n of charity, though as they are
now managed they have seldom any systematic connexion with that
administration. Nor is there any co-ordination between the several
hospitals and dispensaries. If one rightly refuses further treatment to
certain applicants, they have only to wander to some other hospital,
there to be admitted with little or no scrutiny. For usually
out-patients and casualty patients are not even registered, nor can they
be identified if they apply again. Practically they come and go at will.
The definite limitation of cases, according to some standard of
effectual work, association with general charity, trained almonership
and inquiry, and a just regard for the interests of general
practitioners, are stepping-stones to reform. In towns where medical
charities are numerous a representative board would promote mutual help
and organization.

Endowed charities.

Like the poor-law, endowed charities may be permanent institutions
established to meet what should be passing and decreasing needs (cf. the
arguments in _The State and Charity_, by T. Mackay). Administered as
they usually are in isolation--apart from the living voluntary charities
of the generation, and consisting often of small trusts difficult to
utilize satisfactorily, they tend to create a permanent demand which
they meet by fixed quantities of relief. Also, as a rule, they make no
systematic inquiries with a view to the verification of the statements
of the applicants, for they have no staff for these purposes; nor have
they the assistance of almoners or friendly visitors. Nor does the
relief which they give form part of any plan of help in conjunction with
other aid from without; nor is the administration subject to frequent
inspection, as in the case of the poor-law. All these conditions have
led to a want of progress in the actual administration of endowed
charities, in regard to which it is often very difficult to prevent the
exercise of an undue patronage. But there is no reason why these
charities should not become a responsible part of the country's
administration, aiding it to reduce outdoor pauperism. It was never
intended that the poor-law should extinguish the endowed charities,
still less, as statistics now prove, that where endowments abound the
rate of pauperism should be considerably above the average of the rest
of the country. This shows that these charities often foster pauperism
instead of preventing it. As a step to refo