SOCIAL SERVICE Social service is "looking up" in our hospitals. We are coming more and more to realize that the end of our treatment must be to make the sick man whole, and the job does not end with the resolution of his pneumonia or the last dressing of his wound. It is a tremendous field and one which is ripe for tilling in this age of social awakening. The credit for introducing social service in a thoroly broad and systematic way belongs to Richard Cabot chiefly, if not wholly. It is true that more or less social service has always been performed by individuals, as well as by one of the great organizations of the Roman Catholic Church, but before Cabot no serious attempt was made to perfect and universalize it. Cabot bears about the same relation to it that Mor ton did to anesthesia. He is the big figure in the movement. No matter what special genius forces to full fruition, there are always those who rise up and proclaim themselves the true promoters. There were oil merchants before Rockefeller, but we don't associate them with the real rise of the industry. Not much longer will the discharged patient pass dazedly out of the hospital gates, still half sick and unfit to resume his part in the game of life, hard enough for the strong and lighthearted, hard even for the capable. One of our greatest needs is convalescent homes, serving as clearing houses for the half well patient, from which he will emerge with hope and vigor and friends. And the social service will be continued to the point where the erstwhile sick man has actually resumed the place in the economic world out of which his sickness snatched him. The justification for this kind of work is found not alone in ethical, but to a measurable extent in certain economic considerations as well. A municipality by whose hospitals effective social service is done, which includes the teaching of hygiene in a systematic manner, restoration to full health of discharged patients, as well as to economic independence, and the maintenance of family unity, will necessarily find itself in the long run caring for fewer dependents. Herein is found the economic justification. The factors lying behind the misery and sickness that social service is grappling with must be clearly understood. Are prostitution, alcoholism and disease the results of poverty and economic mal-adjustment, or are they the causes of poverty and related social evils? Cabot goes beyond these ele ments and claims that behind all these things that are ordinarily discussed as factors are moral and physical discouragement. He says that men do not care enough about their lives to keep sober or to save money, to obey the laws of hygiene and the teachings of economics, and that the reforms of the prohibitionist, the socialist and the hygienist wait upon the time when we shall have accumulated the spiritual He vigor needed to achieve them. thinks we are too discouraged and dis heartened to avoid disease or plan a economic and physical causes are moral far reaching economic revival. Behind and spiritual forces. He admits that the latter are greatly influenced by the former. We presume that he means that bad economic and physical conditions tend to nullify the moral and spiritual forces. Our own view is that they not only tend to nullify them but that they do nullify them nearly sufficient spiritual vigor already in our always. Cabots to attain fundamental social necessities, but it is being frittered away in small parcels upon immediate, isolated, secondary problems. The inability properly to direct it, or rather to direct it most effectively, is due to personal reservations that are the result of training, religious and otherwise, tradition, prejudices and special interests, reservations that are really at war with that spirit in our Cabots which must, at times, urge them strongly to concentrate their splendid energies upon fundamental causes without reservation. What social service will ever prevail upon them to cast aside their reservations and fulfil what should really be their functions? Social service work ought not to be engaged in as an end in itself. It should be regarded as an expedient, bound ultimately to pass away, along with those things which have called it into temporary being. It is only a phase, after all, of the present-day tendency to tinker with end-results, accomplishing a large measure of good but not striking at fundamental conditions. If all the energies that are now engaged in tinkering would concentrate upon these fundamental conditions, we would not have "to wait upon the time when sufficient spiritual vigor should have been accumulated." There is PLEASANTRIES, PROTESTS AND INDISCRETIONS AN UNHAPPY NEW YEAR IN The village swains of Lenoxdale who anticipated welcoming the New Year with amorous demonstrations must have been somewhat stunned by the order of the health authorities, forbidding kissing on that day. Diphtheria was prevalent in the town, and the Board of Health feared that the usual affectionate observance of the New Year would spread the epidemic. powder. In referring to bedbugs and mosquitoes, a delegate from Boston was eloquent: "I feel the bedbugs skating around on me occasionally, but they never bite. They only enjoy the scenery. And as for mosquitoes, I have found in my exjerience that a feeling of friendliness will keep them from biting. They never come into the tents where we deliver our metaphysical lectures in the summer, and they never bite a New Thoughter twice." If a body meet a body MOSQUITOES AND METAPHYSICS At the New Thought Convention recently held in Omaha, considerable time was devoted to the subject of insects. The New Thoughters fearlessly proclaimed their eternal love for all of God's creatures, and protested against swatting the fly or using roach All would have been in tune with the infinite, had not an eastern delegate insisted that "the mosquitoes of New Jersey need education in the Golden Rule." As far as we are concerned, we announced that we love neither the mosquitoes nor the metaphysicians, but if we had to choose between enduring one or the other, we would certainly not select the latter. Devoted to matters bearing on the economic bases of disease, preventive medicine in its larger social relations, and to the study of the agencies under social control that may improve or impair the physical and mental qualities of future generations. Introduction UNDER CHARGE OF IRA S. WILE, M.D. The establishment of a department of medical sociology marks an advance in medical literature, as may be judged by the paucity of sociological articles in the medical press. As a variation from the ancient order of things possibly some explanation may be in order. include the problems of this category within the domain of the medical art, to be thoroly studied, understood, and scientifically attacked upon public health principles. a Sociology does include the fundamental phenomena that are common to human society at all times. History, economics, even politics, have a bearing upon the health of the community. Malaria may have caused the downfall of Rome. Sexual perversions may have had much to do with the decadence of Greece. The attempt of a Democratic Governor to remove tried and capable Public Health officer is a matter of medical concern inasmuch as it endangers the health of the community for mere political spoils. The psychology of an antifly campaign, the educational value of a country-wide attack upon tuberculosis, should present interesting material for reflection to physicians when it is realized that such health movements were of lay origin. If the doctors can not see the importance of studying sociology, the sociologists appreciate the necessity of studying medicine. The immense value of the statistical side of medico-sociologic problems is barely being recognized. There is difficulty in securing adequate figures from medical sources relating to the births or deaths in various parts of The general study of the social organism has a strictly medical aspect, just as the investigation of the life and habits of the various plants and animals presents problems related to the best methods of developing, improving, and increasing their number and value to the community. "The proper study of mankind is man." Not a man, nor the man, but mankind should be the basis of medical research. Medicine stands for the advance of the human race. Physical health has long been assumed to be the main feature of medical lore. The interrelation of the mental achievements and the physical welfare of the race has long been appreciated but has taken a definite place in the medical literature only under the spur of meeting attacks from religious organizations. The moral diseases that have a tremendous effect upon the longevity of the human race have an equally strong effect upon the physical improvement or retrogression of the race. Under such circumstances it is but natural to this more or less civilized country. The number of births per annum in the United States is an unknown quantity. With this failure at the very beginning of life there is little wonder that the number of children of school age or at gainful employment contrary to the law and moralities, as well as against the best interests of their healthful development, is still an algebraic symbol. The social welfare includes an understanding of the vitality, mentality and morality of the people as they may effect the general social welfare. To properly interpret these three factors, a study of the agencies thru which they are given importance becomes essential. Hence it is necessary to appreciate the various types of social organization in their relation to the public health. Medicine and sociology are closely related. Sociology presents many explanations for the shortcomings of medicine and medicine offers numerous opportunities for the development of sociologic facts. The close interapplication of the resources of both subjects redounds to the advantage of each and the world is the richer therefor. Among social workers it is frequently stated that the medical profession fails to evince sufficient intelligent action or interest in matters that promote the general public welfare save in those departments that are essentially medical or are threatened by invasion from the outside. The accusation of lack of interest is untenable. The sociological facts may not be common to the medical profession, but they are no less common to it than to the other professions. Even the ministry does not appear to be as close to the people as they should be, with a full measure of appreciation of the responsibilities thrust upon them by sociologic shortcomings. The socalled social spirit is slowly permeating the community. It represents a light that does not fail. The medical profession is sharing the present educational propaganda. Furthermore the contributions of such American physicians as Jacobi, Favill, Robinson, Knopf, Edsall, Hedger, Goler, Kelly, Wood, Holt, Keen, and numerous others equally active, bear witness to the intense interest of medical leaders in social progress. To facilitate the leadership of physicians in social work it is our desire to present in these pages a resumé of the efficient work that has been done. A system of current commentary upon the problems as they arise will enable this department to keep abreast of social progress. The underlying point of view will be that everything that pertains to the welfare of the race is essentially medical in nature. Our subscribers are invited to make contributions to the columns. Their suggestions will be cordially received. Their discussion is invited. The department exists to supply a need. The satisfaction of the need and the success of the department depends upon the interest and co-operation of the medical profession. From time to time there will appear suggestive articles written by non-medical men who have had an intimate association with the problems that come within the sphere of influence of the medical profession. Curiously, preventive medicine has received little attention in medical schools. At the present hour the prolongation of life appears to be a central point of desired approach. The prevention of disease is of equally great importance. The unnecessary ing dangerous trades, and bettering housing conditions lessens the financial drain upon families and spares their health from the undermining that is consequent to overwork, nervous tension, fatigue, and under-oxidized atmospheres or high temperatures. ills and accidents form a sad commentary upon the ignorance, indifference and carelessness of our day. There are many forms of living death that are more disastrous to the individual and to the family and to the community than mere loss of life. The economic loss that arises from blindness, deafness, prolonged illness, from deformity, insanity, even helpless old age, is of immense importance as bearing upon the preservation of the health of the community. A physician recently in a public address stated that doctors should not explain things; that they were paid for their wisdom and not for their instruction. This is an indefensible position. that has lost sight of every tradition of the medical profession from the days of the Hippocratic oath. Physicians were originally teachers. They are teachers to-day. In possession of the medical facts that are essential to health, it is their duty to spread the gospel of health. The very word "doctor" means teacher. The physician was originally a student and teacher of natural philosophy. Noblesse oblige. Doctors are under obligation to be teachers in the widest possible sense. This department will deal with political themes possibly but will never be in politics nor be partisan in its comments. The effect of measures such as the Esch bill for taxing dangerous phosphorous matches out of existence will naturally receive attention. The necessity for the establishment of a National Department of Health is far above party politics. The control of immigration by Federal authorities in so far as it affects the health of this nation is of significance to those studying the incidence and spread of disease. The several foci of endemic leprosy in Minnesota and Louisiana bear witness to this fact. Religion in its denominational aspects is removed from our criticisms. A discussion of cults that seek to invade the precincts of the health police Health is a purchasable commodity with some limitations as to the present supply. There are a few persons who are striving for the elimination of disease. The main struggle should be for the conservation of health. From the psychological point of view it is far more healthful and helpful to focus attention upon normal states of health rather than to place all stress upon the pathological states. Preservation of health means a more optimistic task than the wiping out of disease. Prevention carries more responsibility to the mass than does the cure. Free ing Havana from yellow fever is a wonderful advance over having a low death rate from this disease. Sanitary improvements of factories is of more value than the rest cure for the broken down employees. Immunizing soldiers against typhoid fever will do more for the health of the army than rescuing the soldiery from the attacks of Eberth's bacillus. Education as to the import of fresh air, dustless trades, pure water and milk supplies indicates a more forward step in the campaign for a higher degree of health than the establishment of hospitals for the weak lunged or the maintenance of orphan asylums. Decreasing the hours of labor, safeguard |
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