door relief is disbursed through the city infirmary, that institution should become an adjunct to the Cincinnati Hospital, which is certainly one of the best-managed institutions in the country. In the rural districts, the difficulty in medical relief, according to my observation, lies exactly in the line of Gen. Brinkerhoff's remarks. Excessive bills have been rendered. When the physicians had the law on their side, the patients were taken with terribly serious and lingering sicknesses.

DR. P. S. CONNER (of Cincinnati). - I had not intended to say any thing upon this subject to-night. The evils connected with the gratuitous care of the sick exist here as elsewhere, but not to the same extent as in some of our Eastern cities, for the numbers dealt with are much smaller. Of the more than 550,000 dispensary-patients treated in the year 1876 in the cities of Boston, New York, Philadelphia, Baltimore, St. Louis, Chicago, and Cincinnati, more than three-fourths were in Boston, New York, and Philadelphia, the number relative to population being greater in Boston than anywhere else; two out of every seven, apparently, of the entire population of that city, having received gratuitous medical advice and medicine. Of course I know and appreciate the fallacy that exists in thus using the figures we have, fully recognizing the fact that the same individual may and does often apply for relief at different dispensaries and different departments of the same dispensary; thus being counted as so many different persons, and swelling the sum total of applicants relieved. But this is just as true of the other cities named as of Boston, and consequently does not vitiate the correctness of the comparison made between the cities. I am sure, as every one is who has looked into the matter, that a considerable proportion of those treated at public dispensaries are not proper subjects of charity. I took occasion last winter to ascertain, as far as possible, the social status of 96 patients applying for relief in two days at one of our dispensaries here. Of the whole number, more than 60 per cent either gave fictitious places of residence, or were abundantly able to pay for advice and drugs. Among the given places of residence were the Gibson House, wholesale business houses, three-story stone fronts, and in one case a doctor's office. I am sure that it was not the doctor who applied.

The fault does not lie entirely with the community, but also somewhat with ourselves, the medical profession. There is no question in my mind but what the evil is much greater in the East

than in the West; but it is becoming much greater here than it was. My own belief is that the question of medical charities needs a thorough overhauling. I think the State ought to take hold of the matter. There is no more reason why it should be left to private benevolence than why individuals should take care of any other charity. Of course this is rather an Utopian scheme, but I think we will ultimately have to come to it.

MR. SANBORN.—A report made within the last few weeks to the city government of Boston takes up the consideration of the matter referred to by Dr. Conner, at some length, and I think Mr. G. S. Hale, the gentleman who made this report, is the same who made the report from which Dr. Conner drew his Boston figures. These patients, many of them, are counted over two or three times. They wander to different dispensaries and are counted at each one. Then the public supervision is not strict enough. A few years since some benevolent persons left a large sum of money to found a city hospital. The city assumed the burden of the hospital, with the aid of what this bequest provided. Every thing pertaining to the hospital is excellent, except that they have not stopped the gaps where an abuse of medical charity comes in. Persons are received and treated in its liberal and costly manner, who might just as well pay for themselves or else be treated as paupers, and some of whom are in fact treated as paupers when they go out. There are paupers being treated as patients in this hospital, who as soon as they come out immediately go to the city almshouse. The city has not closely enough looked after this, in the opinion of Mr. Hale.

The paupers should not be allowed to use a large hospital, which was particularly established for another class of persons. We propose to remedy this in Massachusetts, by extending the authority of the city over every public charity in the city, and the authority of the State over every public charity in the State.

MR. HENRY W. LORD. - I do not think we can get along with either in-door or out-door relief alone, exclusive of the other, as some persons have proposed. In Michigan we have, of necessity, a good deal of out-door relief in counties where in-door relief is not possible, because there are no public institutions for in-door relief. Suppose, for instance, a mining establishment fails in the northern peninsula of the State: there are several hundred men thrown out of employment, and some poverty results which requires immediate out-door relief. So in many other cases in which

the necessity is only temporary; for instance, a fisherman is drowned, or a man is killed in a mine, and his family thrown into distress and want, and there is no poor-house perhaps within 75 miles. In these cases relief must be afforded at once, and it must, from the nature of the circumstances, be out-door relief.

I have been connected with a good deal of that kind of work, and I believe there is not one of the directors of such charities but what will tell you of frequent cases in which he has discovered that applicants for such relief had no shadow of a claim to out-door relief; but in the vast majority of cases the persons applying for it, in the rural districts, are entitled to it, tramps excepted; so that I don't think, so far as the rural districts of Michigan are concerned, the abuse occurs to a sufficient extent to require particular attention from the State authorities.

PROFESSOR WAYLAND. -This question assumes most importance in cities, where the distress is greatest and the number of paupers largest. I think it is the opinion in this country at least, of those who have given their attention most intelligently to the subject, that out-door relief should be afforded through the medium of voluntary organizations without any official aid whatever. Out-door relief is assistance given to persons whose need, from the very nature of the case, is temporary. If the circumstances of the applicant indicate permanent disability to support the family, it is a case requiring permanent relief which must be in-doors, in other words, in the almshouse. Temporary relief, as I have said, can be most wisely and humanely afforded by voluntary effort, disbursing funds raised by voluntary contributions. Take an example which has fallen under my own observation. In New Haven we have an organization which has been in existence nearly thirty years. The needed funds are annually contributed by benevolent citizens; the same visitors perform their arduous and gratuitous labors year after year. The deserving poor are promptly and adequately assisted, no genuine appeal is ever disregarded, and yet more than once the end of the year has disclosed a balance in the treasury.

Official aid sooner or later degenerates into personal favoritism or outright corruption. The designing and persistent applicant, however unworthy, receives the largest proportion of assistance, and the timid or easily discouraged pauper is thrust aside. Besides, this kind of relief lacks the element of personal interest, and, worse than all, is usually accepted by the applicant as some

thing to which he is entitled as of right. Official aid, if too scantily bestowed, leads to great and undeserved suffering; if too generously or carelessly given, it crowds the town or city with a horde of indolent vagabonds.

MR. ROBINSON.-The Board of Charities of our State (Illinois) is collecting statistics with regard to the amount that was expended in the several counties for out-door and in-door relief. We find that in several counties more was expended for out-door than for in-door relief. That there are abuses in some counties and cities, we are very well satisfied. So far as the rural districts are concerned, I think such is not the case. Out-door relief in many instances prevents persons from becoming permanent paupers. I think with Mr. Lord that we cannot get along in rural counties without out-door relief. It is true that physicians' bills are sometimes exorbitant, but the supervisors have the right to cut them down to a reasonable fee.

MORNING SESSION.

WEDNESDAY, MAY 22, 1878.

The Conference met at 10 A.M., in the College Hall on Walnut Street, the rooms at the Music Hall having been found inconvenient. The chair was taken by Dr. Kenyon of Rhode Island, and the first paper read was that part of Dr. Allen's paper on "The Prevention of Disease, Insanity, Pauperism and Crime," which related specially to Insanity. This is as follows:

:

THE PREVENTION OF DISEASE AND INSANITY.

BY NATHAN ALLEN, M.D., OF LOWELL, MASS.

Upon a subject so large and important as the above title indicates, only a few brief suggestions can be made in a short essay. The topics mentioned cover the whole ground of public charity, and involve the most essential agencies in its administration. No community or people can be found so advanced in civilization, or so perfect in morals, as to be free from these terrible evils; and, notwithstanding the immense labor bestowed and expense incurred to check or prevent them, still as a whole they seem to increase, certainly in some directions. The agencies employed to check them

do not appear very successful, nor do the ends attained correspond to the amount of labor and expense which have been put forth.

In all attempts at reform, or for the removal of great evils, it is the dictate of wisdom to select those agencies which are most likely to bring about the greatest results with the least labor or sacrifice of means; in other words, to nip the evil in the bud, or to dig up and destroy its roots, rather than to lop off only its branches. A great amount of time, labor, and cost are consumed in dealing with the effects of evils, without reducing or removing their chief sources or primary causes. Thus, in the history of disease and insanity, while there has been an immense expenditure of labor and means to cure these evils, little comparatively has been done to prevent them. The same holds true in respect to crime and pauperism.

No truth in history is more self-evident, than that if we would remove evils, whatever may be their nature, their primary causes must first receive attention. And, in order to do this successfully, their origin, or roots, must be made our careful study, and be exposed and set before the public in such a variety of ways that proper means will be employed to eradicate them. The greater the evil, and the more destructive its influence, the more important is its removal. Having had occasion for many years to visit, in an official capacity, almshouses, prisons, and lunatic-hospitals, I have been profoundly impressed not only with the magnitude of the evils which they present, but with the conviction that there is great need of reforms, which reforms may be indicated under the following heads:

1. — Prevention of Disease.

Nowhere, perhaps, can we find better illustration of these principles than in the history and treatment of diseases. Once they were thought to be some distinct entities, some evil spirits, or mysterious agencies, affecting the human body; and, to expel or subdue them, resort must be had to the art of divination, appeals to supernatural or divine power, or the application of some strange artificial means or mysterious medication. As the structure and laws of the human system became better understood, in the sixteenth and seventeenth centuries, these delusions began to disappear, and more correct views of disease to be entertained.

By discoveries in anatomy and physiology, by the use of the microscope and the application of chemical science, by careful