entirely on pauper help. This is especially applicable to the care of the sick. The peace of mind and comfort of a sick person, especially the chronic sick, are largely a matter of trust and confidence in the physician and attendants, and although some of the inmates are really kind and helpful in their care of the sick, the best of them cannot inspire confidence and give to the patient that feeling of respect and sense of security that will be imparted by a paid, trained, uniformed nurse. Though some counties have provided ample accommodation for the sick poor by erecting separate hospital buildings, there is much to be desired in this respect in a number of localities.

The proper classification of destitute adults is undoubtedly the most important question relating to our public institutions devoted to their care. A complete separation has been made of the sexes and of the sane from the insane; a more or less satisfactory separation of the sick from the well and of the workers from the non-workers has been accomplished, and theoretically the two special classes of epileptics and idiots are now provided for in State institutions established to give to these most unfortunate people the benefit of the very best expert medical care and treatment; but, as a matter of fact, large numbers of epileptics and idiots are still in the almshouses.

In the matter of the epileptics, the strong insistence of relatives and neighboring friends, of patients living in the community outside the almshouse, that they be allowed to receive the treatment at Craig Colony for epileptics has resulted in leaving in the almshouses the most helpless and difficult class of patients to care for. In view of the disturbing influence of these two classes on the administration of our almshouses, and that they may all receive the benefit of the scientific and eminently satisfactory care and treatment provided by the State for a limited number, it is earnestly hoped that our next Legislature will make ample provision for the Craig Colony at Sonyea and for the Rome Custodial

Asylum for idiots, so that all the epileptics and all the idiots may in the near future be removed from the almshouses.

The greatest hardship to a quiet, orderly person in becoming an inmate of an almshouse is the enforced association with the depraved, foul-mouthed class sure to be there. The old plan of construction of many of our almshouses prevents the carrying out of as comprehensive a scheme of classification as the administration would gladly adopt, but gradually as new buildings are added it is recognized that among the occupants of the almshouse are those who make for peace and quiet, cleanliness and decency, and they are brought together in a little community by themselves, having their own day-room, dining-room and dormitory, with some small rooms for aged married couples, where they can spend their few remaining days in quiet comfort. Considerable progress has been made along these lines. Many localities are in a state of transition, anxious to better the condition of their dependents, but uncertain just at present as to the wisest course of action, whether to add to the present buildings or to abandon the unsatisfactory, ill-adapted conditions, and on a pleasantly located farm of suitable size erect a group of buildings so arranged that the sick, the workers, the average inmate and the better class may each have practically separate accommodations, but so compact as to be easily under a central administration.

In all large centers of population and capital there seems to be a growing sense of responsibility toward the unsuccessful man, the man who through adversity or sickness or poor business judgment finds himself at the ebb of his physical powers without a home and without money. As growing dependency is forced upon him, he instinctively shrinks from applying for public alms, and it would seem as though this class of people deserves a more congenial ending to life than that afforded by a poorhouse. Society, business men, the churches, all appreciate the situation; and so in all our cities there have been built and equipped private homes for

the aged, where one who has made a losing fight in the battle of life may find a quiet, peaceful ending for an unsuccessful financial career and preserve his self-respect. Numerous and under the auspices of nearly every religious denomination are the private homes established for this class, but with our rapid increase of population we shall need more such homes for both men and

women.

Let us be assured that the heart of the people of the State of New York is ever tender toward her dependent wards. And when public opinion, largely influenced by just such Conferences as this, crystallizes on any course of action for the betterment of our institutions, the legislative branch of our government is always quick to respond to the wants of the people.

An address on the "Problems of the Almshouse" was given by Hon. John W. Keller, President of the Department of Public Charities of the City of New York.

PROBLEMS OF THE ALMSHOUSE.

Although in its legal meaning the word "almshouse" includes the public hospitals, the Municipal Lodging-House for homeless men, and the various institutions on Randall's Island, I shall confine this paper to the treatment of certain problems that have presented themselves in the management of what is locally known as the almshouse. In the boroughs of Manhattan and the Bronx, the almshouse is that group of buildings on Blackwell's Island where the helpless and friendless destitute citizens of these two boroughs are cared for at the public expense. In the borough of Brooklyn there is a similar institution at Flatbush, and in the borough of Richmond there is a poor farm. The problem of managing a general public hospital is comparatively easy. It means the retention and care of a sick person so as to make such person well in the shortest possible time. The problem of the care of dependent children is more difficult than that of the care of the temporarily sick, but intelligent philanthropy has ex

erted itself in this direction to such an extent that though there is still a question of method, the dependent child to-day is very well cared for and not badly trained intellectually, physically and morally.

In the general study and practice of philanthropy the inmates of the almshouse have received less attention than any other class of dependents upon public charity, although in my opinion they should rank next to the sick poor person and the dependent child in the careful consideration of all the agencies that are striving to perfect a system for the distribution of public alms. Insane persons have been segregated and placed under the control of the State with ample funds for their maintenance and care. Epileptics and idiots enjoy similar advantages, but the inmates of the almshouse have been practically left alone. They are the refuse of the world dumped into a corner like so many worn out or broken utensils, a heap of shrivelled and shattered humanity, worthless of itself and neglected of others because in the general opinion there is nothing the matter with the person in the almshouse but worthlessness. He isn't there because he is sick or insane or epileptic or idiotic. He is there because the community won't let him stay anywhere else.

And yet the men and the women who are in the almshouse have more of what is human in them than the insane or the epileptic or the idiotic. They possess all their faculties. Their intelligence, such as it is, is unimpaired and they have all the impulses of good or evil common to people out of the almshouse. Therefore I hold that more attention should be given to them. Even as we have sorted and segregated the insane, the epileptic, the idiot and the victims of various diseases in the public hospitals, so we should go still further and sort and segregate the inmates of the almshouse. No one to-day would think of treating surgical and medical cases in the same ward of a hospital or of permitting any case of contagious disease to enter a general

hospital. We are even We are even now striving to segregate phthisis in order that the general wards of our hospitals shall not be contaminated by it. Even as we strive to protect the sick poor from the evil influence of diseases other than those with which they are afflicted, so we should strive to protect the better people in the almshouse from the immoral influence of the worse people. In the general concentrated effort to do better by the man afflicted with bodily ills or mental derangement we have rather lost sight of the finer and more subtle study of the person who is not sick and not insane, but is still a charge upon the community. I think this is due to the fact that there is hope for the sick poor man and hope for the normal dependent child, and there is sympathy for the insane and for the idiotic and for the epileptic because they are hopeless. But for the inmates of the almshouse there is in the general mind very little sympathy and still less of hope. The general opinion is that they are there by their own fault, and that they would be worthless no matter where they were. In a degree this is true. But the insane person is often insane through his own fault, and he is not only worthless but dangerous wherever he may be. I cannot understand that process of reasoning which concludes to give to a man without a mind more consideration than to a man with a mind, provided both have equal claims upon the care of the State, and surely no one can argue that an insane man or woman has more claim on public charity than the helpless old man or woman in the almshouse.

In problems presented by the almshouse, as in all problems of public charity, I think we deal too little with cause. There are too many people in the almshouse just as there are too many people in the hospitals and the insane asylums and the institutions for the care of dependent children and in the prisons. The energy of the State has been exerted to take care of all these unfortunates rather than to prevent men and women from becoming unfortunate. In this connection I would call attention