any unnecessary meeting of the two sexes on the grounds. It reads "Male inmates are positively forbidden, except on business, to walk or loiter on that portion of the island lying east of the male institution building; females, that portion of the island lying west of the female building."

With the exception of this imperfect separation of the sexes, there is practically no classification aside from what is made by physical condition which may place inmates in the hospital or infirmary. Women with infants, however, have a dormitory of their own in the women's building. In the institution dining room also some attempt is made to have the older men sit on one side of a low screen running down the length of the room and the younger men on the other side. The reason for such division is not apparent.

Those of the same sex intermingle with little or no restraint. The male paupers have a common meeting place in "loafers hall," where they play cards, read and smoke; the female paupers, in the central hall, or day room, of their building, in which they sew, read and doze, sitting in rows on high-backed settles. If the inmates of either building wish to be more by themselves, they can withdraw to their dormitories. In the summer time they sit out of doors when the weather is fine.

In addition to being well housed, the inmates at Long Island are well clothed and fed. None are allowed to use during their stay any of the garments that they brought with them, but on arrival are comfortably fitted out with wearing apparel, while their own clothes are taken to be cleansed, repaired, and put away for them until such time as they depart.

In the system of discipline moral persuasion of necessity very largely takes the place of punishment. But deprivation of privileges may be used as a means of punishment, and, in cases of flagrant disobedience, solitary confinement. The privilege that is most commonly and effectively cut off in the case of the men is the weekly ration of one-third of a pound of tobacco. The solitary cells were used but 6o times last year, 23 coming in the first two months.

Those of the inmates who are able to work are given employment of some kind. Besides performing domestic duties of every sort, they work in the laundry and sewing rooms, and the men in the carpentry shop, about the grounds and on the farm. None of them are paid for their services, who are not required in or about the An idea of the work accomplished by them along certain lines will be conveyed by a few figures. In the sewing rooms, in 1897,the repairing for the entire institution was done and the following articles, among others, manufactured: Aprons, 1,412, bedticks, 105; dresses, 891; night 492; night caps, 362; petticoats, 993; pillow-slips, 850; shoulder shawls, 378; sheets, 1,227; towels, 729; and shrouds, 43.

There were raised on the farm during the same year all the vegetables used by the almshouse, except potatoes, together with hundreds of plants for decorating the grounds, and large quantities of pork and milk.

But all the able bodied are by no means fully occupied, especially in winter, on account of what may be called the institution's deficient industrial equipment. The sewing rooms, for instance, have fewer machines than could be used. "With more machines," a former superintendent says in his report for 1896, the men's outside clothing could be made, and the expense saved of having it made at Deer Island." There is, to be sure, the large farm; but unfortunately this cannot be cultivated during the season when the number of men is the greatest. With the exception of the sewing rooms with their limited capacity, and the farm, which can be worked only a part of the year, there are no means of utilizing the labor of those buildings or on the grounds. Many therefore have little to do, less perhaps than would be good for them. There is, of course, a very large number of those unable to work and hence condemned to pass their time in absolute idleness. But this number could be reduced undoubtedly by more varied means of employment, and many be made the happier for having something to do.

The somewhat monotonous life at the island may be varied by an occasional visit to the city on passes. These passes can be obtained after a residence of three months, but only on a record for good behavior. They entitle the holder to an absence of from one to seven days. As a rule no one can get a pass oftener than once in three months.

The hospital, although a part of the almshouse, is of sufficient importance in itself to be considered a separate institution. The total number of patients in 1897 was 387 men and 573 women. Of these, 305 men and 409 women were admitted during the year, and 297 men and 426 women were discharged. The largest number at any one time was 281, and the smallest, 233. Besides those treated in the hospital, 883 were treated as out-patients. Among the diseases treated were, in the hospital: General debility, 65; senile debility, 91; rheumatism, 38; phthisis, 96; tuberculosis, 4; typhoid fever, 4; alcoholism, 23; epilepsy, 19; dementia, including senile, 34; bronchitis, 29; pneumonia, 13; venereal diseases, 64; and, in the outpatient department: Rheumatism, 39; alcoholism, 16; debility, 71; and venereal, 23. The other ailments treated would exhaust the nomenclature of diseases. The insane are transferred to some hospital for the insane, but cases of mild dementia are retained. Twenty-three cases of insanity were transferred during 1897.

In a hospital of this description the death rate must necessarily be very great. The morgue, which is a separate building, is seldom if ever free from dead bodies. Not infrequently it contains six or seven. About half are claimed by relatives or friends; the rest being buried on the island. The hospital is under the care of a medical superintendent with three assistants. There is a visiting medical and surgical staff. Connected with the hospital is a training school for nurse attendants. The course requires one year and includes general medical, minor surgical, maternity, and infant nursing. Instruction is given by means of lectures and text books, and teaching by the bedside in the regular performance of duties. The first graduating exercises were held in September, 1896; at which time seven pupils received diplomas. There are at present 25 in the school.

The idea that an almshouse hospital should be conducted differently from other hospitals would seem to be fast disappearing. And it should disappear; as the last report of the Long Island almshouse well says: "Whether dependent or independent, sick persons should receive the best possible care, and it is better economy as well as better humanity to insist that the standard of this hospital should be as good as that of any other."

One of the greatest needs of the Long Island hospital is that of a separate building for both men. and women suffering from tuberculosis, who now are kept in open ward. There is need also of an isolation ward for other contagious diseases. Among the rules and regulations for Long Island are the following:

Inmates immediately upon their arrival at the almshouse, unless excused by a physician, must take a bath and change their citizens clothing for a full outfit of institution clothes. Inmates will not be allowed to wear any of their own clothing while in the institution except by express permission of the Superintendent, and all money must be given to the Superintendent for safe keeping.

Inmates must rise at 5.15 A. M., and retire at 8 P. M., at which time all lights must be turned down. The gong will be sounded at those hours.

The regular hours for labor will be from 7 to 11.45 A. M., and from to 4.45 P. M. Hours for meals will be breakfast, 6 A.. M.; dinner, 12 M.; supper, 5 P. M.

Smoking is prohibited within 1,500 feet of any building, or in the building outside of the regular smoking rooms.

Inmates are forbidden, except on business, to enter the barn or other out-buildings, or to loiter about them or the wharves.

Inmates must be bathed at least once a week, and cleanliness both in person and in habits will be enforced. Male inmates must be at their bedside at 11 A. M., and female inmates at 2.30 P. M., every Sunday to undergo inspection of clothing.

Profane, obscene and impertinent language, disorderly or insubordinate conduct, talking in the dormitories after retiring, wilful destruction of institution property, annoying cranky or feeble-minded inmates are strictly prohibited. Inmates must perform such work as may be assigned to them faithfully and well, and obey the orders of their officers and rules of the institution cheerfully and promptly. Leave of absence will be granted to males on Monday; to females on Wednesday.

Dr. L. F. Wentworth, the superintendent, although still a young man, has had considerable and varied institutional experience. Before coming to Long Island he had been assistant physician at the Brattleboro, Vermont, insane asylum, assistant superintendent of the state insane asylum, Topeka, Kansas, superintendent of the state insane asylum at Osawatomie, Kansas, and in the service of the Massachusetts state board of lunacy and charity. He entered upon the duties of his present position in April, 1897.

Besides the almshouse on Long Island there is a much smaller almshouse in Charlestown. This was opened in 1849 as the Charlestown almshouse, but on the annexation of that city to Boston in 1873 it was continued as a Boston poor-house more especially for pauper couples.

The building is of brick, 100 feet long, two stories high, with two wings. To either end a large, attractive sun room has been added within a few years. One half of this building is used for men, and one half for women, the two parts being cut off more or less completely one from the other. In either division, besides two or three dormitories, the largest of which has but 30 beds, there are more or less completely one from the five beds each. The number of these rooms on the women's side is greater than that on the men's. Each part has its own dining room but shares in a common kitchen and laundry. Husbands, however, eat with their wives in the women's dining room. There is an infirmary but no hospital, those needing constant professional care being removed to the hospital at Long Island.

The largest number of inmates here last year was 150, the smallest, 138. There were admitted, males, 73, females, 37; and discharged, males, 70, females, 45. Eleven deaths occurred.

One of the changes proposed by the Board of Trustees is that this almshouse be made an almshouse for women and aged couples, exclusively. The number of women there is now double the number of men; and by making it an almshouse for women and couples only, a more thorough classification, so the trustees believe, could be secured.

Except in respect to buildings and numbers the Charlestown almshouse differs little from that at Long Island. It has, however, a homelike character which the larger institution lacks. The sun rooms, one containing piano and plants, and the sleeping rooms with their four or five beds are almost cosy. The bill of fare here society is much more varied than that of the other almshouse.

Mr. Chandler Eastman has been superintendent since 1889. Previous to his appointment to his present position he had been connected with the institutions at Deer Island and Rainsford Island. He is a veteran of the civil war.

The appointed work of Boston's pauper institutions has been up to the present time and now is merely to care for the paupers committed to their charge. With reference to this task these institutions should be judged first of all. If they are so judged, much may be said in commendation of them. The inmates are comfortably housed, clothed and fed. While the physically fit are required to work, no one is overworked, and the conditions of labor are salutary. The discipline is humane. Special provision is made for the comfort of the aged and infirm, and the treatment of the sick is by the most improved methods. Life in the almshouses may be monotonous, but on the physical side it rises to a far greater plane than the majority of the inmates ever knew before coming to them. But in these institutions there are two distinct classes, which maybe designated as the worthy and the unworthy, the word "worthy" being used with no reference to moral qualities. The former class comprises the aged, sick, the physically and mentally defective -- in a word, such as could not care for themselves whatever might be their opportunities for self support. The latter class includes all the rest. That it is the duty of to relieve and comfort its also worthy poor, in the sense of worthy as here used, goes without saying; but it can be neither the wisdom nor duty of society to care in the same manner for the tramp, the vagrant, and all the other varieties of the professionally idle and vicious. Indeed its own self-protection demands that in the case of this latter class it pursue some other line of treatment, whose aim shall be either to reform them or at the very least to restrain them from preying upon the public. In Boston's almshouses, however, both classes are under one and the same system, a system that contemplates the worthy poor only, leaving all others out of account. As a result, these latter find here comfortable quarters where they may recover from their last debauch and plan fresh essays on society. If, therefore, these institutions be judged from the point of view of what would seem to be the true function of a pauper institution, they would be found wanting in respect to separating the pauper class proper from the work-house class and treating each by itself. But it should be said in justice to the superintendents and trustees that this radical defect is to be attributed rather to the laws and regulations in accordance with which they must act, than to themselves. As long as both the pauper and the tramp are sent to these institutions, they must both be cared for by them; and while the restraint on leaving is so slight and the industrial equipment of the institution so meagre, thorough classification and reformatory methods are out of the question. The two classes should be separated and the former committed to an established workhouse. Superintendent Wentworth well says in his recent report: There is no good reason, except in very isolated cases, why a man under 50 years of age and in good health should go to an almshouse, and there is something radically wrong in a system which permits the professional impostor to thrive at the expense of the worthy poor. That Boston is not indifferent to its pauper institutions is made evident by the changes for the better effected in them within the last few years, such as: Paid attendants for the sick and a visiting staff of physicians; preparation of the food by an experienced cook; removal of insane patients to the proper asylums; discontinuance of labor by prisoners from Deer Island; a suitable semblance for the transportation of the sick; more comfortable chairs for the aged; and benches out of doors. Still further changes along similar lines are recommended by the Board of Trustees in their annual report. The more important of these recommendations are: Additional kitchen and laundry accommodations; ventilation of the men's building; employment of more paid officers; extension of the nurses training school; new male ward in the hospital; and isolating ward for contagious diseases.

The problem of the dependent poor, of which the functions and conduct of almshouses is but a part, gains in importance and in dignity the longer it is studied. Of the finer aspects of this general problem, as well as of the qualities required in those who would aid in its solution, Rev. Frederick H. Wines beautifully says: "Charity has been often characterized as a religious duty, and its administration as a branch of applied science. But it is also an art, one of the fine arts, comparable with music, painting and sculpture. There are in it unsuspected possibilities of beauty and grace, depending upon the symmetry of its proportions and the combination of its elements. As we feel the beauty of rhythm in poetry when wedded to noble or tender conceptions, or of melody and harmony in music, or of unity, simplicity and variety in a picture or a statue, so charity to excite our admiration should exhibit unity in diversity in its design, be true to nature and to life and be instinct with a love pure as the snows, deathless as the skies, and consecrated to humanity and to God. Ruskin's seven lamps of architecture are also the lights by which its radiant pathway can alone be traced; the lamps of sacrifice, of truth, of power, of beauty, of life, of memory, and of obedience."

Section: 

1898: Man's Span of Life

Summary: An article from North American Review recounting numerous instances of centenarians in the 19th century, illustrating that those who lived to old age could live very long indeed!

Man's Span of Life

The North American Review.
Volume 166, Issue 497, April 1898.

By Langdon Kain, MD.

It is a curious fact that authorities do not agree, within a hundred years, as to the utmost limit of human life, though the question is important enough to be positively determined. A comparatively recent writer, the late Sir George Lewis, did not hesitate to affirm that it is not possible for any person to reach the age of 110; that no one, or hardly any one, ever lives to be 100. Mr. Thom and the late Professor Owen agreed that no one has ever been proved to be more than 103 years and a few months old. Haller, Bailey, Flourens, and other early writers, give accounts of persons of the reputed age of 185 years, and in one instance of 200 years.

Popular opinion, and even expert or medical opinion, is not disposed to accept the limit of Professor Owen. Every little while some eminent medical man takes people to task for dying short of a century of life. A short time before his death the late Sir Benjamin Richardson asserted that seven out of every ten sound and reasonable people ought to live to be 110 years old, and would do so if they took care of themselves. The late Mr. Proctor, the popular writer on astronomy, reports a New York physician as saying that in all his experience he had known but one man to die a natural death, his idea of that being the memorable collapse of the wonderful "One Ross Shay. "

The simple and obvious explanation of the wide differences of opinion as to how long it is possible for any human being to withstand the destructive influence of time is that observers and writers are of different degrees of credulity. It is hard to say why no serious investigation of living instances is made, instead of basing opinion on doubtful cases so long past as to make inquiry futile. Louis Camaro, St. Mongah, and the others whose cases are so invariably cited by writers on this subject, have been cruelly overworked, notwithstanding the power of endurance of the typical centenarian. There is no reason to think the percentage of old people is lower to-day than in the time of Haller, or that people do not live as long. On the contrary, Macaulay found that the annual death-rate of London in the latter half of the seventeenth century was one twenty-third of the entire population; while at the time he wrote it had been reduced to one-fortieth, clearly by the increased material prosperity and the more human ways of life. That it has been further reduced since then, largely by the development of sanitary science, is a matter of positive knowledge. Since the effect of advanced civilization was to lower the death-rate, it must also have increased the percentage of persons of great age. It may be affirmed, once for all, that the power to resist disease which lowers the death-rate is also the power that prolongs life.

Another common source of error is the census return. There are persons who look upon everything official as necessarily accurate, and though they might be skeptical as to the personal statement of a reputed centenarian, if his age is reported in the census they accept it as virtually proved. They do not consider that, after all, it is the mere ipse dixit of the person himself, which the census-taker makes no attempt to verify. It is for this reason that Professor Owen and other careful investigators reject the census reports. The census invariably shows that wherever the intelligence and prosperity of the people are highest, the centenarians are fewest. In a Russian census a significant fact was discovered by Flourens. While the returns included 1,063 centenarians in the Empire, there was not a single one in St. Petersburg and Moscow, the new and the old capitals, the most civilized parts of Russia and the most accessible to serious investigation. The inference was that the intelligent and prosperous people have more accurate sources of information and are more trustworthy in their statements of age than the ignorant.

A striking instance of the misleading effect of the census is recent. A German statistician concludes that civilization, or rather education, is fatal to long life. His basis is the fact already mentioned, that in countries where education is general the centenarians are fewer than in countries where ignorance and poverty are the rule. England, with its 28,000,000 people, has only 146 centenarians, while Ireland, with only 5,000,000 people, has 578. Germany, with 50,000,000 people, has only 78 centenarians, while Norway, with but 2,000,000 people, has 230, and the Balkan Peninsula, with a population of 10,000,000, has 5,542. Switzerland has not a single centenarian in her 2,000,000 population. Spain, with 18,000,000 people, has 410 centenarians. Of the alleged centenarians of Bulgaria and Servia, 290 are from 106 to 115 years old, 123 are from 115 to 125, eighteen are from 125 to 135, and there are three between the ages of 135 and 140. A summary shows that England, Germany, Switzerland, and Sweden, where education is general among the people, having an aggregate population of 84,000,000, have only 234 centenarians. Ireland, Norway, Spain, and the Balkan States, where the reverse is the case, having an aggregate population of only 35,000,000, have 6,760 centenarians.

The German statistician takes occasion to state, as a result of his inquiries, that the oldest man is not, as has been said, a Russian of 130 years, not a retired Russian cabman, Kustrim by name, of 140 years, but one Bruno Cotrim, a negro born in Africa, and now living at Rio de Janeiro, of 150 years. Though he poses as a man bristling up with small facts, prurient with dates, a braggadocio of exactness, it is significant that he is not surprised that the last figure in the age of each of these candidates should be a cipher, which is against the laws of chance; and that the age of the second should be just ten years more than that of the youngest, and the age of the oldest just ten years more than that of the second, which is also in violation of the laws of chance. He sees nothing strange in the similarity of the names Kustrim and Cotrim, though here again the laws of chance are brutally outraged.

The inference which the German statistician draws from the census returns is contradicted by every list of persons compiled to show the effect of occupation on longevity. Men of thought are most often at the head for length of years. He forgets, too, that even in Germany, though reeking with culture, there are always many thousands who do not partake of the deadly fruit of the tree of knowledge, but are healthfully illiterate. Yet they rarely escape the common fate, dying before their hundredth year. Adam was warned against the fatal consequences of knowledge, but everything else points to the inference, not that education and comfort are favorable to early death, but to that already noted the lack of accurate information as to their own ages and sometimes the mendacity of the ignorant classes. There is the same sense of vanity in being phenomenally old as in being phenomenally anything else.

Whether the excesses of the rich and the well-to-do are so grave as to make their chances of long-living inferior to those of the illiterate, and especially of paupers, has been often and fully discussed. Most observers will agree with the conclusion of Sir George Lewis, and, later, of Mr. Tollemache, that centenarians will generally be proportionally more numerous in the higher social strata than in the lower; and that the apparent reversal of this by census returns and other centenarian records is due to the ignorance of the illiterate poor, especially paupers, to their love of the marvelous and to their self-interest.

Reputed centenarians in this country whose ages exceed a hundred by more than three or four years have no documentary or satisfactory evidence to offer. The oldest, of whose age there is little room for doubt, though the documentary proof is not complete, was Mrs. Emily Robins Talcott, of the age of 105 years and 4 months. She was born near Hartford, Conn., where she spent most of her life, and died of bronchitis April 20, 1896. Her memory, health, and eyesight were good, and she took care of her own room. She had shaken hands with Washington and Lafayette, and had seen Fulton's first steamboat ascend the Hudson. She said her great-grandmother was 107, and that her mother was within a few weeks of 100.

Hiram Lester, who was alleged to be the oldest man in the United States, was a pauper who died in a North Carolina almshouse in the summer of 1896 at the reputed age of 128 years. His only evidence was the statement of his father, who died in the same almshouse many years ago at the age of 115 years, it was said, Noah Raby, also a pauper, an inmate of the almshouse at Piscatawa, near New Brunswick, N. J., celebrated what he said was his 125th birthday on April 1, 1897. He was born in Gates County, North Carolina, his father being a full-blooded Indian named Andrew Bass. He says he was discharged from the man-of-war "Braudywine" eighty-four years ago, but has lost his discharge papers; that he heard Washington make an angry public address at Norfolk; that he began smoking when he was five years old, and has continued to smoke ever since, and has always been a drinker of liquors. It is on his unsupported statement that the people of the neighborhood regard him with local pride. Mrs. Margaret Bowen died near Chicopee Falls, near Springfield, Massachusetts, in May, 1896, at the reputed age of 121 years. She was born in County Clare, Ireland, and came to this country in 1865. Her husband, still alive, is now 78 years old. James Oney, who died in Knott County, Kentucky, in April, 1896, said he was 115 years old, though there are no records in the case. He was born at Mount Vernon, Virginia, near the home of the man who could not tell a lie, had twenty-three children, three of whom were born blind. Of his 178 descendants, thirteen were born blind. He died virtually a pauper, and was fond of whiskey toddy, getting jolly to the end. His oldest son, blind, is now living in Knott County at the age of 90, which age is also unsupported by evidence. The father had seen Washington often. Louis Darwin and his wife, French Canadians, living at Saint Paul, Canada, aged respectively 107 and 101 years, have been married 81 years, according to their own account. "Jack" Casar, a negro, who was a slave in New Jersey, the body servant of Mr. John Quackenbush, died at Ridgewood, in that State, December 19, 1896, at the reputed age of 106 years. Mrs. Yetta Gerber died in March, 1897, at 52 Suffolk street, New York City, at the age, it is said, of 106 years. She was born in Poland, and distinctly remembered she was 21 years old when Napoleon passed through the village in which she lived on his way to Russia, and again on his return. A few days before her death she entertained visitors by cracking a filbert with her teeth, of which she had never lost one. Joseph Field, there is good reason to believe, was 104 years and 6 months old when he died, April 1, 1897, near Red Bank, N. J., where he had always lived. He was a farmer with a fortune of half a million. He had remained a bachelor until he was 75 years old, when he married a young woman who bore him three daughters. He was able to walk about until a few months before his death. He had always used whiskey in moderation. Mrs. Goings, who professed to be 109 years old, died at Indianapolis in February, 1896. She said her father was 111 at the time of his death and her mother 106. William Taylor, of Augusta County, Va., died at the reputed age of 105 years and ~ months, at Baltimore, where he had gone in search of work as a painter. Mrs. Lorena Huntley, of Moira, Franklin County, N. Y., who was born at Peru, in the same State, died in December, 1896, at the age of 104 years. There is an early family Bible record of her birth.

Hester Jackson, colored, was an inmate of St. Michaels Hospital, Newark, April 16, 1897, which she said was her 104th birthday. She was born a slave at Rahway, N. J., and distinctly remembered that her master, Elston Marsh, was an officer in the war of 1812, and also that she had seen Washington. Jane Brown, also colored, was an inmate of the Home for Aged Colored People in Brooklyn in the summer of 1896, when she celebrated her 103d birthday. She was born a slave in New Jersey, spent much of her life in Philadelphia, and saw Washington. Mrs. Angelique Galipean, a neighbor of the centenarian Darwin's, is said to be 102. She sews without glasses, and walks a mile to church. Her father is said to have lived 110 years. John McKenzie died at Jersey City in December, 1896, at the age of 102. He was called the best-natured man in the world, and it was to his amiability that his long living was due in the opinion of his friends. Mrs. Martha Squires, of Nelsonville, a small settlement near Peekskill, New York, celebrated her 102d birthday October 11, 1896. She has lived there for seventy years, and her neighbors are confident she is as old as she claims to be. Her oldest child is now 85. Mrs. Clarissa Stebbins Lawrence, of Marlboro, near Keene, New Hampshire, was 100 on January 25, 1896. Mrs. Lydia Turner, of West Concord, New Hampshire, was 101 December 8, 1896. She is in good health, and has all her faculties. Mrs. Hannah Bartow was 101 May 1, 1896. She lives at New Brunswick, New Jersey, and is the great-grandmother of a child which weighed less than five pounds at nine months of age. This old lady does not wear glasses and keeps a small candy store. Mrs. Cox, of Holderness, New Hampshire, died of whooping cough in 1896 at the age of 101. Elisha Boulden Glenn, of Newark, N. J., was 100 years and 4 months old November 7, 1896. He walked to the polls the same week. Emanuel Schwab, of East Fifty-sixth street, New York, received each guest at the door on the occasion of the hundredth anniversary of his birth, December 14, 1896. He sang a song and read a poem which he had composed the same week. He walks two miles every morning and smokes a long German pipe. John Lockhart, aged 100, walked into Parkersburg, Pa., in October, 1896, from his home on Lee Creek, fifteen miles away. While in town he danced a jig.

It is interesting, and it may be profitable, to note some of the cases of extreme age to be found in the older records. Not all of the centenarians were paragons of all the virtues. Thomas Whittington, for example, who lived to be 104, was an habitual drunkard, drinking only London gin, of which he consumed from a pint to a pint and a half daily. Philip Laroque went to bed drunk at least two nights in the week until he was 100. At 92 he cut four new teeth. John de la Somet, 130 years old, was an inveterate smoker. Several famous old people were extremely addicted to matrimony. Owen Duffy, who lived to be 122, married his third wife at 116, by whom he had a son and a daughter. Francis Hongo, a Venetian, was five times married and was the father of forty-nine children. At the age of 100 his white hair fell out and a new crop of the original color came in. At the age of 112 he had two new teeth. Margaret Krasiowna, a Pole, married her third husband at ninety-four. She bore to him two sons and a daughter, as proved by the parish register. Margaret McDowal, 106 years old, married and survived thirteen husbands. Among the recorded centenarians are two dwarfs, Mary Jones, 100 years, who was 2 feet 8 inches in height and terribly deformed, and Elspeth Watson, 115 years old, who was 2 feet 9 inches in height. Among the most agile were Mrs. Barrett, who, at the age of 116, climbed a ladder to repair the roof of her cottage; and Elizabeth Alexander, who was particular about her dress at 108, and was used to a daily walk of two miles. Several had peculiar habits. Mrs. Lewson, 117 years old, never washed her face for fear of taking cold, but greased it with hogs lard. John Hussey, 116 years, drank only balm tea as a beverage. John Wilson, the same age, supped always off roasted turnips. Judith Banister, 100, lived entirely on biscuit, bread, and apples during the last sixty years of her life. Old Lord Scarsdale and Lord Combermere, both of whom lived to a ripe age, thought the wearing of a tight belt habitually about the waist had mach to do with their excellent health. Macklin, the centenarian actor, abandoned regular hours of eating in the last sixty-seven years of his life, taking food when he was hungry. Two interesting married couples are reported. Mr. and Mrs Cotterell, aged respectively 120 and 115 years, were married 98 years and never had a quarrel. They died within a few hours of each other. John Rovin, a Hungarian, and his wife, aged 172 and 164 years, lived together 148 years. At the time of the husband's death the youngest son was 116 years old.

The case of Louis Camaro, first reported by Flourens, is famous for its services to the cause of temperance. He published several books on the benefits of an abstemious life. Born with a sickly constitution and living a dissipated life until he was 40, when he was near dying, he became so moderate in his diet that at last the yolk of an egg sufficed for two meals. It is uncertain whether he lived to be only 99, or whether lie reached the age of 104, though he was reputed to be much older. Kentigern, or Saint Mongah or Mongo, is also an evidence of the value of temperance. According to Spottswood his age was 185. One Lawrence, 140 years old, was another temperate man. The Rev. Peter Alley is said by Bailey to have been 111 years old and to have conducted services regularly until a few weeks before his last illness. He was the father of thirty-three children. Other very old persons were Thomas Winslow, aged 146 years; James Bowels, aged 152 years; Margaret Foster, 136 years, and her daughter, 104 years; Zartan, a Hungarian and a proper neighbor of the Rovin's, above-mentioned, 189 years; and Joseph Budge, 107 years, who cut new teeth just before his death.

It may be well to explain here the phenomenon of new teeth so often mentioned in the case of centenarians. Professor Owen investigated several instances and found that the gums had receded, as they tend to do in old age, until the stumps of old teeth were exposed and were mistaken for new teeth.

The absence of trustworthy vital statistics is distressing to all who pursue the subject of longevity. The suggestion of Mr. Galton is worth attention, that each family keep a comprehensive record of important facts.

Section: 

1899: The Subtle Problems of Charity

Summary: An article from The Atlantic Monthly written by Jane Addams, founder of Hull House in Chicago that illustrates some ideas prevalent at the time about old age and poverty.

The Subtle Problems of Charity
Jane Addams
The Atlantic Monthly
Volume 83, Issue 496, February 1899
ext from: Library of Congress American Memory Collection
An article from The Atlantic Monthly written by Jane Addams, founder of Hull House in Chicago that illustrates some ideas prevalent at the time about old age and poverty.

Some excerpts:

The benevolent individual of fifty years ago honestly believed that industry and self-denial in youth would result in comfortable possessions for old age. It was, indeed, the method he had practiced in his own youth, and by which he had probably obtained whatever fortune he possessed.

A professional man is scarcely equipped and started in his profession before he is thirty; a business man, if he is on the road to success, is much nearer prosperity at thirty-five than at twenty-five, and it is therefore wise for these men not to marry in the twenties. But this does not apply to the workingman. In many trades he is laid upon the shelf at thirty-five, and in nearly all trades he receives the largest wages of his life between twenty and thirty.

He naturally regards his children as his savings-bank; he expects them to care for him when he gets old, and in some trades old age comes very early.

A Jewish tailor was quite lately sent to the Cook County poorhouse, paralyzed beyond recovery at the age of thirty-five. Had his little boy of nine been a few years older, the father might have been spared this sorrow of public charity. He was, in fact, better able to support a family when he was twenty than when he was thirty-five, for his wages had steadily become less as the years went on. Another tailor whom I know, a Socialist, always speaks of saving as a bourgeois virtue, one quite impossible to the genuine workingman. He supports a family, consisting of himself, a wife and three children, and his parents, on eight dollars a week. He insists that it would be criminal not to expend every penny of this amount upon food and shelter, and he expects his children later to take care of him.

Parents who work hard and anticipate an old age when they can no longer earn, take care that their children shall expect to divide their wages with them from the very first.

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Full text:

PROBABLY there is no relation in life which our democracy is changing more rapidly than the charitable relation, that relation which obtains between benefactor and beneficiary; at the same time, there is no point of contact in our modern experience which reveals more clearly the lack of that equality which democracy implies. We have reached the moment when democracy has made such inroads upon this relationship that the complacency of the old-fashioned charitable man is gone forever; while the very need and existence of charity deny us the consolation and freedom which democracy will at last give.

We find in ourselves the longing for a wider union than that of family or class, and we say that we have come to include all men in our hopes; but we fail to realize that all men are hoping, and are part of the same movement of which we are a part. Many of the difficulties in philanthropy come from an unconscious division of the world into the philanthropists and those to be helped. It is an assumption of two classes, and against this class assumption our democratic training revolts as soon as we begin to act upon it.

The trouble is that the ethics of none of us are clearly defined, and we are continually obliged to act in circles of habit based upon convictions which we no longer hold. Thus, our estimate of the effect of environment and social conditions has doubtless shifted faster than our methods of administering charity have changed. Formerly when it was believed that poverty was synonymous with vice and laziness, and that the prosperous man was the righteous man, charity was administered harshly with a good conscience; for the charitable agent really blamed the individual for his poverty, and the very fact of his own superior prosperity gave him a certain consciousness of superior morality. Since then we have learned to measure by other standards, and the money-earning capacity, while still rewarded out of all proportion to any other, is not respected as exclusively as it was ; and its possession is by no means assumed to imply the possession of the highest moral qualities. We have learned to judge men in general by their social virtues as well as by their business capacity, by their devotion to intellectual and disinterested aims, and by their public spirit, and we naturally resent being obliged to judge certain individuals solely upon the industrial side for no other reason than that they are poor. Our democratic instinct constantly takes alarm at this consciousness of two standards.

Of the various struggles which a decade of residence in a settlement implies, none have made a more definite impression on my mind than the incredibly painful difficulties which involve both giver and recipient when one person asks charitable aid of another.

An attempt is made in this paper to show what are some of the perplexities which harass the mind of the charity worker; to trace them to ethical survivals which are held not only by the benefactor, but by the recipients of charity as well; and to suggest wherein these very perplexities may possibly be prophetic.

It is easy to see that one of the root difficulties in the charitable relationship lies in the fact that the only families who apply for aid to the charitable agencies are those who have come to grief on the industrial side; it may be through sickness, through loss of work, or for other guiltless and inevitable reasons, but the fact remains that they are industrially ailing, and must be bolstered and helped into industrial health. The charity visitor, let us assume, is a young college woman, well-bred and open-minded. When she visits the family assigned to her, she is embarrassed to find herself obliged to lay all the stress of her teaching and advice upon the industrial virtues, and to treat the members of the family almost exclusively as factors in the industrial system. She insists that they must work and be self supporting; that the most dangerous of all situations is idleness; that seeking ones own pleasure, while ignoring claims and responsibilities, is the most ignoble of actions. The members of her assigned family may have charms and virtues, they may possibly be kind and affectionate and considerate of one another, generous to their friends; but it is her business to stick to the industrial side. As she daily holds up these standards, it often occurs to the mind of the sensitive visitor, whose conscience has been made tender by much talk of brotherhood and equality which she has heard at college, that she has no right to say these things ; that she herself has never been self-supporting; that, whatever her virtues may be, they are not the industrial virtues; that her untrained hands are no more fitted to cope with actual conditions than are those of her broken-down family.

The grandmother of the charity visitor could have done the industrial preaching very well, because she did have the industrial virtues ; if not skillful in weaving and spinning, she was yet mistress of other housewifely accomplishments. In a generation our experiences have changed our views with them; while we still keep on in the old methods, which could be applied when our consciences were in line with them, but which are daily becoming more difficult as we divide up into people who work with their hands and those who do not; and the charity visitor, belonging to the latter class, is perplexed by recognitions and suggestions which the situation forces upon her. Our democracy has taught us to apply our moral teaching all around, and the moralist is rapidly becoming so sensitive that when his life does not exemplify his ethical convictions, he finds it difficult to preach.

Added to this is a consciousness in the mind of the visitor of a genuine misunderstanding of her motives by the recipients of her charity and by their neighbors. Let us take a neighborhood of poor people, and test their ethical standards by those of the charity visitor, who comes with the best desire in the world to help them out of their distresses. A most striking incongruity, at once apparent, is the difference between the emotional kindness with which relief is given by one poor neighbor to another poor neighbor, and the guarded care with which relief is given by a charity visitor to a charity recipient. The neighborhood mind is immediately confronted not only by the difference of method, but also by an absolute clashing of two ethical standards.

A very little familiarity with the poor districts of any city is sufficient to show how primitive and frontier-like are the neighborly relations. There is the greatest willingness to lend or borrow anything, and each resident of a given tenement house knows the most intimate family affairs of all the others. The fact that the economic condition of all alike is on a most precarious level makes the ready outflow of sympathy and material assistance the most natural thing in the world. There are numberless instances of heroic self-sacrifice quite unknown in the circles where greater economic advantages make that kind of intimate knowledge of ones neighbors impossible. An Irish family, in which the man has lost his place, and the woman is struggling to eke out the scanty savings by day work, will take in a widow and her five children who have been turned into the street, without a moments reflection upon the physical discomforts involved. The most maligned landlady is usually ready to lend a scuttleful of coal to a suffering tenant, or to share her supper. A woman for whom the writer had long tried in vain to find work failed to appear at the appointed time when a situation was found at last. Upon investigation it transpired that a neighbor further down the street was taken ill; that the children ran for the family friend, who went, of course; saying simply, when reasons for her failure to come to work were demanded, It broke me heart to leave the place, but what could I do?

Another woman, whose husband was sent up to the city prison for the maximum term, just three months before the birth of her child, having gradually sold her supply of household furniture, found herself penniless. She sought refuge with a friend whom she supposed to be living in three rooms in another part of the town. When she arrived, however, she discovered that her friends husband had been out of work so long that they had been reduced to living in one room. The friend at once took her in, and the friends husband was obliged to sleep upon a bench in the park every night for a week; which he did uncomplainingly, if not cheerfully. Fortunately it was summer, and it only rained one night. The writer could not discover from the young mother that she had any special claim upon the friend beyond the fact that they had formerly worked together in the same factory. The husband she had never seen until the night of her arrival, when he at once went forth in search of a midwife who would consent to come upon his promise of future payment.

The evolutionists tell us that the instinct to pity, the impulse to aid his fellows, served man at a very early period as a rude rule of right and wrong. There is no doubt that this rude rule still holds among many people with whom charitable agencies are brought into contact, and that their ideas of right and wrong are quite honestly outraged by the methods of these agencies. When they see the delay and caution with which relief is given, these do not appear to them conscientious scruples, but the cold and calculating action of the selfish man. This is not the aid that they are accustomed to receive from their neighbors, and they do not understand why the impulse which drives people to be good to the poor should be so severely supervised. They feel, remotely, that the charity visitor is moved by motives that are alien and unreal; they may be superior motives, but they are agin nature. They cannot comprehend why a person whose intellectual. perceptions are stronger than his natural impulses should go into charity work at all. The only man they are accustomed to see whose intellectual perceptions are stronger than his tenderness of heart is the selfish and avaricious man, who is frankly on the make. If the charity visitor is such a person, why does she pretend to like the poor? Why does she not go into business at once? We may say, of course, that it is a primitive view of life which thus confuses intellectuality and business ability, but it is a view quite honestly held by many poor people who are obliged to receive charity from time to time. In moments of indignation they have been known to say, What do you want, anyway? If you have nothing to give us, why not let us alone, and stop your questionings and investigations? This indignation, which is for the most part taciturn, and a certain kindly contempt for her abilities often puzzle the charity visitor. The latter may be explained by the standard of worldly success which the visited families hold. In the minds of the poor success does not ordinarily go with charity and kind-heartedness, but rather with the opposite qualities. The rich landlord is he who collects with sternness; who accepts no excuse, and will have his own. There are moments of irritation and of real bitterness against him, but there is admiration, because he is rich and successful. The good-natured landlord, he who pities and spares his poverty-pressed tenants, is seldom rich. He often lives in the back of his house, which he has owned for a long time, perhaps has inherited; but lie has been able to accumulate little. He commands the genuine love and devotion of many a poor soul, but lie is treated with a certain lack of respect. In one sense he is a failure, so long have we all been accustomed to estimate success by material returns. The charity visitor, just because she is a person who concerns herself with the poor, receives a touch of this good-natured and kindly contempt, sometimes real affection, but little genuine respect. The poor are accustomed to help one another, and to respond according to their kindliness; but when it comes to worldly judgment, they are still in that stage where they use industrial success as the sole standard. In the case of the charity visitor, they are deprived of both standards; she has neither natural kindness nor dazzling riches; and they find it of course utterly impossible to judge of the motive of organized charity.

Doubtless we all find something distasteful in the juxtaposition of the two words organized and charity. The idea of organizing an emotion is in itself repelling, even to those of us who feel most sorely the need of more ardor in altruistic effort and see the end to be desired. We say in defense that we are striving to turn this emotion into a motive: that pity is capricious, and not to be depended on; that we mean to give it the dignity of conscious duty. But at bottom we distrust a little a scheme which substitutes a theory of social conduct for the natural promptings of the heart, and we ourselves feel the complexity of the situation. The poor man who has fallen into distress, when he first asks aid, instinctively expects tenderness. consideration, and forgiveness. If it is the first time, it has taken him long to make up his mind to the step. He comes somewhat bruised and battered, and instead of being met by warmth of heart and sympathy he is at once chilled by an investigation and an intimation that he ought to work. He does not see that he is being dealt with as a child of defective will is cared for by a stern parent. There have been no years of previous intercourse and established relation, as between parents and children. He feels only the postponement or refusal, which he considers harsh. He does not live to thank his parents for it, as the disciplined child is reported to do, but cherishes a hardness of heart to his grave. The only really popular charity is that of visiting nurses, who carry about with them a professional training, which may easily be interpreted into sympathy and kindness, in their ministration to obvious needs without investigation.

The state of mind which an investigation arouses on both sides is most unfortunate; but the perplexity and clashing of different standards, with the consequent misunderstandings, are not so bad as the moral deterioration which is almost sure to follow.

When the agent or visitor appears among the poor, and they discover that under certain conditions food and rent and medical aid are dispensed from some unknown source, every man, woman, and child is quick to learn what the conditions may be. and to follow them. Though in their eyes a glass of beer is quite right and proper when taken as any self-respecting man should take it; though they know that cleanliness is an expensive virtue which can be expected of few; though they realize that saving is well-nigh impossible when hut a few cents can be laid by at a time ; though their feeling for the church may be something quite elusive of deflumition and quite apart from daily living, to the visitor they gravely laud temperance and cleanliness and thrift and religious observance. The deception doubtless arises from a wondering inability to understand the ethical ideals which can require such impossible virtues, combined with a tradition that charity visitors do require them, and from an innocent desire to please. It is easy to trace the development of the mental suggestions thus received.

The most serious effect upon the individual comes when dependence upon the charitable society is substituted for the natural outgoing of human love and sympathy, which, happily, we all possess in some degree. The spontaneous impulse to sit up all night with a neighbors sick child is turned into righteous indignation against the district nurse because she goes home at six oclock. Or the kindness which would have prompted a quick purchase of much needed medicine is transformed into a voluble scoring of the dispensary, because it gives prescriptions, and not drugs; and who can get well on a piece of paper?

If a poor woman knows that her neighbor next door has no shoes, she is quite willing to lend her own, that her neighbor may go decently to mass or to work; for she knows the smallest item about the scanty wardrobe, and cheerfully helps out. When the charity visitor comes in, all the neighbors are baffled as to what her circumstances may be. They know she does not need a new pair of shoes, and rather suspect that she has a dozen pairs at home; which indeed she sometimes has. They imagine untold stores which they may call upon, and her most generous gift is considered niggardly, compared with what she might do. She ought to get new shoes for the family all round; she sees well enough that they need them. It is no more than the neighbor herself would do. The charity visitor has broken through the natural rule of giving, which, in a primitive society, is bounded only by the need of the recipient and the resources of the giver; and she gets herself into untold trouble when she is judged by the ethics of that primitive society.

The neighborhood understands the selfish rich people who stay in their own part of the town, where all their associates have shoes and other things. Such people do not bother themselves about the poor; they are like the rich landlords of the neighborhood experience. But this lady visitor, who pretenA to be good to the poor, and certainly does talk as though she were kind-hearted, what does she come for, if she does not intend to give them things which so plainly are needed? The visitor says, sometimes, that in holding her poor family so hard to a standard of thrift she is really breaking down a rule of higher living which they formerly possessed; that saving, which seems quite commendable in a comfortable part of the town, appears almost criminal in a poorer quarter, where the next-door neighbor needs food, even if the children of the family do not. She feels the sordidness of constantly being obliged to urge the industrial view of life. The benevolent individual of fifty years ago honestly believed that industry and self-denial in youth would result in comfortable possessions for old age. It was, indeed, the method he had practiced in his own youth, and by which he had probably obtained whatever fortune he possessed. He therefore reproved the poor family for indulging their children, urged them to work long hours, and was utterly untouched by many scruples which afflict the contemporary charity visitor. She says sometimes: Why must I talk always on getting work and saving money, the things I know nothing about? If it were anything else I had to urge, I could do it; anything like Latimi prose, which I had worried through myself, would not be so hard. But she finds it difficult to connect the experiences of her youth with the experiences of the visited family.

Because of this diversity in experience the visitor is continually surprised to find that the safest platitudes may be challenged. She refers quite naturally to the horrors of the saloon, and discovers that the head of her visited family, who knows the saloons very well, does not connect them with ~horrors at all. He remembers all the kindnesses he has received there, the free lunch and treating which go on, even when a man is out of work and not able to pay up; the poor fellows who are allowed to sit in their warmth when every other door is closed to them; the loan of five dollars he got there, when the charity visitor was miles away, and he was threatened with eviction. He may listen politely to her reference to horrors, but considers it only temperance talk.

The same thing happens when she urges upon him a spirit of independence, and is perhaps foolish enough to say that every American man can find work and is bound to support his family. She soon discovers that the workingman, in the city at least, is utterly dependent for the tenure of his position upon the good will of his foreman. upon the business prosperity of the firm, or the good health of the head of it and that, once work is lost, it may take months to secure another place. There is no use in talking independence to a man when he is going to stand in a row. hat in hand, before an office desk, in the hope of getting a position. The visitor is shocked when she finds herself recommending to the head of her visited family, whom she has sent to a business friend of hers to find work, not to be too outspoken when he goes to the place, and not to tell that lie has had no experience in that line unless he is asked. She has in fact come around to the view which has long been his.

The charity visitor may blame the women for lack of gentleness toward their children, for being hasty and rude to them, until she learns to reflect that the standard of breeding is not that of gentleness toward the children so much as the observance of certain conventions, such as the punctilious wearing of mourning garments after the death of a chil4. The standard of gentleness each mother has to work out largely by herself, assisted only by the occasional shamefaced remark of a neighbor, that they do better when you are not too hard on them; but the wearing of mourning garments is sustained by the definitely expressed sentiment of every woman in the street. The mother would have to bear social blame, a certain social ostracism, if she failed to comply with that requirement. It is not comfortable to outrage the conventions of those among whom we live, and if our social life be a narrow one, it is still more difficult. The visitor may choke a little when she sees the lessened supply of food and the scanty clothing provided for the remaining children, in order that one may be conventionally mourned. But she does not talk so strongly against it as she would have done (luring her first month of experience with the family since bereaved.

The subject of clothes, indeed, perplexes the visitor constantly, and the result of her reflections may be summed up something in this wise: The girl who has a definite social standing, who has been to a fashionable school or to a college, whose family live in a house seen and known by all her friends and associates, can afford to be very simple or even shabby as to her clothes, if she likes. But the working girl, whose family lives in a tenement or moves from one small apartment to another, who has little social standing, and has to make her own place, knows full well how much habit and style of dress have to do with her position. Her income goes into her clothing out of all proportion to that which she spends upon other things. But if social advancement is her aim, it is the most sensible thing which she can do. She is judged largely by her clothes. Her house-furnishing with its pitiful little decorations, her scanty supply of books, are never seen by the people whose social opinions she most values. Her clothes are her background, and from them she is largely judged. It is due to this fact that girls clubs succeed best in the business part of a town, where working girls and young ladies meet upon an equal footing, and where the clothes superficially look very much alike. Bright and ambitious girls will come to these down-town clubs to eat lunch and rest at noon, to study all sorts of subjects and listen to lectures, when they might hesitate a long time about joining a club identified with their own neighborhood, where they would be judged not solely on their personal merits and the unconscious social standing afforded to good clothes, but by other surroundings which are not nearly up to these. For the same reason, girls clubs are infinitely more difficult to organize in little towns and villages, where every one knows every one else, just how the front parlor is furnished, and the amount of mortgage there is upon the house. These facts get in the way of a clear and unbiased judgment; they impede the democratic relationship, and add to the selfconsciousness of all concerned. Every one who has had to do with down-town girls clubs has had the experience of going into the home of some bright, well-dressed girl, to discover it uncomfortable and perhaps wretched, and to find the girl afterwards carefully avoiding her, although she may not have been at home when the call was made, and the visitor may have carried herself with the utmost courtesy throughout. In some very successful down-town clubs the home address is not given at all, and only the business address is required. Have we worked out our democracy in regard to clothes farther than in regard to anything else?

The charity visitor has been rightly brought up to consider it vulgar to spend much money upon clothes, to care so much for appearances. She realizes dimly that the care for personal decoration over that for ones home or habitat is in some way primitive and undeveloped; but she is silenced by its obvious need. Shc also catches a hint of the fact that the disproportionate expenditure of the poor in the matter of clothes is largely due to the exclusiveness of the rich, who hide from them the interior of their houses and their more subtle pleasures, while of necessity exhibiting their street clothes and their street manners. Every one who goes shopping at the same time with the richest woman in town may see her clothes, but only those invited to her receptions see the Corot on her walls or the bindings in her library. The poor naturally try to bridge the difference by reproducing the street clothes which they have seen; they therefore imitate, sometimes in more showy and often in more trying colors, in cheap and flimsy material, in poor shoes and flippant hats, the extreme fashion of the well-to-do. They are striving to conform to a common standard which their democratic training presupposes belongs to us all. The charity visitor may regret that the Italian peasant woman has laid aside her picturesque kerchief, and substituted a cheap street hat. But it is easy to recognize the first attempt toward democratic expression.

The charity visitor is still more perplexed when she comes to consider such problems as those of early marriage and child labor; for she cannot deal with them according to economic theories, or according to the conventions which have regulated her own life. She finds both of these fairly upset by her intimate knowledge of the situation, and her sympathy for those into whose lives she has gained a curious insight. She discovers how incorrigibly bourgeois her standards have been, and it takes but a little time to reach the conclusion that she cannot insist so strenuously upon the conventions of her own class, which fail to fit the bigger, more emotional, and freer lives of working people. The charity visitor holds well grounded views upon the imprudence of early marriagcs; quite naturally, because she comes from a family and circle of professional and business people. A professional man is scarcely equipped and started in his profession before he is thirty; a business man, if he is on the road to success, is much nearer prosperity at thirty-five than at twenty-five, and it is therefore wise for these men not to marry in the twenties. But this does not apply to the workingman. In many trades he is laid upon the shelf at thirty-five, and in nearly all trades he receives the largest wages of his life between twenty and thirty. If the young workingman has all his wages too long to himself, be will probably establish habits of personal comfort which he cannot keep up when he has to divide with a family, habits which, perhaps, he can never overcome.

The sense of prudence, the necessity for saving, can never come to a primitive, emotional man with the force of a conviction, but the necessity of providing for his children is a powerful incentive. He naturally regards his children as his savings-bank; he expects them to care for him when he gets old, and in some trades old age comes very early. A Jewish tailor was quite lately sent to the Cook County poorhouse, paralyzed beyond recovery at the age of thirtyfive. Had his little boy of nine been a few years older, the father might have been spared this sorrow of public charity. He was, in fact, better able to support a family when he was twenty than when he was thirty-five, for his wages had steadily become less as the years went on. Another tailor whom I know, a Socialist, always speaks of saving as a bourgeois virtue, one quite impossible to the genuine workingman. He supports a family, consisting of himself, a wife and three children, and his parents, on eight dollars a week. He insists that it would be criminal not to expend every penny of this amount upon food and shelter, and he expects his children later to take care of him.

This economic pressure also accounts for the tendency to put children to work over-young, and thus cripple their chances for individual development and usefulness, and with the avaricious parent it often leads to exploitation. I have fed her for fourteen year; now she can help me pay my mortgage, is not an unusual reply, when a hard-working father is expostulated with because he would take his bright daughter out of school and put her into a factory. It has long been a common error for the charity visitor, who is strongly urging her family toward self-support, to suggest, or at least connive, that the children be put to work early, although she has not the excuse that the parents have. It is so easy, after one has been taking the industrial view for a long time, to forget the larger and more social claim; to urge that the boy go to work and support his parents, who are receiving charitable aid. The visitor does not realize what a cruel advantage the person who distributes charity has, when she gives advice. The manager in a huge mercantile establishment employing many children was able to show, during a child-labor investigation, that the only children under fourteen years of age in his employ were proteges , urged upon him by philanthropic ladies, who were not only acquaintances of his, but valued patrons of the establishment. It is not that the charity visitor of an earlier day was less wise than other people, but she fixed her mind so long upon the industrial lameness of her family that she was eager to seize any crutch, however weak, which might enable them to get on. She failed to see that the boy who attempts prematurely to support his widowed mother may lower wages, add an illiterate member to the community, and arrest the development of a capable workingman. Just as she has failed to see that the rules which obtain in regard to the age of marriage in her own family may not apply to the workingman, so also she fails to understand that the present conditions of employment surrounding a factory child are totally unlike those which obtained during the energetic youth of her father. Is it too much to hope that the insight which the contemporary visitor is gaining may save the administration of charity from certain reproaches which it has well deserved?

This never ending question of the means of subsistence not only oppresses the child who is prematurely put to work, but almost crushes a sensitive child through his affectionate sympathy. The writer knows a little Italian lad of six, to whom the problems of food, clothing, and shelter have become so immediate and pressing that, although an imaginative child, he is unable to see life from any other standpoint. In his mind the goblin or bugaboo of the more fortunate child has come to be the need of coal, which caused his father hysterical and demonstrative grief when it carried off his mothers inherited linen, the mosaic of St. Joseph, and, worst of all, his own rubber-boots. He once came to a party at Hull House, and was interested in nothing save a gas stove in the kitchen. lie became excited over the discovery that fire could be produced without fuel. I will tell my father of this stove. You buy no coal; you need only a match. Anybody will give you a match. He was taken to visit at a country house. and at once inquired how much rent was paid for it. On being told carelessly by his hostess that they paid no rent for that house, he came back quite wild with interest that the problem was solved. Me and my father will go to the country. You get a big house, all warm, without rent. Nothing else in the country interested him but the subject of rent, and he talked of that with an exclusiveness worthy of a single-taxer.

The struggle for existence, which is so much harsher among people near the edge of pauperism, sometimes leaves ugly marks on character, and the charity visitor finds the indirect results ninost mystifying. Parents who work hard and anticipate an old age when they can no longer earn, take care that their children shall expect to divide their wages with them from the very first. Such a parent, when successful, seizes the immature nervous system of the child and hypnotizes it, so to speak, into a habit of obedience, that the nerves and will may not depart from this control when the child is older. The charity visitor, whose family relation is lifted quite out of this, does not in the least understand the industrial foundation in this family despotism.

The head of a kindergarten training class once addressed a club of workingwomen, and spoke of the despotism which is often established over little children. She said that the so-called determination to break a child's will many times arose from a lust of dominion, and she urged the ideal relationship founded upon love and confidence. But many of the women were puzzled. One of them remarked to the writer, as she came out of the club-room, If you did not keep control over them from the time they were little, you would never get their wages when they were grown up. Another one said, Ah, of course, she [meaning the speaker does not have to depend upon her children's wages. She can afford to be lax with them, because, even if they don't give money to her, she can get along without it.

There are an impressive number of children who uncomplainingly hand over their weekly wages to their parents, sometimes receiving back ten cents or a quarter for spending-money, but quite as often nothing at all; and the writer knows one daughter of twenty-five who for six years has received two cents a week from the constantly falling wages which she earns in a large factory. Is it habit or virtue which holds her steady in this course If love and tenderness had been substituted for parental despotism, would the mother have had enough affection, enough power of expression, to hold her daughters sense of money obligation through all these years? This young woman, who spends her paltry two cents on chewing-gum, and goes plainly clad in clothes of her mothers choosing, while many of her friends spend their entire wages on clothes which factory girls love so well, must be held by some powerful force.

It is these subtle and elusive problems which, after all, the charity visitor finds most harassing. The head of a family she is visiting is a man who has become blacklisted in a strike. He is not a very good workman, and this, added to his reputation as an agitator, keeps him out of work for a long time. The fatal result of being long out of work follows. He becomes less and less eager for it. and gets a job less and less frequently. In order to keep up his self-respect, and still more to keep his wife's respect for him, he yields to the little self deception that this prolonged idleness is due to his having been blacklisted, and he gradually becomes a martyr. Deep down in his heart, perhaps But who knows what may be deep down in his heart? Whatever may be in his wife's, she does not show for an instant that she thinks he has grown lazy, and accustomed to see her earn, by sewing and cleaning, most of the scanty income for the family. The charity visitor does see this, and she also sees that the other men who were in the strike have gone back to work. She further knows, by inquiry and a little experience, that the man is not skillful. She cannot, however, call him lazy and good-for-nothing, and denounce him as worthless, because of certain intellectual conceptions at which she has arrived. She sees other workmen come to him for shrewd advice; she knows that he spends many more hours in the public library, reading good books, than the average workman has time to do. He has formed no bad habits, and has yielded only to those subtle temptations toward a life of leisure which come to the intellectual man. He lacks the qualifications which would induce his union to engage him as a secretary or an organizer, but he is a constant speaker at workingmens meetings, and takes a high moral attitude to the questions discussed there. He contributes a kind of intellectuality to his friends, and he has undoubted social value. The neighborhood women confide to the charity visitor their sympathy with his wife, because she has to work so hard, and because her husband does not provide. Their remarks are sharpened by a certain resentment toward the superiority of the husbands education and gentle manners.

The charity visitor is ashamed to take this narrow point of view, for she knows that it is not altogether fair. She is reminded of a college friend of hers, who told her that she was not going to allow her literary husband to write unworthy pot-boilers, for the sake of earning a living. I insist that we shall live within my own income; that he shall not publish until lie is ready, and can give his genuine message. The charity visitor recalls what she has heard of another acquaintance, who urged her husband to decline a lucrative position as a railroad attorney, because she wished him to be free to take municipal positions and handle public questions without the inevitable suspicion which attaches itself in a corrupt city to a corporation attorney. The action of these two women had seemed noble to her, but they merely lived on lesser incomes. In the case of the workingman's wife, she faced living on no income at all, or on the precarious income which she might be able to get together. She sees that this third woman has made the greatest sacrifice, and she is utterly unwilling to condemn her while praising the friends of her own social position. She realizes, of course, that the situation is changed, by the fact that the third family need charity, while the other two do not; but, after all, they have not asked for it, and their plight was only discovered through an accident to one of the children. The charity visitor has been taught that her mission is to preserve the finest traits to be found in her visited family, and she shrinks from the thought of convincing the wife that her husband is worthless, and she suspects that she might turn all this beautiful devotion into complaining drudgery. To he sure, she could give up visiting the family altogether, but she has become much interested in the progress of the crippled child, who eagerly anticipates her visits, and she also suspects that she will never know many finer women than the mother. She is unwilling, therefore, to give up the friendship, and goes on, bearing her perplexities as best she may.

The first impulse of our charity visitor is to be somewhat severe with her shiftless family for spending money on pleasures and indulging their children out of all proportion to their means. The poor family which receives beans and coal from the county, and pays for a bicycle on the installment plan, is not unknown to any of us. But as the growth of juvenile crime becomes gradually understood, and as the danger of giving no legitimate and organized pleasure to the child becomes clearer, we remember that, primitive man had games long before he cared for a house or for regular meals. There are certain boys in many city neighborhoods who form themselves into little gangs with leaders somewhat more intrepid than the rest. Their favorite performance is to break into an untenanted house, to knock off the faucets and cut the lead pipe, which they sell to the nearest junk dealer. With the money thus procured they buy beer, which they drink in little freebooters groups sitting in an alley. From beginning to end they have the excitement of knowing that they may be seen and caught by the coppers, and at times they are quite breathless with suspense. In motive and execution it is not the least unlike the practice of country boys who go forth in squads to set traps for rabbits or to round up a coon. It is characterized by a pure spirit of adventure, and the vicious training really begins when they are arrested, or when an older boy undertakes to guide them into further excitements. From the very beginning the most enticing and exciting experiences which they have seen have been connected with crime. The policeman embodies all the majesty of successful law and established government in his brass buttons and dazzlingly equipped patrol wagon. The boy who has been arrested comes back more or less a hero, with a tale to tell of the interior recesses of the mysterious police station. The earliest public excitement the child remembers is divided between the rattling fire-engines, the time there was a fire in the next block, and the patrol wagon the time the drunkest lady in our street was arrested. In the first year of their settlement the Hull House residents took fifty kindergarten children to Lincoln Park, only to be grieved by their apathetic interest in trees and flowers. On the return an omnibusfull of tired and sleepy children were galvanized into sudden life because a patrol wagon rattled by. Eager little heads popped out of the windows full of questioning. Was it a man or a woman ? How many policemen inside? and eager little tongues began to tell experiences of arrests which baby eyes had witnessed.

The excitement of a chase, the chances of competition, and the love of a fight are all centred in the outward display of crime. The parent who receives charitable aid, and yet provides pleasures for his child and is willing to indulge him in his play, is blindly doing one of the wisest things possible; and no one is more eager for playgrounds and vacation schools than the charity visitor whose experience has brought her to this point of view.

The charity visitor has her own ideas concerning the administration of justice. To her mind, the courts can do no wrong. To be sure she has never come in contact with them, and she is shocked as she gradually discovers that the courts are used for justice or revenge exactly according to the ethical development of the plaintiff. Almost the only court which the very poor use, certainly the only one to which they voluntarily appeal, is the police court; and they hasten to that often, not in order to secure justice, but for the much more primitive desire for revenge. The penalties for swearing out a warrant if the arrested person fails to be proved guilty are so inadequate that they are practically never enforced; hence there is no restraint to the impulse against fulfilling the threats of I'll have you arrested, and I'll take the law to you, which are such quick and common retorts in neighborhood quarrels.

An old lady takes care of her five grandchildren, three of them headstrong boys with whom she has no end of trouble. Her only sources of revenue are the precarious earnings of the two older boys and the rent of two thirds of a house, which she owns and partly occupies. She is an affectionate and devoted grandmother, but she balances her overindulgence by administering an occasional good scolding to her children and her tenants. One day she met one of her former tenants upon the street, a welldressed, prosperous young matron, who had left her house owing her ten dollars for rent. The good clothes of the delinquent tenant offered a sharp contrast to the shabby attire of the landlady. She asked for her back rent gently enough at first, but the conversation fast grew acrid and stormy. The tenant refused point blank to pay up, and that evening, at nine o'clock, after the defeated landlady had told the tale to her sympathizing family, and they were already in bed, an officer came with a warrant to arrest the head of the house for disorderly conduct and to carry her off to the nearest police station. Fortunately, the good Irish heart of the officer was touched by the piteous plight of the old lady of seventy-eight, and lie contented himself with her promise to appear before the police justice the next morning at ten o'clock. She came to Hull House early in the morning in a pathetic and bewildered state of mind, that she who had avoided a police court all her life, and had held it up as an awful warning to her grandsons, should now be brought there herself because she had tried to collect the rent justly due her. She went to the police court accompanied by two of her Hull House friends. During the earlier stages of the trial they kept in the background, and were chagrined to find that the old lady appeared very badly. The sight of her triumphant and prosperous tenant brought forth a volley of shrill invective. The tenant was filled with reasonable excuses and surrounded by several witnesses. Sue had meant to pay up as soon as her husband received his months wages, and had repeatedly told the old lady so. She was attacked on the street in the presence of strangers, and her character brought into question. The prosperous plaintiff made so good an impression that the judge was about to dismiss the case with a stern reprimand to the landlady for losing her temper and making a scene in the streets, without any further investigation as to her character or claims. One of her Hull House friends was prompted by her long acquaintance with the defendant to make an appeal so eloquent that the judge grew chivalric, and finally apologized to the old lady for the annoyance caused her; and the light minded although kindhearted tenant, touched in turn by his example, borrowed ten dollars on the spot from one of the swell witnesses whom she had brought, and paid her back rent. The desire to administer justice in the case apparently never occurred to anybody involved. It was a question of bad manners and shrewish retort, eloquent speaking and kind-hearted response, from beginning to end. The desire for revenge was mollified, if not gratified, by the arrest, and the complainant softened. It would be easy to instance dozens of similar cases.

The greatest difficulty is experienced when the two standards come sharply together, and when an attempt is made at understanding and explanation. The difficulty of defining ones own ethical standpoint is at times insurmountable. A woman who had bought and sold schoolbooks stolen from the school fund, books plainly marked with a red stamp, came to Hull House one morning in great distress because she had been arrested, and begged a resident to speak to the judge. She gave as a reason the fact that the House had known her for six years, and had once been very good to her when her little girl was buried. The resident more than suspected that her visitor knew the schoolbooks were stolen, when buying them, and any attempt to talk upon that subject was evidently considered very rude. The visitor wished to avoid a trial, and manifestly saw no reason why the House should not help her. The alderman was out of town, so she could not go to him. After a long conversation the visitor entirely failed to get another point of view, and went away grieved and disappointed at a refusal, thinking the resident simply disobliging, wondering, no doubt, why such a mean woman had once been good to her; leaving the resident, on the other hand, utterly baffled, and in the state of mind she should have been in had she brutally insisted that a little child should lift weights too heavy for its undeveloped muscles.

Such a situation brings out the impossibility of substituting a higher ethical standard for a lower one without the intermediate stages of growth; but it is not as painful as that illustrated by the following example, where the highest ethical standard yet attained by the charity recipients is broken down, and the substituted one is not in the least understood

A certain charity visitor is peculiarly appealed to by the weakness and pathos of forlorn old age. She is responsible for the well-being of perhaps a dozen old women, to whom she sustains a sincere and simple and almost filial relation. Some of them learn to take her benefactions quite as if they came from their own relatives, grumbling at all she does, and scolding her with a family freedom. One of these poor old women was injured in a fire years ago. She has but the fragment of a hand left, and is grievously crippled in her feet. Through years of pain she had become addicted to opium, and when she first came under the residents care was held from the poorhouse only by the awful thought that she would there perish without her drug. Five years of tender care have done wonders for her. She lives in two neat little rooms, where with a thumb and two fingers she makes innumerable quilts, which she sells and gives away with the greatest delight. Her opium is regulated to a set amount taken each day, and she has been drawn away from much drinking. She is a voracious reader, and has her head full of strange tales made up from books and her own imagination. At one time it seemed impossible to do anything for her in Chicago, and she was kept for two years in a suburb where the family of the charity visitor lived, and where she was nursed through several hazardous illnesses. She now lives a better life than she did, but she is still far from being a model old woman. Her neighbors are constantly shocked by the fact that she is supported and comforted by a charity lady, while at the same time she occasionally rushes the growler, scolding at the boys lest they jar her in her tottering walk. The care of her has broken through even that second standard, which the neighborhood had learned to recognize as the standard of charitable societies, that only the worthy poor are to be helped; that temperance and thrift are the virtues which receive the plums of benevolence. The old lady herself is conscious of this criticism. Indeed, irate neighbors tell her to her face that she does not in the least deserve what she gets. In order to disarm them, and at the same time to explain what would otherwise seem lovingkindness so colossal as to be abnormal, she tells them that during her sojourn in the suburb she discovered an awful family secret, a horrible scandal connected with the long-suffering charity visitor; that it is in order to prevent the divulgence of this that the ministrations are continued. Some of her perplexed neighbors accept this explanation as simple and offering a solution of a vexed problem. Doubtless many of them have a glimpse of the real state of affairs, of the love and patience which minister to need irrespective of worth. But the standard is too high for most of them, and it sometimes seems unfortunate to break down the second standard, which holds that people who rush the growler are not worthy of charity, and that there is a certain justice attained when they go to the poorhouse. It is doubtless dangerous to break down this sense of justice, unless the higher motive is made clear.

Just when our affection becomes large and real enough to care for the unworthy among the poor as we would care for the unworthy among our own kin, is a perplexing question. To say that it should never be so is a comment upon our democratic relations to them which few of us would be willing to make.

Of what use is all this striving and perplexity? Has the experience any value? It is obviously genuine, for it induces an occasional charity visitor to live in a tenement house as simply as the other tenants do. It drives others to give up visiting the poor altogether, because, they claim, the situation is untenable unless the individual becomes a member of a sisterhood which requires, as some of the Roman Catholic sisterhoods do, that the member first take the vows of obedience and poverty, so that she can have nothing to give save as it is first given to her, and she is not thus harassed by a constant attempt at adjustment. Both the tenement house resident and the sister assume to have put themselves upon the industrial level of their neighbors. But the young charity visitor who goes from a family living upon a most precarious industrial level to her own home in a prosperous part of the city, if she is sensitive at all, is never free from perplexities which our growing democracy forces upon her.

We sometimes say that our charity is too scientific, but we should doubtless be much more correct in our estimate if we said that it is not scientific enough. We dislike the entire arrangement of cards alphabetically classified according to streets and names of families, with the unrelated and meaningless details attached to them. Our feeling of revolt is, probably, not unlike that which afflicted time students of botany and geology in the early part of this century, when flowers were tabulated in alphabetical order, when geology was taught by colored charts and thin books. No doubt the students, wearied to death, many times said that it was all too scientific, and were much perplexed and worried when they found traces of structure and physiology which their so-called scientific principles were totally unable to account for. But all this happened before science had become evolutionary and scientific at all, before it had a principle of life from within. The very indications and discoveries which formerly perplexed, later illumined, and made the study absorbing and vital. The dry-as-dust student, who formerly excelled, is now replaced by the man who possesses insight as well as accuracy, who holds his mind open to receive every suggestion which growth implies. He can, however, no longer use as material the dried plants of the herbariums, but is forced to go to the spots in which plants are growing. Collecting data in sociology may mean sorrow and perplexity and a pull upon ones sympathies, just as truly as collecting data in regard to the flora of the equatorial regions means heat and scratches and the test of ones endurance. Human motives have been so long a matter of dogmatism that to act upon the assumption that they are the result of growth, and to study their status with an open mind and a scientific conscience, seems well-nigh impossible to us. A man who would hesitate to pronounce an opinion upon the stones lying by the wayside because he has a suspicion that they are geological specimens, and his veneration for science is such that he would not venture to state to which period they belonged, will, without a moments hesitation, dogmatize about the delicate problems of human conduct, and will assert that one man is a scoundrel and another an honorable gentleman, without in the least considering the ethical epochs to which the two belong. He disregards the temptations and environment to which they have been subjected, and requires the same human development of an Italian peasant and a New England scholar.

Is this again a mark of our democracy or of our lack of science? We are singularly slow to apply the evolutionary principle to human affairs in general, although it is fast being applied to the education of children. We are at last learning to follow the development of the child; to expect certain traits under certain conditions; to adapt methods and matter to his growing mind. No advanced educator can allow himself to be so absorbed in the question of what a child ought to be as to exclude the discovery of what he is. But, in our charitable efforts, we think much more of what a man ought to be than of what he is or of what he may become; and we ruthlessly force our conventions and standards upon him, with a sternness which we would consider stupid, indeed, did an educator use it in forcing his mature intellectual convictions upon an undeveloped mind.

Let us take the example of a timid child, who cries when he is put to bed, because he is afraid of the dark. The soft-hearted parent stays with him simply because he is sorry for him and wants to comfort him. The scientifically trained parent stays with him because he realizes that the child is passing through a phase of race development, in which his imagination has the best of him. It is impossible to reason him out of demonology, because his logical faculties are not developed. After all, these two parents, wide apart in point of view, act much the same, and very differently from the pseudo scientific parent, who acts from dogmatic conviction and is sure he is right. He talks of developing his child's self-respect and good sense, and leaves him to cry himself to sleep, demanding powers of self-control and development which the child does not possess. There is no doubt that our development of charity methods has reached this pseudo scientific and stilted stage. We have learned to condemn unthinking, ill regulated kind heartedness, and we take great pride in mere repression, much as the stern parent tells the visitor below how admirably he is rearing, the child who is hysterically crying upstairs, and laying the foundation for future nervous disorders. The pseudo-scientific spirit, or rather the undeveloped stage of our philanthropy, is, perhaps, most clearly revealed in this tendency to lay stress on negative action. Don't give, don't break down self respect, we are constantly told. We distrust the human impulse, and in its stead substitute dogmatic rules for conduct. In spite of the proof that the philanthropic Lord Simafteshury secured the passage of English factory laws, that the charitahle Octavia Hill has brought about the reform of the London tenement houses, and of much similar concurrent testimony, we do not yet really believe that pity and sympathy, even, in point of fact quite as often precede the effort toward social amelioration as does the acceptance of a social dogma; we forget that the accumulation of knowledge and the holding of convictions must finally result in the application of that knowledge and those convictions to life itself, and that the course which begins by activity, and an appeal to the sympathies so severe that all the knowledge in the possession of the visitor is continually applied, has reasonably a greater chance for an ultimate comprehension.

For most of the years during a decade of residence in a settlement, my mind was sore and depressed over the difficulties of the charitable relationship. The incessant clashing of ethical standards, which had been honestly gained from widely varying industrial experience, the misunderstandings inevitable between people whose conventions and mode of life had been so totally unlike, made it seem reasonable to say that nothing could be done until industrial conditions were made absolutely democratic. The position of a settlement, which attempts at one and the same time to declare its belief in this eventual, industrial democracy, and to labor toward that end, to maintain a standard of living, and to deal humanely and simply with those in actual want, often seems utterly untenable and preposterous. Recently, however, there has come to my mind the suggestion of a principle, that while the painful condition of administering charity is the inevitable discomfort of a transition into a more democratic relation, the perplexing experiences of the actual administration have a genuine value of their own. The economist who treats the individual cases as mere data, and the social reformer who labors to make such cases impossible, solely because of the appeal to his reason, may have to share these perplexities before they feel themselves within the grasp of a principle of growth, working outward from within; before they can gain the exhilaration and uplift which. come when the individual sympathy and intelligence are caught into the forward, intuitive movement of the mass. This general movement is not without its intellectual aspects, but it is seldom apprehended by the intellect alone. The social reformers who avoid the charitable relationship with any of their fellow men take a certain outside attitude toward this movement. They may analyze it and formulate it; they may be most valuable and necessary, but they are not essentially within it. The mass of men seldom move together without an emotional incentive, and the doctrinaire, in his effort to keep his mind free from the emotional quality, inevitably stands aside. He avoids the perplexity, and at the same time loses the vitality.

The Hebrew prophet made three requirements from those who would join the great forward-moving procession led by Jehovah. To love mercy, and at the same time to do justly, is the difficult task. To fulfill the first requirement alone is to fall into the error of indiscriminate giving, with all its disastrous results; to fulfill the second exclusively is to obtain the stern policy of withholding, and it results in such a dreary lack of sympathy and understanding that the establishment of justice is impossible. It may be that the combination of the two can never be attained save as we fulfill still the third requirement, to walk humbly with God, which may mean to walk for many dreary miles beside the lowliest of his creatures, not even in peace of mind, that the companionship of the humble is popularly supposed to give, but rather with the pangs and misgivings to which the poor human understanding is subjected whenever it attempts to comprehend the meaning of life.

Jane Addams.

Section: 

1900-1930: Number of People Age 65 Plus Living in Institutions

Summary: The table shows the number of people age 65+ who may have been living in institutions from 1900 to 1930, and their percentage of the total age 65+ population at the time.

The Institutionalized Age 65+ Population, 1900-1930

Somewhere between 2% and 4% of the population age 65 and older may have been living in some sort of institutional setting prior to the Great Depression. Not all of these people needed "long term care". In some cases, they just had no other place to go.Only estimates are available because there were no reliable national statistics available.

Bruce Vladeck estimated that by 1930 there were as many elderly people in facilities for the mentally ill as there were in poorhouses and voluntary and charitable facilities combined. If his estimates are accurate, about half of the total elderly population living in an institution in the early 1900's may have had some sort of mental disease or condition, about the same ratio as we see in nursing homes and assisted living facilities today.

The Institutionalized Age 65+ Population, 1900-1930

The Age 65+ Population 1900 1910 1930
Age 65+ as % of total population 4.1% 4.3% 5.4%
Total population (millions) 76 92 123
Population age 65+ (millions) 3 4 7
Age 65+ living in: 1904 1910 1930
Institutionalized residents as % of 65+ population 2% 2% 3%
Facilities for the mentally ill 20,000 35,000 100,000
Poorhouses & almshouses 53,000 46,000 50,000
Voluntary and proprietary facilities ?? ?? 50,000
Source: Vladeck, 1980; Johnson, 1985

A staff report prepared for the committee that studied old age security in 1935 relied on a few reports done in individual states. One of the more comprehensive surveys was done in New York just prior to the 1929 stock market crash. It determined that 50% or more of the age 65+ population was dependent on relatives or friends (either living with them or getting financial assistance from them to live somewhere else), 2.5% were living in poorhouses or mental hospitals, and 1-2% were living in private homes for the aged. If those percentages were representative of the national experience, that would mean that about 175,000 people age 65 or older were living in poorhouses or mental hospitals and 70,000 were living in nonprofit or proprietary homes. Note that a significant number were self-sufficient because they were still working.

Old Age Dependency in the State of New York
July 1, 1929

Self-Sufficient Persons 65 and over Persons 70 and over
Total Self-Sufficient 44% 36%
  Still working 29% 17%
  Pensions 10% 14%
  Living on personal savings 5% 5%
Dependent Persons 65 and over Persons 70 and over
Total Dependent 56% 64%
  Dependent on relatives or friends 49% 56%
  In community with public or private charity 3% 4%
  In poorhouses or other government institutions 3% 2%
  In nonprofit or proprietary homes 1% 2%
Source: Old Age Security Report

This data comes from several sources. No accurate information really exists on the number of elderly people living in institutions for these early dates. The data on the age 65+ population in mental facilities and poorhouses in 1904 and 1910 comes from Colleen L. Johnson and Leslie A. Grant. Estimates of the institutionalized population for 1930 come from Bruce C. Vladeck. Census data is from the U.S. Bureau of the Census. Current Population Reports, Special Studies, P23-190, 65+ in the United States. (U.S. Government Printing Office, Washington, DC, 1996).

The New York survey was taken from Old Age Security Staff Report, Barbara Nachtried Armstrong and Staff, 1934, from unpublished studies by the staff of the Committee on Economic Security (CES), Volume II.

Section: 

1900-2000: Changes in Life Expectancy in the United States

Summary: Tables showing the changes in expected remaining years of life at birth, age 65, and age 85 for black and white men and women from 1900 to the year 2000.

Life Expectancy

Year White Men Black Men
At Birth At Age 65 At Age 85 At Birth At Age 65 At Age 85
Additional Years 28 4 2 35 5 2
Percentage Change 60% 33% 50% 106% 50% 50%
1900 47 12 4 33 10 4
1910 49 - 4 34 - 5
1920 54 - 4 46 - 5
1930 60 - 4 47 - 4
1940 62 - 4 52 - 5
1950 67 13 4 59 13 5
1960 67 13 4 61 13 5
1970 68 13 5 60 13 6
1980 71 14 5 64 13 6
1990 73 15 5 65 13 5
2000 75 16 6 68 15 6
Year White Women Black Women
At Birth At Age 65 At Age 85 At Birth At Age 65 At Age 85
Additional Years 31 7 3 41 7 2
Percentage Change 63% 58% 75% 121% 63% 40%
1900 49 12 4 34 11 5
1910 52 - 4 38 - 5
1920 66 - 4 45 - 5
1930 64 - 4 49 - 6
1940 67 - 4 55 - 6
1950 72 15 5 63 15 6
1960 74 16 5 66 15 5
1970 76 17 6 68 16 7
1980 78 18 6 73 17 7
1990 80 19 7 74 17 6
2000 80 19 7 75 18 7

Data Sources: National Vital Statistics Reports, Vol. 50, No.6. Life Expectancy at Birth, by Race and Sex, Selected Years 1929-98.; National Vital Statistics Reports, Vol. 49, No.12.Deaths, Preliminary Data for 2000.;U.S. Census Bureau. P23-190 Current Population Reports: Special Studies. 65+ in the United States.

Section: 

1915-1934: State Old Age Assistance Programs

Summary: A summary of the requirements and restrictions of state old-age assistance programs, along with state-by-state data on coverage and expenditures for 1934.

Requirements and Restrictions of State Old Age Assistance Laws

By 1928, just prior to the start of the Great Depression, only 6 states and territories had old-age assistance laws. As the Depression deepened, that number increased, until there were 28 states and 2 territories (Alaska and Hawaii) with old-age assistance programs by 1934, most just enacted in the prior year or two. Unfortunately, the plans were quite limited, and inconsistent from state to state. As summarized in the final report of the Old Age Security Staff to Chairman Witte, the state plans included the following features and restrictions:

  • All but Arizona and Hawaii refused to make payments to older people who had children or relatives who could support them.
  • Most limited assistance to elderly people who were age 65 or older, but quite a few set the limit even higher, at age 75.
  • Most required that beneficiaries must have been citizens and residents of the state for 15 years, some had even longer residency requirements than that.
  • Many required that the beneficiary must transfer to the pension authority any property they possessed before any payment would be made.
  • Most had property and income caps to limit eligibility, generally a maximum of $3,000 in property and $300-$365 a year in income.
  • Most required that benefits would be denied to anyone who gave away property in order to qualify for public assistance.
  • Most required that a lien be placed on the estate of the beneficiary to be collected upon their death.
  • Most required that recipients be "deserving", and benefits were denied to anyone who deserted a spouse, failed to support their families, had committed any crime, or had been a tramp or beggar.
  • Benefits were denied to inmates of jails, prisons, infirmaries, and insane asylums, although a few permitted the payment of assistance for inmates of a benevolent fraternal institution.
  • Most set a cap on monthly payments at $30 a month, although they actually paid about half of that, or $15 a month on average.

The restrictions were so severe and the number of states that actually had launched their plans and committed funds to them were so limited that even in 1935, in the depths of the Depression, there were less than 200,000 people covered under state old-age assistance plans.

History of State Old Age Assistance Legislation

A summary taken from the staff report:

"The first state law was passed in Arizona in 1915 by an initiative act, which abolished almshouses and established old age and mothers' pensions in their stead. However, it was worded so loosely that it was declared unconstitutional on account of its vagueness. In the same year Alaska passes a law, providing assistance to its aged pioneers. This law, though it has been amended on different occasions, is still in effect at the present time.

"No action was taken by any state until 8 years later, in 1923. In that year three states, Montana, Pennsylvania, and Nevada, passed old age assistance laws, but only one of them, that of Montana, has remained in the statute books. In 1925 the Nevada state legislature passed a bill repealing the 1923 law, and putting another one in its place. The Pennsylvania law was declared unconstitutional in 1924 on the basis of the state constitution, which prohibited the legislature from making appropriations for charitable, benevolent and educational purposes. Pennsylvania proceeded immediately to take steps to amend its constitution, but it was not until 1931 that the amendment passed the legislature. Since this amendment had to be repassed in 1933 and then submitted to a referendum vote for approval, it was not until 1934 that Pennsylvania secured action. Thus the decision of the court deferred legislation for ten years in Pennsylvania.

"Ohio, too, took some first steps in the year 1923. The question of old age pensions was submitted to a referendum vote, but it was decided adversely by a vote of almost 2 to 1.

"By 1925 the movement had gained considerable impetus. Although only Wisconsin passed a law which has remained effective since that time; there was much activity in a number of the states. California passed a law, which, however, was vetoed by the Governor. Bills were introduced in the legislative sessions of Illinois, Indiana, Kansas, Maine, Michigan, Minnesota, New Jersey, Ohio, and Texas. In Indiana and Illinois the bills passed the lower house, but were not acted upon by the upper chamber. In four states, Colorado, Minnesota, Pennsylvania, and Utah, commissions were appointed.

"In 1926 one law was added, that of Kentucky. In the same year, the Washington Legislature approved a bill, which was vetoed by the Governor.

"In 1927 Maryland and Colorado passed bills.

"At the end of 1928, after six years of agitation, there were only six states and one territory which had made provision for their aged. They were Colorado, Kentucky, Maryland, Montana, Nevada, Wisconsin and Alaska. All the state laws were of the optional type, i.e., they left the adoption or rejection of an old age assistance system to the discretion of the counties. For this reason these laws had very limited effect only. In these six states, there were slightly above 1000 pensioners, and these were found almost exclusively in Montana and Wisconsin, the former having 884, the latter 295 old people on their pension rolls. The total amount spent by the six states in 1928 was, in round numbers, $200,000.(1)

"From 1929 on, the trend in the pension legislation has been toward making the adoption of the old age assistance systems mandatory upon the counties. This type of legislation proved much more effective, especially when it was accompanied by a provision by which the state shared in the expense of the county. Of this latter type was the California law which was passed in 1929. In the same year, Minnesota, Utah and Wyoming passed laws, which did not provide such state assistance, although those of Utah and Wyoming made the adoption of the system mandatory upon the counties.

"In 1930 the Massachusetts and New York laws were passed, which not only were of the mandatory type but also provided for the state sharing in the expense of the locality.

"In 1931 and 1933 the state legislatures were very active in the field of old age pensions. It is estimated that 100 bills were introduced in the legislatures of 38 states in 1931. In that year five new laws were enacted in Delaware, Idaho, New Hampshire, New Jersey, and West Virginia. Of these all except the West Virginia law were of the mandatory type, but only Delaware and New Jersey provided for state funds. Colorado and Wisconsin amended their laws making them mandatory upon the counties as well as making state funds available for the purpose of old age assistance.

"Ten more laws were added in 1933, in Arizona, Indiana, Maine, Michigan, Nebraska, North Dakota, Ohio, Oregon, Washington, and Hawaii. With the exception of Hawaii, they were all mandatory upon the counties, and in Oregon and Washington the state does not share in the expenses of the locality. Arkansas passed a law in 1933, but it was declared unconstitutional by the state supreme court.

"Iowa and Pennsylvania passed mandatory laws in 1934, the state sharing the entire cost.

"By the end of 1934, twenty-eight states and two territories had passes old age assistance laws."

State Old Age Assistance Laws, 1934

Year Enacted Type # Enrolled   # Eligible % Enrolled Ave. Monthly Pension   Annual Cost to State  
Total     180,003   2,330,390 7.7 $15   $31,192,492  
Alaska 1913 M 446 (c) 3,437 11.1 $20.82   $95,705  
Arizona 1933 M 1,974 (a) 9,118 21.6 $9.01   $200,927
California 1929 M 19,300 (a) 210,379 9.2 $21.16   $3,502,000  
Colorado 1927 M 8,705   61,787 14.1 $8.59   $172,481  
Delaware 1931 M 1,610 (a) 16,678 9.7 $9.79   $188,740  
Hawaii 1931 O No information available
Idaho 1931 M 1,275 22,310 5.7 $8.85   $114,521  
Indiana 1933 M 23,418 (b) 138,426 16.9 $6.13 (b) $1,254,169 (h)
Iowa 1934 M 3,000 (c) 184,239 1.6 $13.50 (c) $475,500 (d)
Kentucky 1926 O No pensions being paid
Maine 1933 M Not yet in effect
Maryland 1927 O 141 (e) 92,972 0.2 $29.90   $50,217  
Massachusetts 1930 M 20,023 (e) 156,590 12.8 $24.35   $5,411,723  
Michigan 1933 M 2,660 (e) 148,853 1.8 $9.59 (e) $306,096 (f)
Minnesota 1929 O 2,655   94,401 2.8 $13.20   $420,536  
Montana 1923 O 1,781   14,377 12.4 $7.28   $155,525  
Nebraska 1933 M Not much being done due to lack of funds
Nevada 1925 O 23   4,814 0.5 $15.00   $3,320  
New Hampshire 1931 M 1,423 (c) 25,714 5.5 $19.06 (g) $298,722 (f)
New Jersey 1931 M 10,560 (g) 112,594 9.4 $12.72   $1,375,693  
New York 1930 M 51,228   373,878 13.7 $22.16   $13,592,080  
North Dakota 1933 M No pensions being paid
Ohio 1931 M 24,000 (e) 414,836 5.8 $13.99 (a) $3,000,000 (f)
Oregon 1931 M Administered by counties; no info available for state
Pennsylvania 1934 M Law just being put into effect
Utah 1929 M 930   22,665 4.1 $8.56   $95,599  
Washington 1931 M 2,239 (b) 101,503 2.2 No information available
West Virginia 1931 O No pensions being paid
Wisconsin 1925 O 1,969   112,112 1.8 $16.75   $395,707  
Wyoming 1929 M 643   8,707 7.4 $10.79   $83,231  

M - Mandatory
O- Optional

1 - Where no special reference is given, the figures are as of December 31, 1933
2 - 1930 Census figures
3 - Where no special reference is given, the figures represent actual cost for the year 1933
(a) As of October 1, 1934
(b) As of August 1934
(c) As of December 1934
(d) Estimated from expenditures of April through November 1934 - $317,000
(e) As of November 1934
(f) Estimated from monthly figures
(g) As of September 1934
(h) Appropriation for 1934

All of the above information was taken from Old Age Security Staff Report, Barbara Nachtried Armstrong and Staff, 1934, from unpublished studies by the staff of the Committee on Economic Security (CES), Volume II.

Section: 

1930: The Great Depression

Summary: Reminiscences of the Great Depression by a factory worker

Henry Boucher, French Canadian mill worker, Woonsocket, MA

Narratives from: American Life Histories: Manuscripts from the Federal Writers' Project, 1936-1940.

Reminiscence of the Great Depression

"After the honeymoon we returned to our jobs, I to the mill and Alice to her job in the Rubber shop where she made $24 a week. After we had settled down I became ambitious for the first time in my life. We talked it over and figured out a budget by which we could save $20 every week. We planned to save this amount every week for the next twenty years, by which time we would be worth $20,000. Then we intended to buy a farm and spend the rest of our life in peace and quiet, never again to worry about a job, slack times, or the necessity to answer the mill bell. It was a beautiful dream and we tried to make it a reality. On the second anniversary of our marriage we had $2,500 in the bank, $500 more than we had planned on. We were living in a comfortable and modern home in a residential district. The furniture was paid for and we did not owe a cent to anyone. We were also the proud possessors of a Ford car that was nearly paid for.

"That night we were very happy and proud of what we had accomplished in the two years since our marriage. Our friends gathered at our home and we held a party. It was a gay party. Some of the time was spent in singing old songs and telling stories, then all gathered around and started telling of the hardships that each of us went through in our childhood -- how we had to wear our older brother's cast-off clothing that was go faded and patched that you could not tell what the original color was; how each of us longed for Sunday, as that was the only day on which we had meat for dinner. The life that we had lived as children was, in 1924, laughable, for all of us knew that conditions could never be like that again. How could we foresee the future? Everyone at the party was well clothed, well nourished, happy, willing to work for what they desired and were working at good pay. Each one was planning to possess more of the necessities and the luxuries of life. One wanted an electric refrigerator, another a new car, some were saving so that they might purchase a home or a business.

"During our third year of married life in 1925, a son was born to us. He was named Henry in honor of my father-in-law. A few months previous to the birth of our son, my wife gave up her job in the factory, but as I had had a promotion to 'warp-starter' and was making $50 a week we were able to continue saving $20 every week. The next year we became the parents of a daughter, whom we named Marie. From this time on I was unable to save $20 a week but put in the bank some money every payday. After the birth of our second son, Homer, in 1927, my wife became ill and needed medical attention. Because of this I was unable to save any money, for the Doctor's bills used up whatever surplus money we had.

"In 1928 work in the mills began to slacken and I was laid off. After being out of work for two months I secured employment in the Saranac mill as a weaver. At this job I received $40 a week, but I believed that in a short time I would again find employment as warp-starter. The next year conditions were worse and I was without work for three months. My wife and I were not worried about the future, as we believed that the mills would be slack for only a short period, as they were in 1921. So we lived on what I made and did not touch the $3,500 that we had in the bank. I was without work for six months in 1930 and we were forced to use some of the money that we had saved. But I was in a better position than most of my friends who were buying houses and were unable to meet their payments. My brother Peter was caught in this condition and as the bank was going to foreclose on his house I loaned him $500. I knew that he, a cutter in the Rubber Shop, making $70 a week, would be able to repay me as soon as his work picked up. Then without warning the Rubber Shop closed down and moved out of the city, throwing 1,500 people out of work. The next year, 1931, the bottom dropped out of everything and we were forced to use up most of our savings. In only one way, was I fortunate, and that was that I had no more Doctor's bills to pay, as my wife was well again. The bank foreclosed on my brother's house and my $500 was gone. My father died in July and after the funeral my mother came to live with me. She did not live long after my father but died in October, 1931. As neither my father nor mother believed in life insurance, all of their children contributed to the cost of the funerals. I was unable to find work and spent the entire year hanging around the streets. By the end of 1931 my bank balance was less than $500 and going down rapidly.

"In September, 1932 I reached the end of my resources. I was desperate, with a wife and three children to support I was unable to find work of any kind. All of my friends were in the same predicament. Finally I had to go on relief, and what a relief that was! I shall always remember my experience while trying to get relief from the city. I went down to City Hall and registered at the Poor Department. After looking me up they gave me a pass to obtain food. But in order to receive the food I had to stand in line on Main Street with every passerby staring at me.

"One day I stood in a line that blocked one side of Main Street for four hours before I received a small bag of flour and two pounds of dried peas. Of course my family was unable to live on what I received from the Poor Department so I was continually moving to cheaper tenements until at last I was living in a basement on Social Street. The same type of tenement that I was born in. The home that I had taken such pride in was broken up and the fine furniture that my wife and I had worked for we had to sell to second-hand furniture dealers. It is not correct to say that I sold the furniture because the money that I received for it was so little that it was almost equivalent to giving it away. But my children had to have food and clothing. The rent had to be paid and coal to be bought.

"There was a soup kitchen on Social Street and my son would go down there with a pail and bring home some soup. This helped out the small amount of food that I received from the Poor Department and kept my family from actual starvation. My family was very poor when I was a child and when work in the mills was slack we would not have much to eat but in Woonsocket never before was it necessary for anyone to have to go to a public Soup kitchen in order not to starve.

"In 1934 I obtained employment as a weaver in the Montrose mill. I worked steady the whole year except for a few weeks when the mill was closed by a strike. But working conditions had changed. They were as different as day and night from the working conditions of the 1920 to 1930 period. The pay had been greatly reduced and the amount of work per man had been increased. I had been making $40 a week as a weaver operating two looms. Now I am operating six looms on the same material and only making $24 a week. I am lucky that I am working on fine worsted cloth because in some mills on coarser cloth, the weavers now operate from eight to twenty-four looms for $24 a week. Apparently the only thing that a textile worker can rely upon in these times is that the mill owner will never suffer lower profits as long as he can transfer the burden upon his employees.

"In 1935 I was again laid off and the money that I had made in 1934 was soon used up, then back to the relief I went. Since that time I have worked about six months in each year, and being unable to support my family when I an not working, I usually spend the rest of the year on the relief. The last place that I worked was in the Montrose as a weaver, in the Spring of 1938. I worked here for four months but I knew that it would not last forever.

"One morning I left my house and as I entered the weave shop I could sense the tension that seemed to be in the air. The looms clattered, the men moved about. The belts and pulleys whirred. A typical weave room interior. But on this Friday morning there was something lacking. No one was talking, there was no laughter. Joseph Boyce, who worked next to me, did not raise his head from his work to call a greeting, nor did he ask me how I intended to spend the weekend, as he was wont to do. Everyone was silently working, busy with their thoughts. For about a week past there had been rumors that the work in the mill was getting slack. Only three days ago six spinners were laid off and the rumor was that eight weavers would lose their jobs this afternoon. I was, in length of service, one of the youngest weavers in the mill and I believed that I would be one of the first to be laid off. But there was nothing sure about it. Sometimes an old hand, whom the boss disliked was laid off and a newcomer kept. This uncertainty kept every weaver under a strain until they knew just who was to get the bounce. So they continued to work hard and silently until lunch time, for this was one day that no one wanted to make a mistake and have the foreman's attention called to him. While eating lunch the weavers could talk of nothing but who was to be laid off. While the newcomers believed that they would be the first to go, many of the old-timers remembered how they had spoiled yards of cloth and how displeased the boss had been with them. They wondered if he would remember the many times that he had bawled them out and take revenge by letting them go. So in this frame of mind the weavers started the afternoon shift.

"This afternoon the foreman of the weave room did not walk around the room as he was accustomed to do, and it was nearly the close of the afternoon before he stepped from his office. Instantly, the eyes of all the weavers were upon him, watching where he was going, and each man hoping that the foreman would not come to him with the sad news. I saw the foreman turn to a weaver and start talking to him. They talked for a few minutes while everyone in the room watched. The foreman then turned away and approached another weaver. The first weaver spread his arms out wide in a gesture and everyone then knew that the foreman was laying off help. All eyes then turned to the foreman, watching to see who was being laid off. I watched the slow progress of the foreman as he went from man to man, telling them the bad news. He was now at the next loom and I prayed that I might be spared. But it was not to be, for the foreman slowly walked over to me and said, 'You know what I have to say. I have a list of men who are to be laid off and your name is on it. They are laying off in every room of the mill and if more work don't come in the rest of the weavers will be out next week. This is no reflection upon your work, which has been good; and I'll be glad to hire you back just as soon as the work picks up.' I replied, 'Well, I guess all the fellows here are in the same boat that I'm in. All of us are broke. This will mean plenty of hardship for my family. After eating good for the past five months, the first few meals of that relief canned Corn beef is going to be hell for the kids. But thanks for your offer to rehire me when the work picks up. I'll certainly be glad to get back to work.' The foreman then returned to his office and the weavers gathered into a group asking each other what the boss said to them. The men who were laid off now that the tension had been broken, began to joke and one said, 'Will Johnny Ryan, the Director of Public Aid be glad to see me? Like hell he will. The last time I was on relief I had to haunt him in order to get any commodities. Every time he turned around I would be at his elbow asking for something.' Another said, 'This loafing is all right in some ways but I'll always blame the last lay off for the twins my wife had.' I said, 'I wonder how long I'll have to wait for my unemployment compensation checks. The last time I had to wait ten weeks before I got the first one and then the amount was wrong.' And so for a few minutes they joked and talked of the future. They then returned to work.

"My mind was not on my looms. I was thinking of the greatly lowered standard of living that my family would have to endure while I was out of work. I thought of my new radio that I was paying one dollar a week on. That would soon be taken back by the dealer. And then there was the dreadful ordeal of informing my wife and children that I had been laid off. I knew that there would be no handiness or laughter in my home this night. How could I support my family on the six or seven dollars a week that I would receive from a relief? How long would I be without work this time? I stood there thinking these gloomy thoughts, not caring how my looms ran. What did I care now if a 'smash' or dropped thread was made in the cloth? Let some one else worry about that. At bell time I made a bundle of my overalls and silently slipped out of the mill. I started walking home wishing that the road was twice as long so that I would not have to face my family so soon.

"When I reached home my wife saw by the sorrowful look upon my face that something had gone wrong and she asked, 'What is the matter Henry?' I replied, 'The same old thing. I'm laid off and don't know when I'll go back.' Across my wife's face an expression of fear flashed but she quickly rallied and said. "Well, you can't help that, so stop looking as though you were at your own wake. We have been on relief before and we're still alive so sit down and eat your supper. You'll feel better then." I sat down at the table but could eat very little. All this time the children, seated around the table, had been listening to the conversation and looking at me with wide staring eyes. Only too well did they know what this meant, less food, no new clothes, no money to go to the movies, peeking through the window curtains when someone knocked upon the door, to see if it was a bill collector, moving to a less desirable tenement in short, misery for everyone in the family. After supper I was unable to stand the silence and gloom that seemed to settle over the house so I put on my coat and said, 'Alice, I'm going down to the corner for a minute.' My wife, knowing full well where I was going said, 'Make sure you come home sober.' So, leaving the house I hurriedly walked to 'Fats' saloon. In there, men would be talking upon every subject. There would also be jokes and laughter and for a few hours I could forget that my next pay would be the last one that I would receive for a long time.

"The next day I applied for my unemployment compensation and because of waiting for these cheeks I was unable to go on the relief for two months. By this time I was completely broke, so for the next few months we struggled along on the six dollars a week that I received from the relief. But week by week we were going deeper in debt for rent, electricity, and many other small bills. One morning a Deputy Sheriff handed me an eviction notice and departed. And there I sat, in the kitchen, alone, forlorn and in despair. It was the morning of November 25, just one month before Christmas, and in my hand I held the notice from the court to evacuate the tenement that I occupied. This was not the first eviction notice that I had ever received. During the past ten years, the deputy Sheriffs had worn a path to my door delivering eviction notices, writs of attachment and liens on my pay. How could I break the news to my wife, when she returned from a visit to a neighbor's house? Where could we go? When you are on relief and only receive six dollars a week it is impossible to support a family and pay rent. The landlords did not care to rent a tenement to families on relief as they could not be sure of their rent. So most of them were demanding their rent in advance. If I could find a tenement, where could I borrow the three dollars for the first week's rent? What a Christmas was in store for my children! As I sat there alone with my thoughts the door opened and my wife walked in. Without talking I handed her the eviction notice. She knew what it was. She had seen many of them since 1930. Silently she laid it down and started to prepare dinner, each of us wondering where we could find a tenement.

"A knock on the door. We looked at each other. What more trouble was coming to us? Good news had been absent from our lives for more than ten years. My wife slowly and listlessly walked to the door and opened it.

There stood Adrian Bonin, with a broad smile upon his face and he said, 'O boy, Henry, I have thees fine news for you. De boss wants for you to come to work tomorrow morning. Thees mill she's get the big order. We'll work all winter.'

"The next morning I was at the mill gates an hour before bell time. There I found all of my fellow workers and I joined in their conversation. Each asked the other what they had been doing during the lay off and what were they going to do with their first pay? There were predictions, laughingly made that 'Fat's' saloon would do a rushing business on pay night. But under all this gay jesting everyone of us knew that when the order was finished in a few months, we would again be laid off, to a tramp the streets while we collected our unemployment compensation checks and then back on relief we would have to go until the mill started running full time again. We had gone through this routine many times in the past ten years and each one of us knew that he would go through it many times in the future.

Section: 

1934: National Advisory Council Conference

Summary: Committee meeting transcript showing the discussion about the role of the family in providing care, and the ways that old age assistance might be provided.

Advisory
Council Conference

November 13, 1934

Mr. I.M. Rubinow, Secretary, B'nai B'rith, of Cincinnati is our first speaker.

MR. RUBINOW: I didn't want to go contrary to the wishes of the audience. After all, I have written my paper, handed it to the stenographer, even given a copy to the newspaper boys. So the paper has done its duty and I may go ahead and discuss the problems at issue.

I want first to make this general statement. We mustn't visualize one specific method of meeting the problem of old age pensions. In Cincinnati in a public address, I recently mentioned that the people of the State of Ohio have shown their interest and humane attitude to the old people by passing overwhelmingly the so-called Old Age Pension Law last year, upon which one of my audience made the remark that the people's altruism was over-estimated, that it was not so much the old people they had been thinking if, but of themselves getting old. From that point of view, old age pensions will, I am afraid, be a dismal failure and disappointment. There is no one way of visualizing our own friends or parents at old age.

There are at least ten different ways of adjustments now being made. We don't even know the distribution of half of the people of the United States over 65. The increased number of people which Mr. Hopkins says do not have to work either when they are old or young, who are not particularly worried as they have made safe and secure investments, and perhaps know the secret of security. That is, of course, a very desirable adjustment.

I am sorry to have to disagree somewhat with moving the age of idleness back to 60. I am at present a member of the Wage Adjustment Board, working on cases of the Street Railway of Cincinnati, and I have learned that they have people over 60, 65, and even 70, who are still running cars. While that might be a most desirable adjustment, I don't know how far to increase such an adjustment. Because of the increased mechanism of industry, it is quite a big question. Industry will have to become less intensive before we can find employment for people over 65. Then there is another problem. Certainly we have not yet been able to decrease the large number of people over 65 who are found to be incurable, who are in insane asylums and institutions of that character. We would like to depopulate them of old people, but we don't know how. There is also the undesirable form of adjustment of enforced residence in a poorhouse, almshouse, or even call it county farm, that we may be able to correct.

There are at least three more popular methods of providing for the aged. One is having the old folks stay with their children, another, the so-called old age pension, gratuitous plan, whether from state treasury or any other source, and the third, service pensions.

Now, the leading thought in my mind is that obviously the form of service pension, from which there are now a few hundred thousand people getting advantage, is in my opinion, and I believe it is the opinion of most social workers, the most desirable solution of the old age problem.

Since the present conference is engaged with the question of what to do with the old folks and what to do with ourselves when we get old, the controversy is between two alternatives, the service pension on the one hand and the old age pension on the other hand.

I think that as far as the psychological and economic phases are concerned the advantages are on the side of the service pension. The difficulty of the service pension at the present is the requirement for long continued service for the same employer. Compulsory contributing old age insurance is no more than the extension of the principle of service pension from the individual employer to cover the entire industrial history of the individual. That is all it means. In this way if you have compulsory contributing old age pensions with the vast majority being given the advantage of this method, it is much more desirable socially, economically, and spiritually than the method of old-age pension so-called. That is why I prefer the compulsory contributing system to the old age pension system, even though I am at present chairman of the Board of Old Age Pensions in my own city, and trying to do the best I know how with that particular law. We have no system of compulsory pensions even now.

Unfortunately we have not the choice between the two methods. It is extremely difficult to introduce and apply at once a system of contributing old-age insurance. You can't insure a house that is on fire, and you can't insure if there is any meaning in the word "insurance," an old man over 65 against economic conditions as the result of his old age, but you can insure the young generations. So obviously state old age pensions must be supplied to those who are in need of assistance, those immediately in need. For all others, the method of compulsory contributing old age insurance is much more preferable than any other system.

This conflict between the two methods is not new. The difficulties confronting America to-day are the same difficulties which confronted Europe. There were exactly the same discussions; exactly the same procedure had to be followed in both England and in France in inaugurating old age pension systems. Things that were done in the earlier stages were afterwards considered unnecessary.

If you accept the duality of the problem--the old already old and for the young who will come old soon--then the technical question is to find the best solution of both aspects of the problem.

We have old age pension laws in 29 states already. Let us hope in the near future the rest of the states will enact old age pension laws and thus make this system nationwide.

May I take another two or three minutes to point out one very important consideration in the immediate sizing up of the problem confronting us? That is that at best the so-called old age pension gratuitous grants are after all a modified, camouflaged form of relief, which do not meet the conditions, and might as well be nothing, because they are based upon evidence of need. The one thing 75 investigators in our little town have to struggle with is determining, not whether the people are deserving, but whether they are in need. Of course, when you get into a situation of this kind there is bound to be the temptation to misrepresent or exaggerate. I certainly do not blame the old people. If I were dependent and had to make a sad story of my own life, I probably could succeed in making up a good one. The "means test" is a consideration of old age legislation.

While I am rather hesitant in criticizing this legislation, particularly in the presence of the author of the first bill, it must be recognized that American legislation added another undesirable requirement. I am trying to do my best on every occasion to point that out, as it apparently has not penetrated the public conscience. Not only do we apply the "means test" to the old people, but we apply it to their descendants. No old age pension law outside of the United States asks for that. That emphasizes the charity, philanthropy, and relief aspects of our legislation. We have to go into the economic conditions, not only of the old folks themselves, but of every one of their children, and grandchildren. It seems even the ancestors are involved.

In addition to the service pension at one end and the free gratuitous pension on the other, there is also a third accepted method of adjustment. That is, for the old people to be a burden upon their children. With the present condition of the county at large, the present leveling of wages, the present difficulty of keeping up the American standards (the American standard about which we talk so much, and which is more of an aspiration than recognized economic fact) I maintain the imposition of the burden of support of the old, if placed upon the children to the extent of depriving the children or the grandchildren of their purchasing capacity is not a desirable adjustment. Whether or not the old folks should live with their children we will not go into.

I believe the federal government has a very strong duty to perform in this respect, not only because it may stimulate adoption of new old age laws in the 17 or 18 states that haven't these laws yet, but because by subsidy there can be an increased rate of pensions, which at present varies in the different states by ten or twenty dollars a month. It has been maintained that $17 is sufficient for the maintenance of old folks on a level of decency and comfort.

Only by national control over state systems achieved through the promise of a federal subsidy can we have at least a decent system of free public old age pensions to work with, until we get service pensions.

(Following is the speech prepared by Mr. I. M. Rubinow.)

Within the inevitable time limitations I can only lay down to-day in a somewhat dogmatic way, a few fundamental principles underlying the problem we are to discuss. Perhaps the first principle is recognition of the fact that the problem has many ramifications, that the aged do not represent one uniform group, and that no plan for the aged can be satisfactory unless it recognizes at least the most important variables.

There is, to begin with, the question of age which may begin at 60 and extend to 80 or 90 or more; second, the factor of health; third, the general economic status; fourth, the occupational status: fifth, the marital and family status. It is further important to recognize the fact that none of these five conditions always remain static, that every one of them is subject to change--age, health, the existence of responsible relatives, and even occupational and general economic status.

Because of the influence of these numerous factors in various combinations we find in a cross section of to-day at least ten groups making various methods of adjustment to secure the necessities of life, as follows:

the old persons remaining at their jobs, or occupations until 70 or perhaps even until 80
the fortunate minority which may rest on its economic laurels, drawing upon inherited wealth or upon saving of a successful economic life,
those who have earned and receive a satisfactory pension from their former private or public employer,
the large, though gradually decreasing number of recipients of war pensions, whose number may perhaps increase if the pension principle is applied to the veterans of the World War,
the very large, perhaps the largest, number of those who are supported by their children or other relatives,
a rather limited number of persons receiving regular relief from private philanthropic agencies,
guests or inmates of private homes for the aged, having a very great variety of standards of comfort,
the aged population of our poorhouses or almshouses or county farms,
the aged in homes for incurable or insane asylums,
and the latest development, the recipients of the so-called state old age pensions.
Unfortunately, there are no figures to indicate the distribution of the 6,500,000 persons over 65 years of age among those ten classes, to say nothing of the possibility of a residuum which continues to shift for itself in various distressing ways.

At least approximate estimates can be made of recipients of public and war pensions, inmates of public almshouses and private old folks homes and hospitals for incurable and mental disease, and even recipients of old age pensions in a number of states. The total number of these classes, however, amounts to considerably less than 1,000,000. Only rough guesses can be made of those still employed, living on savings, or living in children's homes. And the population of cheap lodging houses and the residuum which may be in the gutter is an absolutely unknown quantity. The few local investigations which have been made are not sufficiently trustworthy. No study which dates back to the pre-depression era can serve as a guide because of the tremendous changes which have taken place in the value of savings, the employment of the aged, and the ability of the majority of workingmen's families to support their parents. Perhaps a thorough investigation of the distribution of our aged population among these classes should be the first task in a scientific study of the problem if it were not for the fact that such investigation, besides being costly, might take a good deal of time and delay necessary action.

At any rate the important problem that faces us is not so much the exact distribution among these ten groups which may fluctuate from year to year, particularly under stress of exceptional economic conditions, but some agreement as to the comparative fitness and desirability of these various methods of facing old age. In regard to some of them a general agreement can perhaps be easily reached, but unfortunately, these are the methods which perhaps we can influence but slightly. We should like to see fewer people ending their lives in insane asylums or hospitals for incurables, but this represents a medical problem of which we cannot dispose to-day. Perhaps at the other extreme we would admit the desirability of the aged retaining their health, working capacity, and working opportunity until the end of their days, but again that opens a complex problem of industrial organization that cannot be easily answered. For instance, can private competitive industry be so adjusted as to provide an increasing opportunity for workers who have passed the crest of productivity and endurance? We might all envy the fortunate minority that can live on income from accumulated capital, but how to increase the number of those who can accumulate enough for such a happy old age is a problem perhaps even more complex than all the problems presented by social insurance. One couldn't very well look towards an extension of war pensions as a method of solving the problem of old age without placing one's hope in a continuous series of destructive wars.

Old folks homes present a traditional and popular escape for some, but are altogether unacceptable for sound psychological reasons to many. Institutional care will always be needed for some proportion of the aged. This may be easily admitted in the case of those who are incapacitated either physically or mentally, but may be optional with healthy old men and women, depending upon their comparative sense of gregariousness. On the other hand the public poorhouse will be condemned by most and, in fact, has been one of the most potent factors in popularizing better methods of provision.

Thus by a process of exclusion there remain certain methods of care for aged persons, incapacitated primarily by lack of economic opportunity. These are service pensions, dependence upon relatives, and so-called public old age pensions. Compulsory social old age insurance is obviously but a modification of service pensions extended from one specific employer to the entire industrial history of the individual.

The history of the movement towards systematic public provision for old age in Europe and the rest of the world during the last 40 years has been, to a very large extent, a more or less friendly conflict between the two methods, compulsory insurance and so called state old age pensions. The discussions around this problem in this country during the last 25 years have, after all, been merely a reflection of similar discussions and arguments in all the other countries. Perhaps the most interesting aspect of this discussion throughout these 40 years has been the tacit but altogether erroneous assumption that both methods are equally applicable to all the elements of population, and that therefore the problems necessarily reduces itself to the choice between the two. The slightest consideration of the problem must show that this is not so, and particularly is not so at any one moment when a system, whichever it be, must be adopted.

It is but a trite observation that social measures are not adopted for eternity. They must present an effort to meet, first, the immediate problem which confronts society, and in addition, plan as far as possible for the immediate future. The immediate problem is to determine the distribution of the aged among the ten classes indicated above, some highly desirable and some highly undesirable. The task is to influence this distribution so that there would be a larger proportion of the aged finding satisfactory adjustment and a reduction in the number of those whose adjustment is obviously unsatisfactory. No counsel of perfection need be aimed at in the beginning. Few counsels of perfection are easily achieved.

The obvious problems that present themselves as soon as the whole question is considered are what to do with the unknown distressing residuum, the people on the bottom, the people who manage to get along, we don't know how. And only slightly above them is the population of our poorhouses and county homes. They present the picturesque though gruesome aspect of the problem of old age. For them private social agencies have advocated private assistance or even public outdoor relief, and more recently old age pensions. The efforts of disguising the poor relief aspect of so-called old age pensions are praiseworthy indeed. They indicate the humanness either of the social worker or reformer or legislator. Yet an analysis of the situation should not find any difficulty in recognizing that disguise. Can one question what the result of an inquiry would be among millions of workers, young or old, and particularly young, if they asked to state what method of provision for themselves they would prefer, an ample and earned service pension or dependence upon a skimpy and gratuitous grant out of public funds? But in the presence of millions who have not earned their pensions and are in need of help, a discussion of this character might appear to be purely academic. The standards of so-called pensions in the United States have already shaped themselves even though the movement is only a few years old. An average grant of between $15.00 and $20.00 a month, a searching inquiry into economic status, the hated so-called "means test" of England aggravated in the United States by an equally searching means test of relatives (which I shall touch upon presently), and numerous qualifying conditions, moral, political, or others, taken together, so forcefully emphasize the relief character of pensions that a mere use of the word pension--and even that is not universal--is not sufficient to disguise it. At the other extreme are pensions earned, partly paid for, free of the means test, coming not as a gratuity but as a matter of right, and not subject to the vagaries of state appropriations.

In a sliding scale of social conditions the choice is never between the uppermost and the lower rung. No human being, except it be in sentimental movies, has his choice between clipping coupons and sleeping in a bowery lodging house. The choice usually lies between adjacent areas. I would want to provide to all those who are not economically independent and who cannot continue at their normal occupation, a decent and reasonable service pension, but it cannot be done--certainly not in a day or a year. There is no social justice in limiting the opportunity for such pension to the lucky few who have worked all their lives for one large and prosperous and generous corporation. Again, any action on behalf of the aged is induced by the problem of the aged to-day. A public grant with or without disguise is obviously the only practical way of meeting that problem. It is a rational way on the part of working society, you and I who are still earning a living, to meet the problem of old age of the other fellow, of the old men and women who are down and out. But how many are there, not only among us but among the millions of wage workers, salaried employees, or even farmers, who would be willing to consider this method a satisfactory answer to the problem of the future, the problem of their own old age? If then, we only are concerned about the problem of distress of the aged of to-day, an old age pension system, perhaps more generous than those already adopted, may be considered sufficient. But if we are to legislate for tomorrow as well, the advantage of a service pension system must be recognized.

As to what should be the best method of procedure is another problem, perhaps merely a technical problem which must receive separate consideration. Whether to establish a comprehensive system of compulsory insurance in which the entire financial responsibility for the years gone by, spent in service by each individual prior to his insurance, will be carried by the public treasury, whether to adopt and continue straight old age pensions, side by side with the compulsory insurance scheme, and allow the insurance scheme gradually to replace the free pension system, is a question of method. Whether both steps should or can be taken at once will depend very much upon the social and political situation of the moment. England and France adopted old age pension systems years before the compulsory scheme was provided. In this country we already have some 30 state old age pension systems not all of equal effectiveness. It is not unreasonable to expect that with some effort the system might become universal except for the inevitable tardiness of the south in social legislation. The skimpiness of even the best of their systems and the tendency to reduce the standards because of pressure of fiscal difficulties points to the desirability of a national subsidy and control. At best the method cannot be expected to come up to the dignity and thoroughness of service pensions through old age insurance.

Perhaps I have said enough about the fundamental distinction between old age pensions and compulsory insurance, but if I may take the liberty of a few more minutes I should like to point out one very significant factor which differentiates the old age pensions in the United States from the systems prevailing in other countries, and that is the introduction of the "means test" not only for the aged themselves but for their so-called responsible relatives. To come back to our original analysis of the ten methods of present provision for old age, American pension legislation evidently assumes without argument that the fifth method, support by children, is at least as desirable as, or perhaps preferable to, public support through old age pensions. It makes the violent assumption that wherever such support is found it represents a socially satisfactory answer to the problem of old age. It says little concerning the social cost that the imposition of this burden of support of the aged upon their children represents; it gives no consideration to the lowering of the standard of living of millions of families and their children. It assumes that the average wages today are sufficient not only for the maintenance of the worker and his wife and children, but even of ancestors. Perhaps it is only through the humaneness in the application of this principle that the cruelty of this system is somewhat mitigated. But it is that very humaneness that emphasizes the charity aspect of American so-called pension legislation. In our haste to get something done we have allowed this point of view to penetrate practically all of our state pension legislation that has been written on our statute books during the last ten years. The implications are too obvious to require any extensive comment, even if there were time. Only national control over state systems achieved through the promise of a federal subsidy or threat of its elimination can correct this tragic situation.

CHAIRMAN DEWSON: At any rate, my three questions were answered. The next speaker on our program is Mr. Lester H. Loble of Helena, Montana.

MR. LOBLE: It is a distinct honor and a source of satisfaction that permits me to come this great distance from the heart of the Rocky Mountains in Montana to our nation's capitol and be privileged to exchange ideas with you national leaders interested in old age security.

In view of the fact that it was my good fortune to be legislative author of the first old age pension bill passed in the United States, introduced during the time I was a Democrat floor leader of the Montana Legislature in 1923, I may perhaps be permitted unusual contentment and satisfaction at this notable gathering and be allowed to tell you of the operation of years of old age pensions.

I know little of the theory of old age security but much, I believe, of the practical operation, the tremendous advantages and the pitfalls. To those who are opposed on the grounds of paternalism, let us remind them that government is not a dividend-paying institution, except in the happiness and contentment of its people.

In 1923 there was no awakened consciousness of the desire for old age pensions. It was introduced in our legislature during times that were most difficult and following a year of drought and distress.

The only organized effort made in behalf of the passage of this law was by the Fraternal Order of Eagles. Much credit is due to this organization which gave of its memberships, its money, and its time in assisting in the final adoption of the bill introduced. The leaders of this organization, Mr. Frank Hering of South Bend, Indiana and Mr. Conrad H. Mann of Kansas City, Missouri, were very important in the establishment of the first old age pension law in the United States.

The bill that finally passed was not mandatory but optional with the boards of county commissioners of the several counties. It is not the best old age pension law that could be drawn, but it was the best that could be secured in the pioneering of this movement.

At the same time that I was preparing the old age pension bill for Montana, one was being drawn in Pennsylvania. I collaborated with some of the eminent legal minds of that state. I was fearful that under the constitution of the state of Montana the act would be held unconstitutional if the pensions were paid from the state treasury, but if they were paid from the county poor fund it would withstand attack. I therefore proceeded along that line. Pennsylvania adopted a law along different lines that was held unconstitutional. Our law has never been attacked nor has any attempt been made to repeal it or amend it. By its provisions any person over the age of 70, who has been a citizen of the United States for 15 years, and who has an income of less than $300 per year, may receive an old age pension, the maximum of which may be $25 per month. The cost administrating of this law has been nothing. Without additional compensation, the boards of county commissioners of the respective 56 counties in Montana constitute the old age pension commissions.

Often a pensioner has some real estate, but an income of less than $300 per year. It may consist of a home. Before granting the pension the commission may require that this property be deeded to the county, effective upon the death of the pensioner, and from the proceeds of the sale of this property at the time of the death of the pensioner, the amount of pension paid during his lifetime, plus 5 per cent interest, is repaid to the county, and the balance from the sale of property goes to the pensioner's heirs. Thus the counties are often reimbursed the entire amount of the pension paid, with interest. Heirs, who in the lifetime of the pensioner have not been interested in his welfare, do not succeed to the pensioner's property until the county has been repaid.

Pensioners received during these 11 years approximately $14.00 per month. The official figures of the United States Bureau of Labor Statistics issued by the United States Government disclosed after a national survey, that the average cost for the care in a poorhouse of an aged person is $334.64 per year, or $28.42 per month. Thus 11 years of actual experience in the administrations of this law discloses beyond contradiction that it is twice as costly to confine an aged person in a poorhouse as it is to grant him an old age pension. As has been demonstrated beyond question, it is an economic saving. The pension system has closed some of the poorhouses of Montana. Poorhouses cannot compete against pensions.

We had but little difficulty in putting the law into operation. There was some resistance from the boards of county commissioners who preferred to give supplies to the aged poor instead of money. We had to eliminate early political pressure in granting of pensions and in various counties had volunteer committees, usually recruited from the Fraternal Order of Eagles, that assisted the boards of county commissioners in investigating the condition of the pensioners so that the law would not be imposed upon.

A few years after the law was in effect, a vice president of a large Pittsburgh steel corporation called at my office and advised me that he was making a survey as one of a committee of the Manufacturers' Association, that he personally was opposed to the old age pension system, but that he wanted full information about it.

Instead of telling him anything about it, I took him by automobile to a little village 20 miles from Helena. We stopped in front of a little vine covered loghouse, walked up a rustic path to the door and were admitted by a little old white haired lady. He observed a tidy home, on the floor was a hand-made rug, on the table a family Bible; on the wall hung a picture of her husband in one of the heavy gilt frames of yore. Her name was Mary Galliger. She and her husband had been trail blazers and pioneers of Montana. On her eightieth birthday she stood in front of a banking institution and read these chilling, type-written words, "Closed by order of the Banking Department. In the hands of a receiver." Within the vaults of that institution rested every dollar that she and her husband had accumulated---ample to care for her--carefully saved for old age. She found herself, an old lady of culture, education, and refinement in the twilight of life, without relatives, without money, without earning capacity. Had it not been for the old age pension law she would have ridden in the black wagon to the poorhouse, there among the derelicts of the world to sit in her tiny, plastered room, wondering why her life should thus be ended. Instead, she lived out her life in her own little home, surrounded by her friends, puttering in her garden, happy and contented, and there finally passed away.

I introduced her to my friend and told her that he was interested in old age pensions and she, from the infirmities of old age, not understanding, and looking at him through eyes dimmed with cataracts gave him her blessing for having assisted in the passage of old age pensions. As we left her home he inquired as to what she was receiving and was informed that she received $15.00 a month, that she owned her home. Had it been necessary to send her to the poor farm the cost would have been $30.00 a month.

We drove on a few miles up into the hills of the Rockies. There we stopped at a prospector's gold mining claim. We sat down on the edge of an old broken-down wagon box and waited for the owner. I pointed out to my friend the tunnel, hundreds of feet in depth that had been dug out by hand, the crude hoists and even more obsolete hand mining machinery. It was a typical prospector's layout. From across the hill came Jones Callahan, almost with the step of youth, carrying his pick and shovel and a sack of ore across his back, a long, flowing white beard, a rugged man of the outdoors, aged 92. He had prospected this claim for 45 years, had found but little, yet was as enthusiastic as if he had just started. Before he operated this mine he had discovered one of the richest gold mines in Montana. Like many of his kind he received little for his effort; in fact he sold his interest in this mine years before for $4.00. That mine was produced millions of dollars in dividends and has paid thousands of dollars in taxes. At this very moment it is one of the best paying mines in the state of Montana, hiring scores of men. But this man was a miner, a dreamer, always just going to strike again. Living high up in the Rocky Mountains in his little miner's cabin, he spent his last day on earth with his pick and shovel, still pursuing the elusive gold.

Jones Callaway received a pension of $20.00 a month. It was ample for his needs. He refused to take it until he was told that it was not charity, but in recognition of a life well spent. He talked a long time to my friend from Pittsburgh and this old miner's enthusiasm fired the imagination of my friend from the east. Jones Callaway is long since dead and I cannot remember the name of my friend from Pittsburgh, but he has not forgotten Jones Callaway I know, for when he left and started back down the road he said to me, "I came out here convinced that old age pensions were purely paternalistic, socialistic, unworkable, but I have changed my mind." What report made to his committee, I do not know, except that a few years later I observed in one of the annual reports of the Manufacturer's Association, at least a tacit approval of old age security.

The following figures are the official figures of the State Auditor of the state of Montana, issued under the seal of the state of Montana, and are recorded in his office and kept by him under the requirements of the law.

The first nine months of the year 1923, the first year of the law's existence, disclosed that pensioners received $65.24 per year per person, only $5.43 per month per person.

For the first year, 1924 $151.74 per person per year $12.64 per person per month
" 1925 $174.14 " $14.36 "
" 1926 $179.59 " $14.96 "
" 1927 $167.97 " $13.91 "
" 1928 $188.35 " $15.69 "
" 1929 $168.77 " $14.15 "
" 1930 $154.30 " $12.85 "
" 1931 $158.34 " $13.18 "
" 1932 $145.37 " $12.12 "
" 1933 $ 87.32 " $ 7.27 "

Let us for a moment analyze the figures. Eleven years is a fair test in the trial of this law, as in 11 years are represented good and bad years, prosperity and adversity. The man now 70 years of age receiving a pension was 59 years of age at the time the law became effective. The increase in the number of pensions granted has not been in accord with the claims of its opponents at the time of its adoption. As a matter of fact the increase has been quite gradual. Death and changing conditions are, of course, important factors in the number of people who apply for pensions.

In 1923 349 pensions were granted
" 1924 521 "
" 1925 583 "
" 1926 584 "
" 1927 693 "
" 1928 884 "
" 1929 875 "
" 1930 1032 "
" 1931 1130 "
" 1932 1254 "
" 1933 1781 "

You must bear in mind that while Montana does not have the characteristics of many of the eastern states, the state is a combination of industrial and farm life; located there are the largest copper mines in the world, and throughout western Montana there is much mining and some industrial activity. The eastern part of the state is largely made up of farming communities where large ranches are located, engaged in the production of wheat, cattle and sheep.

In 1933 there was quite a large increase in pensions over 1932, but there was a decrease in the amount paid to each pensioner. This was due to two factors. There was a greater demand for pensions, but there was less money with which to pay them. As a consequence the amount each person received was materially reduced. The pensions are paid from the country poor fund and many of these funds are depleted due to delinquent taxes.

Why is it that an old person can live on a pension of $14.00 a month when it cost $28.00 a month to maintain him in a poorhouse? The answer is found in the fact that the person is not lost to the community and is still partially self-supporting. For illustration, Jack Ferguson, a pensioner, now dead, received his first pension when he was 72 years of age. Hale and hearty, he still continued his business of driving an express wagon for the delivery of small parcels. Though the wagon was dilapidated, and the horse looked as old as himself, he could and did make from fifty cents to a dollar a day during good weather. In the winter he was unable to work. During those months he was on the old age pension list, and religiously, during the summer months when he could work, he had himself removed from the rolls. These old timers earn something. They do some mining, take care of public parks, act as watchmen, and engage in various kinds of activities that permit them to earn a part of their living. They remain among their friends who help them. Remove them to a poor farm and they are lost to society forever. Their self-respect is gone as is their meager earning capacity, and they become dead weight, with nothing to hope for but the call of the Almighty.

Old age security is but payment of a debt that this generation owes to those trail blazers of yesteryear who have made our present existence possible. The law is very little abused and is a haven of refuge to many people who never believed they would need assistance. This law will never be repealed because 11 years of trial have shown it to be a far cheaper method of caring for the aged poor and because it is more humane.

I speak by command of silent lips on behalf of the old age pensioners of the west who have gone on to their reward, on behalf of the contented aged people of Montana who are able to live out their lives with some security, though small. I speak for a state that has tried the experiment and knows that old age security is possible, economical, and humane.

I submit with these remarks the complete record from the State Auditor's office of the state of Montana, which, under the seal of the state shows the process of old age pensions in Montana over a period of 11 years.

We are great in area, small in population, approximately 600,000, but nearly 2,000 old men and old women in the state of Montana are to-day receiving old age pension security.

It is gratifying to know that we have a Committee on Economic Security whose record of past achievements on behalf of the masses of the people lends sincere encouragement to the progress of old age security, that under the leadership of our President and the illustrious Secretary of Labor, the old people have renewed hope.

I trust that legislation will soon be enacted so that instead of 28 states of the Union now in the old age security column, the entire population of this glorious country will know that the haunting fear of poverty in old age has been forever removed from the hearts of our people.

CHAIRMAN DEWSON : I think that Mr. Loble paints a very modest picture of the part he has played in this work.

Our next speaker is Mr. Royal Meeker, former United States Commissioner of Labor Statistics, New Haven.

MR. MEEKER : Madam Chairman, ladies and gentlemen: I have no written document. If I am permitted to speak just a few minutes, I have just a few notes which I may or may not be able to read.

First of all, I would like to direct your attention to the fact that relief or pensions are the last ditches against insecurity, social and economic. You can't insure anything that doesn't exist; you can't give a pension unless you have funds out of which to pay pensions.

The first and most important measure for social security is the revival of industry, constituting employment for the unemployed, constituting income for the lack of income, to take care of the necessities from whatever cause they may arise.

The first and most important step then as a relief measure which this Committee on Economic Security can offer to the President, is a complete revamping and reconstruction of our banking credit and monetary system. I repeat, our banking credit and monetary system--it is one united, indivisible, system--will do more for reestablishment of industry, and reestablishment of income, than all the pension relief measures that could be devised in a hundred years.

The second step is the organizing of industry, conducting it, providing for the conducting of industry so far as possible in an orderly systematic way, so that the balance between consumption and production may be immeasurably improved.

The third and last measure is insurance and relief.

In spite of all we do, men do become unemployed and must be maintained. Men become invalidated and must be maintained. Otherwise we must adopt that philosophy, or rather that policy which obtains among primitive peoples. I am told among certain tribes of Eskimos it devolves upon the eldest son of the ancient patriarch of the family, when the old man cannot pull his weight in the boat anymore, to take the ancient out and knock him in the head. We haven't been reduced to that condition in this country, but if we keep on in the direction we have been going in the last five years, we will arrive there, because we are returning with disconcerting rapidity to that difficult stage of civilization where we will have to use the hand loom, the shoemakers' tools, etc., to furnish our clothing. We are not there yet; it is not necessary for us to discard the ancient invalid in society. We are not yet dragging these ancient, dependent old people out to the city dumps, as they do in China.

May I just briefly survey the whole field which does properly come under the jurisdiction of social insurance against the hazards, the physical hazards of existence? All of the major hazards of existence may be classed properly under six heads: birth, unemployment, illness, accident, invalidity, death. I don't include old age, because old age is not primarily a major classification. Old age falls under two heads, invalidity due to advancing years, and unemployment due to depreciation or advancing years or both.

I greatly honor the Fraternal Order of Eagles for their work in calling attention to the need to provide against dependency and misery attendant upon the advancing years. But I think a word of general admonition, if not criticism, may well be uttered here. It is, I think unfortunate that attention has been centered so wholly upon old age as a cause of dependency, leading to the subordination, if not the actual ignoring of other causes of dependency, which on the whole are much more important than old age. Does that answer your question, Madam Chairman?

With regard to the question, "Why not resort to insurance instead of pensions?" I would say, supplementing what Dr. Rubinow has said, that it is wholly impossible to substitute insurance for pensions because of the present problem which confronts us. People are now suffering from lack of employment, from invalidity, and they must be taken care of. We cannot wait for 30 years to build up a reserve fund in order to take care of these dependent people. That is, it seems to me, a sufficient answer, but we are in the process of the shaping of all state legislation and we should keep in mind what Dr. Rubinow so ably outlined, that is, the necessity of providing for all kinds of invalidity, whether from old age or from other cause, and the building up of a reserve fund, the establishment of what he calls "service insurance." Call it what you will, I don't care, but I think the principle of insurance should be instilled into every old age pension measure that is introduced anywhere.

I have heard during this conference, and I hear it everywhere, whether I stay at home or go abroad, the idea of technological unemployment--just as if something new had come into the world. That is a mistaken idea. It is just as old as the division of labor, and that is pretty old. There has been technological unemployment from the beginning. I suppose that when some men devised the first instrument for scraping up the surface of the ground, so that corn or whatever they had to plant might be planted, I suppose that led to technological unemployment. For instance, these extremely primitive instruments, which consisted of cross sticks, were invented as it did to hunt around in the brush and gather berries, overtake the rabbit, etc., in order to obtain the food supply for the tribe.

Therefore, technological unemployment has always existed. I doubt very much, you may dispute what I am going to say, whether there is any more technological unemployment to-day in New York than there was in the beginning of the nineteenth century when the industrial revolution so-called was in full swing. I doubt very much if the proposition of technological unemployment to-day is as great as then. However, it is of no matter, purely an academic question.

I don't think we should accept the doctrine that technological improvements increase unemployment, and that therefore from now on we must look forward to an increasing volume of unemployed persons, whether they are unemployed because they have reached the age of 65, 40, or 45, whatever the age limit may be. I see no reason why we should accept that doctrine. It is the most utter arrant nonsense. Technological improvements tend to wash themselves out, to create more employment.

We are in a terrible state of unbalance now, but we have been just as unbalanced before, and I think we have the ability to get back into balance. It is some job, I grant you, but it is the same job that has been done time and time again. And don't forget this old world is a pretty aged institution. I suppose all of you studied ancient history when you went to high school. I didn't go to high school. I didn't go to college. I supposed you studied the history of Egypt. You had perhaps 20 or 30 pages on Egypt and it seemed a very compact piece of history. But there were at least a dozen different Egypts, and dozens and dozens of crises occurred in the history of Egypt. Every one of these crises were as serious to the people of Egypt as this world crisis is serious to us now. There have been industrial revolutions time and again, but the world is not yet bankrupt.

I think we are going to pull out of this. We are in conference for the first time and have some hope of getting through an old age pension system. The only reason it is advocated is because it is the only thing possible. An insurance system is utterly impossible now. The pioneer work done by the Fraternal Order of Eagles and the Federation of Labor has made possible old age pensions.

I have great hopes that we can succeed by driving deeper, in order to provide and care for these hazards of life by an insurance system. It can be done and the time to do it is now. Don't put off unemployment insurance and the building up of unemployment reserve funds until it is too late. I contend that industry cannot afford to delay. The only thing that can save industry from bankruptcy is to adopt unemployment insurance and build up a reserve fund.

Just one more remark. I see the Chairman is getting nervous, and anxious to get to the President's reception. I want to go myself as I have not seen him for some years. I strongly favor the system of federal grants in aid. I think that the federal government has the means of tapping sources of income which cannot be reached successfully by the states, because of state boundaries, etc.

I would strongly suggest that the Committee on Economic Security consider very carefully and recommend very powerfully to the President, the use of grants in aid by the federal government to every state which will enact old age pension laws that measure up to the standards laid down by the federal government. It is the only way to get through some states, and I think the Wagner-Lewis Bill does give us the means of helping old age security from the end of unemployment insurance, as the last measure in the revival of industry.

CHAIRMAN DEWSON: The next speaker on the program is Mr. Abraham Epstein, Executive Secretary, American Association for Social Security, New York City.

MR. EPSTEIN: Madam Chairman, ladies and gentlemen: I am sorry as I am just recovering from a serious illness that I cannot liven up this discussion a little bit. I think this discussion needs a little life, but I am afraid I am not up to the test to-day.

There is one thing that strikes me in both the discussions to-day, this morning and this afternoon; it has struck me too during all my years of interest in this subject, and that is, that the chief difficulty, probably, that prevails in the United States, is the idea of perfection.

We can never discuss one problem by itself. We want to solve all the problems of the universe. And not only do we want to solve all the problems of the universe, but we want to solve the problem in a perfect way. If you had a suggestion that would solve a problem 90 per cent, there would be a demand for a remedy that would solve all the problems 100 per cent. If we in this country get to that stage which our forefathers reached, that is, to stick to one thing at a time and discuss one thing at a time, feeling even a 60 or 70 per cent solution of a problem is worth doing, better than doing nothing, we could make some progress.

While I am not disagreeing with Mr. Hopkins, I do know from my many years of experience that it is dangerous to emphasize that no program of social security is complete unless it has this or that.

We all know, of course, that any program of social security will be complete if complete security is provided and the best kind of security. But I believe that since we are just imperfect human beings, and most of us are imperfect, we should confine ourselves for the present to one problem, at least try to solve one problem at a time, not 100 per cent, or even 90 per cent. If you can only get over that philosophy to the legislatures, I think that all of our problems on social security in this country will be solved.

The reason that there is no perfect remedy for making old age absolutely secure, no matter what principle is adopted, no matter what legislation we enact, is that there will always be certain flaws to make it at least just below 100 per cent perfect, if for no other reason than the fact that the members of the Senate and House of Representatives are fallible people. Some may not believe that, but at least most of us agree on it. Therefore, we cannot expect infallible laws.

We are not going to have perfect old age security legislation, but I do believe that kind of old age security legislation that will meet present conditions, is the best kind of legislation.

This is the subject on which most people become confused. In my 18 to 20 years of hard work, I don't think I can point to a single person whom I have been able to make understand. They all get confused. Even congressman who have been sponsoring bills have gotten mixed up and gone in the other direction. People do not understand, but it is as simple as a, b, c's.

You have a problem to-day of millions of people who have no jobs, and their children cannot support them. That is simple.

All we can do is to get a scheme--not a perfect scheme--but a scheme that will best provide with some decency. I think that everybody in this country and in Europe realizes that the old age pension system, as it is known in this country, whether called this or that, or whether it is a perfect thing or not, can be improved. At least, the idea of keeping all the people in homes on a small pension from the government is a better system, both from the point of view of economy, social and spiritual, than any previous system we have had in this country.

Now, I think that all of us can agree also that in the case of a man 65 or 70 years of age with no job and no children to support him, there is only one thing to do and that is to get him a straight pension. Can't we settle that matter for once and stop this talk about contribution? These contributions mean or presuppose the earning of wages.

Remember most of the people of that age have no wages and no money. Let's not talk about it any more and for once come to the agreement which we already ought to know, because for seven years we have had a bill--seven years is supposed to be the ripening age for a bill to mature--and it should have matured last year. Now then we have a bill in which we said to accomplish this thing we will need the federal government to subsidize some of the states making provisions for the aged, because some of the states cannot do it themselves. There should be universal agreement on that.

It seems to me before devising the most perfect scheme, we should at least do this. We are not going to have 100 per cent perfection, but I for one will be darned happy to see 60 per cent of the problem solved.

I come in contact with dozens of old men and women in New York drawing $30 or $35 a month from the city. I can see the change in these people, and I confess even in my sickness, I get cheer out of it. It makes me quite happy over this accomplishment, although we do know that there are other people in New York who are entitled to it and not getting it. But there are 52,000 more getting it now than before.

Let us first of all understand that there is no other way, no better way of meeting the present problem than improving the existing pension legislation through federal subsidy. That was provided on the O'Connor Bill maturing in Congress, and there is absolutely no reason for a bill of that sort having to go through again this year. It should have gone through last year.

There is another problem. That is in relation to the taxpayer. Do we wish to continue this kind of system? Let me suggest as Dr. Rubinow suggests, that you can't relieve yourself of this problem in the future by establishing a contributing pension system, which will not mature for a good number of years. Until that system matures, give the people straight pensions and ultimately establish a fund which will be able to improve a great deal of the present handicaps. Eliminate the "means test," and all sorts of things will be automatically eliminated. Take the burden from the government and put it on the people themselves.

This seems to me very simple and yet here are 20 years of educational work on this thing, and I challenge you to find six people in this country who understand the matter. We have not been able to get Congress to understand it in spite of its simplicity.

I only hope the Committee on Economic Security will be able to reach the nation with this very simple proposition--not with the aim of getting a perfect scheme. Even the Committee is fallible. I at least think so. I don't expect the perfect thing, not even from the White House. But let us be contented with half-perfection for even half is better than none at all. Thank you.

CHAIRMAN DEWSON: Before I throw the meeting open for discussion, I want to read this note.

"The President desires to meet the members of the advisory Council in advance of the general reception. This will make it necessary for the members to be at the White House at four-forty-five p.m."

It will therefore be necessary to close this meeting at 4:20 so that those belonging to the Council can leave.

We have 20 minutes left during which we can discuss the question of old age insurance and pensions.

MR. FRANK MORRISON (Secretary of American Federation of Labor): I desire to say that the American Federation of Labor is wholeheartedly in support of old age pensions. We feel that men who have devoted their time to industry and the government should be take care of in their old-age.

We believe that it is cheaper for the country itself to have old age pensions with a uniform age for the receipt of pensions, than for individual industrial organizations and governmental units to have varying systems.

Only a few years ago this Federation declared in favor of old age pensions, because many of the international unions set up old age pensions for their own members. The organization of which I am a member, International Typographical Union, gives an old age pension of $8 a week for all men over 65 years of age who are unable to secure sustained employment because they have infirmities.

Formerly, when a man died his pension died with him. His wife did not have the protection of the pension. Now the pension that would come from the states or from the federal government including the District of Columbia and Alaska, would cover both the man and his wife separately and distinctly, so that they would have protection in their old age.

We feel that until a man or woman is protected in old age, until we have laws that protect the workers by insurance against unemployment, conditions are not satisfactory. I want to ask you gathered here to-day, what more splendid thing could happen, if we should on the basis of these meetings enact an unemployment insurance law and give impetus to the various states to secure the enactment of old age laws? We would thus be covering our citizens from the cradle to the grave.

MR. F. S. KELLOGG (Manufacturers' Association, New Jersey): As I have listened to the discussion here to-day, I have become increasingly convinced that we will not find a solution of these problems until we consider the individual worker. I feel that a reserve should be accumulated, not as a means of relief at the present moment. I recognize what other experts have said, that you cannot accumulate to meet the present situation, is correct. Accumulations to meet the present situation should have been started years ago.

CHAIRMAN DEWSON: Would you begin it now?

DR. KELLOGG: The state has got to take care of that end of the thing.

CHAIRMAN DEWSON: For the future?

DR. KELLOGG: For the future and we should begin now to accumulate that fund. To my mind that should be accumulated for each individual worker and should be available for that worker's needs, if that worker's needs happen to come first by unemployment. And if he isn't unemployed it should be for old age, and if he doesn't reach old age and get out of employment previous to death, then that fund should be available to his family and his people at his death.

I don't believe we will get any solution of this problem until we do two things, get down to the individual worker, and make the fund, if I may say it in this way, limber and flexible enough to satisfy the conditions that may arise, the catastrophe which meet the worker, so much for non-employment, so much for life, so much for old age pension, these reserve funds must have enough mobility and flexibility to meet these different problems.

The Manufacturers' Association of New Jersey has been studying this problem. I want to say here, there seems to be a popular idea that each and every Manufacturers' Association is opposed to the proper solution of these problems. I can say our association is not. It is willing to cooperate toward the proper solution, and any information which it has gathered together or has on hand, or any ideas which it may have, or any assistance it can give, are at the disposal of the Committee. Thank you.

Section: 

1935: Social Security Act

Summary: The complete original text of the 1935 Social Security Act

The Social Security Act of 1935

Full text of the original legislation:

INDEX

PREAMBLE
TITLE I- GRANTS TO STATES FOR OLD-AGE ASSISTANCE
Appropriation
State Old-Age Assistance Plans
Payment to States
Operation of State Plans
Administration
Definition
TITLE II- FEDERAL OLD-AGE BENEFITS
Old-Age Reserve Account
Old-Age Benefit Payments
Payments Upon Death
Payments to Aged Individuals not Qualified for Benefits
Amounts of $500 Or Less Payable To Estates
Overpayments During Life
Method Of Making Payments
Assignment
Penalties
Definitions
TITLE III- GRANTS TO STATES FOR UNEMPLOYMENT COMPENSATION ADMINISTRATION
Appropriation
Payments to States
Provisions of State Laws
TITLE IV- GRANTS TO STATES FOR AID TO DEPENDENT CHILDREN
Appropriation
State Plans for Aid to Dependent Children
Payment to States
Operation of State Plans
Administration
Definitions
TITLE V- GRANTS TO STATES FOR MATERNAL AND CHILD WELFARE
PART 1- MATERNAL AND CHILD HEALTH SERVICES
Appropriation
Allotments to States
Approval of State Plans
Payment to States
Operation of State Plans
PART 2- SERVICES FOR CRIPPLED CHILDREN
Appropriation
Allotments to States
Approval of State Plans
Payment to States
Operation of State Plans
PART 3- CHILD WELFARE SERVICES
PART 4- VOCATIONAL REHABILITATION
PART 5- ADMINISTRATION
TITLE VI- PUBLIC HEALTH WORK
Appropriation
State and Local Public Health Services
Investigations
TITLE VII- SOCIAL SECURITY BOARD
Establishment
Duties of the Social Security Board
Expenses of the Board
Reports
TITLE VIII- TAXES WITH RESPECT TO EMPLOYMENT
Income Tax on Employees
Deduction of Tax from Wages
Deductibility from Income Tax
Excise Tax on Employers
Adjustment of Employers' Tax
Refunds and Deficiencies
Collection and Payment of Taxes
Rules and Regulations
Sale of Stamps by Postmasters
Penalties
Definitions
TITLE IX- TAX ON EMPLOYERS OF EIGHT OR MORE
Imposition of Tax
Credit Against Tax
Certification of State Laws
Unemployment Trust Fund
Administration, Refunds, and Penalties
Interstate Commerce
Definitions
Rules and Regulations
Allowance of Additional Credit
Conditions of Additional Credit Allowance
TITLE X- GRANTS TO STATES FOR AID TO THE BLIND
Appropriation
State Plans for Aid to the Blind
Payment to States
Operation of State Plans
Administration
Definition
TITLE XI- GENERAL PROVISIONS
Definitions
Rules and Regulations
Separability
Reservation of Power

SHORT TITLE - The Social Security Act (Act of August 14, 1935) [H. R. 7260]

An act to provide for the general welfare by establishing a system of Federal old-age benefits, and by enabling the several States to make more adequate provision for aged persons, blind persons, dependent and crippled children, maternal and child welfare, public health, and the administration of their unemployment compensation laws; to establish a Social Security Board; to raise revenue; and for other purposes.

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

TITLE I- GRANTS TO STATES FOR OLD-AGE ASSISTANCE APPROPRIATION

SECTION 1.
For the purpose of enabling each State to furnish financial assistance, as far as practicable under the conditions in such State, to aged needy individuals, there is hereby authorized to be appropriated for the fiscal year ended June 30, 1936, the sum of $49,750,000, and there is hereby authorized to be appropriated for each fiscal year thereafter a sum sufficient to carry out the purposes of this title. The sums made available under this section shall be used for making payments to States which have submitted, and had approved by the Social Security Board established by Title VII (hereinafter referred to as the Board ), State plans for old-age assistance.

STATE OLD-AGE ASSISTANCE PLANS

SECTION 2.
(a)
A State plan for old-age assistance must
  1. provide that it shall be in effect in all political subdivisions of the State, and, if administered by them, be mandatory upon them;
  2. provide for financial participation by the State;
  3. either provide for the establishment or designation of a single State agency to administer the plan, or provide for the establishment or designation of a single State agency to supervise the administration of the plan;
  4. provide for granting to any individual, whose claim for old-age assistance is denied, an opportunity for a fair hearing before such State agency;
  5. provide such methods of administration (other than those relating to selection, tenure of office, and compensation of personnel) as are found by the Board to be necessary for the efficient operation of the plan;
  6. provide that the State agency will make such reports, in such form and containing such information, as the Board may from time to time require, and comply with such provisions as the Board may from time to time find necessary to assure the correctness and verification of such reports; and
  7. provide that, if the State or any of its political subdivisions collects from the estate of any recipient of old-age assistance any amount with respect to old-age assistance furnished him under the plan, one- half of the net amount so collected shall be promptly paid to the United States. Any payment so made shall be deposited in the Treasury to the credit of the appropriation for the purposes of this title.
(b)
The Board shall approve any plan which fulfills the conditions specified in subsection (a), except that it shall not approve any plan which imposes, as a condition of eligibility for old-age assistance under the plan-
  1. An age requirement of more than sixty-five years, except that the plan may impose, effective until January 1, 1940, an age requirement of as much as seventy years; or
  2. Any residence requirement which excludes any resident of the State who has resided therein five years during the nine years immediately preceding the application for old-age assistance and has resided therein continuously for one year immediately preceding the application; or
  3. Any citizenship requirement which excludes any citizen of the United States.

PAYMENT TO STATES

SECTION 3.
(a)
From the sums appropriated therefor, the Secretary of the Treasury shall pay to each State which has an approved plan for old-age assistance, for each quarter, beginning with the quarter commencing July 1, 1935,
  1. an amount, which shall be used exclusively as old-age assistance, equal to one-half of the total of the sums expended during such quarter as old-age assistance under the State plan with respect to each individual who at the time of such expenditure is sixty-five years of age or older and is not an inmate of a public institution, not counting so much of such expenditure with respect to any individual for any month as exceeds $30, and
  2. 5 per centum of such amount, which shall be used for paying the costs of administering the State plan or for old-age assistance, or both, and for no other purpose: Provided, That the State plan, in order to be approved by the Board, need not provide for financial participation before July 1, 1937, by the State, in the case of any State which the Board, upon application by the State and after reasonable notice and opportunity for hearing to the State, finds is prevented by its constitution from providing such financial participation.
(b)
The method of computing and paying such amounts shall be as follows:
  1. The Board shall, prior to the beginning of each quarter, estimate the amount to be paid to the State for such quarter under the provisions of clause (1) of subsection (a), such estimate to be based on
    (A) a report filed by the State containing its estimate of the total sum to be expended in such quarter in accordance with the provisions of such clause, and stating the amount appropriated or made available by the State and its political subdivisions for such expenditures in such quarter, and if such amount is less than one-half of the total sum of such estimated expenditures, the source or sources from which the difference is expected to be derived,
    (B) records showing the number of aged individuals in the State, and
    (C) such other investigation as the Board may find necessary.
  2. The Board shall then certify to the Secretary of the Treasury the amount so estimated by the Board, reduced or increased, as the case may be, by any sum by which it finds that its estimate for any prior quarter was greater or less than the amount which should have been paid to the State under clause (1) of subsection (a) for such quarter, except to the extent that such sum has been applied to make the amount certified for any prior quarter greater or less than the amount estimated by the Board for such prior quarter.
  3. The Secretary of the Treasury shall thereupon, through the Division of Disbursement of the Treasury Department and prior to audit or settlement by the General Accounting Office, pay to the State, at the time or times fixed by the Board, the amount so certified, increased by 5 per centum.

OPERATION OF STATE PLANS

SECTION 4.
In the case of any State plan for old-age assistance which has been approved by the Board, if the Board, after reasonable notice and opportunity for hearing to the State agency administering or supervising the administration of such plan, finds-
  1. that the plan has been so changed as to impose any age, residence, or citizenship requirement prohibited by section 2 (b), or that in the administration of the plan any such prohibited requirement is imposed, with the knowledge of such State agency, in a substantial number of cases; or
  2. that in the administration of the plan there is a failure to comply substantially with any provision required by section 2 (a) to be included in the plan; the Board shall notify such State agency that further payments will not be made to the State until the Board is satisfied that such prohibited requirement is no longer so imposed, and that there is no longer any such failure to comply. Until it is so satisfied it shall make no further certification to the Secretary of the Treasury with respect to such State.

ADMINISTRATION

SECTION 5.
There is hereby authorized to be appropriated for the fiscal year ending June 30, 1936, the sum of $250,000, for all necessary expenses of the Board in administering the provisions of this title.

DEFINITION

SECTION 6.
When used in this title the term old age assistance means money payments to aged individuals.

TITLE II-FEDERAL OLD-AGE BENEFITS OLD-AGE RESERVE ACCOUNT

SECTION 201.
(a)
There is hereby created an account in the Treasury of the United States to be known as the Old-Age Reserve Account hereinafter in this title called the Account. There is hereby authorized to be appropriated to the Account for each fiscal year, beginning with the fiscal year ending June 30, 1937, an amount sufficient as an annual premium to provide for the payments required under this title, such amount to be determined on a reserve basis in accordance with accepted actuarial principles, and based upon such tables of mortality as the Secretary of the Treasury shall from time to time adopt, and upon an interest rate of 3 per centum per annum compounded annually. The Secretary of the Treasury shall submit annually to the Bureau of the Budget an estimate of the appropriations to be made to the Account.
(b)
It shall be the duty of the Secretary of the Treasury to invest such portion of the amounts credited to the Account as is not, in his judgment, required to meet current withdrawals. Such investment may be made only in interest-bearing obligations of the United States or in obligations guaranteed as to both principal and interest by the United States. For such purpose such obligations may be acquired
  1. on original issue at par, or
  2. by purchase of outstanding obligations at the market price. The purposes for which obligations of the United States may be issued under the Second Liberty Bond Act, as amended, are hereby extended to authorize the issuance at par of special obligations exclusively to the Account. Such special obligations shall bear interest at the rate of 3 per centum per annum. Obligations other than such special obligations may be acquired for the Account only on such terms as to provide an investment yield of not less than 3 per centum per annum.
(c)
Any obligations acquired by the Account (except special obligations issued exclusively to the Account) may be sold at the market price, and such special obligations may be redeemed at par plus accrued interest.
(d)
The interest on, and the proceeds from the sale or redemption of, any obligations held in the Account shall be credited to and form a part of the Account.
(e)
All amounts credited to the Account shall be available for making payments required under this title.
(f) The Secretary of the Treasury shall include in his annual report the actuarial status of the Account.

OLD-AGE BENEFIT PAYMENTS

SECTION 202.
(a)
Every qualified individual (as defined in section 210) shall be entitled to receive, with respect to the period beginning on the date he attains the age of sixty-five, or on January 1, 1942, whichever is the later, and ending on the date of his death, an old-age benefit (payable as nearly as practicable in equal monthly installments) as follows:
  1. If the total wages (as defined in section 210) determined by the Board to have been paid to him, with respect to employment (as defined in section 210) after December 31, 1936, and before he attained the age of sixty- five, were not more than $3,000, the old-age benefit shall be at a monthly rate of one-half of 1 per centum of such total wages;
  2. If such total wages were more than $3,000, the old-age benefit shall be at a monthly rate equal to the sum of the following:
    (A) One-half of 1 per centum of $3,000; plus
    (B) One-twelfth of 1 per centum of the amount by which such total wages exceeded $3,000 and did not exceed $45,000; plus
    (C) One-twenty-fourth of 1 per centum of the amount by which such total wages exceeded $45,000.
(b)
In no case shall the monthly rate computed under subsection (a) exceed $85.
(c)
If the Board finds at any time that more or less than the correct amount has theretofore been paid to any individual under this section, then, under regulations made by the Board, proper adjustments shall be made in connection with subsequent payments under this section to the same individual.
(d)
Whenever the Board finds that any qualified individual has received wages with respect to regular employment after he attained the age of sixty-five, the old-age benefit payable to such individual shall be reduced, for each calendar month in any part of which such regular employment occurred, by an amount equal to one month s benefit. Such reduction shall be made, under regulations prescribed by the Board, by deductions from one or more payments of old-age benefit to such individual.

PAYMENTS UPON DEATH

SECTION 203.
(a)
If any individual dies before attaining the age of sixty-five, there shall be paid to his estate an amount equal to 3 « per centum of the total wages determined by the Board to have been paid to him, with respect to employment after December 31, 1936.
(b)
If the Board finds that the correct amount of the old-age benefit payable to a qualified individual during his life under section 202 was less than 3 « per centum of the total wages by which such old-age benefit was measurable, then there shall be paid to his estate a sum equal to the amount, if any, by which such 3 « per centum exceeds the amount (whether more or less than the correct amount) paid to him during his life as old-age benefit.
(c)
If the Board finds that the total amount paid to a qualified individual under an old-age benefit during his life was less than the correct amount to which he was entitled under section 202, and that the correct amount of such old-age benefit was 3 « per centum or more of the total wages by which such old-age benefit was measurable, then there shall be paid to his estate a sum equal to the amount, if any, by which the correct amount of the old- age benefit exceeds the amount which was so paid to him during his life.

PAYMENTS TO AGED INDIVIDUALS NOT QUALIFIED FOR BENEFITS

SECTION 204.
(a)
There shall be paid in a lump sum to any individual who, upon attaining the age of sixty-five, is not a qualified individual, an amount equal to 3 « per centum of the total wages determined by the Board to have been paid to him, with respect to employment after December 31, 1936, and before he attained the age of sixty-five.
(b)
After any individual becomes entitled to any payment under subsection (a), no other payment shall be made under this title in any manner measured by wages paid to him, except that any part of any payment under subsection (a) which is not paid to him before his death shall be paid to his estate.

AMOUNTS OF $500 OR LESS PAYABLE TO ESTATES

SECTION 205.
If any amount payable to an estate under section 203 or 204 is $500 or less, such amount may, under regulations prescribed by the Board, be paid to the persons found by the Board to be entitled thereto under the law of the State in which the deceased was domiciled, without the necessity of compliance with the requirements of law with respect to the administration of such estate.

OVERPAYMENTS DURING LIFE

SECTION 206.
If the Board finds that the total amount paid to a qualified individual under an old-age benefit during his life was more than the correct amount to which he was entitled under section 202, and was 3 « per centum or more of the total wages by which such old-age benefit was measurable, then upon his death there shall be repaid to the United States by his estate the amount, if any, by which such total amount paid to him during his life exceeds whichever of the following is the greater:
  1. Such 3 « per centum, or
  2. the correct amount to which he was entitled under section 202.

METHOD OF MAKING PAYMENTS

SECTION 207.
The Board shall from time to time certify to the Secretary of the Treasury the name and address of each person entitled to receive a payment under this title, the amount of such payment, and the time at which it should be made, and the Secretary of the Treasury through the Division of Disbursement of the Treasury Department, and prior to audit or settlement by the General Accounting Office, shall make payment in accordance with the certification by the Board.

ASSIGNMENT

SECTION 208.
The right of any person to any future payment under this title shall not be transferable or assignable, at law or in equity, and none of the moneys paid or payable or rights existing under this title shall be subject to execution, levy, attachment, garnishment, or other legal process, or to the operation of any bankruptcy or insolvency law.

PENALTIES

SECTION 209.
Whoever in any application for any payment under this title makes any false statement as to any material fact, knowing such statement to be false, shall be fined not more than $1,000 or imprisoned for not more than one year, or both.

DEFINITIONS

SECTION 210.
When used in this title--
(a)
The term wages means all remuneration for employment, including the cash value of all remuneration paid in any medium other than cash; except that such term shall not include that part of the remuneration which, after remuneration equal to $3,000 has been paid to an individual by an employer with respect to employment during any calendar year, is paid to such employer with respect to employment during such calendar year.
(b)
The term employment means any service, of whatever nature, performed within the United States by an employee for his employer, except-
  1. Agricultural labor;
  2. Domestic service in a private home;
  3. Casual labor not in the course of the employer s trade or business;
  4. Service performed as an officer or member of the crew of a vessel documented under the laws of the United States or of any foreign country;
  5. Service performed in the employ of the United States Government or of an instrumentality of the United States;
  6. Service performed in the employ of a State, a political subdivision thereof, or an instrumentality of one or more States or political subdivisions;
  7. Service performed in the employ of a corporation, community chest, fund, or foundation, organized and operated exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals, no part of the net earnings of which inures to the benefit of any private shareholder or individual.
(c)
The term qualified individual means any individual with respect to whom it appears to the satisfaction of the Board that-
  1. He is at least sixty-five years of age; and
  2. The total amount of wages paid to him, with respect to employment after December 31, 1936, and before he attained the age of sixty-five, was not less than $2,000; and
  3. Wages were paid to him, with respect to employment on some five days after December 31, 1936, and before he attained the age of sixty-five, each day being in a different calendar year.
Section: 

1939: Retirement and Old-Age Assistance

Summary: Circumstances and expectations about retirement from both the well-to-do and not so well-to-do as documented in interviews done by authors in the Federal Writer's Project.

Narratives excerpted from: American Life Histories: Manuscripts from the Federal Writers' Project, 1936-1940.

Many businessmen or professionals had comfortable retirements, because many had both pensions and second careers they could engage in after retiring from their original career. Others that had pensions or property also seemed to be well-off in retirement. Retirement was not so nice for the working class.

The Well-To-Do

Judge Sidney Saylor, judge, Charlotte, NC

After serving on the bench for a quarter of a century, it seemed the proper thing for a man of seventy to retire and give somebody else a chance. I was getting a little tired and I no longer needed the full salary. I am now retired on two-thirds of the regular pay for life and that is enough to supply my simple wants. Besides, I have saved up something all along from my salary. My life is well insured and I feel reasonably sure my wife and small family will never suffer want.

Like most retired men, I have dreamed of having me a farm and of spending my last days in otium cum dignitate, as my old Latin professor used to say. It might keep my weight down and improve my appetite and sleep to spend hours walking over my acres, but I'm afraid I'm getting too stout and lazy to enjoy that form of sport. Also, I have been accustomed to mingling with people daily for so many years that I'm afraid I'd miss these contacts. So I reckon I'll spend my declining years in a wheel chair being trundled along the busy thoroughfares of the city. A judge in a large Northern city who was still active on the bench at ninety said his vitality was due to the bad air he breathed in the courtroom. Perhaps the dust of city streets will preserve me.

Jacob Ernst, retired hardware store owner, Columbus, NE

Living a retired life at his home, 1871 Seventh Street, where he indulges to his heart's content in his hobby of plain and fancy wood-working, is Jacob Ernst. Many years ago Mr. Ernst represented the first ward as a member of the city council. In more recent years, after he had long since retired from active business, he served for 16 years as an assessor in Columbus.

David Morin, French Canadian business man, Old Town, MA

He went to work as the manager of a pool and billiard hall on Water Street, that was owned by his brothers Frank and Lawrence, where he remained until his ill health forced him to retire in 1936. He hasn't worked anywhere since, and as he is well off, he probably won't again.

Alexander Beaton, retired Army Colonel and attorney, Corsicana, TX

Major Beaton went to Taos, New Mexico, with three companies of the regiment and remained there, doing duty as acting adjutant of the battalion, until the end of the war, when he returned to Independence, Mo., with the entire regimental command, where with his fellow-soldiers he was, in the fall of 1848, honorably discharged from the service. He now draws a pension of $8.00 per month as a Mexican war veteran from the United States government.

[After retiring from the Army] he was employed in the County Clerk's office and was later appointed to fill the unexpired term of a former incumbent of the office of County Assessor and Collector of taxes and, while so engaged, industriously applied himself to the study of law. He was admitted to the bar in 1851, license being granted by Hon. O. M. Roberts, the presiding judge, afterwards Chief Justice of the State Supreme Court, Governor of Texas, and later, senior law professor in the University of Texas. Major Beaton afterwards, for a period of over thirty years, engaged in the practice of the profession.

Major Beaton retired from active business and professional pursuits and moved to his  residence, "Gem Hill," which overlooks the city of Corsicana and is one of the most exquisitely beautiful and well appointed country-seats in the South.

Mr. Coburn and Mr. MacCurrie, discussing retirement, Thomaston, CT

Mr. Coburn: "Sure, he likes it [speaking about his brother's new career in the Navy]. Why wouldn't he? He didn't have nothin' here but a WPA job. Now he's got somethin' with a future in it. A young fella stays in the Navy a few years and he can learn most anything he wantsta. They teach a lad a trade, you know, if he wansta learn one. And if he stays in the outfit for twenty years, he gets a nice little pension. Pretty nice to be able to retire on pension when you're only about forty or so."

Mr. MacCurrie: "Yes, you're right. There's Claude Thompson doon here. He gets a nice little sock from the government every month, and what he makes in the shop besides."

Mr. Coburn: "Didn't he get retired for disability of some kind?

Mr. MacCurrie: "He went deaf. It was due to some kind of accident, I forget now just what it was. There was some kind of accident, I forget now just what it was. There was some kind of an explosion, and he rescued some of the sailors. He got a medal for heroism, or something o' the kind."

Mr. Coburn: "Well, in that case, he deserves a pension."

Frank Sowersby Gray, retired hardware executive, Jacksonville, FL

After delivering papers for the Florida Times-Union and working for a while helping my father in the shops of the Florida Railway and Navigation Company, which later became the Jacksonville, Tampa and W., being the beginning of the Atlantic Coast Line Railroad in a later merger, I obtained a position with the S. B. Hubbard Hardware Company as an office boy on June 1, 1878. I was in the employ of this firm for fifty-five years, becoming President of the company upon the death of Mr. Hubbard in 1903.

I retired for active service at the store, which I saw grow from a modest retail hardware establishment to a wholesale house with a territory covering several adjoining states and a swarm of hustling employees. But I have not retired altogether; I am still on the board of directors.

I was one of the founders in 1885 of the American Trust Company, later taken over by the Atlantic National Bank. I am still on the board of directors, also for another local bank, and have been one of the bond trustees of Duval County since 1890, including the St. Johns River bridge - too much responsibility for one of my age. I'll have to pass some of it to younger shoulders. And just look at this stack of unanswered letters! Six inches high. I have three secretaries at the store, but do not like to trouble them with my personal mail.

I still own a great part of this property on Len Turner Road, which I myself laid off years ago, and for thirty-five years have had a large farm there on Moncrief Creek near Dinsmore.

This house, where I have lived for fifty years, is in need of a new roof and other repairs, and the man who has attended to my property upkeep for fifteen years is sick. He might as well be dead, because he'll never get up again. Present day mechanics are unreliable ... just grab what money they can and take little interest in their work. I have three houses on the farm, too, that heed going over. Things like that are beginning to worry me - afraid I'm getting old."

Work? I love it. I have worked hard all my life. I have been through many discouraging situations and in tight places, but I always came through with flying colors, because I worked hard.

A.S. Rattan, retired doctor, Ft. Worth, TX

After we got here, I decided I wanted to be a doctor. I studied enough to get me a little business, then started out in Mason County in 1890. I turned out to be a saddle bags doctor. You know, carry all your stuff on a hoss and go from one ranch or farm to another. I was just as regular as the old circuit riding persons except when some contagious disease broke out.

I got to thinking maybe the grass grew a little greener out in the panhandle so I lit out for Channing and Hartley counties. I made me a route out there the same as I did before but it was too far between customers so I came back to Parker county for awhile, then I came into Fort Worth and went into the drug store business.

I've run drug stores all over Fort Worth since I came back. The two biggest ones were on Allen Avenue and another one on East Front Street.

I finally got too old to do much pill rolling so I retired and come out here to the Masonic Home. This is a mighty fine place for an old man to spend his last days.

Now, about being married, I've been married three times. I don't have any use for an old bachelor that's gone through life without helping take care of somebody. There happened to be 10 or 12 old bachelors together here the other day and I says, 'A man that never married or raised a family and took care of kids got no business being took care of in his old age. He oughta be done like we used to do an old stag, just drag him off into the head of an old holler and let him dry up'. Then I walked off and left them gaping. You know, when I'm not feeling my age so bad, I'm lots of fun. I'm all the time into some devilment like that.

Mrs. Laura Jones, widow of Civil War soldier, Palestine, TX

I live here with my great niece and her husband and they look after me. Of course the home belongs to me, but I receive a pension from the Civil War and have a small income from real estate and savings invested, but I need some one to be with me as I am getting pretty feeble, and can hardly get about in the house

John Sam Johnson, retired farmer in Huntersville, NC

Why, them welfare people laughed at me when I asked about getting old age pension. I have got as good a farm as there is in Mecklenburg County but that ain't got nothing to do with the price of eggs. I thought all old people who didn't have any help was supposed to get that pension. I ain't got but that one boy who is serving time. If he was here he wouldn't be no account to me for he's got T.B. He stayed over here in the County Hospital a long time and is in the Hospital now. I don't see what the law wants with a man laying up in the Hospital.

I got enough to live on--I have been advised to give my farm and everything away so I could draw the old age pension. If I was to do that I would be crazy--I'd wake up some morning and find myself in the asylum...I guess I'm better off without a wife. If she had stayed with me, she probably would have kept me from  accumulating anything for my old age--as it is, I'll not have to be buried by the County, even if I am a Republican.

The Not So Well-To-Do

Mr. George R, unmarried retired factory worker, Thomaston, CT

Sure, got plenty of time to talk. Got more time than money. It's gettin' so, I don't know what to do with an my time any more. Can't see to read. Got cataracts on both eyes. I can just about see to walk. People tell me I'm goin' to git smacked by a car crossin' the street one of these days. Well, I tell 'em, 'twon't be much loss. Not much loss. You get as old as I be, and no family nor close relations, and you ain't got much to look forward to but passin' on to the next world.

Sure, I believe in it. Don't seem likely this here world is the best there is. Gits worse every year When I was your age, 'twasn't a bad place to live Wa'n't no wars goin' on, everybody was workin' that wanted to work, folks were satisfied to live quiet and peaceful. Wa'n't no radios blastin' you out of the house, wa'n't no cars killin' thirty thousand people every year. That's what changed everything -- your automobile. Your automobile is what ruined this country, more ways than one. Every little squirt that makes as much as fifteen dollars a week has to have an car. And that's where most the fifteen dollars goes -- into the car. Who gits all the money? Why, the big gas companies. Big gas companies git all the money. Goes right out of circulation.

Yes, I worked in the shop here 47 years. Retired me two years ago. They let a bunch of us old timers go all 'bout the same time. Give us a little pension, but that's goin' to stop pretty soon now. And when it does I don't know how I'm goin' to git along. I could git me in old age pension, if I wanted to sign my life insurance away. Woman from the state come here some time ago I says, 'Nothin' doin'', I says. 'Think I'm goin' to sign away my chance for a decent burial?' I says 'That's all I got to look forward to.' She says, 'Well, I wouldn't look at it that way.'

Don't know if I can come in on this Social Security or not. Seems to me I can, but I'll have to find out about it. I know they was takin' money out of my pay, down to the shop. Seems to me I ought to git somethin'.

Elvira Barbee, widow and laid-off factory worker, Concord, NH

"Mr. Barbee made good money working for the telephone company," Elvira says, "and we never wanted for a thing; we lived well and had just a plenty of everything." But when Elvira was thirty-two, Mr. Barbee died leaving her with $1500, three children to support and another one coming. The $1500 lasted several years, then Elvira went to work in the mill. "I wasn't raised to work in the mill, but I wasn't above doing it to support my children," she will tell you pertly.

When Marie [her oldest child] was about thirteen, Elvira managed to get the child into the magnificent Junior Orphanage at Tiffin, Ohio, and there she stayed for six years. Elvira says she worked and sacrificed to keep Marie there and she thought surely the girl would help with the family, but she was to be greatly disappointed. During the six years she had been away, Marie had forgotten what it was like to live on Mill hill. Elvira figures that "Marie got used to having steam heat, hardwood floors, and all such luxuries that I just couldn't give her. There was plenty of young men paid attention to her, but the wouldn't have nothing to do with the them. It looked like she thought she was too good for them."

Marie got a job at a small cafe, but she refused to help the family, was irritable and unhappy. This summer she went to stay with her aunt near Hamlet and she wrote her mother that she wasn't coming back home. Her aunt then helped her to get into the Hamlet Hospital for nurses training. Elvira believes that in time Marie will "come to her senses" and help with the family. "But it hurt me more than anything that's ever hit me," the woman repeats again and again, "I laid in the bed and cried for two weeks."

Next year Eugene, the oldest boy, will be sixteen and he will go into the mill to help support the family. Elvira is terribly proud of her children and she is ambitious for them. She will not let the two younger ones go to the mill grammar school although it is closer. They go to the school downtown. She sees to it, too, that they look as nice as any other children there. Her ten year old daughter, Helen, has a permanent and her nails are expertly polished by a neighbor. Helen is the pride of her mother's life. Besides being "primpy," she can cook, wash, and housekeep as good as a grown up.

Since Elvira was laid off from the mill several years ago, she has had a hard time supporting the children. She goes out as a practical nurse, but never often enough to bring in a steady income. Her principal income has been the $20 she receives every month from the State Mothers Aid fund, but this is not enough. She has tried to get work in the mill in spite of the fact that she "feels too nervous to stand mill work." She wants to get in the WPA sewing room.

Elvira and her three children live in three rooms of a Locke Hill house. They rent the rooms from the Walter sisters, and pay $4.00 a month, which is half of the rent and telephone bill. Elvira moved in to nurse Lottie Walter when she broke her pelvis bone, and she liked staying in the little house because rent was cheap. But for weeks now the Walter girls have been trying to put her out, they insult her and try to "pick a fuss." Elvira doesn't know where she can go; rent is so high in most places.

Mr. and Mrs. Snead, retired railroad shop employee, Jacksonville, FL

Mrs. Snead, with her husband, two sons, and a daughter, settled in the Lackawanna section of Jacksonville when the Atlantic Coast Line Railway shops were established in that locality where the men of the family secured work. Mr. Snead has retired, but the two sons are still employed in the shops, living on nearby Edison Avenue with their families in homes of their own, while the daughter, also married, lived two doors away at 570 Orgam Street. There are no sidewalks, so that it was necessary to walk down the shell paved street from Edison Avenue to the number 562.

Mrs. Snead is a well preserved woman of 70, and answered the knock at the door, the bell being out of order. She is rather stout, with blue eyes and reddish brown hair, and was dressed in a wine-colored print dress. She invited me in and glanced with pride around the living room of the small green bungalow home where touches of her handwork were in evidence in the crocheted lace on the edges of the curtains at the windows and the numerous cushions on the couch in the corner and the easy chairs.

A large pasteboard card by the outer door bore the penciled notice - "Fresh Eggs, 25 cents."

"Yes, we keep a few chickens," Mrs. Snead said. "My husband is bothered quite a bit with asthma, and it is good for me to be out in the open as much as possible. The big yard with the flowers with the flowers and chickens keep him occupied. He was rather disappointed that eggs were so plentiful this Easter time he could not obtain a higher price."

Anonymous Local Railroad Character, Seattle, WA

When it came retirement age, he faced it without any emotion; didn't seem to be either sorry or glad, nor to have any plans as to what to do with his new leisure. Like so many other railroad men, he only lasted a few months after his retirement. The regulations said he couldn't be a checker any more, and--well, he couldn't be anything else, so that was that.

Robert White, mill worker in Thomaston, CT

Yessir. Castin' [in the mills]? No I never did that. It's a hell of a job. The fires burn a man out. Lots of them get burnt out. That heat is no good for a man. You know Charley Buckland? He's burnt out. That man used to be as fleshy as I am, but look at him now. Skinny as a rail. He couldn't retire though. He got out of the castin' shop more than ten years ago, and I don't think he ever intended to work again in his life, but he couldn't stand idleness. He asked the Old Man to take him back. So the Old Man gave him a soft job in the packin' room. Retirement kills a man. They've pensioned 'em off, over there, but they never live long afterwards.

Old Abel Beardslee went like that. He was gettin' old, got so he was fallin' asleep at the work. You can't do that workin' on the rolls. The Old Man saw him noddin' a coupla times, and he finally persuaded him he ought to retire on a pension. Old Abel died before he was out a year. He'd of been alive yet, if they'd let him work. But of course if a man can't keep up with the work, and he might get hurt or something, he can't expect to stay there.

They're pretty good about it, the company is, they let a man stay on as long as possible. But they're far behind some of the others on their pensions in this country. Now I went back to Ireland on a trip with my old man in 1924. And over there, they got it fixed so that a man gets half of what he earns at the time he retires. If a man gets thirty dollars a week, his pension is fifteen. They should adjust it like that here.

Mr. MacCurrie, Thomaston, CT

I see they laid off the fellas over 65 years old on the WPA. They're supposed to be eligible for the old age pension. That's all right for some of them, but what aboot a mon like Harry Wakeley? He's got kids too young to work. Now's he goin' to get along on the old age pension? The government has got a lot of ticklish problems. You're goin' to see fireworks in this session of Congress.

They ought to make them pensions higher. They give me six dollars a week. I get a dollar for spendin' money. I don't give a dom myself, I wouldn't get any more anyway, but it's my landlady that suffers. She ought to get more. Why the town pays seven dollars a week to people that take care of the poor. Some of them fellas that can't work, they board around, and the town pays seven dollars a week for their keep.

They laid off some of the lads on the WPA durin' that last layoff was supposed to be drinkers. I guess some of them were. But when they went up to the Selectman for relief, he said he was goin' to have them all sent up to some county poor house. Said they were goin' to take all them fellas from all over the county and put 'em away like that. By God, I don't think they can do it. They can put 'em in Norwich, but they've got to prove they're inebriates, first.

Albert Beaujon, clockmaker, Thomaston, CT

Business got bad and I went to work in the clock shop. Now I'm seventy five years old and nobody wants as any more. I work on the WPA, but they wanta have me quit that. Say I'm gettin' too old. Say I oughta apply for old age pension. Seven bucks a week. My old lady's sixty.

She can't get any, unless they change the law. She says if they change the law, fine, get through, we'll get along okay if we both draw pensions, but otherwise how're we gonna do it?

I pay sixteen dollars rent. Then there's light and gas and fuel in the winter time. How'm I gonna do all that on seven bucks a week?

Mr. M., marble quarry worker, West Rutland, VT

Q. How does the [quarry company] pension work?

A. Well, they used to be retired from active service when they were about seventy-five. That was when the company paid the pensions. A few years ago the pension plan was set up and premiums paid about half by the company and half by the marble worker. Under this plan he could be retired at sixty-five. Many of the workers do not like to have this premium deducted from their wages and so do not belong to the pension plan. The payment on retirement is based on the average wage during the past ten years. If the workers are fired or quit they can withdraw the money they have paid into the pension fund.

Peter Odenwald, factory worker, Thomaston, CT

Funny how that business went to hell, ain't it? Well, it ain't no worse than a lot of others, right now at that. I worked down in Waterville, Burbecker and Rowland's for a good many years. Then the Beardsley and Wolcotts got ahold of it and they went under, and then this company from Massachusetts took it--they kind of rented the place--and it was all right for a while--and then they moved back to Fairhaven. And I got laid off and I ain't worked since. I coulda gone up there to work, but what the hell, I was only gettin' a couple days a week, and it woulda cost me seventy five or eighty bucks to move and after I got there I probably woulda got laid off again and then where the hell would I be? So I got this unemployment insurance for thirteen weeks, and in the meantime I had an application in for the old age pension and the week after I got my last check, the pension started comin'. Of course it's only seven bucks a week, but I can get by on it, if I'm careful. I wish I had a couple bucks more, and then it wouldn't be so close figgerin'. I don't want to be rich, I don't give a damn as long as I can get by. The only thing I'm afraid of is some day they'll do away with it. But there ain't no use worryin' about it, is there? Take it as it comes and don't worry about what's gonna happen, that's the way I always figgered.

Tom Nolan, homeless, jobless, Irish American horse truck driver, New York City, NY

Old Tom, for many years a New York City horse track driver but now jobless, homeless and living by his wits because there was no place for him in the trucking or any other industrial field since 'age' and the coming of motor tracks made him 'obsolete,' said: 

"... no horse, and Old Jerry [his horse who had 'horse sense'] least of all, ever wasted his time worryin' about the 'future and frettin' about what would happen to him in the future like 'man sense' makes men do.

"For instance, ye can go around this block...or ye can sit out in the Square on a sunny day...or ye can go down to the Bowery, or to th' 'flop joints' or to the beer hang-outs and what do ye see?

"Ye see hundreds of men like meself -- and many of them unlike meself who have been 'big money shots' in their time and thought they were on top of the world, and who have spent the best part of their lives 'worryin' about th' future' -- schemin' and plannin', skimpin and savin' and often starvin' themselves, or even cheatin' their fellowmen' to get enough ahead so they would be sure not to starve -- or practically starve in the 'future.' And what the hell happened?

"The 'future' sneaked-up on them in spite of all their worryin' and schemin and so forth and smacked them in the eye for a row of garbage cans the same as it did me...and all their damned worryin' and frettin' had been for naught!

"Many times I have worried about me 'future' which is now me 'present' and got scared for fear I would not have a place to sleep or something to eat when the damn 'future' came...So, I would skimp meself, cut down on me tobaccy, wash me own shirts instead of lettin th' Chinaman do it -- even do without me beer... Once I saved up $19.00 and tucked it in me shoe, thinkin' I was on the way to bein' a 'capitalist' with me future well provided for... What happened? 'Twas then that them teeth that had been botherin' me bothered me a damned sight worse and, well, hell the dentist got the $19.00 and five dollars more out of me next two week's wages!

"'Twas always the same. But still, with me 'man sense' instead of me 'horse sense' I spent a good deal of time worryin' about the 'future.' Indeed, sometimes to such an extent that it all but spoiled me enjoyment of the 'present'. Often, remorse would overtake me if I drank an extra mug or two of beer and I would find meself thinkin' -- 'Tom Nolan, ye damned old fool, ye had better be savin' this money ye are squanderin' on beer and tuck it away so ye'll be havin' it in the 'future' when no doubt ye'll be needin' it worse than hell!'

"Yes, I would find meself thinkin' to meself like that and 'twould spoil the enjoyment of me beer... That was me 'man sense' workin'.

"But Jerry, now, with his 'horse sense' instead of 'man sense' like we have got -- Did he ever worry about th' 'future? He did not. When I put him in his stall at night, he knew he had earned what was comin' to him, and he knew also that he would get it and had no anxiety at all in his mind.

"He would go at his oats and his hay with a clear conscience and a good appetite -- with never a thought of losin' his job or his income or of anything else to upset his digestion and cause him remorsful dreams about what might happen to him in the 'future'...

"And when the 'future' came what happened to Jerry? He -- well, he, was a damned sight better off with never a minute lost in his life worrin' about the 'future' and which showed that he had good 'horse sense', that I was with all me damned worryin' about the 'future' of meself with me 'man sense' -- I'll be damned lads, if I understand it, or know which is better 'horse sense' or man sense, and so far I've found no one else who does understand it or know what its all about..."

Section: 

1939: Sailors' Snug Harbor, Staten Island, NY

Summary: Life in Sailor's Snug Harbor in 1938 as described by a writer in the Federal Writer's Project.

Text from: Library of Congress American Memory Collection

The interviews took place in an anteroom of Hospital Ward 2; on the hospital balcony; and at the bedside of Mr. Perry. The anteroom is unfurnished, except with chains in which sit a few of the inmates of the ward who are able to take recreation without assistance. A door leads to the balcony, which overlooks the beautiful grounds.

The Sailors' Snug Harbor, a home for aged and disabled mariners, stands on the north shore of Staten Island, New York. It is situated on the banks of the Kill Von Kull, a narrow channel connecting Newark Bay with the Upper Bay of New York Harbor. The grounds cover an area of one hundred acres, and are entirely enclosed. About sixty acres are laid out in lawns, flower beds, and shade trees. More than fifty buildings stand on this portion of estate, and represent expenditures of several millions of dollars. Eight main buildings, used as dormitories and mess halls, are connected by corridors of brick and stone, thus obviating the necessity of the Home's guests walking outside during inclement weather. The term [guests?] is used advisedly; for while this is a benevolent institution, it does not conform to the general conception of a place of charity. The old sailors are treated with due respect and receive every care and consideration. They are provided with all reasonable comforts. The rooms are bright and cheerful, and reflect that scrupulous neatness and cleanliness which is characteristic of seamen, ashore or afloat. Most of the sleeping-rooms have but two occupants. A generous table is maintained and food of excellent quality furnished; in testimony where of the unstinted praise of the residents themselves is heard by all who choose to mention the subject of cuisine.

Residents of this Institution are allowed the fullest liberty compatible with good order and their own peace and comfort. Subject to minor restrictions, they may go and come at their pleasure, between the hours of 7 a.m. and 9 p.m. Should a guest desire to remain away later than nine o'clock, or if he wishes to absent himself over night, or longer, he must anticipate his procedure and get special permission and a pass, which may be obtained almost for the asking.

Situated within its large acreage, the Home has its own bakery, dairy, storage warehouse, laundry, power plant, hospital and dispensary. A church, modelled after St. Pauls of London, and one-sixteenth the size of that famous cathedral, holds religious services on Sundays. There is also a chapel, where prayer-meetings are conducted on certain week-nights and where the members of the church choir meet to practice.

A commodious auditorium with a large seating capacity provides entertainment in the way of moving-pictures and occasional concerts. Many stage-plays have been presented here, too; and, incidentally, the old mariners still sing the praises of the W. P. A. Theatre Project and the histrionic ability of its members who, until recently, have been giving performances for their benefit. Much regret is expressed of the discontinuance of these shows.

A considerable part of the domain is under cultivation, and most of the vegetables consumed are grown upon this land. Cattle stables and piggeries are situated within the grounds. The animals actually are [bred?] upon the premises. Twenty pigs are slaughtered at a time, to supply the tables with fresh pork. The dairy, already mentioned, has its own machinery for pasteurizing the milk, all of which is furnished by the Institution's own cows.

A large staff of hired help includes farm hands, engineers, mechanics, carpenters, repair men, clerks, orderlies, laborers, butchers, stablemen and persons in various other capacities. The hospital staff includes a Superintendent and two resident physicians. A registered pharmacist has charge of the dispensary.

The local administration of this vast social enterprise is vested in a Governor who, with his family, occupies a beautiful residence, situated apart from but close to the main building, wherein he has his private office. The present incumbent is Captain W. F. Flynn, retired master mariner and courteous gentleman. Governor Flynn presides over the well-being of approximately seven hundred old mariners.

Sailors' Snug Harbor was founded by Robert Randall, Esq., of New York City, whose last will and testament - drawn by Alexander Hamilton, on June 1, 1801 - bequeathed almost his entire estate for the establishment and maintenance of a home for aged and disabled sailors. Mr. Randall's estate, a twenty acre farm, occupied the site of what now is valuable property in Manhattan. It lies between Fourth and Fifth Avenues, and Sixth and Tenth Streets.

The income from real estate on this rich property furnishes adequate funds for the up-keep and perpetuation of the imposing buildings which stand on the ground of The Sailors Snug Harbor, a monument to the benevolence, philanthropy and foresight of its distinguished founder. Although the will was made in 1801, litigation and other causes delayed the purchase of the site for the Home on Staten Island until thirty years later.

The first building was erected in 1831-32, and during the year following, fifty seamen were admitted to the Institution. Since that time, it has provided for nearly nine thousand sailors. It's present guests are ex-mariners of various ranks. Among them are a great many former masters of all type of vessels that sail the seas.

Section: 

1948-1968: Nursing Home Closures

Summary: An analysis that indicates that about 7,000 nursing homes may have closed from 1948-1968, while 13,000 new homes were opened.

At the same time that new nursing homes were being added, older facilities were closing down, particularly the small home-based or "mom and pop" operations. Because of these closures, comparisons of the number of total facilities at the beginning and end of any period understate the amount of new facilities that were being added.

There are really no statistics on how many facilities closed and opened, but we can draw some very general conclusions about the level of activity by combining data from a few sources. It is possible that about 3,000 nursing homes may have disappeared in the 1950's and about 4,000 additional facilities may have disappeared in the 1960's. If that is correct, the following table shows the high level of turnover that may have been taking place in the 1950's and 1960's:

  Beginning   Closed   Opened   Ending
TOTAL 9,000 -7,000 13,000 15,000
1950's 9,000 -3,100 4,000 9,900
1960's 9,900 -3,900 9,000 15,000

Rational and source of data:

A 1969 survey of facilities estimated there were about 18,000 facilities, 15,000 of which were "nursing care" or "personal care with nursing" facilities. In another report, the National Center for Health Statistics (NCHS) Monthly Vital Statistics Report (July 1972, Number 21, Volume 4) reported they had asked each of about 18,000 homes in a 1968 survey to indicate whether they had been in operation 10 years prior (in 1958) and 20 years prior (in 1948). That report found that 60% had been in business for 10 years or less, about 40% of them had been in business in 1958, and only 14% had been in business in 1948. That would seem to indicate that about 13,000 (86% of the 1969 total) were added in either the 1950's or 1960's, and about 9,000 (60% of the 1969 total) must have been added during the 1960's.

In its 1986 report on For-Profit Enterprise in Health Care, the Institute of Medicine (IOM) estimated that there were about 9,000 nursing homes in the country in 1950, and 9,900 in 1961.

Combining all this data, it appears that 3,000 nursing homes may have disappeared during the 1950's and another 4,000 may have disappeared during the 1960's.

Another indication that the high number of closures may be reasonable comes from Inpatient Health Facilities, As Reported from the 1971 MFI Survey (NCHS Series 14, Number 12), which determined that 1,445 nursing homes closed in only two years between 1967 and 1969.

If this is accurate, the increase of 900 nursing homes from 1950 to 1961 and 4,100 beds from 1961 to 1971 reported by the IOM may greatly understate the number of new facilities which were opening. Much of this information is estimated, and there is no way to be sure these numbers reference comparable facilities. Although this information is somewhat speculative, it is provided to illustrate the level of turnover that may have been occurring during this period.

Section: 

1948: Report of the Advisory Council on Social Security Concerning Care in Medical Institutions

Summary: Discusses eligibility for OAA payments in public institutions, Recommends expansion of program to pay for care in nursing homes.

The following text is an excerpt from a 1948 report of the Advisory Council on Social Security which resulted in major changes in the Social Security legislation in 1950. This excerpt explains why the Old Age Assistance program in 1935 excluded payments to individuals in public institutions, and recommended that OAA be expanded to be made available to public institutions that provide medical, rather than domiciliary, care. It also recommended expanding assistance payments to pay for care in nursing homes, and creating a system of state oversight of nursing homes.

Recommendation 4. Care of the Aged in Medical Institutions

The Federal Government should participate in payments made to or for the care of old-age-assistance recipients living in public medical institutions other than mental hospitals. Payments in excess of the regular $60 maximum made to recipients living in public or private institutions or made by the public-assistance agency directly to these institutions for the care of aged recipients should be included as a part of medical-care expenditures under recommendation 3, page 112**. To receive Federal funds to assist aged persons in medical institutions under either public or private auspices, a State should be required to establish and maintain adequate minimum standards for the facilities and for the care of persons living in these facilities. These standards should be subject to approval by the Social Security Administration.

Many recipients of old-age assistance suffer from chronic ailments and some of these conditions require prolonged treatment in medical institutions. Private institutions and commercial nursing homes with charges within the financial reach of recipients of old-age assistance do not have sufficient capacity to provide for all recipients need- in care in medical institutions. In some communities, public medical institutions could care for these aged persons if the Federal Government were to bear a share of the cost. Moreover, if Federal funds were available for this purpose, communities would be stimulated to develop additional facilities for the care of chronically ill persons and to improve the quality of care in such facilities.

Care for aged and chronically ill persons is a growing problem and in the opinion of the Council is a Federal concern. Today more than 350,000 recipients of old-age assistance are bedridden or are so infirm as to require considerable help in eating, dressing, and getting about indoors. Of them, about 50,000 are living in commercial boarding or nursing homes or private institutions. Some of these persons living in such homes or institutions are getting very unsatisfactory care. Of those living in their own homes or with others, many need prolonged treatment in medical institutions.

As the number of aged persons in the population grows, the number needing nursing-home and other services for the chronically ill will also rise. Since the passage of the original Social Security Act, the number of persons aged 65 and over has increased from about 8,000,000 to nearly 11,000,000. In another 25 years there will probably be almost twice as many aged persons in the United States as there are today.

Care of chronically ill persons in medical institutions is necessarily expensive. A needy person without ‘some additional resources can- not obtain satisfactory care with an assistance payment limited to $50 a month. In Connecticut in 1946, for example, the average cost of nursing-home care for the aged was $118 a month.

We believe, therefore, that the Federal Government should participate in monthly amounts in excess of $50 paid to old-age-assistance recipients living in medical institutions, including commercial nursing homes meeting prescribed standards, and should participate also in payments made by the State or local agency directly to such institutions for the care of aged recipients. Such expenditures should be classified as medical-care costs and should be included in the aver- age monthly maximum recommended for medical care in recommendation 3 (p.112).** Thus the Federal Government would share in individual payments beyond the regular maximum, but total Federal expenditures for medical care, including care of aged persons living in private or public medical institutions, would be limited to a monthly average of $6 per recipient for the program as a whole.

In writing the Social Security Act, Congress prohibited Federal participation in payments to persons living in public institutions. In so doing, it sought wisely, we believe, to discourage care of needy persons in almshouses. In many localities in the Nation, persons unable to support themselves previously had no choice but to go to the almshouse. We believe that it would be desirable to continue for the present to prohibit Federal sharing in assistance to recipients of old-age assistance in public domiciliary institutions. This recommendation therefore is limited to medical institutions. Although some States have developed public homes supplying a very high quality of care, there is still danger that in other States, Federal participation in the cost of domiciliary care would encourage the continuance or return of the almshouse. Safeguards should be imposed by statute and by regulations of the Social Security Administration to preclude the use of the old-fashioned “poor house ”for recipients of old-age assistance. Safeguards would also be needed to protect the rights of recipients to live where they choose, without pressure to live in institutions if they do not wish to do so.

At present the Social Security Act does not require States giving assistance to persons living in private institutions or nursing homes to establish any standards for the operation of such facilities. Some of the private institutions and nursing homes in which recipients are living offer a very poor quality of care and do not properly protect the health and safety of the recipients. We believe that, as a condition of eligibility for Federal funds, a State aiding needy aged persons in public and private medical institutions and commercial nursing homes should be required to have an authority or authorities that would establish and maintain adequate minimum standards for institutional facilities, and for the care of aged persons living in these facilities. The Social Security Administration should, before approving the standards established by a State, assure itself that the recipients of old-age assistance residing in private and public medical institutions and commercial nursing homes will receive adequate medical and nursing services and that their safety will be adequately protected. For institutions, both private and public, to be considered as medical institutions under this recommendation, the institutions should maintain and operate facilities for the diagnosis, treatment, or care of persons suffering from illness, injury, or deformity, and be devoted primarily to furnishing medical or nursing service.

It is estimated that the additional annual cost to the Federal Government under this recommendation would range from a low of $20,000,000 to a high of $32,000,000.These amounts have been included as part of the estimated cost for medical care under recommendation 3 (p.112).**

* The Federal Government now shares in money payments to aged individuals living in private institutions, but it does not share in aid to persons who are living in public institutions, unless they are receiving only temporary medical care. Persons in public mental hospitals would not generally be competent to handle their own payments and are therefore excluded from this recommendation.

** Author's note: "Recommendation 3 on page 112" was a general recommendation to provide medical care to recipients of Old Age Assistance.

Advisory Council on Social Security, Recommendations for Social Security Legislation: The Reports of the Advisory Council on Social Security to the Senate Committee on Finance. 80th Congress 2nd Session, Document NO. 208, 1948.

Section: 

1950-1970: Nursing Home Population and Costs

Summary: Statistics on nursing home usage and costs from 1950-1970.

Nursing Home Supply, Expenditures, and Utilization, Mid-Twentieth Century

The data in the following table comes from a variety of sources, and it's impossible to tell if all of them were referring to exactly the same facilities and residents, so it is imprecise. However, it probably is good enough to create a very general picture of nursing home utilization and expenditures in the mid-twentieth century. The explosion in utilization and costs that took place after FHA financial assistance for nursing home construction was made available in 1959 and again after Medicare and Medicaid were enacted in 1965 is obvious. Also note that the percentage of the cost borne by the federal government increased far more than that borne by state and local government.

U.S. Population 1950 1960 1970
Total population 151,000,000 179,000,000 203,000,000
Population age 65+ 12,300,000 16,500,000 20,000,000
Age 65+ / total population 8.1% 9.2% 9.8%
Nursing Home Supply and Utilization 1954 1963 1969
Number of nursing homes 9,000 13,100 15,300
Number of beds 260,000 507,500 879,000
Number of residents 260,000 470,000 793,000
Nursing home residents / 65+ population 2.1% 2.8% 3.9%
National Nursing Home Expenditures 1950 1963 1969
National spending on nursing homes (millions) $187 $1,055 $3,567
Expenditures per resident $700 $1,800 $5,300
Federal/State/Individual Share of Expenditures 1950 1963 1969
Federal direct payments for care 0% 18% 24%
State/local direct payments for care 10% 13% 14%
Non-government payments for care 
(includes government payments to individuals)
90% 69% 62%

Data Sources

As compared to the earlier table of the institutionalized population, this table now includes only "nursing homes" and excludes people in facilities for the mentally ill or those in custodial, or board and care homes. Data on the number of homes and residents comes from estimates made by the Institute of Medicine and Master Facility Inventories done by the National Center for Health Statistics (NCHS). Census data is from the U.S. Bureau of the Census. Current Population Reports, Special Studies, P23-190, 65+ in the United States. (U.S. Government Printing Office, Washington, DC, 1996).Nursing home expenditure data is from the IOM report and from National Health Expenditures tables posted on the web site of the Centers for Medicare and Medicaid Services.

Section: 

1950-1980: Nursing Home Fires

Summary: Hundreds of people died in multi-fatality nursing home fires.

Not surprisingly, with government financial spigots open wide and few restrictions on what nursing homes should look like or how they should operate, quality issues started to come to the forefront. Among other problems, the lack of standards and the old age of many of the converted buildings made nursing homes fire hazards. When they did burn, there were often many deaths because they were filled with frail elderly residents who were unable to get themselves out of danger. One of the most tragic events was a fire in a nursing home in Warrenton, Missouri o