CHAPTER XIV. THE RELIEF OF THE POOR. THES HE first appropriation made by Congress for the relief of the poor in the District of Columbia is contained in act of July 4, 1864, appropriating $2,000 for the relief of the victims of the explosion in the cartridge factory in the United States Arsenal, the amount being increased by $2,500 two years later. In 1867 the sum of $15,000 was expended, under the direction of the Freedmen's Bureau, for the temporary relief of the destitute poor, and it was provided that where practicable the money should be used to give employment on public works. In 1869-70 $30,000 was expended under the direction of the mayors of Washington and Georgetown and the president of the levy court of the District of Columbia, and in 1870-71 the further sum of $30,000 was appropriated to enable the Secretary of War to provide for cases of absolute necessity among the poor of Washington and Georgetown, on recommendation of the Washington Association for the Improvement of the Condition of the Poor, or the National Freedmen's Relief Association, or the Industrial Home School. The Secretary of War was empowered to agree with the benevolent institutions named, or with other persons, to furnish the supplies necessary, whenever he could do so advantageously. In 1872 the Secretary of War expended $12,000 on the care of destitute aged persons in the District of Columbia, and in 1875 the Commissioners of the District of Columbia obtained an appropriation of $10,000 to relieve the suffering poor.1 Under the act chartering the Washington Market Company the annual rental of $25,000 paid by that company was set apart for the support and maintenance of the poor. Under this law the District Government became a trustee of this fund. The company claimed that the rental was subsequently reduced to $20,000 by joint resolution of the District Assembly; and that, still later, the Board of Public Works, acting under a law of Congress authorizing it to purchase a site for a municipal building, purchased from the company the property immediately in front of the market building, agreeing as a consideration to further reduce the annual rental to a sum varying from $5,500 to $7,500, according to the amount of annual tax upon the market company; and 1 Senate Ex. Doc. 84, Forty-fifty Congress, second session, pp. 119, 120. that the difference between the varying sum and the full amount of the poor fund should be paid by the District Government. From July 1 to December 1, 1874, the amount received from this source was $3,257.44; of which sum $656.50 was paid for the treatment of the poor at the Freedmen's Hospital and $200 was paid to charitable institutions. This very heavy reduction in the amount received for the relief of the poor was accompanied by a change in the method of administering relief and by an economy that left the District rather benefited than injured by the new system. During the fiscal years 1871 to 1873, inclusive, the average annual expense was $18,406.92. Under the board of health during the three months ending November 30, 1874, the expendi ture was at the rate of $5,000 per annum. The number of persons treated by the physicians to the poor was 840, and the number of burials at public expense was 49. During the succeeding eleven months 5,797 persons were treated, at a cost of $7,029.06 for physicians' serv ices and $2,162.65 for medicines. Congress having failed to provide the necessary means to continue the work, the employment of physicians to the poor was discontinued August 31, 1876. The number of people who died in the District of Columbia without medical attendance during that year was 689, as reported by the medical sanitary inspector. "What a comment upon a civilized community!"2 II. The act of June 11, 1878, providing a permanent form of government for the District of Columbia, abolished the board of health and created the health office, to be under the charge of a physician appointed by the Commissioners of the District of Columbia, and known as the health officer. Dr. Smith Townsend, the first incumbent of the office, in his first annual report called the attention of the Commissioners of the District to the fact that a number of people died annually in the cities of Washington and Georgetown for want of medical attendance and the want of medicine, while untold suffering was entailed upon many that survived. He held that the District of Columbia had a large pauper element, brought hither by certain peculiar causes which have affected no other city. In his first report Dr. Townsend says: There are at this time 40,000 negroes in the District, a majority of whom flocked to the seat of Government just after the war, expecting to gain an easy livelihood and find perpetual employment at the hands of those who gave them freedom; but the reaction came, and with it hard times, and these people found that freedom had its trials and tribulations as well as its joys and pleasures. Once imbued with the customs of city life, they were loath again to return to the farm and field, and they have remained in the shanties and huts which fill the alleys and back streets of Washington and Georgetown. Poorly clad, ill fed, and surrounded with filth and 1 Report of William Birney, assistant attorney, District of Columbia, December 1, 1874. PHYSICIANS TO THE POOR. 169 squalor, they fall an easy prey to disease and are a constant care to the health authorities. There is also a large number of poor whites who find the struggle for existence a hard one, and who, when sickness overtakes them, find difficulty in procuring medical attention. Many persons are annually brought to the national capital by reason of the tedious delays which sometimes attend legislation, or the procurement of official position, or through the failure of some cherished plan, and are thrown upon the charities of the District. Should disease overtake them in poverty there is no provision for their cases. There is no other city in the country of even half the population of Washington but that makes provision for the medical care of its indigent poor. That many die for lack of medical care is illustrated by the fact that the health officer is called upon daily to investigate the cause of death in cases where no physician had been in attendance, and where no medical aid whatever had been rendered. On January 15, 1879, authority was granted to the health officer to expend $1,200 in the care of the sick poor, that amount to defray the expenses of the service to March 31 following. Dr. Townsend set out at once to organize the service and systematize its workings. The first thing done was to appoint 9 physicians, at a salary of $30 a month each; then 12 druggists were designated and contracts entered into with them to furnish medicines upon prescriptions of the physicians to the poor at reduced rates. Knowing that the most rigid economy and closest surveillance would be necessary in conducting the service, the health officer issued explicit instructions to the physicians, stating that reliance would be placed upon their judgment in determining those properly entitled to this charity, and in judiciously selecting and prescribing medicines and appliances in the treatment of diseases, with a view to economy, as well as to the best interests of the patient and the public. A sick pauper entitled to their attention and prescription was defined in plain terms, and they were then instructed in cases of doubt always to lean on the side of humanity and sympathy for the suffering. A list of preparations and the quantities designated were given as being believed to be adequate for the requirements of the service, and the contract druggists agreed to furnish, at a price not to exceed 15 cents for each prescription, medicines of the best quality, properly prepared and put up, upon prescriptions of the physician to the poor, and to furnish to the health officer weekly statements of accounts upon blanks furnished for that purpose, prescriptions being retained as vouchers. The physicians were also required to make weekly reports, showing the name of patient, location, age, sex, color, social relation, whether the attendance was by office consultation or visit, and general remarks.1 In the opinion of the health officer the system worked admirably, and in a short time everything ran smoothly, and the sick poor were well provided for. Before the expiration of the term for which the $1,200 was furnished, an appropriation of $5,000 for this service was secured and the work was continued on the same basis, better results ensuing The system then adopted is still in use. than, in the opinion of the health officer, could have been accomplished by any other system. "Various methods have been urged as substitutes," the health officer says, "but nothing presented so far compares favorably with the one adopted." Some persons favored the establishment of a dispensary and the enlistment of a corps of volunteer physicians, but he thought the failure of volunteer enterprises of most kinds where considerable labor has been involved was a sufficient argument against this method. "Physicians, like most other mortals," he said, "like to be remunerated to a certain extent for their services, and when acting in a volunteer capacity prefer to go according to their own ideas rather than in conformity with any established rule set up by one acting as their director. System is required in all work, and unless the man is paid for his services he chafes under discipline. A paid corps of physicians for attendance on the poor is of all things necessary, and is as far superior to what it would be under a volunteer system as the paid fire department is in comparison with the old volunteer companies." In this connection the health officer disclaimed any reflection upon "that worthy, benevolent, and well-conducted institution, the Central Dispensary, which has rendered much assistance in taking care of those persons able to present themselves for treatment, and which was doing good work in its way. Volunteer physicians in this case attend, during certain hours of the day, all applicants who present themselves at the dispensary, but this does not reach the class attended by the physicians to the poor, and the kind of volunteer service here involved is very different from covering a certain piece of territory and being bound to answer, day or night, any call that may be made." The health officer estimated that $7,000 annually was required to conduct the service properly. In addition to supplying the poor with medicines and medical attendance, the health officer, during 1879, supplied the sick poor with food, under an appropriation of $3,000. Through the medium of the physicians to the poor, a list of articles of diet, such as would be suitable for the sick person and his or her family as well, was made, and contracts were entered into with grocers at convenient points in the various sections to furnish these articles upon orders of the physicians to the poor at reduced rates. The system worked to the entire satisfaction of the health office, the expenditures coming far within the limit of the expectation of the health officer. The investigations of the office showed that the most worthy objects of charity were not those who proclaimed their needs upon the highway and asked alms of all they met. This class would bear watching. The public charities are the ones most preyed upon, and it was surprising to learn the class of persons who would apply for alms when it is known that any general fund was to be distributed. Hundreds of applications were made to the physicians to the poor for orders for food by persons who were not in the remotest degree entitled to the benefits of such a charity. Acting under instructions to investigate every case carefully 1 and satisfy themselves of the worthiness of applicants before giving orders, many of these unworthy ones were brought to light. When informed that they were able to take care of themselves, or that the fund was only intended for the really destitute, they said that they "heard it was being given out, and they thought they might as well get some of it as anybody else," or that they "had as much right to it as so and so," who had been helped, etc. III. On November 20, 1878, John Connell, sanitary officer of the Metropolitan police, reported that scarcely a week passed without two or three persons being brought to his office by officers of the Executive Mansion, or from the several police stations, who, upon examination by the proper medical officers, were found to be insane, and who had to be sent to the Government Hospital for the Insane at the expense of the District, although they were in no sense its proper wards. His office was also charged with furnishing transportation for nonresident paupers toward their homes. This class of paupers had increased very much during the past year, many of them being wounded soldiers or soldiers' widows, or the mother or sister of a deceased soldier, who were unable to provide themselves with the necessities of life owing to the general stagnation of business and their utter inability to obtain employment of any kind. In their necessity they were tempted to come to Washington in the hope of obtaining employment of some kind from the Government, or securing a pension. Failing to obtain work, and rarely obtaining pensions, they found themselves among strangers, without means to return to their homes. The amount allowed for the transportation of prisoners to the workhouse and for paupers was but $2,000. The item of transportation to the workhouse amounted to $1,200, leaving a balance of but $800 for the transportation of paupers, which was entirely inadequate. The sanitary officer remarked that such people, by their personal appeals were frequently annoying, not only to individual citizens but to Members of Congress during the session; and he asked for an increased amount for the transportation of these poor people toward their homes. He reported that during the year he had sent to the Washington Asylum sick and destitute persons to the number of 361; to the Providence Hospital, 140; to the Freedmen's Hospital, 107; to the Government Hospital for the Insane, 84; to the Columbia Hospital, 4; to the Colored Orphan Asylum, 2, and to St. Ann's Infant Asylum, 1, making a total of 699. IV. In January, 1881, a meeting was held at Willard Hall, and a fund was raised for the relief of the poor. The money was expended under the direction of the Commissioners of the District of Columbia, through |