with a word, and their reasons for being seriously displeased are proffered easily. It is true that too often they have been much put upon. Listen, get their point of view, remember that even the irrelevant things that they say will help you to estimate their value as witnesses, then-push beyond to the things that more immediately concern your client, being careful to seek, even here, only those items of evidence that each particular Relative seems fitted to give. Confer with them about the possibilities already in mind. "Relatives are often indignant to find we have made a pretence of consulting them merely to foist upon them our own plan." The consultation must be genuine. Sometimes their own resourcefulness puts ours to shame.

After a number of Relatives have been seen, their plans may conflict or their adherence to any one plan of action may be halfhearted. In that case it may be well to follow up the separate interviews by arranging a conference with all of them together. This makes for clearness of understanding and dignifies their part in the treatment that is to follow.

The approach to Relatives is made more difficult sometimes by the fact that the social worker is the bearer of bad news.

An S. P. C. C. was notified by a day nursery of a mother's serious neglect of her young baby. The woman was only twenty-one, had come to the city to study at a technical school, and was receiving money regularly for this purpose from her parents in another state. They knew nothing of her illegitimate child or of her marriage to its father three months after its birth. The society wrote as follows: "We have been interested for some little time in the welfare of your daughter, Mrs. and her daughter, Ethel, and, on account of the neglect of the child's parents, the Judge of the Juvenile Court has placed the child temporarily with a state agency. We might have allowed this matter to go on without bringing it to your attention, but, at the request of the Judge, who has dealt in a most kindly way with your daughter, we are asking you to come to her assistance and to save her from the degradation to which she now seems destined unless those who are most concerned about her can work vigorously for her redemption. Instead of going into the details, we should like to ask whether you or your wife or both could not come to this city and consult with us or send some one equally interested to represent you with whom the whole matter can be talked over."

Two days later the girl's father appeared and her mother soon after-simple country people and both very helpless. But another daughter of the family proved to have the necessary strength of character. She was given the legal guardianship of the child, and mother and child went back later to the country home.

The effort to get in direct communication with these particular Relatives, not trusting to letters only in so delicate a matter, was prompted by a sound instinct. Relatives are often at such a distance that personal interviews are impossible, however, and this is especially true in the United States, where frequent migrations within the large cities, and migrations from county to county or state to state make our communications with Relatives at once more difficult and more necessary. Immigration is a further complication. It has been said that many of our social clues run into the Atlantic Ocean, thus compelling us to communicate indirectly through mayors, consuls, etc., in other countries.

SUMMARY OF THIS CHAPTER

1. The statements of this chapter do not apply to Relatives in the immediate family of a client, but include all others whether related by birth, by marriage, or by descent.

2. It is necessary to keep in mind in all our contacts, however, the distinction between relationship by birth or descent, and relationship by marriage, for the latter is associated, often, with a peculiar type of prejudice.

3. Discrimination must be used as to which Relatives to see and when; they should not be seen to the exclusion of other important sources. It is possible also to overestimate the claims of kindred, irrespective of character, habits, or circum

stance.

4. The chief failings of Relatives as witnesses are (1) their prejudice, (2) their assumption that they know more than they really do, (3) their lack of understanding of a social situation and of social values.

5. On the other hand, differential diagnosis and treatment would be sadly impoverished without their characteristic contributions of (1) individual and family history, (2) insight, (3) backing and active co-operation.

6. Aside from their ability to serve, Relatives have a moral right (whenever they have tried to do their duty, that is) to be consulted. Our consultations with them should be genuine; they should be given a chance to aid in shaping our social policies, instead of having plans of treatment imposed upon them ready-made from with

out.

1 In a study of the thirteen-year-old boys in the city schools of 78 American cities (places of between 25,000 and 200,000 inhabitants) it was found that only one in six of the fathers of these boys was living in the city of his birth, and that among the boys themselves, only a few more than half were living where they were born. Of the fathers 40 per cent, of the boys 9 per cent were foreign born; but the migration of 44 per cent of the fathers and 33 per cent of the boys was within the United States. See Some Conditions Affecting Problems of Industrial Education in Seventy-eight American School Systems, by Leonard P. Ayres. Pamphlet of the Division of Education, Russell Sage Foundation, 1914.

7. Responsibility for support from near Relatives can be enforced by the state. Public social agencies charged with the administration of support laws often fall into the error of ignoring the other and higher services that Relatives could render. Private agencies make a similar mistake when they approach Relatives with the sole object of procuring relief. It does not follow, however, that Relatives should be relieved of any financial responsibility that they can bear without endangering their own social welfare.

I'

CHAPTER X

MEDICAL SOURCES

F, ON the basis of the social case work records then available

for study, this book had been written fifteen years ago, it

would probably have been found that the outside source of information consulted oftener than relatives even was employers. But there has been a shifting of interest from data about earnings and occupation to data about health and disease. All of these groups of facts are closely interrelated, of course, and the change is merely one of emphasis. So marked is it, however, that there may be need later of new emphasis upon another group of sources to preserve our social center of gravity.

The lists of outside sources used by the 56 social agencies whose records were studied show that Medical Sources were consulted two and a half times as often as employers and other work sources. In 2,800 cases, to be exact, 1,828 Medical Sources were consulted and 743 work sources. The multiplication in recent years of medical agencies both curative and preventive, especially in large cities like those included in our study of sources, accounts in part for this; in part, it is due to the fact that some agencies for the care of the sick now have social as well as medical records-social records that can be consulted with profit, that is. But part of it is also due to a change in the attitude of non-medical social workers toward their own task. In seeking to remedy bad social conditions they have come to recognize more fully the great handicap of bad physical conditions, and have learned to welcome, in the effort to remedy these, the aid of a newer and more constructive medical science. Their awakening is due, in part, to their own deepened experience of human need, but even more is it due to the socialized members of the medical profession, who have led the way in many departments of social endeavor-a way in which the lay social workers have been only too glad to follow.

1 See Appendix II, Table A.

The kinds of Medical Sources most often consulted by the 56 agencies were physicians, hospitals and sanatoria, dispensaries, medical-social service departments, nurses, and public health departments. It must be conceded that social workers have been handicapped, often, in their use of these sources of information by their lack of knowledge of even the most elementary facts about disease and by their lack also of understanding of the organization and discipline necessary in a hospital or dispensary. But, as these pages are an attempt to estimate the social value of the various sources of evidence, and as the case records studied show not only the great serviceableness but the occasional failure of Medical Sources, it may be well to follow the plan already followed in the chapter on Relatives and illustrate these failures at once, even at the risk of seeming to overemphasize them. It will be evident a little later that much more can be said on the other side.

I. WHERE MEDICAL EVIDENCE SOMETIMES FAILS Case notes under this head made in the course of our extended case reading tell their own story of (1) a non-social attitude, (2) conflicting diagnoses and prognoses, and (3) faulty medical records.

1. Non-social Attitude. Let two illustrations suffice. It may be that both show poor medical work also, but the writer makes no attempt to pass judgment upon their medical aspects:

A child-saving agency found a little girl of seven in a boarding house where she had been placed by her mother, a waitress. This mother was described as "suspicious, quarrelsome, and altogether difficult." Her child was illegitimate. The little thing's eyes were seriously inflamed, her whole face swollen, eruption behind ears and on scalp; she had been in this condition for two months, often seen by mother, but no medical care procured. The public health department had diagnosed the child's condition as syphilitic five years earlier. The mother was persuaded by the society to permit them to place the patient in a hospital, the hospital authorities agreeing to report to the society's agent a few days before discharge. Later the hospital reported that the child had been discharged, at the request of the mother's physician, or at the request of someone representing himself as such over the telephone. Only the last name of this physician was known at the hospital.

On complaint of a commission for the blind, a physician was prosecuted by an S. P. C. C. for failing to report a case of ophthalmia neonatorum. The eyes of a sixweeks-old baby had been irreparably injured by this disease. The physician employed was fined $50 and appealed the case. Among other witnesses for the prosecution was an eye infirmary. A copy of the prosecuted doctor's letter to the board of health was also entered in evidence against him.