The Hospital Social Service Quarterly A Magazine Published in the Interest of Social Service and Dealing with the Many Problems of the Hospital Superintendent, Doctor, Auxiliary Committee, Volunteer and Nurse in Relation to Medical Social Service. PUBLISHED QUARTERLY UNDER THE AUSPICES OF THE HOSPITAL SOCIAL SERVICE ASSOCIATION OF NEW YORK CITY EDITORIAL STAFF DR. E. G. STILLMAN, Editor MISS N. F. CUMMINGS, Managing Editor 405 Lexington Avenue, New York,. N.Y. CONTRIBUTING EDITORS MICHAEL M. DAVIS, JR., Director, Boston Dzsjnmsary JOHN E. RANSOM, Superintnzdani, 7 he fifichael Reese Dz:~peusary, Chicago Mrss IDA M. CANNON, Chief of Social Service, fifassachusetts General Hospital, Boston Mrss MARGARET S. BRoGDEN, Super'lJisor, Social Service DejJ't, Johns Hopkzizs Hospital, Baltzinore Mrss M. ANTOINETTE CANNON, Chief of Social Servzce, Hospital of University of Penmylvania, Philadelphza Mrss MARY E. WADLEY, Chief of Soda! Service, Bellevue Hospital, New York MISS EDNA G. HENRY, Director, Social Service DejJ' t, Indiana University, IndzaJtapolis, Ind. DR. jESSICA B. PEIXOTTO, University of CaliforJtia Hospital, Berkeley, Cal. SUBSCRIPTION PRICE, $J.50 SINGLE COPIES, .50 Advertising Rates may be bad on application Copyrighted by E. G. Stillman CONTENTS PREVIOUS NUMBERS Vol. I No.1 The Epidemic of Influenza. DR. Lours I. HARRIS...................... 3 Medical Social Work and the Influenza Epidemic. M. ANTOINETTE CANNON 15 Extension of Medical Social Work to Naval Hospitals. RuTH V. EMERSON 22 Summer Training School in Social Reconstruction at Smith College. PRoF. F. STUART CHAPIN ............................ 27 The American Association of Hospital Social Workers ................. 33 St. Luke's Hospital Course for Social Service Volunteers. AMYL. CLEAVER 41 Vol. I No.2 The Medical Social Unit. SIDNEY E. GoLDSTEIN...................... 55 The Clothing Committee. MARY BELKNAP .MURPHY.................... 63 The Follow-up Work at Presbyterian Hospital. E. 'I'. PATTERSON, R.N. 71 The Nutrition Class. M1ss LucY 0PPEN............................... 86 Medical Social Service and Hospital Organization. RICHARD MAcKENZIE 95 The Handicapped Employment Bureau. Mrss E. RIGBY .............. 101 Occupational Therapy for Interned Patients. ALicE H. WALKER, R. N. 106 Relation of Dispensary Social Service to the Syphilitic. DR. ANNA M. RICHARDSON 109 Work for Convalescent Children. HENRY DwiGHT CHAPIN, :\L D ....... ll4 Vol. I No.3 The Therapeutic Use of a Hospital Library. ELIZABETH GREEN ....... 147 SIDNEY I. ScHwAB, M.D. Annual Meeting of the American Association of Hospital Social Workers 158 My Medical Social Service Experience in France. RICHARD CABOT, M.D. 163 Is There Such a Thing as Clear-Cut Function? HELEN WALLERSTEIN ... 157 Standards of Social Service Work. E. H. LEWINSKI-CORWIN, Ph. D ..... 179 Course in Social Work with Mental Hygiene Cases. KATHERINE TucKER 182 Employment Bureau for the Handicapped. MARION WALLACE ........ 184 Maternal Nativity aud Infant Mortality. P. R. EASTMAN....... 190 Treatment of Malnutrition among Children. MuRRAY H. BAss, M.D ..• 195 The Polish Grey Samaritans. ELsA M. BuTLER ..................... 200 To What Extent Shall the Settlement Worker Use Case Records w. H. MATTHEWS 204 Increase in the Last Four Years in Cost of Living in an Unskilled Laborer's Family. M. E. WADLEY ............................. 211 Nutrition Cases at St. George's Church. HELEN WALLBRIDGE, M. D ..... 216 Practical Points in Hospital Social Service. E. WEISS ............... 223 Notes on Life of St. Vincent de Paul. N. F. CuMMINGS ................ 228 Who Started Hospital Social Service? S. S. GoLDWATER, M.D .......... 235 The Hospital Social Service Quarterly VoL. I NOVEMBER 1919 No.4 MEDICAL SOCIAL SERVICE OF THE FUTURE* CHARLES P. EMERSON, M.D. Dean Indiana School of 111 edicine Indianapolis, Indiana Few ideas in the hospital world have proven as contagious as has that of medical social service. This movement started in Boston about thirteen years ago, following the report of the work of Dr. Richard C. Cabot and his friends in the Massachusetts Gen­ eral Hospital. Five years later over seventy such departments had been organized in hospitals and dispensaries and now medical insti­ tutions seem to consder a social service worker as a necessity and are almost ashamed if they have none. Indeed, we have hardly begun to realize the value of these departments to our medical institutions and to their patients. *Read before the Social Service Section of the American Hospital Association, Cin­ cinnati· Sept. 11, 1919. 264 lVIedjcal Social Service of the Future But what is medical social service? Several speakers of this conference have used that technical term so often and so glibly during the past two days that they must have thought we all would know just exactly what they meant. Did we? I did not. A few years ago when I corresponded with seventy-two such departments to find ou't what they were doing I found that hospital social service meant seventy-two different, often quite different, things. The chances are that our differences of opinion are in part at least due to the fact that we are talking on quite different subjects. \iVhat is the essen6al element in medical social service? Let us try to clarify our minds by reviewing some of the various forms which hospital social service has taken in the past in order that we may proceed with our subject, medical social service of the future. At the outset we must, as we review all these different forms of medical social service, ask the question: Have these a greatest common divisor? If not, is there in this confused mass of ideas, most of them excellent, one or a few which deserve to be empha­ sized in the future at the expense of the others? There are several very good reasons why the medical social service of the past started along so many different lines. One is that the first motive which prompted every worker was the desire to correct certain definite, glaring errors which he had noticed in the methods of the administrative or professional workers of the hospital or dispensary in which he was interested, and since the weak points in the different institutions were so varied in character the aims of their social service workers were equally varied. It was a common observation then that the patients of dispensaries and hospitals were so bewildered, so forlorn, so confused, so unhappy. They did not know how to use the professional service offered and nobody seemed to care. Usually they could not follow the advice given. The doctors were so busy, the nurses so professional, and the patient only a "case." The social service workers first en­ deavored to treat the patients as friends. They tried to make them feel at home. They acted as guides, as interpreters. They ex­ plained what the doctors' advice meant. They enoouraged, they comforted, they persuaded, they quieted anger, they healed hurt Charles P. Emerson, M.D. 265 feelings, they listened to the problems of the home and they per­ sonally as well as through benevolent societies helped to solve these problems in order that the mother or wage earner might improve the advantage offered by the hospital. Such service was splendid and should continue, but not as medical social service. This is but the correction of faults in the organized work of administrators, doctors and nurses, faults which were the inheritance of the black century (the Eighteenth) of nursing and of medical care. These persons should break \Vith the past and make such social service unnecessary. It surely is poor business to organize and support one expensive department to correct the unnecessary shortcomings of other departments. Some of this work may always be necessary, but it should be a side issue. Another reason for the confusion and variety in the efforts of early social service workers was their inability to obtain coopera­ tion satisfactory to themselves with the long established city charity organizations and other general philanthropic societies. It is usually necessary for the social service workers to organize more or less material relief for their pa6ents ami. along their own definite lines. Since their object in this help is different frmn that of the charity worker and since the older organizations already had fixed policies and habits well established, a failure to cooperate was in some cases unavoidable and so the medical worker must of neces~ity act inde­ pendently. I think I am correct that the actual, concrete on;aniza­ ti.on of the early work was in no small degree the direct result of a failure of city charitable societies and these hospital workers to get together. But this state of affairs should not be permanent. One of the most gratifying and flattering trihutes to the value of medical social service is the willing and generous support and cooperation of those who control the funds of benevolent societies for the relief of the sick poor. This is fortunate in more \Va~vs than one since the medical worker loses value when he becomes involved in the dis­ pensation of material relief. Social service workers should know hovv to interest benevolent societies in their patients, but that should be a side issue. The sick poor we try to interest them in are not a nevv problem to these societies. They are the same persons they 266 Medical Social Service of the Future have helped for years. If they cooperate with us, this work at once gains value. Of one point we are certain: the medical social service worker should not personally dispense any material relief. We believe that a hospital cannot even afford to allow general charity workers in its buildings (although it should be greedy to get aJl it can for its patients and their families from the organizations whose officers are outside of its walls). Free medical and surgical treat­ ment is one of the greatest of charities, certainly it is one of the most expensive, and it is desirable that the patient understand this in order that we may obtain his necessary cooperation in the treat­ ment of his own case, and this co-operation involves frankness, confidence and a certain camaraderie between patient and doctor.