In treating a condition which has been allowed to exist for many years almost without challenge from the local authorities, and which has grown upon the passive or indifferent attitude of the public, sweeping and immediate reforms can be instituted only at the cost of serious temporary injury to certain charitable work of a necessary character. I believe that the best results will be obtained if the city authorities first decide clearly the relations to be established between the city treasury and private charitable institutions, and then move toward that end by gradually conforming the appropriations in the budget to that idea, in such a manner that progress shall be made as rapidly as may be consistent with the desire to avoid crippling excellent charities which have been led to depend for many years upon public assistance. By this, of course, I do not mean to suggest that we should approach the subject with excessive timidity, for the evils that exist have assumed such proportions that a more or less severe use of the pruning knife must be made in dealing with appropriations, else the effect will be scarcely perceptible. I am convinced that ultimately the cause of charity will benefit rather than suffer from this course, for it is a serious objection to the whole subsidy system that it tends to dry up the sources of private benevolence.
In making up the budget for 1900 I shall urge my associates in the Board of Estimate to agree with me to limit the appropriations for charity to actual relief work accomplished. The giving of public money in lump sums to private societies and institutions for miscellaneous charitable work, of which there is no public or official inspection, should be discontinued at once. It has been the practice for some years past, both in Brooklyn and New York, to donate annually lump sums of money to such organizations. In New York these amounts have been for the most part comparatively small, and principally derived from the Theatrical and Concert-License Fund. In Brooklyn the amounts have been larger, and were obtained originally from the Excise Fund, and later directly from the budget. This practice should be wholly discontinued. The charter itself contains stringent prohibitions against the distribution of outdoor relief by the Department of Public Charities, and the spirit of these provisions would certainly seem to disfavor accomplishing the same result in an indirect manner. Many of these recipients of public funds devote themselves exclusively to outdoor relief, and an examination of the purposes of some of these organizations shows that, however proper these may be as the result of private benevolence, they are extremely improper objects of the public bounty. The immediate and permanent discontinuance of appropriations to all such societies and institutions will correct one of the gravest abuses of the present system. If the persons conducting these miscellaneous charities are really sincere, and believe that they are doing good, they can readily obtain from private sources the funds necessary to carry on the work.
I shall urge that all appropriations to institutions of every kind not controlled by the city be limited to per-capita payment for the support of public charges, and that a system of thorough inspection be at once established to ascertain if present and future inmates are really persons entitled to maintenance at public expense. In addition to this precaution, the comptroller should have full power to withhold payments to any institution after an appropriation has been made if in his judgment, after examination, the money has not been earned. The payment of city money to dispensaries should be discontinued, except in special cases where the work done is clearly a proper charge against the public treasury. No money should be paid for the treatment of dependent persons in any private hospital while there is unoccupied room in the city hospitals.
The city maintains its own hospitals, while at the same time subsidizing private institutions which compete with them. During the last few years great improvements have been made in the city hospitals, but their condition is still capable of considerable further improvement. While sometimes overcrowded, it frequently happens that the city hospitals are not filled to the limits of their capacity, and it would seem as though the city should not deal with private hospitals except as subsidiary aids or adjuncts to the public institutions. It stands to reason that so long as there are vacant beds in the city hospitals and the city is at the same time subsidizing private hospitals at a cost greater than the expense of caring for patients in its own institutions, a wrong is being done to the taxpayers. If private hospitals are to receive public assistance at all, payments should be made only at some uniform rate, approximately the same as the cost per capita of maintenance in the public institutions.
The gravest problem of public charity is the support and training of dependent children, because that has to do with the making of future citizens of the republic as well as the relief of immediate suffering. This work is entirely in the hands of private societies and institutions. The rearing of large numbers of children in either private or public institutions is in itself an evil—a necessary evil—and likely to continue as long as there is extreme poverty, but still an evil, and not to be fostered by subventions of public money in unnecessary cases, when parents are really able to provide for their support.
To build, equip, and maintain public buildings for the care of dependent children seems to me entirely impracticable. Regardless of the matter of expense, which would be enormous, all the disadvantages of the "institutional system" would continue, and it is not likely that public employees could be obtained who would rear children as economically, as efficaciously, or with the same devotion and self-denial as is the case with the religious orders and associations now performing this work—in many respects so successfully. The care of these children by direct governmental agencies being therefore practically impossible, in the city of New York at least, and it being recognized that the present system is likely to continue for many years, if not permanently, the most should be made of it. With the religious training of children the city has nothing to do. Their moral training may also be left safely to those now responsible therefor. On the other hand, the State is vitally concerned with their mental and physical development, and visitation and control for the purpose of maintaining a proper standard in these respects is essential. This form of public charity, like many others, has been abused, and many children are now supported in institutions who probably should not be there. For the rearing of a child into a possible useful man or woman a poor home is better than a good institution, and it is the duty of the city authorities to extend the work of inspection and investigation of such cases until they make it impossible for fraud in the commitment and retention of children to escape detection.
The reduction and regulation of appropriations as outlined can not be classed as a radical reform, and will work no hardship upon any dependent person who is a proper charge upon the city. The saving to the taxpayers, if the plan I have suggested is adopted, will approximate one million dollars in 1900, and a steady reduction of expenditures for charitable work should continue for several years to come.
CHRISTIAN SCIENCE FROM A PHYSICIAN'S POINT OF VIEW.
By JOHN B. HUBER, A. M., M. D.