Hospital Social Service

PUBLISHED MONTHLY BY YHB HOSPITAL SOCIAL SERVICE ASSOCIATION OF NEW YORK CITY INCORPORATED 9 EAST THIRTY-SEVENTH STREET, NEW YORK, N. Y.

DR. E. G. STILLMAN, Editor

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SUBSCRIPTION PRICE Domestic $2.00 Canadian $2.50 Foreign $4.00 Single Copies, 35 cents Advertising Rates may be had on application HOSPITAL SOCIAL SERVICE Editorial Notice to Contributors \ ------

S cope of Papers.— This Magazine is published in the interest of Social Service and deals with the many problems of the Hospital Superintendent, Doctor, Nurse, Auxiliary Committee and Volunteer in relation to Medical Social Service.

Priority of P ublication.— Papers accepted for publication will be printed as far as possible in the order of their receipt.

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R eferences.— Authors are requested to prepare their references lystematically. They should be numbered consecutively in their text and collected at the end o f the paper in the same order under "References.” References to literature cited should contain: (a) if a book, the name (including initials) o f the author or authors, the title o f the book, the place of publication, the publisher, and the date of publication; (b) if a n artical in a periodical, the name (in­ cluding initials) o f the author or authors, the title of the article, the name of the journal, the year of publication (in Arabic numbers), the volume number (in Roman numerals) and the page (in Arabic numerals) should be given.

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MAXIMILIAN KERN, M.D. Assistant Professor, General Medical Foundation; Medical College, Chicago, Illinois

The history of epilepsy is the history of medicine. As far back as history penetrates we find recognition and an attempt to treat the dread condition. Its symptomatology was accurately described by Hippocrates. Like other nervous and mental diseases it was for long ages regarded with a kind of superstitious awe as a special affliction and a mark of the wrath of God. The epileptic was possessed by a devil and his treatment was by prayer and exorcism. Barbaric and untutored man is everywhere inclined to superstition and to fear the supernatural. It was only to be expected that he should refer to higher powers than his own what his intelligence failed to understand and his arts to relieve.

The Riddle of Epilepsy It is practically only within the past quarter century that any real progress has been made toward solving the mystery of the etiology of epilepsy. More progress has been made during this period than in the twenty preceding centuries. Not that we are now arrived at a full knowledge o f the disease and its causation, but at least we have a very fair comprehension of the factors involved in epilepsy, of the mechanism by which the epileptic syndrome is produced, and of measures which either restrict its ravages or entirely cure it. Our knowledge o f the causation, pathology and therapeutics o f epilepsy today stands upon a rational scientific basis, and each day is bringing new facts to light which narrows the field by excluding factors not directly concerned with the production of the epileptic symptom- complex or by the discovery of new facts and processes which bear directly on some phase o f the evolution of the malady. W e are bring­ ing histology, chemistry, pathologic physiology and other modern scientific laboratory methods to our aid, we collate facts and con­ crete observations which explain many doubtful and obscure phenom­ ena, and the general result is that we are gradually clarifying the picture o f the exact nature of epilepsy and the organic structural 265 266 Epilepsy and Endocrines bases which are affected, and are therefore enabled in a logical way to devise a system of rational therapeutics. While our knowledge is not yet exact, it may be safely said that it is constantly tending to become exact, and that the medical aspect of epilepsy will soon be on the same level as that o f disease in any part o f the human organism. The innumerable hypotheses regarding epilepsy, remnants of the older philosophical and even theologic views, have been ruthlessly swept away in the light of modern research; we are guided only by the facts as we find them and the logical deductions from these facts.

Epilepsy and the Internal Secretions

The study of the internal secretions in man has especially thrown a flood of light on the nature of many diseases and especially of idiopathic epilepsy. By clinical observation and experimental inves­ tigation we have found how epilepsy can be produced, and that in man there can be no doubt that derangement of the internal secre­ tions is one of the most important factors, if not the basic factor it­ self, in the production of the condition and in its maintenance. In­ deed, I am convinced and do not hesitate to say that it will ultimate­ ly be proved that every case of true idiopathic epilepsy will show an endocrine imbalance. This assertion is somewhat strong, yet I think it is quite justified when we regard the entire failure o f treatment based upon the assumption that idiopathic epilepsy was due to some anatomical lesion in the brain or other distinctive pathological changes. More has been accomplished in the cure and amelioration of epilepsy since the introduction of organo-therapy than by decades of empirical drug administrations. The most that can be said in favor o f drugs is that they were sedatives, which while they calmed the unfortunate sufferer, did not only fail to cure him but rather added to his malady. The endocrine basis of epilepsy is sound and scientific; it rests upon observed facts; its proofs are each day being multiplied and its general acceptance is only delayed by the professional obstinacy which has always been evident in dis­ carding time-honored conceptions. For real progress it is essential that we should be agreed on the conception of epilepsy in order to prevent misunderstanding. I speak here, of course, not of traumatic epileptic seizures or those caused by some definitely established pathological condition, such as a brain tumor, but of what is commonly known and accepted as idiopathic or essential epilepsy. M. Kern 267

The Newer Views on the Causes of Epilepsy Time will not permit of my discussing many of the modern views put forward as a pathogenetic basis for idiopathic epilepsy, but there is at the present time almost a consensus of opinion, based upon modern research methods, that idiopathic epilepsy is a syndrome due to various factors which develop upon a constitutional basis of in­ fection or a toxic state, or to glandular dyscrasia as predisposing or participating causes. The tendency to implicate the internal secret­ ing glands has recently culminated in treatment by adrenalectomy. The general basis beneath these views is that toxins in the blood pro­ duce high vascular tension leading to excessive hyperemia of the cor­ tex, which is a recognized cause o f epileptic seizures.

Toxemia and the Internal Secretions

I am willing to admit that idiopathic epilepsy is a toxemia which acts upon the nervous system, but I think that the toxemia itself re­ sults from endocrine malfunctioning or discrepancy. The thyroid gland and adrenals, if not other glands, are well known to be regula­ tors of metabolism and elimination. The parathyroids seem to control or at least to play an important role in the destruction o f toxic sub­ stances which have a special predilection for attacking the nervous system, and with the pituitary they are also specially connected with the metabolism of calcium and phosphorus, both of which seem to be concerned in the production of epilepsy. Enough is known to prove that various metabolic abnormalities resulting in definite organic manifestations are associated either with excessive or defective func­ tional activity of different glands. It is quite evident that defective metabolism must result if the hormonic balance is not maintained, and that oxidation and catabolism o f waste materials is interfered with. Toxic wastes are retained in the organism. If it be admitted that epileptic seizures are connected with metabolic defects and that the exciting cause is some toxic element in the blood, then it follows that there is no more fertile source for such a pathogenesis than constantly defective glandular functioning.

Clinical Support to the Endocrine Theory of Epilepsy

Clinical findings support the view that idiopathic epilepsy has endocrine disturbance as a basis. Epilepsy has been repeatedly ob­ served associated with thyroid and other glandular abnormalities. 268 Epilepsy and Endocrines

Again, acromegaly and the adiposo-genital syndrome of Froelich are frequently associated with epilepsy. Frankl-Hochwart1 showed that the hypophysis was involved in one-sixxth o f the cases o f epilepsy. Ohlmacher2 and Volland3 have found persistent thymus in 25 per cent o f the cases of epilepsy. Systematic anatomo-pathological examina­ tions of epileptics by Claude and Schmiergeld4, Parhon and Stocker6 and others, have shown the thyroid sclerosed in 25 per cent of the cases. Post-mortem examinations of epileptics have disclosed in al­ most every case that the principal organs o f internal secretion are involved. In six cases of idiopathic epilepsy studied by Lissar and Nixon6 all six patients showed evidence of dyspituitarism with strikingly beneficial results from organotherapy. Seven cases studied by Leahy7 in the Bellevue Hospital, New York, seem to have demon­ strated a definite relation between deficient ovarian or pituitary secre­ tion and epilepsy, but practically every case showed more than one gland involved. Cushing8, Tucker9 and Timme10 have all shown that epilepsy is connected with malfunctioning of the pituitary gland. Lowenstein11 of the Washington University, St. Louis, studied sixteen cases of epilepsy of all types to find if there was a connection between the malady and endocrine dyscrasia, especially of the hypo­ physeal type. Thirty-one per cent of these cases were benefitted by pituitary medication. In the 128 epileptics with endocrine manifestations studied by Patterson12, the great majority showed a pituitary syndrome. L. P. Clark13 refers to epileptoidal states and fainting attacks in adolescents with hypopituitarism which can be remedied by specific organotherapy. I recently reported14 five cases of idiopathic epilepsy, in four of which I had most gratifying results from the use of pluriglandular extracts. In these four cases the histories showed stigmata which could be traced to glandular secretion deficiency, and in the case in which organotherapy seemed to fail, it is doubtful if the epilepsy was of the idiopathic type, as trauma played an important role. The successes obtained by myself and others from endocrine ex­ tract therapy in the treatment o f epileptics seem to justify the view that this promises to be a most potent method o f relieving these un­ fortunates. My own cases were treated with a combination of thy­ roid, pituitary, ovarian and testicular extracts. In view o f the length of time during which the relieved patients have been free from ■ f - ■ ' b w tmM-mI

■

M . Kern 269

any phenomena of epilepsy, there can be little doubt that absolute cures have been brought about for the time being, although o f course it would be somewhat premature to class them as permanent cures.

The Social Aspect of Epilepsy Just a few words on the social aspect of the question. W e know how widespread epilepsy is, and that the terrible malady is a lifelong horror to those afflicted with it ; they are filled with the dread of how and when their next seizure will occur. They know that they are regarded much as lepers might be by their fellows, and it is no matter for wonder that many end their unhappy existence by their own hand. There is, moreover, the misery caused to their relatives and friends, who must perforce share the anxiety and hopelessness o f the victim, and can see no relief. Further, there is the economic loss, for these unfortunates either cannot work or else cannot obtain any work when their affliction is known. T o their families they are an appalling burden, or maybe the burden falls upon the State, which is obliged to keep up expensive homes for the care of epilep­ tics. This social aspect of epilepsy need not be stressed as it is self­ evident. Since the publication of my own report the number of letters that I have received from epileptics and their friends as well as from their physicians and others has opened my eyes to the intense interest that is everywhere felt in anything which promises a cure or relief for the unhappy victims of epilepsy. The complete failure of the usual methods of treatment to afford more than a passing relief, as well as the knowledge that the constant use of powerful drugs may MSS in time render the patient’s condition more intolerable than before, has driven epileptics to become the prey of every quack and nostrum- monger who deludes them with the false hope of relief. xsll Social service nurses and all those in any way interested in com­ munity health work, who, in execution of their duties, must come in close contact with epileptics, can do no better service than to warn them of the fallacy of trusting to quacks and nostrums. They should bring to their attention the blessed message that their case is not hope­ tv'® less; that there is in fact a great probability of relief and even o f cure, from the recent advances in the treatment of epilepsy by the extracts from the glands of internal secretion. The nature of the glands, their importance in the organism, the probable connection o f their malfunctioning with the epileptic seizures, and the reasonable­ ness of treatment by glandular extracts, should be explained, and 270 Epilepsy and Endocrines will be received with the greatest interest by these sufferers; it will be a message of joy. This is the point I wish particularly to stress in this paper— that epilepsy is a disease which is liable to be completely cured by a proper endocrinological treatment. I have endeavored to show the connection between the endo­ crines and epilepsy; it requires but a short reflection to show that there is an inter-relation between the central nervous and the sym­ pathetic nervous systems, the latter of which governs all the pro­ cesses of secretion and metabolism. This indicates how epilepsy should be successfully treated. It is, as previously remarked, difficult to uproot time-honored views and to change more or less biased opinions to a new concep­ tion, but it must be to a great extent the task of social service workers to spread the new gospel and to cast the seed where it may yield the best fruit. The road is open and it is our duty to go on and en­ deavor to reach the glorious goal of affording relief, if not perman­ ent cure, to that vast class of human unfortunates who up to now have not benefitted from the progress of medical science. Such a result would combine the highest social service with a stupendous national and economic gain.

BIBLIOGRAPHY

1— Frankl-Hochwart: Internal Congr. Med., Buda-Pest, 1909. 2— Ohlmacher: Phila. Med. Jour., 1898, No. 1. 8—Volland: Zeitschr. f. d. ges. Psychiat. u. Neurol. 1900, P. 307. 4—Claude and Schmiergeld: Encephale, Paris, 1909. No. 1. 8—Parhon and Stocker: Bui. Soc. de Neurol, de Jassy, 1921, No. 5-6. 6— Lisser and N ixon : Med. Clin. No. Arner., 1923, VI, 1471. 7— Leahy: N. Y. St. Jour. M ed, 1922, X X II, 8. 8— Cushing: “The Pituitary Body.” 1912. 9— Tucker: The Role of the Pituitary Gland in Epilepsy, Arch. Neur. & Psych, 1919. 10— Timme: Arch. Neur. & Psych, 1920, iii, 601. 11— Lowenstein: Amer. Jour. Med. Sc, 1923, clxiii, 120. 12— Patterson: Hematological Pictures in Endocrine Syndromes Associated with Epilepsy, Amer. Jour. Psychiat, 1923, ii, 427. 13— Clark: Amer. Jour. Med. Sci, 1923, clxiii, 211. 14— Kern: The Role of Endocrinology in Epilepsy, Amer. Jour. Clin. M ed, 1923. Goldstein: New York Med. Jour, 1922, cxvi, 330. Orr: Jour. Ment. Sc, 1923, Ixix, 45. Marchand: Rev. Neur. Par, 1922, xxxviii, 1435.

30 North Michigan Avenue. DISPENSARY ADMITTING AT LAKESIDE HOSPITAL

. C O N S T A N C E B. W E B B Director, Social Service Department, Lakeside Hospital, Cleveland, Ohio.

When the system of admitting patients to Lakeside Dispensary was re-organized in 1920, two main considerations were kept upper­ most— speed and fairness in making decisions. It was felt that just as the greater the speed with which patients could be entered, the more patients could be seen and treated in the limited space available; so the more fairly and considerately each patient was treated, the more ready he would be to co-operate and the more fully we could hope to utilize the Dispensary. Each patient is, of course, given the usual admittance card on his first visit and on each subsequent visit presents it at a desk immedi­ ately inside the front door. A t this desk a clerk operates a telauto­ graph (familiar to all of us in hotels and banks) which instantly records the patient’s name, his dispensary number and the department to which he is to go, on a similar machine in the dispensary record room. From this desk, where he also leaves his 10 cent fee, the patient goes direct to his department and waits. An orderly in the record room gets out his chart and sends it on a mechanical carrier (in our new hospital we hope to have pneumatic tubes) to the pages, who carry it at once to the department indicated. Several points, we feel, are gained by this method: in addition to securing much greater speed, the confusion arising from patients waiting to secure their own cards is avoided, each department can see at any given time how many patients are on hand, the patients do not handle their own charts, and when the patients must wait they can do so sitting down instead of standing. The method of entering new patients always seems cumbersome, no matter how concisely it is told, but the fact that, in actual practice, the last patients arriving are usually ready for the doctor within fifteen minutes after the doors are closed to new admissions, indicates that speed is not sacrificed to thoroughness and consideration for the patient. 271 272 Admitting at Lakeside Hospital

Each new patient is interviewed first by the admitting physician in order to determine the department to which he should be assigned. In the order in which he arrives, he is then seen by a clerk who gets from him the simplest identifying information; i. e., the surname, address, first names and ages of each member o f the family, nation­ ality and by whom referred. A check is placed on the application blank (Fig. I ) * opposite the name of the member o f the family who is the patient wishing treatment and the name of the department to which the admitting doctor has assigned him is indicated. From this point, after paying his 25 cents, 15 cents for a new card, and 10 cents for his first admission, the new patient goes directly to his department and the application blank is sent at once to the record balcony on the mechanical carrier. The registrar looks up the name in the card index which is kept according to a copyrighted system known as the Russell Index. This index was put in because the file was known to contain numerous duplications, which, of course, meant two or more medical records for a given patient. The plan of the system is to disregard the presence of vowels and so group certain easily inter­ changeable consonants that when the cards are filed according to this plan, names quite differently spelled are thrown together in the file according to first names and are easily recognized as belonging to the same individual. For instance, in the usual file, John Derightus, would be a long way from John Diraitis and it would necessitate much imagination, to say nothing of time, on the part of the file clerk to identify them. With the Russell system it has been possible to identify as many as eight or nine patients in a single afternoon who have insisted that they were never in this dispensary before, and of course it is of great value in locating the records of the ten to twenty who have either lost or forgotten their cards each afternoon. W hen the registrar has looked up the new patient’s name in the index, a clerk in the record room makes out a new medical chart, gives the patient a medical and a group number for his admittance card and for his medical chart, and puts these numbers on the application blank. The blank, the new medical chart and the admit­ tance card are all clipped together and sent down to the social worker in the department to which the patient has been assigned by the doctor. The group number mentioned, is always recognized by its prefix

♦Page 276. C. B. Webb 273

“ O ” , as 03176. By means of this grouping, it is possible at any time for the physician or the social worker to get at all of the facts, both medical and social, for any given family so that if the physician wishes to study the physical condition of one of his patients in the light of the physical condition of the other members of the family, he can easily do so. It is also of material help in getting at any information desired by other agencies. Index cards (Fig. I I )* are made out with the names of the entire family on them and are filed under the first name of the head of the family. Data concerning each member known to the Dispensary is entered on this card. When there is an intensive social record of the family, an S is placed before the O in the group number. When a patient is entered with a Steering Blank, from an outside agency which thereby retains the social responsibility for the problem, a Roman numeral 1 is placed before the medical number of the individual sent in. W hen a Slight Service record is being kept by one o f the workers a letter corresponding to that department is placed before the medical number of the individual, so that any information can be located at once. For instance, if a slight service record is being carried by the orthopedic worker on Harry Jones, age 10, the index card will show after Harry’s name—B-213765. Whenever a slight service problem becomes sufficiently complicated to warrant an intensive record the information is incorporated in the intensive record and the slight service record is destroyed; the B is crossed off and an S is placed before the group number o f the whole family. It should also be said that in order to be able to locate a patient for someone who does not know the first name of the head of the family, a plain card is typed in red ink with just the parents’ names and numbers and referring to the proper family card. This is filed according to the patient’s own first name. If at some previous time, another member of the same family has been in the Dispensary and certain social data has been secured from him, that information is sent to the worker with the application blank and some o f the ques­ tions already answered need not be asked again. , A t this point, a word may be said of the application blank, which at first thought might seem superfluous or suggest an undue amount o f clerical work. As a matter of fact this blank saves much time, and effort in the end. Besides aiding in almost absolutely identifying the patient at once, it precludes the necessity for asking many ques­ 274 Admitting at Lakeside Hospital

tions the second time, gives the social worker a picture o f the make­ up o f the family at a glance, is used as a basis for the information typed on the index card, is sent to the social service clearing house and is returned by them with their registrations noted on the reverse side. In order to bring about the best possible co-ordination in the social and medical functions of the Dispensary, a social worker or clinic manager has been placed in each clinic as well as in the depart­ ment dealing with house cases. This makes the relationship o f physician and social worker particularly close. The clinic managers with the aid of volunteers, are responsible for entering all new patients, talking with such o f the old patients as need advice or guidance in carrying out the instructions of the physicians, follow­ ing up by letter or by calls those patients who need to return to the Dispensary and do not do so, and calling into play such outside organizations as the social needs o f the patients indicate. It is the policy of the social service department to be so sensitive to the many agencies available in the community that, in connection with some already developed organization, the worker may do her particular piece o f work in such a way that the patient and his family may be given the fullest chance for recovery and normal living. In many instances, o f course, intensive case work is done by the dispensary or house workers but every patient has some contact with Social Service. It will be noticed that at no point in this admitting pro­ cedure is there any discussion with the patient regarding his eligibility until he reaches the social worker in the department to which the doctor has assigned him. The reason for this is obvious, since neither the doctor nor the clerk are in any position to decide the question, except from superficial appearances which are more often misleading than indicative. By having the social worker in each department handle her own admissions, we accomplish two things. In the first place, the worker attached to a special clinic is so familiar with the diseases treated there, the probable cost of treatment outside and the effect on the patient’s earning capacity that she can determine more easily than anyone else, the wisdom of admitting or excluding a given case. In the second place, the patient comes into contact at once with the person with whom he is to deal during his entire treatment in that particular clinic— he has the feeling of privacy and individual C. B. Webb 275 attention because he discusses his personal affairs with just this one person from the beginning. This arrangement, we feel, gives the patient a better appreciation of the close-working relationship of the doctor and the social worker — and also makes it possible for social problems to be recognized and taken care of by the social worker without waiting for them to be referred to the Department by the doctor. The underlying principles on which our Dispensary admitting procedure is based, then, a re: (1 ) Speed in admitting both old and new patients. (2) Contact at once with a physician. (3) Identification of all new patients before entering. (4) Privacy in asking and answering questions. (5 ) Minimum questioning as to social data by a single individual with social training. (6) Admission determined in the light both of the economic situation and the physical disability by one working in close relationship with the doctors specializing in each group o f diseases. 276 Admitting at Lakeside Hospital

Fig. I. APPLICATION BLANK Lakeside Dispensary SOCIAL SERVICE DEPARTMENT

Date

Surname

Address

New Social History No.

Indicate Patient by Check Dispensary Numbers

M ’s First Name

W ’s ” ” Children’s Names Age

Remarks

Referred by Previous Record

Form G -l 10m 7-23 H Surname Color Nationality Soc. Hist. No.

Children Date of Birth Occupation Dispensary Number First Name of M. First and Maiden Name of W.

„

Date Address Cross References

-M

Form G-3 15m 12-23 R

'AgZ-- CONSERVATION OF SOCIAL ENERGY*

ESTHER LORING RICHARDS, M.D. Associate Professor o f Psychiatry, Johns Hopkins University, Baltimore, Maryland

The worker in child-placing problems, the worker in hospital social problems, the worker in community problems, are ceasing to classify and tabulate types of dependents, and are coming to speak a common language of inquiry into the dynamic forces at work in undermining social stability. I remember in the dark ages o f under­ graduate days electing a course called “Charities and Corrections.” It was the most popular course in a college where over 50% of the students majored in economics. In this course it was driven home to us that poverty with its miserable progeny of ill-health, moral dilapidation and crime was a disease to which ignorance, alcoholism, feeble-mindedness and those brain-teasing subtleties of economic competition and uneven distribution of wealth were the contributing factors. Preventive and remedial devices seemed obvious, in spite o f the fact that from the days of Plato men have described ideal com­ monwealths in which there was no want. W e studied the pauper, the alcoholic, the criminal, the professional inhabitant o f the red light district, and grieved that academic obligations must postpone by even a few years that moment when we should be free to cast in our lot with the seasoned warriors against economic disorder. These warriors have accomplished great things for economic equality, economic independence and economic sufficiency. They have taught the laborer how to shorten his hours and increase his wages; they have endeavored to teach him the remunerative value of higher standards o f health and sanitation; they are attempting to safeguard him from the consequences of alcohol and venereal disease. In no country like our own have their efforts met with such success, if one can judge from industrial production, financial prosperity, national spending, magnificent school systems and comparatively luxuriant protective legislation. And yet as a nation we are far from being a contented people, and our dissatisfaction can hardly be attributed to self-depreciation. *Read at the annual meeting of the Maryland Conference of Social Workers, Baltimore, December 4, 1923. 278 E. L. Richards 279

There is scarcely a period in the circuit of the months when some volcanic formation of smouldering discontent does not erupt, and pour out heated streams of rioting, night raids and other forms of aggressive defiance of laws made and subscribed to be these same participants in calmer moments of their evistence. The state militia arrives, a board o f arbitration meets, and this particular menace to public safety is quiescent for the time being. We non-combating citizens, looking on at a discreet distance, take sides with operators and mine owners, with garment makers or cloth­ ing magnates, with bootleggers or probation officers, justifying our conclusions by rationalizations that take the form and color o f life­ long prejudices, and unconscious wish fulfillments for comfort and satisfaction. The panic averted, the engines of rescue gone home, we too turn back to our getting and spending with the thought that surely the time cannot be far off when something will be done about it all. Perhaps a change o f political parties, a government ownership and control, or a shaft of light from economic research will put an end to these spasmodic outbursts of social unrest. The orthodoxy o f the political economist seems to teach that if the State would only do a few right things its citizens would not become troublesome. A professor1 of this subject in one of our large eastern universities concludes an essay on the cure for poverty with this sen­ tence : “ By pursuing a consistent policy of reducing the supply of un­ skilled labor, of increasing the supply o f the scarcer kinds of employ­ ing talent, as well as the supplies of land and capital, we can, by progressive stages, approach as near to equality o f incomes as be­ tween occupations as we care to.” But can the activities of human beings on the chess-board o f life be so easily controlled by manipulating Distribution, Production, Organization of Industry, Regulation of Immigration, etc.? Do “equality of incomes” and “the principle of self-interest” constitute the great motivators of individual and group conduct? T o those of us who spend our days amidst the concrete problems of indicidual maladjustment, the psychology of the economist sounds strangely inadequate and unimaginative. It seems to ignore the fact that a human being is generously endowed with instinct wants which clamor for expression in behavior, from birth to the dissolution of life. Through the nurture o f early training, educational contacts and social relationships, these instinct wants develop into a complexity of motive life that controls the behavior of an individual in a manner of 280 Conservation of Social Energy 1 which he is usually unconscious. These instinct wants have to do with such common ingredients o f human nature as sensitiveness, jealousy, anger, revenge, suggestibility, fear, stubbornness, lack of initiative, self-pity, the desire for sex satisfaction, for worship, for freedom, for leadership, for acquisition of wealth and power and skill. The thinking and acting o f every individual being represents combinations of such instinct-activities, stimulated, accentuated, inhibited or repressed by circumstances of environment, constitution­ al endowment, physical status and habit training. And it seems only reasonable to believe that in this field of motive research lies the key to resultant behavior, be it pauperism, drug addiction, and lawless­ ness o f the economically dependent, or the equally disquieting symptoms of human discontent and restlessness expressed in parlor socialism, free love cults and academic radicalism. The operator annually habituated to throwing down his tools as the most critical moment for production in his particular industry seems ostensibly justified in this procedure of mob tyranny by the nature of his demands. But what are the deeper cravings beneath the cry for shorter hours, and higher wages and more recognition of open shop ? There is desire for the adventure of change, not so much from con­ ditions that are intolerable, as change from the stationary to the new and untried; there is desire to revolt, not so much against oppression as against any implication of interference with individual fre e d o m - forgetting the fact that the greatest bondage in the world is self- imposed. And there is the satisfaction of registering protest in an atmosphere heavy with anger, excitement, and the noise of public agitation. The restlessness of adventure, the churning irritation of petty restraints, the yeasty ferments of pugnacious moods, need only the suggestibility of crowd and slogan to precipitate in days and hours an industrial crisis which may threaten the health and equanimity of a nation for months. And while the economist is attempting to reduce these labor problems to static terms (freight rates, market prices) dealing with the efficient production o f goods, the student o f social science, o f psychology, o f public health and o f psychiatry is endeavoring to cul­ ture these bacterial flora of behavior fundamentals from human specimens that appear in his laboratories of daily routine. He is going behind the symptom picture of mal-nutrition, delinquency, ethical irresponsibility, economic dependence and unemployment, to see if he can discover the conflicting drives of personality that E. L. Richards 281

may, perchance, be largely responsible for each individual failure to make a satisfactory adjustment to life. A s a working equipment for such a study, it is necessary to recon­ struct the setting in which the maladjustment developed, recording the facts o f inheritance, the habit data and determining influences of early environment, the achievement and temperamental responses o f the school period, the curves of working efficiency and their factors of modification, the reactions to sex demands and the responsibility of family formation, the types of satisfactions, the habitual moods, the ratio between capacities and ambitions. This may seem like a large order o f social inquiry, and yet its faithful pursuance through even a limited number of cases will enable the worker to form standards of human values that will save him or her in the long run a large measure of discouragement and mortification, not to mention loss of valuable time. I have read social case histories that were inventories of household furnishings and statistical reports of sewerage, lighting, ventilation, garbage disposal and family budget, but not a word in the eight or ten pages attempted to describe the mental attitudes o f the inhabitants of these dwellings. Yet it is the human stuff, and only the human stuff, with which we have to work in the rehabilita­ tion of sanitation and health and budget. I suspect that many of you feel that moods and thinking habits, with their behavior responses of concrete doing and saying, belong to “ mental cases” , and hence are the business o f the psychiatric social worker, who has caught on to the crystal reading methods of her psychiatric chiefs. Not a bit of it! There is no such corner on common sense approach to any problem of human distress. The mind with which we work in the business of living and the press o f personal relationships is as simple to observe and understand as any other fact of daily observation and experience, could we but educate ourselves against mind-blindness, and what A dolf Meyer has called “ mind-shyness.” Let me illustrate with a simple story, which each of you can duplicate as you listen. In May, 1923, Samuel I., an Italian boy of eleven years, was referred to our psychiatric dispensary by the principal of the Parental School here in town. He had been com­ mitted to this school by the Juvenile Court because o f habitual truancy and running away from school. At the school it was noticed that he cried a great deal and seemed uneasy and on edge. A social organization which had been in touch with this family for 282 Conservation of Social Energy seven months reported the parents uncooperative, the children ragged, and the living conditions crowded and unwholesome. On actual examination Samuel was found to be physically normal except for some underweight and an eye-strain easily corrected by glasses. His mental age, according to the Binet Test, was equivalent to his physical age. The child was uncommunicative on the subject o f his misdemeanors. History had it that he had left home the previous summer for a week, and since then had gone away for a day or two at a time at irregular intervals. He was not associ­ ated with any gang, and there was no rumor of his stealing. He would be found asleep under doorsteps, or wandering idly around the street. His teacher had no complaint of him except the poor attendance. “ W e could never find out the trouble,” she wrote, “ but something was wrong in the home, because the little sister came to school in a highly nervous condition, and cried if you asked her the simplest question in the kindest manner.” On direct questioning Samuel had told the teacher that he was beaten on returning home from his wanderings, and this was true. W ith this data and an interpreter from the International Institute, our psychiatric children’s worker approached the home of Samuel and found that its setting was all that had been described. The father was a laborer for the City Water Department. His earning capacity was $27 a week, but recurrent attacks of abdominal pain had reduced him to $16. The mother added $5 to the weekly budget by finishing coats. She was a silent and morose woman, whose native disposition was not improved by a severe eye-strain, and the increas­ ing financial burden. Every spare penny was sent to Italy for the grandparents’ transportation as some future date. There was usually food o f some kind to eat, but aside from this the housekeeping was neglected except for what eight-year-old Jennie could do. Obviously, the first step in unraveling the “mind” of Samuel was to gain the confidence of his parents. It was discovered that behind the persistent lack o f cooperation and dogged silence respecting their troubles was bitter mortification that Samuel’s wicked behavior had exposed them to the lime light of inquiry from school and community agency and Juvenile Court. They resented the fact that the arm of civic institutions had reached into their home and wrested from them a problem o f parental management which they believed they were doing their best to handle. The idea that Samuel was sick and not bad took root in the E. L. Richards 283 first interview. Sickness was a topic they understood, and one upon which they were easily able to elaborate. The father’s symptoms were disclosed, and the mother’s constant headache. Both came to the hospital willingly for examination. Two months from the date of the first visit the mother had received glasses, the father’s chronic appendix had been removed and he had returned to normal working capacity, and the welfare organization had reduced their relief to three pints of milk a day. It then seemed the proper moment again to discuss Samuel directly with his parents, and try to show them that he was not being punished for “badness,” but trained to develop better habits. A fter much persuasion they went out to see him at the school, and were obviously pleased with the great improvement in his appearance. He was ruddy and full of play and talked o f the good marks he had received in his grade work. They were told that they could either take him home or leave him till the beginning of the school year. They chose the latter. On September first the child returned to an entirely different home from the one he left last May, and his open appreciation of the change has been expressed by his marked desire to stay in it. A t present writing it is learned from four different sources that Samuel has not missed a day in school thus far, and is doing very good work. He has lost none of the improvement in appearance that he gained while at the Parental School. His teeth are clean, his clothes are clean and whole, his habit o f silence and easy tearfulness has disappeared. He looks one in the eye, and gives an impression of independence and self-respect. The family receive no outside aid; the man is working steadily. In this case we see a commonplace problem of social adjustment in the discrepancy between tastes and requirements for satisfaction among the foreign born and American born generations o f the same household. That such unevenness of progress in the course of adaptation is capable o f the gravest consequences is a fact painfully familiar to students in every phase of social science. Had Samuel returned to parents who continued to regard him as a disgrace worthy o f outcast, and to take out on him in nagging all the resentment born of their pent-up feelings, the time spent by court and school in dealing with his truancy would have been practically wasted. And why did these parents fail to see kindness behind the hands stretched out to help them? It is natural to attribute such lack of insight in 284 Conservation of Social Energy

this and similar cases to anti-American trends, and prejudice due to ignorance found in a class of individuals too commonly characterized in our case records as “ low-type.” And yet this particular father and mother were sullen and uncommunicative and suspicious and openly antagonistic because they had not grasped another point of view. Time has proven their capacity for understanding, and appreciation, and heroic rising to the emergency of a domestic crisis to a degree that strengthens one’s faith in the plastic surgery of social research. In contrast to the above story of adjustment possibilities in seemingly unadjustable human material, I would give another history. In December, 1921, a boy of twelve years was referred to our psychiatric dispensary by the pediatrics service of the Johns Hop­ kins Hospital because of “nervousness” for which no physical basis could be found. The “nervousness” consisted of occasional facial twitching and fidgeting of hands and feet, fears of the dark, and temper tantrums when crossed. He was a shy, timid, mother- clinging boy, who did satisfactory sixth-grade work, and easily reached an Intelligence Quotient of 100 in the Binet-Simon Test. One naturally turned to the home background, expecting a simple adjustment would quickly straighten out his difficulties. The father died in 1910, leaving five children; the mother had remarried, and by this marriage there was one child, a girl of eight years who, by the way, is also developing screaming and tantrum reactions supposed to date from a vague attack of encephalitis. The home atmosphere was heavy with poorly repressed friction, inertia, hypochondriacal whin­ ing, and insolent discontent. The mother complained that the step­ father was gruff and abusive, begrudging food to the step-children and spoiling his own little daughter. She would leave him, she said, were it not for his support. The step-father had worked steadily and contributed to the family budget, but since the older children became grown, he had objected to supporting them, and invested his savings elsewhere in his own name. The son, William, and the daughter, Anna, were working, but Mary Elizabeth, aged 21 and Fred, aged 15 were lolling about the house, apparently quite oblivious to the possibility o f any occupation. Mary Elizabeth, in 1916, had been on our medical service for a few days, following a dramatic attempt at asphyxiation. The psychiatric note on her at that time states that her behavior was a spite reaction, associated with a tantrum over not E. L. Richards 285 being able to have a dress she wanted. She was not mentally defec­ tive. A year later she married, and she and her husband have been living with her family ever since, the husband also being chronically unemployed. The boy, Fred, was committed to the Maryland Train­ ing School in February, 1920, for truancy. He was paroled in July, 1921, supposedly to work at an industrial plant in this city. The records of that concern state that he worked there from December 5, 1921 to January 9, 1922, and then left because he considered $9.00 a week inadequate pay. In the spring of 1922 he broke his parole, and was taken back to the Maryland Training School in June. In October, 1922, the mother obtained a writ of habeas corpus to with­ draw him from the Training School. A t the hearing, the Training School case was represented by able counsel who argued from social facts presented by the Family W elfare Association which has been in touch with this household, and by our own psychiatric social worker. But the boy was released. In July, 1923, he married a girl o f 15 years. (H e is now 17 years old). In September, 1922, the step-father withdrew from the family, and since then mother and children have been grinding along on the income of William and Anna and a male lodger. And where is 12-year-old Guy, who started out to be the hero of this tale? H e is almost 14 now. He is sleeping in the bed with his mother because he continues to be afraid o f the dark. He is still having temper tantrums too, because he is “ nervous and high-strung.” W e attempted to make summer plans to get him out of the home at least for a few weeks, but when the moment for action arrived, the maternal promises o f cooperation materialized into requests for nerve tonic. And why have the Family Welfare Association, the Juvenile Court, the Maryland Training School, and our own Psychiatric Social Service working together and in relief shifts, failed in an adjustment of this family situation? W e have not been baffled by a hopeless budget; we have not been baffled by alcoholism, drug addic­ tion, physical incapacitation, feeble-mindedness or insanity. W e have been thwarted by a rigidity of mental attitudes expressed in life-long tendencies to lack o f initiative, vacillation, insincerity, rest­ lessness o f spirit and querulous discontent habitually projected upon the environment in monotonous fault-finding and petty nagging. 286 Conservation of Social Energy

The focus of infection is the mother. One can see her starting out in life with the above-mentioned facilities o f adaptation. True to form the first husband was not canonized till after his death and replacement by the last incumbent. The children, William and Anna, escaped the familial pattern by having to leave home early and get out into the working world. Mary Elizabeth and Fred grew up without even a step-father’s training. “ I told my children they didn’t have to mind when Mr. B. spoke to ’em. He was not their father.” From the home insubordination actively encouraged by maternal excuses and whining, it was but a step to similar behavior in school. There was continuous truancy, with the subsequent history you have heard. W hen I talked with Mary Elizabeth in 1916, following her tantrum and suicidal “ blowout,” she refused either to discuss the matter on the medical service or consider transfer to our psychiatric wards. “My mother says I was just nervous, and she doesn’t want anyone coming here to bother me about it.” It was to this mother and to this home that an over-sympathetic justice consigned Fred, who had not in the 16 years of his life given evidence of a single quality o f stability. Y ou will not wonder then, that when the small Margaret appeared in our dispensary with the complaint of “nervous­ ness” several weeks ago, I refused to refer her to our social service department for any action in the matter. W e deal here with human material that is fundamentally unadjustable, and unadjustable by virtue of a chronic habit-formation as fatal to its victims and as demoralizing in its influence as the addiction to narcotics or alcohol. Out of a family of six children only two have not completely suc­ cumbed to the determinism o f maternal attitudes, and there is no touch of medical or social science that can change the latter now. The harvest of need is great, and the reapers of healing so few that we must needs conserve our energy for direction into channels of usefulness. The larger vision of service demands that we distin­ guish between the household of Samuel and the household o f Guy. There is no formula for differentiation beyond a careful and detailed sifting of facts, and an honest and common-sense effort to size up the stuff from which the family problem is created. This sizing up involves something more than complacently labeling individuals “mental deterioration”, “low-grade mentality”, “subnormal”, etc. Said a tired worker visiting our clinic not long ago, “ Mental cases are so hard to adjust.” She referred to patients requiring commit­ E. L. Richards 287 ment to state hospitals for mental diseases. H ow easy it is to go about dividing the world on this simple basis o f demarcation, while we are blind to the great facts of mind that clamor for recognition in the utterance and behaviour o f men, women and children with whom we are in daily contact. With how many cases on our records today are we marking time because o f failure to understand, and evaluate the per­ sonality components of their respective problems? Are we de­ pending too much on questionnaire or other special form of inquiry into fields of investigation, and neglecting the practice of asking ourselves a few direct questions as to what are the most natural and commonplace facts we would like to know in order to get at the heart of the matter as expeditiously as possible? The medical student holding tightly to the leading-strings of a scheme o f record-taking, not infrequently misses the whole point of the case by reason of his eagerness to cover every topic in the outline. While a normal symptom of development and growth in adolescence, its manifestation would be decidedly pathological in the physician with a reasonable measurement of experience. Yet I have been impressed with the frequency of the query, “ What form of outline do you use in your social histories ?” And I have attended informal discussions of social organizations and listened to bickering as to whether facts A and B should have been written up under topic I or II of the out­ line, and I have heard what seemed to me good case work from the standpoint of adjustment goals riddled by criticism apparently as trivial. W e need uniformity o f method in the approach to social problems, and we need to get together on topical outlines of investi­ gation, but no scheme of record has ever been formulated which can take the place o f individual reflection and analysis in every instance of human maladjustment that comes to us for help. In expressing these thoughts I would not have you think me un­ mindful of the tremendous difficulties under which you work. I know you are struggling with a pressure of duties that tends towards the discouragement of diffuse and scattered efforts; I know you are contending with inadequate financial recognition, and worse yet, with a spirit o f condescension and hypercriticism in high places. I know also that many of you hospital social workers feel you are working for and not with the physicians and superintendents o f the staff; that cases are dumped on you to adjust because nobody knows what else to do with them, and that in too many instances you are obliged 288 Conservation of Social Energy to flounder alone without the appreciation or interest of even a simple inquiry as to the outcome o f long and patient hours of labor. It is because o f the strain o f these very hardships that I would have you learn to conserve your energy as much as possible. As heads of organizations and chairmen of meetings for discussion, I would not have you waste your time picking flaws in the technicalities o f case presentations, but rather direct the thought o f your co-workers and students towards the vital questions at issue in every problem o f mal­ adjustment. Remember that behind budget and living conditions and physical health there is the attitude of parents towards each other and towards the children, there is the attitude of parents towards each other’s methods of child training, there is the houeshold thinking and behavior in matters of religion, education, moral standards and social contacts. These are the factors with which we have to work in re­ habilitation— sometimes to success where we least expect it, and sometimes to a degree of failure that disappointment and blind optim­ ism alone makes us unwilling to recognize.

REFERENCES 1Carver, T. N. “ Essays in Social Justice,” p. 375. Howord Univ. Press, 1915. Q f m m mm

OCCUPATIONAL THERAPY FOR THE CARDIAC

MARGUERITE H. MUSSER ■ Philadelphia, Pennsylvania

T o bring sunshine and cheer and take away shadow and fear! might well be the slogan o f the Occupational Therapist on her daily round o f visits as she goes to each patient, interesting and helping them materially, physically and financially. In Philadelphia there has been tried an experiment of having a worker do house to house work with cardiac cases unable, or perhaps unwilling to keep on with their regular occupations. These cases are referred in main by the hospitals having heart clinics (although all institutions have been given the privilege of using this means of relief). A card is sent by the hospital with the classification of Class I, II, III, IV , as decided by the doctor, and the name, address, previous occupation and financial situation signed by the social worker of the Committee on Occupation for the Heart Handicapped. This is immediately followed up by a communication to the patient requesting him to remain at home a certain day and hour when the therapist will call— enclosing, of course, a post card for them to reply upon. The worker then visits, taking materials, etc., with her and what­ ever trend or mode o f work appeals to the patient, is the one encour­ aged. H e is left supplies enough for a week’s work at the end of which the therapist returns and buys in the article, giving a fair price for the work and deducting only the cost of materials. The Associa­ tion takes the chance of being able to sell these things as it has been found o f utmost importance to make the patients feel that even in the beginning they can produce saleable things. O f course, it is impossi­ ble to dispose of many of the articles turned out and there is much waste to be considered but the therapeutic value always overbalances every other consideration, and we believe that the patient who is kept busy is far happier than the one who lies and broods in idleness. This mental encouragement is one of the great aims of the Asso­ ciation. The therapist is also on duty at a weekly night cardiac clinic connected with a prominent hospital in Philadelphia. Here she starts 289 290 Conservation of Social Energy the patients working while waiting their turn to be seen by the doc­ tors. The clinic visit she, of course, follows up by a home visit. A class has been started Saturday morning in the headquarters o f the Philadelphia Association for the Prevention and Relief of Heart Dis­ ease for the cardiac handicapped, for children and adults who are in good enough condition to make weekly visits. Starting with one or two members, this class has become quite sizable. A s an example of the work that has been done I might quote the case of a veteran of the Spanish War (referred by the Veterans' Bureau). This man was interested at once in basket making and became wonderfully proficient in a few weeks time. H e is now en­ gaged in an occupation which enables him to furnish most o f the support for his wife and two children without injury to his heart. There is also work done in the Children’s Home once a week, where it is so eagerly seized that it is almost impossible to meet all of the childrens’ demands. This short sketch has been written in hopes of conveying to the public what is being done toward aiding cardiac cases and how the experiment has become an actuality and one that has come to stay. CULTS AND CURES

JACOB A. GOLDBERG, A.M., Ph.D. Director, Committee for Health Service Among Jews, New York, New York The medical profession and the lay public have long been aware of the adage of “A sound mind in a sound body.” This adage in­ volves a double thought, both that a sound body is necessary for a sound mind, and that a sound mind will favorably influence the health o f the body. The influence of the mind in the causation and in the cure of disease has been exaggerated in general literature and in many so- called scientific writings, but it is nevertheless real and must be recognized. There has been much damage wrought by ignorant enthusiasts and wilful imposters who have caused modern super­ stition of medical matters to become crystallized into numerous cults, mind cures and faith-healing procedures. Many of these are similar to various ancient and medieval reme­ dies insofar as their logic or worth is concerned. Such truth as there may be in some o f these cults and procedures is similar to that in the “Weapon Ointment Cure” of days gone by. This was a rem­ edy consisting of a large number of different things including human blood, pulverized mummy and moss that had grown on the skull of a thief. The peculiar part of the whole thing was that this ointment was to be rubbed on the weapon that had inflicted the wound and this was supposed to cure the cut. Even Lord Bacon in his day would not presume to deny the efficacy of this treatment but failing to account consistently for it he said, “ W e must accept the facts and leave them unexplained.” True therapy or cure as opposed to the aforementioned methods involves the employment o f reason in the place o f sophistry, and the use of scientifically correct knowledge by properly trained and quali­ fied persons instead of deception and wilful dishonesty. Numerous physical conditions can either be improved or retarded by the mental attitude and the nervous stability of the patients in­ volved. For instance, in the phenomenon of fatigue there is gradual diminution of functional power and the difficulty of continuing work already begun. This is accompanied by other phenomena, such as pain, muscular contracture, extreme lassitude and may even produce breathlessness, perspiration and palpitation o f the heart. Other 291 292 Cults and Cures functions that may be disturbed because o f lack o f nervous stability are the digestion, motor reactions, blood pressure, sensory powers, and the bodily temperature. While mental and nervous stability do not cure physical and chronic ailments such as tuberculosis, heart disease, arteriosclerosis, cancer and similarly serious conditions, yet the general physical state may be materially affected. The patient suffering from pneumonia or tuberculosis or one of many other physical conditions may definitely influence the bodily condition through mental and nervous control. Concomitant with mental and nervous health goes the better functioning of the human organism as a whole, which aids material­ ly in the bodily struggle against physical disease. The Education of Self It is the sound mind which the more often creates the healthy body, not that it suppresses actual disease but because it gives us strength to endure certain of our diseases and live in rational ad­ justment to them. It is through the knowledge of self that people ought to safe­ guard themselves against certain forms o f mental and nervous instability. In order that self-education may be given a fair chance in the struggle against disease it is imperative to avoid deception inherent guidance. Such cults and faith-healing procedures undoubtedly help some temporarily, though the serious ailment continues to offer resist­ ance against complete recovery. In the Carnavalet Museum in Paris there is an autograph o f Alexander Dumas, the younger, which is indeed a keen observation; it says: “ H ow is it that while children are so intelligent, men are so stupid ?” and the witty writer adds: “It must be because of educa­ tion.” The process o f education through which children pass, both in and out o f the home, determines their mental make-up in later years. Whatever the part played by heredity, the thing that counts in the making or marring of a human life is the influence by which that life is surrounded in the formative years of childhood. A deeper under­ standing of the child by the adult, and therefore a deeper sympathy with its problems, will result in a greater desire and a greater capaci­ ty to help the child develop his inherent powers and qualities to their highest, and the utilization in adulthood of the defensive powers developed in the early years of life. EDITORIAL

Years ago there was a tendency to regard much less seriously the functions of the social service worker in the hospital clinic than is the case to-day. She was a new factor then, and her field o f work was much larger than was her knowledge to cope with it, from the hospital standpoint. Her advent in the early days o f hospital service was marked by maladjustment in the division of labor between her­ self and the working staff of her institution. Where medical duties left off, social ones commenced, and where the two were merged, were points not then sufficiently clarified to permit her to function along the broad lines which make her invaluable in clinic work today. A mutual and thorough understanding developed by long associa­ tion each with the other has built up between the medical staffs of hospitals and their social service workers a splendid humanitarian machine—and yet not so machine-like as to admit the inference of perfunctory performance o f work for the poor. The trained social service worker to-day is able not only to alleviate and prevent much suffering among her clinic charges, but also by virtue of her taking over these duties, relieves medical men and nurses o f responsibilities in this direction, which, before the social service worker’s identifica­ tion with hospitals, consumed many valuable professional hours. According to legend, hospitals originally were devoted exclusively to the poor. The well-to-do were treated within the comfortable surroundings of their homes. W ith the advance of time and con­ sequent changes in living conditions, hospital facilities were gradually afforded to the well-to-do in increasing measure. Eventually, dur­ ing one era, hospitals generally were frankly constructed with the idea o f adequately accomodating non-clinic patients, and giving such incidental treatment to the needy as the thought of those days deemed requisite. The thought has changed and softened during later years. Accomodations and treatment for the poor have increased enormously. A warmer expression toward these unfortunates has been pronounced by the self-sacrifice of physicians, surgeons and nurses, giving their time— often their contributions, and by the increasing contributions so generously coming from the public. Hospital doors, opened wider to the poor to-day than they have been for many decades, bring responsibilities of a sociological nature which in these times can only be handled by skilled social service 293 294 Editorial

workers functioning with the clinic. The general demand for sensi­ ble, even-tempered and well-educated young people to take up this great work is increasing at an astonishing rate. There might soon arise a question of supply of the right kind of material. Undisci­ plined young people are still present in too great numbers. The best elements among the high school, and particularly among the university graduates should have made clear to them the oppor­ tunities for good they can do in this work before they make definite vocational decisions. If they are tempermentally fitted for the work they will never regret having devoted themselves to it. True, different fields of activity might have hidden beneath the soil that elusive pot of gold for the digging; but there are plenty of eager and strong hands for that. It is the others we need, who realize that there might be less substance in reward, but who can make o f their lives a veritable treasure-house through ministrations to the unfortunates around them.

L ouise M . Coe, Social Service Worker, St. Bartholomews Clinic & Hospital, New York City. Poughkeepsie, New York, has started a movement to secure a city hospital for the treatment o f contagious diseases.

The Division of Maternity, Infancy and Child Hygiene of the New York State Department of Health now provides approved pack­ ages of umbilical dressings.

The American Red Cross announces that courses for teachers will be given this summer in Home Hygiene and Care of the Sick. The institutes will be held at Simmons College, Pennsylvania State College and the Colorado Agricultural College.

The Child Adoption Committee of the Central and Free Syn­ agogue received $15,000 from the estate of the late Philip Waldheim for the establishment of a nursery for the care of little children pend­ ing adoption.

A Social Service Department has been established at the Willard Parker Hospital, New York. Miss Bessie King is head-worker.

According to the annual report of the Maternity Centre Associa­ tion, more than one-third of the women cared for during the past year applied on their own initiative. In 1922, the Association nurses had to canvass the district for more than one-half o f the patients.

The following resolution was adopted by the Minnesota-North Dakota State Conference o f the Catholic Hospital Association o f the United States and Canada at their Second Annual Meeting held at the College o f St. Scholastica, Duluth, Minnesota, July 18th and 19th, 1923:— Resolution No. 2— That it be recommended that a social service department be established in all hospitals of this conference. Membership of the Conference— Hospitals, 23. Minnesota 14 North Dakota .... 9 295 296 News Notes

The Metropolitan Life Insurance Company reports for its 15,000,­ 000 industrial policyholders representing one-seventh of the combined populations of the United States and Canada, the lowest January death rate ever registered— 9.7 per 1000.

Byndenwood, situated on a beautiful mountain top is “ something quite different” in the way of a resort. It is an ideal rest and recrea­ tion home for professional women and their friends. Club rates are from $18 to $25 per week, American plan. For information ad­ dress :— M rs Claire W rightson, . Byndenwood, Wernersville, Pa.

The National Tuberculosis Association, 370 Seventh Avenue, New York City, announces a novelty in food dishes—the Kraker Kup— “the cup to eat.” This novel cup is made of graham flour and lined with a coating of pure chocolate. It is proposed to use it for serving milk to children. The child drinks the milk and nibbles the cup at the same time. One can appreciate the joy of drinking from such an unique receptacle.

A course of eight lectures in Infant Hygiene is given in the Toronto Canada, Schools to girls in the upper grades.

Dr. J. L. Blumenthal has been appointed Director o f the Bureau of Child Hygiene of the Department of Health New York City.

The Annual Conference of Health Officers and Public Health Nurses will be held at Saratoga Springs, New York in June.

Dr. Hugh S. Cumming has been reappointeed Surgeon General of the United States Public Health Service.

A recent report of the State Department of Health shows that of the 7,155 pupils in private and parochial schools in Albany, 99.02 per­ cent have been vaccinated against smallpox.

National Hospital Day will be observed May 12th. News Notes 297

The New York State Department of Health is giving the third extension course in maternity and infant hygiene in Troy, Hudson and Mineola beginning the first of April. This course is open to registered nurses or graduates of approved hospitals and will be given by Miss Ruth Wood.

The Berkshire Industrial Farm at Canaan, New York, a school for maladjusted boys will, in cooperation with the Commonwealth Fund of New York City, begin a study of conduct disorders.

A large farm at Fishkill, New York has been purchased by the New York City Kiwanis Club for the purpose o f establishing a health camp for boys.

The New York State Charities A id Association reports that there has been a drop o f 25% in almshouse population since 1910.

Charles H. Johnson, former secretary of the New York State Board of Charities has been appointed Superintendent of Valeria Home.

The Fifth Avenue Hospital, New York has established a Hay Fever and Asthma Clinic, Fridays, 2 -4 p.m.

Miss Harriet Jane Smith, Director of the Social Service Depart­ ment of the New York Nursery and Child’s Hospital has resigned.

There will be a special meeting of Catholic nurses for the purpose of forming an International Guild of Nurses, at the Providence Hospital Auditorium sometime during the American Nurses Asso­ ciation Convention which is to be held in Detroit the week of June 16th, 1924. Notice of the time and place of the meeting will be posted at the Convention. A retreat for nurses and series of further Conferences for the organization of the International Guild of Nurses will be held at Spring Bank, Okauchee, Wisconsin, the head­ quarters of the Catholic Hospital Association immediately after the meeting in Detroit.

Through the efforts of the Virginia Graduate Nurses’ Association, a chair o f nursing is to be established at the University o f Virginia. The New York Hospital has established a special clinic for the treatment o f children suffering with kidney diseases.

The story of the East Harlem Health Centre is graphically told by a one-reel film— “ It W orks.” The picture tells the story o f how gtj/hvi twenty-two agencies at the suggestion o f the American Red Cross came together under one roof and have worked together successfully for almost three years. The film is available free of charge except for the cost of transportation to Health and Welfare Agencies. Ap­ plication for the film should be made to Kenneth D. Widdemer, East Harlem Health Centre, 345 East 116 Street, New York City. fiV';!

According to a report recently issued by the Childrens Welfare Federation, New York City now leads ten of the largest cities in the low infant mortality rate.

The late Dr. L. Emmett Holt, who died in Peking, China, January 14th, bequeathed $25,000 to Columbia University to support an annual fellowship for the study o f the diseases of childhood and a like amount to the Babies Hospital.

Miss Anna J. Driscoll was recently appointed Assistant Secretary of the Health Information Service of the New York Tuberculosis Association. The organization feels particularly fortunate in securing the services of Miss Driscoll who brings to the work a broad experi­ ence goth in tuberculosis and public health work. The Information Service of the Association is open from 9 A.M. to 5 P.M . and Saturday until 12. When it is possible for it to assist with any problem o f tuberculosis, please write or call at the office 10 E. 39th St. Murray Hill 7772.

INDUSTRIAL HYGIENE CLINIC FOR THE DIAGNOSIS AND TREATMENT OF INDUSTRIAL DISEASES The need has long ago been recognized by the medical profession at large in the State of New York for a clinic especially equipped and adapted for the diagnosis and treatment o f industrial diseases. Accordingly, an arrangement to this end has been perfected under the joint auspices of the Reconstruction Hospital in New York City,

i. i News Notes 299

the Industrial Hygiene Division of the State Department of Labor and the College of Physicians and Surgeons. This important move concerns not only the wage earner, the em­ ployer and the individual physician, but society at large, as the well being and efficiency of the State are of necessity concerned. It should receive the active support of the medical profession in the State. Elaborate plans are being made for making studies o f occupational diseases and for publishing the results o f research in new methods of treatment. It is contemplated as the Clinic develops to train doctors and nurses for special service in industrial medicine and surgery. The Industrial Hygiene Clinic is now open at the Reconstruction Hospital, Corner of 100th Street and Central Park West. The Re­ construction Hospital has been equipped with all of the devices neces­ sary for the diagnosis and treatment o f industrial diseases. On the staff o f this clinic there are eminent specialists and consultants. The Hospital employs X-rays, electrotherapy, phototherapy, hydrotherapy, massage, mechanotherapy and occupational therapy. Consultation Hours Tuesdays and Fridays 2 to 4 P.M. Treatments given Mondays, Tuesdays, Wednesdays, Thursdays, Fridays from 9 to 5— Saturdays from 9 to 12. For further informa­ tion address the Director, Industrial Hygiene Clinic, 100th Street and Central Park West, New York City.

NEW PUBLICATIONS A new edition of “Child Labor in the United States: Ten Ques­ tions Answered” publications No. 114 of the Children’s Bureau of the United States Department of Labor has just been issued. Limited quantities may be purchased at five cents a copy from the Super­ intendent of Documents, Government Printing Office, Washington.

“Do you wish your child would mind every time you speak? Have you stopped to think why he does not?” Mental Hygiene Bulletin, Vol. II, 2 ; February, 1924. These tabulated questions show a rare understanding of child psychology and will prove invaluable to parents and teachers. 300 Abstracts

COMING MEETINGS National Tuberculosis Association, Atlanta, Ga., May 5-9. American Medical Association, Chicago, 111., May 19-23. American Psychiatric Association, Atlantic City, N. J., June 3-6. National Nursing Convention, Detroit, Mich., June 16-21. National Conference of Social Work, Toronto, Canada, June 25- July 6.

ABSTRACTS “Provision for the Care of Convalescents in New York City,” N. Y. Med. Jour, and Rec., 1923, C X V III, 759. The Public Health Committee of the New York Academy of Medicine after making a study of the factors in the problem of convalescent care for New York City patients makes a report under the following heads; con­ valescent needs; available facilities, under which are listed the 62 homes and the bed capacity of each; utilization of existing facilities; administration; hospital experience. The outstanding need is a com­ munity policy with reference to institutional convalescence, a co­ ordination of all the existing activities and a formulation of adequate administrative and medical standards. Until this is done, many physi­ cians would hesitate to curtail the length o f hospital stay o f patients and to transfer them to convalescent homes. A central bureau of information could be of value in promoting higher standards and in reducing the amount of under-utilization of existing facilities.

“Principal Problems of Child Health Work in New York City,,r E. H. Lewinski-Corwin, Better Times, 1924, V , 8, 14. From the findings of a survey of child health work in New York City, Lew­ inski-Corwin draws the conclusion that there is insufficient functional coordination and planning on the part of the various agencies and not enough self-criticism and self-analysis to cause the elimination of unfit organizations and methods. The greatest needs are for a re­ search agency, an institute of Child Welfare; periodic surveys; ef­ fective social machinery in order to prevent duplication of effort; whole-hearted cooperation of the medical profession.

“ Social Responsibility for the Care of the Delinquent Girl and the Unmarried Mother,” K. F. Lenroot, Jour. Soc. Hyg., 1924, X , 74. Lenroot says the social responsibility for the care o f the girl is two­ Abstracts 301 fold— that o f prevention o f delinquency and the scientific study o f the girl’s problems and needs in order to help her to evaluate her own assets and liabilities and to form the basis for intelligent treat­ ment. The home, the school and the church are the normal agencies for character building, but all of these should be open to trained social workers who are not only able to read danger signals in the life o f the individual child, but are also capable o f modifying subtle though detrimental forces in family life. The Commonwealth Fund’s Program for the Prevention of Delinquency and the Women’s Co­ operative Alliance of Minneapolis are given as examples of agencies which are doing this. Understanding of the girl necessitates a psy­ chiatric study. The maximum of normal adjustment and the mini­ mum of differentiation from modes of living which are customary in the community should be striven for. “ It might be helpful in plan­ ning for an unmarried mother to ask what treatment would have been adapted to her needs had she not been a mother, and then to make the adjustments necessary to enable her to meet her respon­ sibilities toward her child.” The National Conference o f Com­ missioners on Uniform State Laws has approved a Uniform Illegiti­ macy which has been adopted in four states. Case work with illegiti­ macy act which has been adopted in four states. Case work with illegitimacy and for preventive measures should include the boy as well as the girl.

“ Social Hygiene and Public Health,” H. S. Gumming, Jour. Soc. Hyg., 1924, X , 65. Gumming holds that social hygiene is a definite part o f public health functions since “ syphilis and gonorrhea consti­ tute the most disastrous communicable disease problem of the present time.” The progress of the last ten years in more wide spread in­ formation, greater and better facilities for treatment of venereal diseases and the abolition o f segregated districts are discussed. In the future we must extend educational publicity and begin our work with younger individuals. This should be carried on through the home, the school, where many opportunities are offered, lectures, and printed material. W e must improve the environment o f youths, giv­ ing more opportunity for wholesome recreation. Segregation of venereally infected persons and sterilization o f mental defectives lead­ ing an irregular sex life are measures which we should strive to bring about. 302 Abstracts

“The Social Hygiene Movement in Relation to Community Or­ ganization,” E. Street. Jour. Soc. Hyg., 1924, X , 82. Street makes the statement that practically all social movements are dependent, in large part, upon the problems which are being attacked by the social hygiene movement, and the social hygiene movement, for its fullest effectiveness, depends upon these other types of social agencies for cooperative service. Ways are suggested by which these two inter­ acting movements may be mutually helpful in such fields as those covered by agencies for child welfare, health, help for the blind, aid for the deliquent.

“The A. I. C. P. Nurse Case-Worker,” A. E. Dines, Nat’s. Health, 1924, V I, 169. Since early days the aim of the New York Association for Improving the Condition of the Poor has been the improvement of the health and welfare of the individual and family. Since the physical side takes precedence and since there is rarely a family that on first contact does not show need of the Nursing Bureau, there has gradually been developed the nurse case-worker. There are now about fifty of these combination workers on the staff of this organization. There is some discussion o f the details of work and the success of the plan.

“ Milbank Memorial Fund Health and Tuberculosis Demonstra­ tions,” J. A. Kingsbury, Nat’s. Health, 1924, V I, 167. The plan of the Milbank Memorial Fund as stated by Kingsbury is “ to spend two million dollars in promoting health demonstrations in three typical American communities, embracing a population of one-half million people.” It will demonstrate by cooperation with public health authorites and voluntary agencies, whether by the intensive appli­ cation o f known health measures the extent o f sickness and the mortality rates can be reduced and whether whether these results can be achieved in a short time and at a moderate cost. For a period of five years, the project known as the New York Health and Tubercu­ losis Demonstrations, will be carried on in Cattaraugus County, the city of Syracuse and a metropolitan district. It is estimated that a total yearly per capita expenditure of three dollars will be necessary. The State Charities Aid Association has been chosen as the Fund’s principal operating agency in rural and urban areas while the Associa­ tion for Improving the Condition of the Poor and the New York Abstracts 303

Tuberculosis Association will probably be among the chief participants of the metropolitan demonstration.

“The East Harlem Nursing and Health Demonstration,” G. L. Anderson, Nafs. Health, 1924, V I, 157. The objects o f the East Harlem Nursing and Health Demonstration as outlined by Anderson are to determine: (1) What personnel would be required to carry out an intensive, preventive public health nursing program in a given community; (2) the relative value and costs of the various parts of such a program; (3) the value of generalized as compared to special­ ized nursing service; (4) the perfection of methods of work on the basis of experience, especially in fields where experience is most limited, such as preventive work for the pre-school child; (5) the cost of carrying on such an approximately adequate program. There is a discussion of the district, organization, personnel, budget plan o f work and such results as are apparent after one year. The demon­ stration is to be conducted for a three year period.

“Public Health Activities in Foreign Fields,” K. M. Olmsted, Nat's. Health, 1924, V I, 151. Public Health nursing has been developed to some degree in 41 countries, says Olmsted, and with a few exceptions has taken place during the last five years. The situa­ tion existing in a country and the type of worker needed have caused different methods of education for nurses, but in general, the plan of including public health theory and practice in the last year o f train­ ing is the one most approved. There is also a marked preference for generalized rather than specialized nursing service. Letters are quoted at some length showing the progress of the work in Finland, Siam, Latvia and Belgium.

“The New Convalescent Home for Children at Palo Alto, Cal­ ifornia,” M. R. Walsh, Am. Jour. Nursing, 1924, X X IV , 453. Un­ like most convalescent homes, says Walsh, the one for children at Palo Alto, California not only admits convalescents, but also those who still need nursing care. The latter are housed in a separate building. Climate and beauty are gifts of nature but every detail of arrangement has been worked out with the idea of convenience, rest­ fulness and home atmosphere. Four nurses are employed for the twenty beds of the Home. Support is obtained by voluntary contri­ butions, supplemented by the San Francisco Community Chest. HOSPITAL SOCIAL SERVICE DIRECTORY ALABAMA D othan The Moody Hospital Ida S. Inscor, R.N., Headworker

T l T C T T m T l ? U. S. Veteran’s Hospital No. 91 Red Cross Social Service

ARIZONA T ucson U. S. Veteran’s Hospital No. 51 Red Cross Social Service W hipple B arracks U. S. Veteran’s Hospital No. 50 Red Cross Social Service L. L. Cortright, Director

ARKANSAS L ittle R ock St. Vincent’s Infirmary Social Service Department Miss Melanie Walker, Head- worker N orth L ittle Rock U. S. Veteran’s Hospital No. 78 Red Cross Social Service Pauline Peters, Chief

CALIFORNIA A rrowhead Springs U. S. Veteran’s Hospital No. 54 Red Cross Social Service George E. Kammerer, American Red Cross Director; Knights of Columbus Director, A. B. Mahoney Berkeley Berkeley Health Centre Margaret L. Spiers Cam p K earney U. S. Veteran’s Hospital No. 64 Red Cross Social Service Otto S. Lund, Chief Los A ngeles Anita M. Baldwin Children’s Clinic of the California Lutheran Hospital Social Service Department Rosanna Stockley, R.N., Director Children’s Hospital Society Social Service Department Anna E. Valens, R.N., Head- worker Jewish Clinic and Dispensary Social Service Department Lillian Lubin, Headworker Los Angeles General Hospital Social Service Department Agnes C. Finnigan, Headworker Methodist Hospital of Southern California Oakland Baby Hospital of Alameda County Social Service Department Mrs. Bertha Wright, Headworker P alo A lto U. S. Veteran’s Hospital No. 24 304 Hospital Social Service Directory 305

San F rancisco Hospital for Children and Training School for Nurses, Out-patient and Social Service Department Edna J. Shirpser, Headworker Mount Zion Hospital, Dispensary Social Service Department Josephine Abraham, Headworker Stanford University Hospitals and Clinic San Francisco Maternity Lane Hospital Florence Cummings, R.N., Director San Francisco Hospital Department of Public Health Mrs. Clara B. Tyler, R.N. University of California Hospital Social Service Department Rose Steinhardt, Headworker San Leandro r Alameda County Hospital Social Service Department Mrs. Mabel C. Deering, Head- worker

COLORADO D enver U. S. Veteran’s Bureau Contract Hospital Red Cross Social Service Gladys Meade, Chief University of Colorado Dispensary Social Service Department Edna M. Reynolds, Headworker Fort L yon U. S. Veteran’s Hospital No. 80 Red Cross Social Service Mary B. Chew, Chief

CONNECTICUT Bridgeport Bridgeport Hospital Social Service Department H artford (1) Hartford City Hospital Social Service Department Theodale Soale, Headworker (2) Hartford Hospital Social Service Organization Laura S. Brownell, R.N. M iddletown Connecticut State Hospital Social Service Department Margaret Allin, Headworker N ew H aven Grace Hospital Social Service Department Margaret C. Gifford, Headworker New Haven Hospital and Dispensary Social Service Department Katherine E. Salkeld, Head- worker U. S. Veteran’s Hospital No. 41 Red Cross Social Service Margaret Bishop, Director N orwich Norwich State Hospital, Neuropsychiatric Clinic Betsy Mitchell

DELAWARE W ilmington Delaware Hospital ■' 'V Social Service Department Mary L. Cook, R.N., Headworker 306 Hospital Social Service Directory

DISTRICT OF COLUMBIA W ashington " Children’s Hospital Social Service Department Mrs. Harriet F. Bryant St Elizabeth’s Hospital Social Service Department Sarah F. Schroeder U. S. Veteran’s Hospital No. 32 Red Cross Social Service Agnes V. Brophy

FLORIDA L ake City U. S. Veteran’s Hospital No. 63 Red Cross Social Service Dorothy Gundy

GEORGIA A tlanta Grady Hospital Social Service Department U. S. Veteran’s Hospital No. 48 Red Cross Social Service Mrs. D. M. Robinson, Director A ugusta U. S. Veteran’s Hospital No. 62 Red Cross Social Service Pauline Radford, Chief Savannah U. S. Marine Hospital No. 20 Red Cross Social Service Mrs. Margaret F. Newell, Director

IDAHO B oise U. S. Veteran’s Hospital No. 52 Red Cross Social Service

ILLINOIS Chicago Central Free Dispensary Social Service Department Mrs. Gertrude Howe Britton, Director Chicago Lying-in Hospital and Dispensary Social Service Department Ena M. Allen, Director Chicago Memorial Hospital Social Service Department Garceal G. Smith, R.N. Chicago State Hospital Social Service Department Marion E. Shepard, Chief Children’s Memorial Hospital Social Service Department Adelaide Mary Walsh, R.N. Children’s Southside Free Dispensary Social Service Department Helen Ogren Cook County Hospital Illinois Training School Social Service Department Marion C. Prentiss, Director Grant Hospital of Chicago Social Service Department Mary B. Marshall, R.N., Head- worker Home for Destitute Crippled Children Social Service Department Mrs. Blanche Mathews Hendrich, R.N. Hospital Social Service Directory 307

Illinois Society for Mental Hygiene Social Service Department Helen L. Myrick, Organizer Institute for Juvenile Research Social Service Department Cornelia D. Hopkins Mercy Hospital Social Service Department Michael Reese Dispensary Social Service Department Janet Schoenfeld, Acting Director Michael Reese Hospital Social Service Department Helen Beckley, Director Northwestern Dispensary Social Service Department Zoe Harpster, R.N., Director Presbyterian Hospital of the City of Chicago, Social Service Department Jessie Breeze, Director Provident Hospital and Training School Social Service Department St. Joseph’s Hospital Social Service Department St. Luke’s Hospital Social Service Department Anna C. Armstrong U. S. Marine Hospital No. 5 Red Cross Social Service U. S. Veteran’s Hospital No. 30-A Red Cross Social Service Anna Dalton, Director University of Illinois Dispensary Division of Neurology and Psychiatry Social Service Department Florence Partridge Wesley Memorial Hospital Social Service Department Harriet Ege, Director

D ecatur . Decatur and Macon County Hospital Social Service Department Mrs. Myrtle Edwards

Elgin Elgin State Hospital Social Service Department Zaida E. Udell, Chief Evanston Evanston Hospital Association Social Service Department Josephine Koch Crain, Director Jacksonville _ Illinois School for Destitute and Blind Social Service Department

M aywood Edward Hines, Jr., Hospital Social Service Department Mrs. Helen R. Commiskey, Director

W infield Charles Winfield T. B. Sanatorium Social Service Department Anna F. Jacobs, Director

INDIANA Crawfordsville Culver Union Hospital Social Service Department Mrs. Essie A. Davidson

Evansville U. S. Marine Hospital No. 8 Red Cross Social Service PJ ,v!V' f , ? , i 4 f ,' , : f J ^■/,. : ^ -: s. ■ ;•■_> f . ' -,;•■• ■' %-■ • • ■ t- •/,■'V ' • - •,»•;•, t?- '• *1... •''■>1, ■ V'T^P .,.. .„

308 Hospital Social Service Directory

Indianapolis Indianapolis City Hospital Social Service Department Margaret E. Bloor, Director Robert W. Long Hospital of Indiana University Social Service Department of Indiana University Edna G. Henry, Associate Profes­ sor of Sociology Robert E. Neff, Director M arion National Military Home Red Cross Social Service Mrs. May D. Ballon, Director Oaklandon Sunnyside Sanatorium Social Service Department Harold S. Hatch, Superintendent y South B end Children’s Disp. and Hospital Assn. Social Service Department J. Campbell St. Joseph’s Hospital— Out Patient Dept. Social Service Department Lucy M. Reilly

IOWA low a City State Psychopathic Hospital Social Service Department June F. Lyday K noxville U. S. Veteran’s Hospital No. 57 Red Cross Social Service

KENTUCKY D awson Springs U. S. Veteran’s Hospital No. 79 Red Cross Social Service Louisville Children’s Free Dispensary Social Service Department Louisville City Hospital Social Service Department Catharine A. Hope, Director U. S. Marine Hospital No. 11 Red Cross Social Service Ann Pennebaker, Director Newport U. S. Veteran’s Hospital No. 69 Red Cross Social Service LOUISIANA A lexandria U. S. Veteran’s Hospital No. 27 Red Cross Social Service Helen L. Blanton, Chief Jackson East Louisiana State Hospital Social Service Department Betty C. Britton N ew O rleans Charity Hospital Social Service Department Laura Bachman, Headworker Touro Infirmary Social Service Department Mrs. D. N. Dickson, R.N. Head- worker U. S. Marine Hospital No. 14 Red Cross Social Service Juanita Daye, Chief Hospital Social Service Directory 309

MAINE A ugusta Augusta State Hospital Social Service Department Mary M. Adams Bangor Bangor State Hospital Social Service Department Virginia Rohde, Headworker E ssex Essex Sanatorium and Main Contact Hospital, Social Service Department Lucy Clare Finley P ortland U. S. Marine Hospital No. 16 Red Cross Social Service Dept. Mrs. Ruth C. Weymouth, Chief

MARYLAND B altimore Hebrew Hospital and Dispensary Social Service Department Myra L. Kraus, Director Johns Hopkins Hospital Social Service Department Margaret S. Brogden, Chief Mercy Hospital Social Service Department Sister Mary Helen University of Maryland Hospital Social Service Department Grace Pearson Mental Hygiene Committee Margaret Dudley, Headworker Federal Park U. S. Veteran’s Hospital No. 42 Red Cross Social Service

MASSACHUSETTS Boston Berkeley Infirmary Social Service Department Julia E. Keith, Headworker Beth Israel Hospital Social Service Department Ida C. Brass, Headworker Boston City Hospital Department of Social Work Gertrude L. Farmer, Director Boston Dispensary and Hospital for Children Social^ Service Department Ruth V. Emerson, Headworker Boston Lying-in Hospital Medical Social Service Dept Helen R. Fowler, Chief Boston Psychopathic Hospital Social Service Department Suzie L. Lyons, Chief Boston State Hospital Social Service Department Marie L. Donohue, Headworker Carney Hospital Out-patient Department Sister Mary Gabriel, Headworker Children’s Hospital Social Seiwice Department Mabel R. Wilson, Director Collis P. Huntington Memorial Hospital Social Service Department Emily G. Philpotts, Headworker Infants Hospital Social Service Department Mrs. Anna P. Smith Mass. Charitable Eye and Ear Infirmary Medical Social Service Dept. Jessie M. C. Hume, R.N., Chief Mass. General Hospital Social Service Department Ida M. Cannon, Chief 310 Hospital Social Service Directory

Mass. Homeopathic Hospital Social Service Department Alla A. Libbey, Headworker Maverick Dispensary Neva E. Dewar, Headworker New England Hospital Out-patient Dept., New England Hos­ pital for Women and Children Sarah Beatty, Headworker Peter Bent Brigham Hospital Social Service Department Alice M. Cheney, Headworker Robert Breck Brigham Hospital Social Service Department Louise B. Powers U. S. Veteran’s Hospital No. 44 Red Cross Social Service Ruth Wadman, Chief Cambridge Cambridge Hospital Social Service Department Ellen V. Griffin, R.N., Head- worker Chelsea U. S. Marine Hospital, No. 2 Woman’s Seaman’s Friend U. S. Naval Hospital Red Cross Social Service Aletta E. Horn D anvers Danvers State Hospital Hannah Curtis, Room 109, State House, Boston Fall R iver Fall River General Hospital Social Service Department Mrs. Esther H. Stewart Union Hospital of Fall River Social Service Department Deborah H. Barus, Headworker Foxborough Foxborough State Hospital Social Service Department Elizabeth L. Mosley, Headworker Gardner Gardner State Hospital Social Service Department Carolyn D. Harlow Mattapan Boston Sanitorium Social Service Department Gertrude J. Maynard Medfield Medfield State Hospital Social Service Department Mary H. Holland New Bedford St. Luke’s Hospital Letitia G. Kelly, R.N., Head- worker Newton Lower Falls Newton Hospital Social Service Department Gertrude M. Herrick, Worker N orthampton Northampton State Hospital Social Service Department Lucia Pratt, Worker R utland U. S. Veteran’s Hospital No. 89 Red Cross Social Service Katherine Crothers, Chief T aunton Taunton State Hospital Social Service Department Esther C. Cook, Headworker Hospital Social Service Directory 311

T ewksbury State Infirmary Social W ork under Dept, of Public Welfare, State House, Boston Flora E. Burton, Supervisor , \ f W avekley Mass. School for the Feeble-minded Social Service Department Mabel A. Matthews, Headworkei

W estborough Westborough State Hospital Social Service Department Ruth A. Beebe, Worker

W orcester Memorial Hospital Washburn Free Dispensary Anna C. Strickland, Director Worcester State Hospital Social Service Department Jennie A. Harrington, Head- worker

W rentham Wrentham State School Social Service Department Alice Raymond, Head worker Vineyard Haven U. S. Marine Hospital No. 22

MICHIGAN

A nn A rbor State Psychopathic Hospital Social Service Department Mrs. H. S. Mallory, Headworker University Hospital Social Service Department Dorothy Ketcham, Director

D etroit Children’s Hospital of Detroit Social Service Department Henrietta J. Potts, R.N., Director Detroit Osteopathic Hospital Social Service Department Emily Daniel, R.N., Headworker Grace Hospital Social Service Department Emma Jane MacDonald, Head- worker Harper Hospital Social Service Department Alice H. Walker, Director Michigan Mutual Hospital Social Service Department Helene M. Cooper, Headworker Providence Hospital Social Service Department Receiving Hospital Social Service Department St. Mary’s Polyclinic Social Service Department Charlotte Giles, Social Worker U. S. Marine Hospital No. 7 Red Cross Social Service Merton Wheeler, Director Wayne County Psychopathic Clinic Social Service Department Dr. Nellie Perkins, Headworker Women’s Hospital and Infants’ Home Social Service Department Maud C. Stimson , 312 Hospital Social Service Directory

Grand R apids / Blodgett Memorial Hospital Social Service Department Mabel Tompkins, Director Butterworth Hospital Social Service Department Mrs. Lottie Felkner, Worker S t Mary’s Hospital Social Service Department Catherine Murray, Worker K alamazoo Kalamazoo State Hospital Estella M. Hughes, Headworker T ravers City Travers City State Hospital Social Service Department Miss Howland

MINNESOTA D uluth Duluth Free Dispensary St Luke’s Hospital Assn. Marian Bodey, R.N. M inneapolis General Hospital Social Service Department Alma Holzschuh, Director Maternity Hospital, Inc. Social Service Department Emma Louise Baird U. S. Veteran’s Hospital No. 68 Red Cross Social Service Theresa Neuburger, Director University Hospital Social Service Department Marion A. Tebbets, Director Rochester Mayo Clinic Kahler Corp. Hospital Medical Social Service Charlotte N. Bundy, Headworker St. Paul Aucker Hospital Social Service Department Rena Brainerd City and County Hospital Social Service Department S t Paul Medical Dispensary Social Service Department Mrs. Helen Anderson Young, Director State Hospital for Crippled Children Social Service Department Hazel O. Olson, R.N. U. S. Veteran’s Hospital No. 65 Red Cross Social Service MISSISSIPPI Gulfport , U. S. Veteran’s Hospital No. 74 Red Cross Social Service Minnie L. Stockton, Worker MISSOURI K ansas City Children’s Mercy Hospital Anna A. Anderson, R.N., Head- worker Kansas City General Hospital Social Service Department for Hospital and Health Board U. S. Veteran’s Hospital No. 67 Red Cross Social Service U. S. Veteran’s Hospital No. 92 Red Cross Social Service Wheatley-Provident Hospital Clinic Hospital Social Service Directory 313

St. Louis Barnard Free Skin and Cancer Hosp. Mrs. Anna Colina, Headworker Barnes Hospital Children’s Hospital Jewish Hospital Washington University Dispensary St. Louis Hospital Social Service Department Edith M. Baker, Director City Hospital No. 2 (Colored) Social Service Department Health Department Municipal Clinic Social Service Department St. John’s Hospital Dispensary Social Service Department Helen Cullinane St. Louis City Hospital Social Service Department Mrs. Stella Barnes St. Louis Maternity Hospital Social Service Department Mrs. Elizabeth Johnson St. Louis Mullanphy Social Service Department St. Louis University Clinic Social Service Department Mrs. Stella Gillick St. Luke’s Hospital Social Service Department Retta L. Snyder

MONTANA H elena U. S. Veteran’s Hospital No. 72 Red Cross Social Service Marjorie Jackson, Chief

NEBRASKA O m aha University of Nebraska School of Medicine Miss Grace E. Buckley

NEW HAMPSHIRE Concord New Hampshire State Hospital Department of Social Work Elsie E. Alexander, Headworker P ortsmouth > U. S. Naval Hospital Red Cross Social Service Mrs. Ruth C. Weymouth, Chief

N E W JE RSEY Camden Cooper Hospital Social Service Department Mrs. Emily Yoxall Smyth, Head- worker

E lizabeth Elizabeth General Hospital Social Service Department Mrs. A. M. Hasbrouck, R.N. E nglewood Englewood Hospital Assn. Child Hygiene and Hospital Margaret Hickey, R.N., Head- worker Alison Wylie, R.N., Director Long Branch Monmouth Memorial Hospital Social Service Department Stella Jacobs, R.N., Headworker M orris P lains N. J. State Hospital Social Service Department Mildred H. Hurley N ewark Babies Hospital Coit Memorial Social Service E. W. Murray, M.D., Director St. Barnabas Hospital Social Service Orange Orange Memorial Hospital and Dispensary, Social Service Dept. Alice E. Renaud, R.N., Head- worker P aterson Nathan and Miriam Earnert Memorial Hospital Social Service Department Plainfield Muhlenberg Hospital W elfare Department T renton N. J. State Hospital for Insane Mrs. Maude B. Rue

N E W M EXICO Fort Bayard U. S. Veteran’s Hospital No. 55 Red Cross Social Service Edna W . Collins, Chief

N E W Y O R K Binghamton Binghamton City Hospital Social Service Department Binghamton State Hospital Social Service Department Helen C. Hanofin, Social Worker B uffalo Buffalo City Hospitals and Dispensaries Natalie Ryan, Social Worker Buffalo General Hospital Social Service Department Mary Churchyard, Headworker Buffalo Homeopathic Hospital Social Service Department Mrs. Frank Underwood, Head- worker Buffalo State Hospital Social Service Department Maud A. Bums, Headworker Children’s Hospital Social Service Department Sophia D. Roess, Headworker U. S. Marine Hospital No. 3 Red Cross Social Service Lydia M. Clarke, Chief Central I slip, Long I sland Central Islip State Hospital Social Service Department M. Elizabeth Dunn, Headworker Hospital Social Service Directory 315

H elmuts Gowanda State Homeopathic Hospital Social Service Department Mrs. Florence Bement

K ings Park 6 Kings Park State Hospital Social Service Department Margaret J. Doherty, Headworker

M iddletown Middletown State Homeopathic Hospital Social Service Department Maysie T. Osborne, Headworker

New Y ork (see also Brooklyn, Bronx, Staten Island, Long Island) Babies Hospital Social Service Department Mildred Sawyer, Headworker Beekman Street Hospital Social Service Department T. R. Keogh Bellevue and Allied Hospitals (See Fordham, Harlem and Gouverneur Hospitals) Social Service Department Mary E. Wadley, R.N., Head- worker Beth David Hospital Social Service Department May Belikoff, Headworker Beth Israel Hospital and Dispensary Social Service Department Elizabeth J. Caiger, Headworker Broad Street Hospital Social Service Department Helen Campbell, Headworker City Hospital Social Service Department Mrs. Katherine D. Ermold, R.N., Headworker Clinic of the Cornell University Medical College Anna King, Chief Clinic Exec. Community Hospital Social Service Department Grace Martus, Headworker Fifth Avenue Hospital Social Service Department Helene H. Prentiss, Headworker Flower Hospital Social Service Department Mrs. V. Perepelkin, Headworker Fordham Hospital Social Service Bureau Helen E. Sanford, R.N., Head- worker French Hospital Social Service Department Mrs. Mary G. Bubser, R.N., Headworker Gouverneur Hospital Social Service Bureau Mrs. Emma Morse, R.N., Head- worker Harlem Hospital Social Service Department Mrs. Josephine Hill Squire, R.N., Headworker Hospital for Joint Diseases Social Service Department Veronica MacMillan, Headworker Hospital for Ruptured and Crippled Social Service Department Jessie H. Prest, R.N., Head- worker Italian W elfare League Italian Hospital Cordelia M. Townsend Jewish Maternity Hospital Social Service Department Sarah Saperstein, R.N., Head- w orker 316 Hospital Social Service Directory

John E. Berwind, Maternity Clinic Anna L. Brooks, Headworker Knickerbocker Hospital Social Service Department Sarah J. Shockey, R.N., Head- worker Lebanon Hospital Social Service Department Jeanette Crysler, Headworker Lenox Hill Hospital A. Jacobi Hospital for Children Jean Gray Long, R.N., Director Lincoln Hospital and Home Social Service Department Mrs. E. W. Haydon, R. N., Head- worker Lutheran Hospital Dispensary Social Service Department Anna Drewes Lying-in Hospital Social Service Department Miss Goodman Manhattan Eye, Ear and Throat Hospital Social Service Department Margaret Van Fleet, Director Manhattan Maternity Hospital { Social Service Department Anna M. Young, Headworker Manhattan State Hospital for Insane Social Service Department Amelia J. Massopust, R.N., Head- worker Manhattan State Hospital Red Cross Social Service Elizabeth Brockett, Chief Memorial Hospital Social Service Department Florence M. Trudgeon, Head- worker Metropolitan Hospital Social Service Department Jessy C. Palmer, R.N., Head- worker Misericordia Hospital Social Service Department Mrs. E. Hitchman, Headworker Montefiore Hospital for Chronic Diseases Social Service Department Mrs. Sadie Luttinger, Headworker Mt. Sinai Hospital Social Service Department Fanny Lissauer, Headworker N. Y. Neurological Institute Social Service Department Mary A. Tobin, R.N., Head- worker N. Y. Children’s Hospital Social Service Department Victor C. Dodworth, Director Under Bureau of Investigation, Dept, of Public Welfare New York Dispensary Social Service Department Jean G. Ross, R.N., Headworker N. Y. Eye and Ear Infirmary Social Service Department Mrs. M. E. Gearhart, Headworker New York Hospital Social Service Department Hannah L. Josephi, R.N., Headworker N. Y. Infirmary for Women and Children Social Service Department Lillian Lent Montells, Head- worker N. Y. Nursery and Child’s Hospital Social Service Department Harriet Jane Smith, R.N., Head- w orker Hospital Social Service Directory 317

N. Y. Polyclinic Medical School and Hospital, Social Service Department Anna Foley N. Y. Post Graduate Medical School and Hospital, Social Service Department Mrs. J. W. Beveridge, Head- worker N. Y. Skin and Cancer Hospital Social Service Department Olga Lange, Headworker Peoples Hospital Social Service Department Augusta Mintzen, Headworker Presbyterian Hospital Social Service Department E. Thayer Patterson, R.N. Director Reconstruction Hospital Social Service Department Katherine Verdery, Headworker Rockefeller Institute Hospital Social Service Department Edith L. Rains, R.N., Head- worker Roosevelt Hospital Bureau of Home Welfare Mrs. Helen Price, Headworker St. Bartholomew’s Clinic and Hospital Social Service Department Louise M. Coe, Headworker St. Luke’s Hospital Social Service Department Amy F. Cleaver, R.N., Head- worker St. Mark’s Hospital Social Service Department Mrs. E. E. J. Kjaer, Head- worker St. Vincent’s Hospital Social Service Department Mrs. Julia J. Duffin, Director Seaside Hospital and Floating Hospital of St. John’s Guild Social Service Department Mrs. Elizabeth B. Goheen, Head- worker Sloane Hospital for Women Social Service Department Grace R. Bolen, Headworker Tonsil Hospital Social Service Department Mrs. J. Horton Ijoms, Head- worker U. S. Marine Hospital No. 21 Red Cross Social Service Florence Burgham U. S. Marine Hospital No. 43 J. Bertha Fulton U. S. Marine Hospital No. 70 Madeline Oldfield, R. N., Chief Vanderbilt Clinic Social Service Department Mrs. Anna F. Dwight, R.N., Headworker Woman’s Hospital Social Service Department Louise M. Renier, Headworker

Bronx Bronx Hospital Social Service Department Minnie Zalkind, Headworker U. S. Veteran’s Hospital No. 81 Red Cross Social Service Elizabeth Nairn, Chief

Brooklyn Beth Moses Hospital Social Service Department Mrs. Rosamond P. Bilder Brooklyn Hospital Social Service Department Mary H. Combs, R.N., Head- w orker 318 Hospital Social Service Directory

Brooklyn State Hospital Social Service Department Mrs. Frances C. Tanner, R.N., Headworker Cumberland Hospital Social Service Department Bessie A. Vojik, R.N., Head- worker Greenpoint Hospital Social Service Department Ethel B. MacQueen, R.N., Head- worker Jewish Hospital of Brooklyn Social Service Department Selma F. Dichter, R.N., Head- worker Kings County Hospital Social Service Department Lucy A. Connelly, R.N., Head- worker Long Island City St. John’s Hospital Social Service Department S. J. Farrell, R. N., Headworker Long Island College Hospital Polhemus Clinic Florence Totman, R.N., Director Methodist Episcopal Hospital in the City of Brooklyn Social Service Department Clara B. Powell, Social Worker St. Giles Hospital Out-patient Department Mrs. Gladys Weber Nelson St. Mary’s General Hospital Social Service Department H. Marcella Phillips, R.N. U. S. Naval Hospital Red Cross Social Service Major J. C. Butts, Field Director Ogdenburg St. Lawrence State Hospital Social Service Department

Poughkeepsie Hudson River State Hospital Station B. Social Service Department Nellie A. Doughty, R.N., Head- worker

Rochester Highland Hospital Social Service Department Sarah Caldwell, Headworker Rochester Dental Dispensary Social Service Department Beulah E. Fuller, Headworker Rochester General Hospital Social Service Department Elizabeth Lowry, BL. Rochester General Hospital and Dispensary Social Service Department Mary L. Hall, AB., R. N. Rochester Homeopathic Hospital Social Service Department Mary H. Rogers, Headworker Rochester State Hospital Social Service Department Minnie I. Gainey, Headworker

Staten I sland Sea View Hospital Social Service Department Alvena Lausman, Headworker Staten Island Hospital Social Service Department Grace A. Haven, Headworker

T roy Samaritan Hospital Burdette and Peoples Avenues Social Service Department Ada H. Stafford U tica Utica Dispensary Social Service Department Utica State Hospital and Psychiatric Clinic Social Service Department

V alhalla Grasslands Hospital Social Service Department E. Louise Pond, Headworker

W illard Willard State Hospital Social Service Department Nellie C. Quinn, Headworker

NORTH CAROLINA O teen U. S. Veteran’s Hospital No. 60 Red Cross Social Service Charles P. Pratt, Director

OHIO A kron Children’s Hospital and Dispensaries Social Service Department Helen C Flaherty, Headworker City Hospital of Akron Social Service Department Lelin Townsend, R.N.

Chillicothe U. S. Veteran’s Hospital No. 87 Red Cross Social Service Dr. Abraham Dunn, Director

Cincinnati Children’s Hospital Social Service Department Mrs. Alice Cramer, Social Worker Cincinnati General Hospital Social Service Department Luwinna Little, Exec. Sec. Cincinnati T. B. Sanatorium Social Service Department Mrs. Betty M. Holmes, Head- worker Jewish Hospital and United Jewish Social Agencies Dispensary Social Service Department Jeanette Herman, Headworker Psychopathic Institute Jewish Hospital Social Service Department Mrs. Florence M. Rosenthal, Headworker

Cleveland Babies Dispensary and Hospital Social Service Department Mrs. Aurilla Storey Fairview Park Hospital and Dispensary Social Service Department Miss Nora Kohl Huron Road Dispensary Social Service Department Sara James Lakeside Hospital Social Service Department Mrs. C. W. Webb, Director Maternity Hospital Dispensary of Maternity Hospital, and Western Reserve University Betty C. Connelly, Headworker a. 320 Hospital Social Service Directory

Mt. Sinai Hospital of Cleveland Social Service Department Gertrude Steuer, Headworker Neuropsychiatric Clinic American Red Cross Anna Belle Tracey St. Alexis Dispensary Social Service Department Katherine A. Gallagher St. Luke’s Hospital Social Service Department St. Vincent’s Charity Dispensary Social Service Department Ethel M. Turk U. S. Marine Hospital No. 6 R. C. Social Service Alma M. Lucht

H amilton Mercy Hospital Social Service Department Sarah O’Connor, R.N.,

T oledo St. Vincent’s Hospital Social Service Department Mrs. O. P. Forrester, Head- worker

Y oungstown St. Elizabeth’s Hospital and Dispensary Social Service Department Elizabeth Connelly, R.N. Youngstown Hospital Out-patient Department Winifred Campbell, R.N., Head- worker

OKLAHOMA O klahoma City State University Hospital ft Social Service Department Kittie Shanklin, Headworker M 1

OREGON P ortland m U. S. Veteran's Hospital No. 77 Red Cross Social Service Esther Kelly, Director

PENNSYLVANIA B ryn M awr Bym Mawr Hospital Social Service Miss Helen B. Jones Parry

Chester Chester Hospital Social Service Department B. O. Stevenson, R.N., Head- worker D anville State Hospital for Insane H. V. Pike, M.D., Clinical Director Germantown Germantown Dispensary and Hospital % Social Service Department Helen M. Pugh Hospital Social Service Directory 321

Lancaster Lancaster General Hospital Social Service Department Mrs. May F. Coppinger, Head- worker

P hiladelphia Babies Hospital of Philadelphia Social Service Department May A. Pabst, Headworker Bureau of Health Division of Child Hygiene, Health Centre, No. 1 Florence M. Bush, Supervisor

P hiladelphia Children’s Hospital of Philadelphia Social Service Department F. Isbell Doolittle, R.N., Head- worker Children’s Homeo. Hospital Franklin and Thompson Streets Social Service Department Diagnostic Hospital Social Service Department A. K. Sutton, R.N., Headworker Eagleville Hospital and Sanatorium for Consumptives Social Service Department Amy L. Seyfert, R.N., Head- worker Frankford Hospital Frankford Ave. and Wakeling St. Social Service Department Graduate School of Medicine University of Pennsylvania, Polyclinic Medico and Chirurgical Hospital Social Service Department Henri-Ette Kirch, Director Hahneman Medical College and Hospital Social Service Department Josephine Bright, Headworker Henry Phipps Institute Social Service Department Fanny Eshelman, R.N., Head- worker Hospital of the Protestant Episcopal Church in Philadelphia Social Service Department Mary E. Pollock, Headworker Hospital of the University of Pennsylvania Social Service Department Rita Lord Scudder Howard Hospital Social Service Department Irene H. Virdin, Headworker Jefferson Hospital Social Service Department Estelle G. Wasson, Director Jewish Hospital and Dispensary Social Service Department Antoinette Heitman, R.N. Jewish Maternity Hospital Social Service Department Nellie A. Gealt, R.N., Head- worker Lankeniau Hospital Social Service Department Sister Fredericka Fessler, Head- worker Methodist Episcopal Hospital Social Service Department Ida Watson, Headworker Misericordia Hospital Social Service Department Mary E. Ward 322 Hospital Social Service Directory

Mt. Sinai Hospital Social Service Department Pennsylvania Hospital, Department for Sick and Injured r Social Service Department Irene Hayward, Headworker Philadelphia General Hospital Medical Social Service Mary R. Ferguson, Supervisor Philadelphia Hospital for Contagious Diseases Social Service Department M. Ruth Butler, Supervisor Philadelphia Hospital for Mental Diseases, Social Service Jane Estabrooks Philadelphia Orthopaedic Hospital and Infirmary for Nervous Diseases Social Service Department Mrs. Ida E. Norton, Director Presbyterian Hospital Social Service Department Frances Hostetler, R.N., Head- worker St. Christopher’s Hospital for Children Social Service Department Edith J. McComb, Headworker Samaritan Hospital Social Service Department Mrs. Laura M. Southwick, Head- worker U. S. Veteran’s Hospital No. 49 Red Cross Social Service Cecile R. Kennedy, Chief West Philadelphia Hospital for Women Social Service Department Bella C. Donlan, Headworker Women’s Hospital of Philadelphia Social Service Department Lillias Lober, Headworker Women’s Southern Homeo. Hospital Social Service Department Mabel F. Hawkins, Headworker

Pittsburgh Allegheny General Hospital Social Service Department Alida Winkelman, Headworker Elizabeth Steel Magee Hospital Social Service Department Helen L. Hillard, Headworker Mercy Hospital > Social Service Department Elizabeth Cosgrove, A.B., Head- worker Pittsburgh Free Dispensary of Univ. of Pittsburgh Eye and Ear Dispensary Social Service Department Minnie E. Pfordt, Director Pittsburgh Skin and Cancer Foundation Social Service Department Lillian M. Hobart St. Francis’ Hospital Social Service Department Katherine Carroll Southside Hospital and Dispensary Social Service Department Anna E. Rothrock, Headworker U. S. Marine Hospital No. 15 R. C. Social Service Department Mrs. Catherine Hoyt, Chief Western Pennsylvania Hospital Social Service Department Grace Woodrow, Headworker Hospital Social Service Directory 323

Scranton Hahnemann Hospital and Dispensary Social Service Department Mary E. Kelly, Headworker W ilkes-B arre Mercy Hospital Social Service Department Helen Mattingly, Headworker Wilkes-Barre City Hospital Social Service Department Evelyn E. Wick, Headworker

RHODE ISLAND H oward State Hospital for Mental Diseases Social Service Department Mary M. Thomson, Headworker Newport Hospital Social Service Department L. Margaret Crowe, R.N,. Director Pawtucket Memorial Hospital Social Service Department Muriel Bales, R.N., Headworker

Providence Providence City Hospital Social Service Department Mrs. Mary Lippincott, R.N., Director Providence Lying-in Hospital Social Service Department Grace C. Upham, Director Rhode Island Hospital Social Service Department Bess H. Medary, Director SOUTH CAROLINA Greenville U. S. Veteran’s Hospital No. 26 Red Cross Social Service Mrs. Ethel W . Cain, Director SOUTH DAKOTA H ot Springs Battle Mountain Sanitarium Social Service Department Florence Rischatsch, Director

TENNESSEE Johnson City National Sanatorium Social Service Margaret Williams, Worker

M emphis U. S. Veteran’s Hospital No. 88 Red Cross Social Service U. S. Marine Hospital No. 12 Red Cross Social Service

TEXAS Legion U. S. Veteran’s Hospital No. 93 Red Cross Social Service Maude Short, Headworker

San A ntonio Robert G. Green Memorial Hospital Medical Social Service Madge Loranger, Headworker

Mrs. Annabel Johnson

Otallie Jennrich, R.N., Head- worker Milwaukee Maternity Hospital Social Service Department Mary Campbell, Chairman Mt. Sinai Hospital and Dispensary Social Service Department Anna I. Goldstein, Headworker W aukesha U. S. Veteran’s Hospital No. 37 Red Cross Social Service Miss C. R. Myers, Chief

WYOMING Fort M cK enzie U. S. Veteran’s Hospital No. 86 Red Cross Social Service Emma Kotz, Headworker

CANADA

BRITISH COLUMBIA V ancouver Vancouver General Hospital Social Service Department Mary L. Thompson, Director Hospital Social Service Directory 325

MANITOBA W innipeg S* Children’s Hospital of Winnipeg Social Service Department Miss A. E. Gilroy, Headworker 0m Winnipeg General Hospital ■ m Social Service Department Stella J. Pollexfen, Headworker

ONTARIO T oronto General Hospital Social Service Department J. M. Kniseley, Headworker Department of Public Health maintains Hospital Extension Service at several Hospitals Zada N. Keefer, Superintendent

QUEBEC M ontreal Children’s Memorial Hospital ' kim Social Service Department Mrs. Amy B. Hilton, Director Montreal General Hospital Social Service Department M. Ada Davison, Headworker Montreal Maternity Hospital Social Service Department Mrs. Robert Adair Royal Victoria Hospital Social Service Department Alice Rushbrooke, Headworker Western Hospital Social Service Department Miss Nan I. McMann, Head- worker

HAWAIIAN ISLANDS H onolulu Queens Hospital Social Service Miss Margaret Catton, Head- worker

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