IV. (3)

I now wish to advert to a subject which has not, I think, received the attention it deserves. I refer to the tendency of medical charities and the poor-law medical service to nourish the spirit of pauperism. Considerable indignation has been occasioned by the neglect of sick paupers which has occurred in some parishes, and there is a movement for a general and uniform improvement in the medical treatment of paupers. Everyone must hold in the highest estimation men who, like the author of “Social Duties,” devote the highest talents to a work of this kind; and few who have read this work could have failed to acquiesce in the humane views put forth. Yet I think we must take care lest in yielding to the impulses of humanity we do more harm than good. I fear we may make the Union hospital so easy of access, and so attractive, that it may lead half-way to the Poor-house itself. Whenever I see the admirable infirmary built at Withington by our member Mr. Worthington, and described in our Transactions, this is the thought which suggests itself. But I feel bound to go further, and call in question the policy of the whole of our medical charities, including all free public infirmaries, dispensaries, hospitals, and a large part of the vast amount of private charity. What I mean is, that the whole of these charities nourish in the poorest classes a contented sense of dependence on the richer classes for those ordinary requirements of life which they ought to be led to provide for themselves. Medical assistance is probably the least objectionable of all the forms of charity, but it nevertheless may be objectionable. There is nothing more sure than that a certain percentage of any population will be suffering at every moment from illness or disease. It is almost certain that every man, woman, and child will require some medical treatment, and no family is really in a solvent condition which is not prepared to meet the average expenditure for this purpose. Every hospital and free dispensary tends to relax the habits of providence, which ought to be most carefully cultivated, and which cannot be better urged than with regard to the contingency of sickness. The Times not long ago published some very remarkable and complete statistics, compiled by Mr. Hicks, showing that the annual revenue of the established charities of London alone amounted to more than two millions a year. I fear that not only is a large part of this wasted in the excessive costs of management, but that a further large portion really goes to undermine the most valuable qualities of self-reliance, and so form a bribe towards the habits of mendicancy and pauperism. About forty years ago it be came apparent to the statesmen of that day that the Poor Laws, as then administered, were doing immense injury by allowing a distribution of public money in aid of wages, and encouraging every one to rely upon the public funds for subsistence. I fear we are in danger of falling into a similar mistake now by placing upon the ratepayers or upon charitable persons the whole cost of the medical service of the poorer classes. There is really no reason why such a state of things should exist, and many why it should not exist. At present the result of almost all charitable efforts is to make the poor look upon assistance as a right and natural thing in every contingency of life. If they merely want a little medicine there is a free dispensary; if they have a bad eye or ear, there are appropriate institutions; if anyone is in weak health he seeks a free order of admission to a Southport or a Buxton Hospital; and when the most natural possible crisis in a poor woman's life approaches, she looks forward to the aid of St. Mary's Hospital. Now, I ask, why should the poorer classes be thus encouraged and instructed to look to the wealthier classes for aid in some of the commonest requirements of life? If they were absolutely unable to provide for themselves the reason would be a strong and intelligible one, but I do not believe that the people are really in such a hopeless state of poverty. On the contrary, the wages of the greater part of the working-classes, and in these districts almost the whole, are probably capable, if wisely expended, of meeting the ordinary evils and contingencies of life, and were providence in small matters the rule, the most unhesitating aid might properly be given in the more unforeseen and severe accidents and cases of destitution.

But there is little use in bewailing an evil unless some mode of remedying it can be found. There is not much difficulty in discovering the only remedy applicable to medical charities. No one can seriously think of abolishing those charities; but why should not the working-classes be required to contribute towards institutions mainly established for their benefit. Self-supporting dispensaries exist in many places which afford all requisite aid to any person subscribing some such small amount as 1d. or 2d. each per week. I have heard that some of the London hospitals have considered the idea of adopting this system, and refusing aid in all minor cases but to their own subscribers. It would not be necessary to render the hospitals self-supporting. Endowments and public contributions would usually enable every hospital or dispensary to give back in medical aid several times the value of what is given in small contributions. The object would be not so much to raise money as to avoid undermining the prudent habits of the people. Non-contributors might still be relieved, but only on the payment of a fine; and, of course, cases of severe accident, illness, or destitution would still be relieved gratuitously as at present.

We cannot be supposed yet to have reached a point at which the public or private charity of one class towards another can be dispensed with, but I do think we ought to look towards such a state of things. True progress will tend to render every class self-reliant and independent. Self-help is the truest kind of help, and you confer the greatest benefit upon a person or a class of persons when you enable and induce them to do without your aid for the future. Money spent in the education of the young has this beneficent effect. Money spent in most other modes of charity has generally the opposite effect. Hence, I venture to look upon £1 spent in the education of the young as worth £50 spent in most other charitable uses.

I am hardly likely to overlook or underestimate the mistakes committed by Trades Unions, but can we deny that they embody the true spirit of self-help? So far as their funds are spent upon the relief of sickness, the support of those who are bonâ fide out of employment, or crippled by accident, they represent the truest form of providence, and they are already one of the bulwarks against the flood of pauperism. I do not despair of the time when these societies will understand the harmful and hopeless nature of their struggle against capital, and when that day comes, and working-men devote themselves to the accumulation of capital and the employment of it for their own benefit, a new and more hopeful order of things will not be far distant.

Having ventured to speak against the abuse of medical charities, I think I need not spare my remarks upon an innumerable multitude of other charities which have nothing to recommend them. I allude to the small doles of money and bread, coals and blankets, and other articles, which, in almost every parish in England, are given out chiefly through the hands of the clergy at intervals, according to the benevolent but mistaken intentions of testators. In Manchester I have seen the Cathedral entirely filled by an indiscriminate crowd of poor persons, each summoned to receive a blanket or coverlet. Every one, of course, must know that a certain amount of physical comfort may thus be caused; but what is this to the demoralising effect of such casual charity upon the energy and prudent habits of the recipients? I do not hesitate to say that such charities are an unmitigated nuisance, and that the money is not merely thrown away but used to do harm. It would accordingly be a most salutary measure to divert a considerable part of these misused funds to the promotion of education. Such funds are really public and not private funds, and when the State recognises in the Poor Law an indefeasible right of every person to maintenance under certain most necessary conditions, and spends a huge annual sum of money in consequence, it has a perfect right and duty to inquire into the application of other public funds which really go to swell the crowd of paupers.

The British Poor Law of 1832 is one of the wisest measures ever concerted by any government, and we of this generation hardly appreciate what it has saved us from. But I much fear lest any mistaken feelings of humanity should lead us to relax the rigour of its application, and to allow it in one way or other to be circumvented and counteracted. Should this be so, then, I say that British pauperism is simply a hopeless and permanent, and probably an increasing reproach to the civilisation of this country. Doubtless the state of things is somewhat better than it was before 1832; but, considering the nature of the reforms since effected, the amount of the wealth acquired, and the general amelioration in the other ranks of society, I venture to say that the improvement in the numbers and prospects of the poorest class who are or may become paupers, is really inconsiderable. And I shudder to think what might be the effect of any serious impediment to our future progress, such as a long-continued war, the competition of other nations, or a comparative failure of our own material resources.