is the school of industry, that believes in setting every one to work. One believes in repose and self-denial, and produces the better individual men, noble examples of consecration to ideas. The other produces the better state of society. To which should we belong? Let me be enrolled in the school of industry.

A recent French writer in philosophy, M. Tarde, has brought out the fact that one of the greatest forces in the world is that of imitation. His book is on the "Law of Imitation." He tries to show how the great movements of men have gone forward under this influence. Is not imitation what we commend in our efforts among the poor? Must we not get them to imitate the industry, temperance, thrift, of those who are above them? May we not more and more make good use of this law of imitation? Shall we not bring good examples before those whom we are trying to influence?

I went last evening to the great exhibition of the devices of electricity in Madison Square Garden. It was filled with thousands of people who were seeing processes and instruments absolutely unknown ten or fifteen years ago. No one can go there and reflect without being conscious that beyond these ingenious appliances there is something mysterious and unknown. What is that electricity? Can you tell me? Can any one? Yet we are conscious that here is something pervading the world which we are able to control and apply, but which we do not understand. Is not that paralleled by the state of society at the present time? Is there not some force outside of the individual, outside any leader, any school? Is there not some force at work which we are all conscious of? Some would say it is the spirit of the age, of the times, vox populi, vox Der. Some would say it is the still small voice of Jahveh, some that it is the Zeitgeist. But every one must recognize that there is a Power leading us forward which we cannot divine, a Power perpetually making for the improvement of mankind and the extension of universal brotherhood.

That is the lesson of history. Without knowing why or how, we and thousands more, in this and other lands, are struggling hard to overcome our foes,- infirmity, sloth, appetite, and ignorance,by legislation, by investigation, by sanitation, by co-operation, and by association, in the hope that some time or other victory will be ours. Great results have proceeded and will follow from the aggregated influences of those who are thus toiling for peace on earth, good will to man.

XV.

Minutes and Discussions.

SECRETARY'S REPORT.

FIRST SESSION.

Wednesday night, May 18, 1898.

[For full report of first session, see Introduction.]

SECOND SESSION.

Thursday morning, May 19.

The Conference was called to order at 10 A.M. by the President, Hon. William Rhinelander Stewart, who read the annual President's address. Subject, "The Duty of the State to the Dependent and the Erring.".

The General Secretary, Rev. H. H. Hart, called the attention of the Conference to the rule ordering the appointment of the Committee on Time and Place, and asked the different delegations to select one member from each State to make that committee.

The subject for the morning was the report of the Committee on the Use and Abuse of Medical Charities, Dr. Stephen Smith, chairman.

The report of the committee was read by Dr. Smith (page 320). A paper on "The Use and Abuse of Medical Charities in their Relation to Medical Education" was read by Professor Austin Flint, M.D. (page 328).

An address was made by Rev. Dr. David H. Greer, rector of St. Bartholomew's Church, New York, on "The Use and Abuse of Medical Charities in their Relation to Religious Societies and Churches" (page 332).

ABSTRACT OF REMARKS BY WICKES WASHBURN, M.D., NEW YORK.

It has been claimed that the first dispensary was started by a Christian; but it must not be forgotten that the sick poor were taken to the portals of the temples, and Esculapius ministered to their wants long before the Christian era.

True charity is a legitimate offspring of Christianity; but indiscriminate charity is not true charity, as every one who has studied charity from a scientific standpoint will admit. And nothing which is not true can be Christian. It is well known that churches, next to hospitals and dispensaries, are the worst offenders in causing pauperism; and, as pauperism causes crime, so the churches in many cases defeat their own ends. Why should the churches themselves see to it that the patient takes up his bed and walks? That this is not necessary is proven by the fact that there are five thousand vacant hospital beds in the city of New York to-day. We give those who conduct them full credit for believing that the investigations as now conducted are effective, whereas they are in reality the cause of mirth, even among those interrogated; for we cannot bring ourselves to call it investigation at all. If the list of alleged investigated cases were submitted to the Charity Organization for review, or, better still, to put for one month the investigation into the hands of that society, which can be done by paying for it, I am sure error would be found. I am the more confident of this error from the fact that in the Charity Organization Society it is found necessary to supply sufficient investigators so that five cases per day are investigated by two investigators. This same kind of investigation would leave about three-quarters of the cases under Dr. Greer's care untouched; or, in other words, his investigators make about one-quarter of an investigation in each case. No wonder they find unworthy only five out of a thousand, while we find five hundred to every one thousand. The amount found by him bears a remarkable proportion to the amount found by our investigators, when we remember that only one-quarter of an investigation is really made.

All admit the abuses. Few have traced them, however, to their logical conclusions. It has been stated by eminent authorities in Europe and this country as well that indiscriminate medical relief is the entering wedge to pauperism. Let us look back to the appropriations and expenditures in this city in 1830, and compare them with those of the present day. The expenditures for all charities in New York City in 1830 was $129,021.66 (of which $4,000 was for dispensaries). The population of the city at that time was 202,589, about 64 cents per capita per year. Expenditures for all charities in the city in 1897 would on that same basis have been $866,792. The actual expenditure was, however, $3,538,071.85.

As the population, according to the last census was 1,515,301, a

little computation will show that between $2 and $3 per capita was spent per year, or about four times as much as in former times. Let us see if there is anything in the manner of distribution of relief to the poor which will in any manner account for this enormous increase; and bear in mind that these figures do not take into consideration the moneys spent by the private and semi-private institutions then or now, such figures for comparison being at present impossible to find.

In 1791 the New York Dispensary adopted the following rule:

STATE BOARD OF CHARITIES. SPECIAL REPORT ON DISPENSARIES.

First, in regard to the admission of patients. Rule 7, adopted in 1791, provided as follows: "Patients shall be admitted by a recommendation, signed by a member, who is to consider him or herself engaged upon honor not to recommend any but such as are in his or her opinion really necessitous." A member was one who had contributed a given sum of money which entitled him or her to send patients to be treated in the dispensary. This rule continued until dispensaries began to increase, when all restrictions were removed; and the following reason was given for the indiscriminate treatment of patients:

"No questions are asked to wound the sensitiveness of poverty, and no reproofs offered to drive away the vicious. This is not our business. They suffer, or they would not come for aid; and, while we do not measure out our beneficence with a censorious hand, we know that we are doing good, securing the common weal, and are speaking to the hearts of all by showing that a common interest still unites the different classes of community, and bridges over the immense gulfs which, at first sight, seemed to separate them."*

This rule seems to have been abrogated at about from 1830 to 1835, and would, to my mind, account, in a large measure, for the increase in poverty.

To show how matters are going now, after all the remedies the dispensary and hospital people are ready to apply, let us look at two cases. The one is told me on the authority of a brother physician living in the next block to me. He had arranged to operate on a woman on a given day, since the first of this year. The doctor was to receive $125 for his services, which the patient declared herself able and willing to pay. The night before the operation was to be performed, a friend of the woman called on her, and, learning of the proposed operation, ridiculed her "for paying $125 for what she could have for less than nothing! Why," said the friend, "You can go to the New York Hospital, and pay less for your board than you pay where you are, and have the operation thrown in." The woman tried, found that she could, and did. The doctor went to the hospital superintendent later, to protest against people who could pay being thus treated for practically nothing. The superintendent informed the doctor that there was no way at present to prevent such things occurring. This woman was an outof-town resident, and not at all entitled to treatment here.

* The New York Eye and Ear Infirmary, established in 1820, was the first special dispensary.

Less than two months ago a man was injured at the corner of Broadway and 21st Street, and taken into a drug store. I was sent for, responding immediately, and found there an old gentleman whose face was badly injured. He was sitting up in a chair and perfectly conscious. When I had partially dressed his wound, the ambulance arrived; and, with the ambulance surgeon, I made the old gentleman ready for removal. When we had finished, without so much as asking me if I wished to retain the case, the ambulance surgeon started to take the old gentleman away without asking him even if he wished to go. The old gentleman declined to move, saying, "I am not going to a hospital." The police came to the aid of the ambulance surgeon, and together they tried to urge the old gentleman to go to the hospital; but he stoutly refused. The policeman and the ambulance surgeon adjourned to a corner of the store, and there arranged to tell the old gentleman that he might get in the ambulance to be taken home. This he also refused to do; and others came to the aid of the officers of the law, to urge and force the old gentleman to go to a hospital. He continued to refuse and resist. I now came to his assistance by saying: "Gentlemen, you cannot take me to a hospital against my will: I am thoroughly conscious. So is this old gentleman; and, although he is injured, you have no more right to interfere with his preference than you have with mine, he being thoroughly conscious."

He was taken home in a cab, and made a good recovery, although eighty years of age. Now I submit that, when the taxpayers' money and the private moneys are perverted, as in the first case, it is bad enough; but, when personal liberty is violated, it is time to call a halt.

We do not wish to see any of the dispensary managers in the condition of mind a dispensary manager was as portrayed by a recent novelist (Dr. Hillis). This dispensary manager is supposed to have made the following confession: :

"My system of transacting business was so complete and perfect in detail, and the punishment for the infraction of a by-law so condign and swift, that insubordination was rare and never formidable at our hospital or dispensary. Our effort to discriminate between the deserving and the impostor at our hospital gate was an imposition and a sham. While we pretended to treat only the deserving and needy at our hospital and dispensary, we waved to the crowds to come on. We wished to make a show: we had a mania for increasing the list of paupers and mendicants on our dispensary ledger.

"In a moment of weakness, Satan whispered in my ear that the well-dressed and respectable element that crowded to my dispensary should have protection; that their interests, their honor, and their presence demanded some mark of recognition from the governors of the hospital and the Free-to-all Memorial Dispensary. They did not wish to be branded as paupers or considered as dependants. They