This is no theoretical case. Here is an actual condition. It is well to learn by the blunders of another, even from an adversary. It is not at all likely in the case in hand that the conditions described wil long continue. What has heretofore been a business of reformers, and it is a singular thing that the reformers always land in good positions on the new job, is going to be changed.

The metropolitan method has been found to be much too expensive.

In 1906 the cost of maintenance to the city in Bellevue and the Allied Hospitals was a per diem per capita of $1.50 in Bellevue and $2.62 in Gouveneur. But these figures are made without considering the cost of gas and electricity furnished by the Department of Water Supply, an item in 1906 of about $26,000, and without considering the vast sum of money now invested, being stil invested and expended generally for development and maintenance of the various properties.

In 1907 the increased per capita cost for maintenance and supplies was between 15 and 20%, and this will again be increased during 1908, possibly 10% more.

In the Department of Charities, without taking into account the value of the different properties, and the investment in these public hospitals run into many millions, say $25,000,000, and more than likely $40,000,000, the annual per capita cost for 1906, as printed in the Department Annual Report, was for the City Hospital $303.67 per patient; for Kings County Hospital $408.62 per annum per patient; for the Bradford Street Hospital $2,848.43 per patient per annum, or from $1.12 as a minimum to $8 per day as a maximum. But these you will bear in mind are simply the daily expenditures for maintaining the patient in the hospital. To show you how this system will increase public expenditure, let me tell you that the Public Charity Department for 1909 asks for an increase of $742,855.18. The increase in Bellevue will be proportionately as large and the increase. in the hospitals of the Board of Health will be proportionately much larger.

ANOTHER WAY.

One would naturally ask, is there any other method of procedure? Can a civic government make use of any other

agency to do this work and care for its sick and suffering? Fortunately, for the purpose of illustration, there is a good system, advantageous in a high degree, and it can be easily followed profitably, in any city, anywhere.

The professional philanthropists, as a rule, hold that a civic community should do all its work of charity in institutions of its own creation and under its own control. This is alleged to be necessary to augment civic property, develop the civic system and cultivate civic pride. Really necessary to furnish jobs to the pupils of the professional philanthropists.

Now, whatever is created within civic boundaries making for the betterment of humanity, the embellishment of the city, or the care of the physical well-being of the citizens, is entitled to awaken civic pride if it be brought into being by the benefactions of individuals, as much as though it were created after a resolution by the civic government and paid out of the city treasury.

THE SECOND COURSE.

In the City of New York, after 60 years of development, there can be counted in the wards of its public hospitals all told, exclusive of its hospitals for contagious diseases, 3,894 beds. These are created by the city for the care of its sick poor and injured.

In the so-called Budget of Private Institutions there are upwards of 90 private hospitals with which the city transacts business. These private hospitals in every instance have been created through the benefactions of private individuals. There are many other private hospitals besides these 90 of which I am speaking.

In the beginning these private hospitals came into being through the efforts of representatives of the various religious bodies. Two causes give motive and spring to their action. One was the mediocre care furnished in our public hospitals, and then there was the natural desire of the various religious communities to afford their own sick and suffering the opportunity of being cared for amidst the surroundings furnished by sympathetic friends and in the consolation of their own religion. The development of these

private hospitals has been and is amazing. Nationality, also, has played an important part in this gratuitous work for suffering humanity. We have German, French, Jewish, Italian, Swiss, Spanish, Norwegian and Hungarian hospitals, and some of these again divide in the different branches of their religions. There are Catholic, Protestant and Hebrew hospitals under distinct racial and religious control and support.

Again, as medical science has developed, private practitioners have secured the co-operation of men of larger means, who, because of the affliction of some member of their family, have had interested attention called to the lack of hospital facilities for particular diseases, and so there has come into being a large number of splendid institutions, having as the object of their existence the relief of some special disorder. Thus we have hospitals for the care of the eyes and ears, or the ruptured and crippled; the orthopedic cases, or the care of cancer, or for maternity, and again special hospitals for the care of children or of tubercular patients.

In spite of all the tremendous expenditure on the public hospitals they have proven to be totally inadequate to meet the demands. I told you there were in the public hospitals all told, 3,894 beds, but in the private hospitals, in which the city is glad to place its sick poor and its emergency patients, on the same day I counted the public hospital beds there were 10,436 beds, and this vast number takes no account of St. Luke's the Presbyterian, Roosevelt and the New York hospitals, all very large institutions.

Thousands of our best citizens are on the boards of management of the private hospitals, and the ablest doctors in the country strive or compete for admission to their staffs; in these institutions the best methods prevail and medical and surgical science find great opportunities for development, experiment and success. When the city uses the private hospital it gets a personal service gratuitously for which it is too poor to pay, could never pay.

Now, these hospitals have carried entirely the burden of their own construction. The city pays nothing toward the creation of these institutions, and yet private philanthropy has succeeded in investing, and my estimate is conservative, more than $30,000,000 in these hospitals, and the debt on

them all would hardly reach $4,000,000, and I know of from seven to ten millions more soon to be devoted to the erection of more private hospitals.

In the year 1906 the city paid for patients cared for in these institutions about three-quarters of a million dollars, and during the same year the institutions themselves raised and maintained by themselves, over ten and a quarter millions of dollars. The entire public hospital system costs, say in 1908, three millions to maintain, the city pays to the private hospitals, say one million more, and the private hospitals raise and expend not less than eleven milions.

AN IMPORTANT QUESTION.

Shall the city government ignore the abundant hospital facilities created by private philanthropy, which can be placed at the public disposal or shall it take advantage of private munificence and thereby utilize the unselfish and noble personal service given so ungrudgingly by its best citizens; and shal it incidentally relieve the burden of the taxpayer by just so much as private philanthropy is willing to supply?

To ask this question is to answer it. Why should any coterie of gentlemen, alive to the opportunity of transacting civic business at its best, when matters of charity are at stake, allow political or party questions to enter and so fail to do what is undoubtedly for the best of all concerned?

THE DREAD OF PUBLIC CHARITY.

A very long experience leads me to say what I think no well-informed person will deny, that the vast majority of the suffering poor and needy in any city are afraid of public charity. They are driven to it as a last resort only, and they accept it with misgivings and dread. This statement finds surprising illustration in much experience with the public and private maternity hospitals. The two public hospitals of this class in the Charity Department on Blackwells Island have 96 beds and 47 beds. It is extremely difficult to get anyone to occupy them. A charity commissioner of recent date, a reformer by the way, anxious to secure this class of patient for the benefit of his medical staff, violated all the rules of the Board of Estimate and Apportionment,

the law of the State and departmental procedure in these matters by accepting patients as public charges residing in outside cities and from the rural districts. Furthermore, his anxiety for these patients caused him to keep them weeks and months as "waiting women" at public expense. There are few women indeed who wish to have a child born in a public institution. Rightly or wrongly it is regarded as an ineffaceable stigma. On the other hand, the Morgan and Sloan Maternities to be spoken of as to their accessories and care, only in the superlative degree, are besieged by poor

women.

COST OF CARE IN PRIVATE INSTITUTIONS.

At the present time, 1908, New York is paying to private institutions for its needy patients a flat rate of $1 per diem for medical cases and $1.10 for surgical cases. For infants under two years of age, and in children's hospitals under the age of five years, 45 cents a diem. In hospitals conducted exclusively for consumptives, 80 cents. For cancer patients, 80 cents, and for the chronic, incurable or infirm, 40 cents per day. These sums in nearly all cases do not pay the actual cost to the private institutions, and undoubtedly the city should pay the whole average cost of expenditure or maintenance, but no private hospital has refused to accept a case upon the city terms. Is this plan an advantageous plan to the taxpayer? Is it satisfactory to the patient? As to the taxpayer it really costs him, all investment and expenditure considered, a per diem per capita in Belleview of $3.76, in Gouveneur $6.28, in Harlem $5.34, and in the hospitals of the Public Charity Department a per diem per capita of from $1.94 to $10.20.

That ought to answer the question as to the taxpayer. As to the comfort and consolation to the patient, or whether he will go to a public hospital and receive official charity or go to a private hospital conducted by people of either his religion or that of his family, nothing need be said.

THE SENSIBLE CONCLUSION.

There is but one sensible conclusion. Well informed city authorities everywhere will stimulate the development of private charitable institutions to the extent of the powers