peated till the last vestige of a domicile was lost; while the raids on the treasury were made so recklessly that the gift of a peck of meal and a pair of shoes was made the basis of claim for the support of a large family for an entire winter; that the names of the dead were returned, as recipients of aid, by the score at once; and, in one instance, the whole population of a small manufacturing village was registered as paupers.

The consequence of all this was neglect, filth, ignorance, illegitimacy, and complete demoralization. Still it was the "old way," and there was great reluctance to depart from it. Nor was it till the misfortunes of Ireland threw upon our shores and upon our charity multitudes of starved and fever-stricken victims, that the frightened towns began to clamor for a change of policy. This resulted in the erection of four large State establishments for the reception and support of non-settled paupers, which were opened in 1854; thus introducing the second period of eleven years, terminating in 1865, during which local aid from the Commonwealth was cut off, and relief was granted to the non-settled poor only in the State institutions. At the same time stringent laws were passed for the removal of indigent strangers to their homes without the State.

In two respects the new policy wrought a great gain, for by efficient administration the number of dependants was reduced one half, and "repeaters" were detected and restrained. But very shortly a most serious difficulty appeared, which could not be disregarded. As the law compelled the towns to maintain all nonsettled paupers not sent to the State establishments, and as the cost of relieving the sick was likely to be large, the local overseers availed themselves in full of their almost unrestricted power of commitment. The sick were taken from their beds, or carried on their beds, many miles to the State almshouses. Some of them died on the way; others in the entries and stairways, before they could reach the hospital wards; many received such a shock as to destroy their last chance for life; and the rest endured great inconvenience and pain of body and mind most detrimental to recovery. Besides, contagion was thus disseminated through the community, and, introduced into institutions containing from five hundred to a thousand inmates, destroyed many innocent lives. At last the public became indignant at this inhumanity; the legislature was appealed to, and an act was passed in 1865 forbidding the towns, under penalty, to send to the State almshouses "any person ill of

contagious disease, or any other sick person whose health would be endangered by removal." All such patients were to be retained and provided for by the towns, under the direct supervision of the State, and a reimbursement was to be made by the latter to the former, proportioned to the reasonable expenses of each case. The administration of this law, with others additional to it, was intrusted to the Board of State Charities, who were empowered to appoint a special agent to execute it. Thus was inaugurated the present policy of local relief with State supervision, which has marked the third period from 1865 to 1878.

In the saving or prolonging of life by greater care and less exposure of the sick;

In the availing of the contributions and the healing sympathy of relatives, friends, and neighbors, and of the very many who feel that "it is more blessed to give than to receive;"

In maintaining the family relation, and the ties of a permanent home;

In continuing the children in the public schools;

In keeping up the self-respect of the household;

In utilizing the productive power even of those who can earn but a little;

In retaining labor where it belongs, and in enabling the workman to resume production as soon as his disability has passed by; In saving the sufferer from the torture of separation from all he loves, or the family (if, as is often necessary, they should be forced to accompany him) from the inevitable demoralization of an almshouse life.

(2) A more selfish economy, manifest,

In obtaining better results for half the money;

In shortening by quite one-half the period of non-production ; In reducing or closing a part of the State's pauper establishments, and in avoiding the erection, equipment, and maintenance of at least two more institutions.

(3) The prevention of the spread of small-pox and dangerous contagious diseases, by shutting them out from the institutions, and checking them locally by personal presence, advice, and effort.

(4) The detection of impostors who are shamming sickness, and the summary putting-down of "dead-beats," who, under this

system, administered alike all over the State by experienced officers, cannot obtain in another town what they have been refused already in one.

(5) The instruction of the overseers in their legal duties, and in the methods of dealing humanely and economically with the poor; thus saving to the towns a heavy annual outlay and much needless litigation, diminishing very considerably the actual number of paupers, and checking pauperization from injudicious almsgiving.

(6) The proper distribution of the public burdens, by fixing the legal settlements of those who have one, and causing "kindred of ability" to provide for their own.

(7) And, finally, a careful scrutiny of all the bills, in every case, by the medical officers who have supervised that case, cutting off all improper expenditure, and by so doing preventing such outlays by the towns in the future, as well as effectively guarding the State treasury from illegal or unnecessary drafts.

3. Its Methods.

These at least have the merit of simplicity. Whenever an overseer of the poor of any town is called upon to relieve a sick State pauper, he must at once mail to the Board of State Charities a written notice stating the fact, and giving the name and residence of the patient, with the alleged disease. He then provides medical attendance, if required, and other necessaries, according to his judgment, modified only by such directions as he may receive from the State Board; and, when the case is closed, he must send his account to that Board for audit and allowance. Here his duties end. On receipt of the notice, the Board details a competent officer, of medical education and experience if possible, to examine the patient,

1st, Physically, to see if the illness is real or pretended, serious or trivial; if he can bear removal to a State almshouse or not; and, if so, whether, on the whole, he should go or stay; if he is properly treated, or wretchedly quacked; if he has enough, under the circumstances, for his comfort, or is unduly pampered or cruelly pinched. He is also instructed to note carefully the habits of the family as to cleanliness, thrift, and sobriety, and the sanitary condition of the premises and the vicinity.

2d, In his social relations, to learn what his family, relatives, and friends can or will do for him; what savings may have been

If

accumulated, and perhaps secreted; whether he has "kindred of ability," who are liable in law for his maintenance; and to draw out the whole history of the family, so far as it will throw any light upon his malady or its treatment, or upon the chance of bettering his condition. The number and age of the children, living and dead, are ascertained and recorded; and also the amount, description, and time of aid received from the overseers or other sources. he has been a pauper before, the dates and places are recorded. 3d, In his civil relations, to ascertain his places of residence, taxation, military service, and all other facts tending to show whether he has or has not a legal settlement in some city or town in the State. If so, that town is notified, and the State's liability ceases. In short, while all needless and impertinent prying into private affairs is peremptorily forbidden, the examination in each case is meant to be exhaustive, not only in view of the immediate occasion, but of possible prospective cases from the same family or its connections.

Though this may seem a formidable programme, our bright and experienced officers gather all the essential facts in a very brief time. They are, in most cases, only "the short and simple annals of the poor." The reports are returned to the office of the Board, and carefully studied; a decision is speedily reached, and the basis fixed for the audit of the claims. They are placed on permanent record, and greatly diminish the labor, should the same parties apply again.

In one respect, this visitation is of the utmost importance. The mass of the State poor is found in the lowest class of society. Many of them are strangers, and unacclimated. Ill fed and clad, and worse lodged, with diminished vitality, with no ambition and little hope, they offer but slight resistance to disease. The stern law of hereditary descent is not baffled here, but acquires augmented sway as it passes down their generations. Few of them suffer from the maladies incident to corroding care, or the wear and tear of business. Filth, foul air, cold, and starvation are their foes; and, per contra, soap and water, open windows, a good fire, and nutritious food are their essential needs. I have just examined the record of 2,000 cases occurring among this class in 1877, and find that 1,184 were due to miasmatic and zymotic diseases, and to insufficient or imperfect nutrition (the last class leading by several hundred); 279 directly to exposure; 161 to rheumatism; 205 to accidents; and 121 to diseases of the heart,

spine, and brain, many of which were doubtless caused by rum and tobacco. The records of thirteen years tell the same story.

Now, if these poor creatures could always have the benefit of the intelligence and skill of the honorable medical men of Massachusetts, the interposition of the State would be less necessary; but they are too apt to fall into the hands of the charlatans, who hang around the skirts of the profession, or of the routine "doctor," who doses from habit, and the more energetically as he catches a glimpse of the town treasury. His attenuated victim, just trembling on the verge of life, lying torpid in the odors of his own foul excretions, is purged, blistered, and narcotized, secundum artem, while the rest of the family are getting ready for the same process. It is just here that we venture to discard the doctor for the more harmless butcher, and to supplant the druggist with the milkman. Pure air and cleanliness, with a cheering fire, abundance of milk and beef-tea, and substantial oatmeal, with hearty words of encouragement, in a wonderfully short time restore the patient, re-invigorate the family, and relieve the overseer. The man was sick only in the sense that he was drugged, poisoned, and starved. We have spoiled much physic in these thirteen years. This may not be strictly "scientific," but it is agreeable to common sense, and very agreeable to the patient. Of course we do not interfere in every case, nor in any case where a competent and responsible physician is in charge; but when the exigency appears, we do not hesitate to take the responsibility, and are rewarded by the continuance of life, the shortening of the disability, and a surprising shrinkage of the bills. One thing more must be added. In case small-pox should suddenly break out in a small country town, or in any community where there is not a competent or efficient board of health, our officers are ready to start at an hour's notice, with the best quality of vaccine-virus, and lend their advice and personal assistance in suppressing it. With existing arrangements, it seems quite impossible that the fatal experience of 1872-73 can be repeated, when more than one thousand deaths from small-pox occurred in Boston alone, and twice that number in Massachusetts.

4. Its Results.

The limits of this paper compel us to state results generally, though I should be glad to corroborate them with tables, analyses, and comparisons.

First, we find an unlooked-for and remarkable reduction of ex