manently. If the woman was in an infectious stage of the disease, there was danger to the children during every minute of their stay with her; and if she was not, they could stay with her indefinitely provided she was examined from time to time."

4. A Medical Diagnosis Should Have a Date. The illustration just given serves to emphasize the further point that physical and mental conditions change, and that a diagnosis of six months ago must be brought up to date before we can safely make it the basis of social action.

5. Beware the Medical Opinions of the Non-medical. It is only natural, perhaps, that non-medical social workers who see much of sickness should not only become alert to its signs and symptomsthis much they should always be-but that they should also begin to pride themselves upon this alertness, and air their views of matters strictly medical. "There is nothing," writes a hospital social worker, in commenting upon a group of case records in which this tendency appears, "that will more quickly antagonize a physician than for the social worker to make even a suggestion of a medical diagnosis. The more medical training one has, the more cautious one grows about this." We should be at great pains to give the doctor any social facts that seem to be significant, but we should spare him, in so doing, our medical guesses. Otherwise, we are likely to find in him, at the very moment that we most need an open mind, a closed one.

A medical-social worker says of her instructions to new assistants, "I always caution them, in asking a physician to examine a patient, not to make a diagnosis. For example, instead of taking a child to the doctor and saying, 'I think Johnnie has adenoids,' say, ‘Johnnie sleeps with his mouth open. Is there any obstruction in his nose?""

A nurse records that a certain woman is "extremely thin and delicate looking;" a non-medical social worker describes the same woman as "thin and consumptive looking." This last term should not be used until after a physical examination.

A district worker in a charity organization society sent a girl to a nerve clinic with this memorandum: "Mary has a delusion that she is pregnant." She was found to be three and a half months pregnant and a shocking condition of neighborhood immorality was unearthed by the discovery.

6. Doctor to Doctor Is More Frank. The Hippocratic oath1 is now interpreted more broadly than formerly, and doctors are often

1 It may interest social workers to know the exact terms of the Oath of Hippocrates. They are as follows: "I swear by Apollo the physician, and Aesculapius and Health [Hygeia] and All-heal [Panacea], and all the gods and goddesses, that,

willing to give information, in confidence, to social workers whose use of it clearly will be not only social but for the best interests of the patient. As court procedure becomes more and more socialized, physicians will probably be more willing than now to place their information at the service of judges, especially in cases involving the welfare of children or the protection of the community. As social work is more skilfully done, they will treat social practitioners with a still larger measure of confidence than at present. Meanwhile, social workers must recognize that, in difficult cases, doctors who do not know them well or understand their methods of work and are therefore unwilling to give them information are more likely to deal frankly with doctors who do understand and who are enough interested to act as intermediaries.

The social service department of a dispensary sought the report of a diagnosis made three years before by a large public hospital, explaining that it might throw light on the problem of present treatment. They received promptly a diagnosis of "pelvic disturbance." But the dispensary doctor who was treating the case, by communicating directly with the hospital later, secured a diagnosis of “venereal infection."

The secretary of an agency for the care of girls reports that she always prefers to get a medical opinion, especially in perplexing cases, through a wellknown physician who is an active member of her directorate. One letter sent by the head of an

according to my ability and judgment, I will keep this oath and this stipulationto reckon him who taught me this Art equally dear to me as my parents, to share my substance with him, and relieve his necessities if required; to look upon his offspring in the same footing as my own brothers, and to teach them this Art, if they shall wish to learn it, without fee or stipulation; and that by precept, lecture, and every other mode of instruction, I will impart a knowledge of the Art to my own sons, and those of my teachers, and to disciples bound by a stipulation and oath according to the law of medicine, but to none others. I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. I will give no deadly medicine to anyone if asked, nor suggest any such counsel; and in like manner I will not give to a woman a pessary to produce abortion. With purity and with holiness I will pass my life and practice my Art. I will not cut persons laboring under the stone, but will leave this to be done by men who are practitioners of this work. Into whatever houses I enter, I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption, and further, from the seduction of females or males, of freedmen and slaves. Whatever, in connection with my professional practice or not in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret. While I continue to keep this Oath unviolated, may it be granted to me to enjoy life and the practice of the Art, respected by all men, in all times! But should I trespass and violate this Oath, may the reverse be my lot!"-Genuine Works of Hippocrates, trans. from the Greek by Francis Adams, Vol. II, p. 278–80. New York, Wm. Wood and Co., 1886.

institution for the feeble-minded in answer to the inquiry of this physician is as follows: "It appears that is about two years behind in school work, perhaps a little more, but her defect seems quantitative rather than qualitative, and I do not believe that she is defective enough to warrant her commitment at this time. I told the young lady who brought her that I thought the problem would have to be worked out further before anything could be done. Her responses to the laboratory tests were not convincing, but she has the natural feminine subtlety and reticence, and I do not believe that a single examination would begin to map out the entire field. Should her dishonest habits continue [the girl had been stealing money] she might be committed to the reform school, and there they would have the opportunity and are properly equipped to make a thorough study of the problem."

7. Careful Reporting Wears Away Prejudice. An unco-operative attitude on the part of physicians, where the social worker needs their help in securing social action (whether in individual cases or in other ways), can sometimes be accounted for by the inability of the non-medical social worker to make his daily contacts with Medical Sources as helpful as they should be. Written summaries of the social side of any case reported for diagnosis or treatment are aids to this, provided they are accurate, clear, and without irrelevant detail.

Dr. Adolf Meyer, in commenting upon the same record that was submitted to Dr. Cabot,1 points out the shortcomings of certain medical reports in the case and adds: "They probably also never had a written summary of the type of the one sent Mrs. Scott [superintendent of the girls' reformatory]. . . . Now a consulting alienist such as was to be appealed to would really have been unjustified in making a far-reaching estimate without such documents or copies of documents."

A critic of this criticism submits that, while it is well to present a written social summary, the doctor does not always read it. A better way, according to this second critic, would be to make a report orally to the doctor, to interest him in the material that the social worker has to give, and then hand him the written summary before leaving. At the time, it might mean little to him, but two months later, when he knew his patient better, some part of it might mean a great deal.

When a Medical Source has been helpful in a given case, it would be well worth while to report briefly to that source later in just what manner the help had furthered social treatment, thus strengthening the relations of the two kinds of work at their point of intersection.

8. Miscellaneous Suggestions. The following suggestions as to the detailed use of Medical Sources need no illustration:

1 See p. 214.

To establish the identity of a record or of a patient in a large hospital the name or number of the ward, and, in large dispensaries, the number of the patient's dispensary card, will be found useful.

The lodge doctor can frequently give some medical report and other information about the men of the family. This is especially true in foreign families, where it often happens that no other physician has been consulted.

Medical records sometimes contain non-medical information of value. New York hospitals, for instance, record the names and addresses of the two nearest relatives or friends of the patient. A tuberculosis sanatorium, by recording the name of the person responsible for the payment of board, helped a non-medical agency to discover several years later a co-operative relative. One hospital record brought to light the approximate amount and the whereabouts of money in bank.

The physician who has treated some family regularly for years is able to throw light on other home matters than the health of its members. At times of sickness and death relatives appear who have not been heard of before, and the family doctor is in a good position to estimate the depth of their interest, as well as the closeness of the bond within the immediate family group.

SUMMARY OF THIS CHAPTER

1. So marked is the emphasis now put upon data about health and disease in nearly all forms of social case work, that any failures of Medical Sources as witnesses stand out in bold relief. These failures fall under the three heads of (1) non-social attitude; (2) conflicting diagnoses and prognoses; (3) faulty medical records.

2. Parallel failures should be noted in the witness of social work sources to the medical profession. Conflicting diagnoses and prognoses are even more common in social work than in medicine.

3. The two types of data—social and medical—are complementary. It follows that social workers might hold a strategic position, were they better equipped to recognize and report upon the early signs of impending physical or mental breakdown. Earlier reporting of these signs would add materially to the number of cures. It is impossible to overstate the importance of cultivating a habit of awareness at this point, of being alertly watchful for the more obscure signs of breakdown. 4. In all relations with doctors, hospitals, etc., we should

(1) Ask for prognosis as well as diagnosis, for the probable duration and outcome of the disease, and for ways of helping to hasten recovery and avoid recurrence

(2) Economize medical resources, by selecting the best sources and using them to the full

(3) Seek first-hand information, and not depend upon hearsay statements of "what the doctor said"

(4) Note the date of a medical diagnosis before making it the basis of social action

(5) Beware the medical opinions of the non-medical

(6) Seek the mediation of a physician in securing important medical information not otherwise procurable

(7) Report with special care the social side of medical cases.