E

THE SOCIAL DOCTOR

W. P. CAPES

VERY profession is ministrative to some degree, but as yet not all ministrative work is generally recognized as professional. The physician ministers to physical ills, the clergyman to the moral ills and the lawyer to the legal ills. All in these three professions act in an advisory capacity for those who are living, temporarily at least, some kind of abnormal lives. So common have become the practices of these professional men that their aid is sought and accepted by the public as a matter of fact. In every community their services are regarded as a necessity, and no matter how great may be the demands for their advice the moral or physical standing of that community appears not to deteriorate in the least, in the eyes of its neighbors. The fact that there is moral or physical abnormality, it seems, does not count, so long as an effort is made to correct the defect.

Besides the physician, the lawyer and the minister there is in all the larger cities, and in many of the smaller ones also, another class of ministrative workers—the social workers. Although the calling of these workers is not as yet recognized universally as professional, what they do is nevertheless as important to the community as the efforts of any person engaged in the professional activities. While Dr. Jones is caring for the sick, Attorney Brown is aiding those either in legal difficulty or seeking justice and the Rev. Dr. Johnson is looking after the spiritual needs of his parishioners, the social worker is ministering to the social and economic needs of that part of the community which for one cause or another is in the pinch of poverty.

The social worker has had as difficult and trying a struggle for recognition of his services to humanity as did the minister or the lawyer. It was many years before public opinion could be convinced that a clergyman should be recompensed for services rendered. Precedent and sentiment had prejudiced the public mind against the salaried theologian. Gratuitous service had been given so long that for a preacher of the gospel to sell his

labor was regarded as almost sacrilegious. The pioneer social worker started out with practically the same handicap, and as he has progressed his burden has become heavier, for he has had not only to overcome the prejudices of an uninformed or misinformed public, but also to fight all the battles of the poor, who, recognizing his worth, have demanded his services. Indeed, charity less than one hundred years ago was not recognized as genuine unless it involved sacrifice on the part of the dispenser. Tradition was responsible for that popular impression, and that same tradition is still responsible for the opinion held by many that true charity consists in giving only alms to the hungry and homeless. Charity had been dispensed so long by volunteers that prejudice against the salaried worker, whose services had become valuable by long experience, was quite as strong as it had been against the minister. When, however, society began to realize that poverty is an abnormal social condition and that to `remove and prevent it expert personal service as well as temporary help such as food, clothing and shelter, is necessary, those who had devoted gratuitously a part of their time to serving the poor became convinced that more must be done than they could do if any progress were to be made. As a result, what these kindhearted and sympathetic persons could not find the time to do they were willing to pay others to do for them. And so as the social problems grew in number, complexity and importance and as the searchlight of investigation brought to public attention evil forces that had been working undisturbed because they were unrecognized, the necessity for organizing paid service became apparent. The first radical move in this direction was made by the New York Association for Improving the Condition of the Poor, which in 1879 substituted paid relief visitors for volunteer service. Since that time recognition of the value of trained service has been rapid among social service agencies, but the public has been slow to accept these views.

Not until society realizes that poverty is as contagious, curable and preventable as disease will the full worth of trained service and the necessity for it in family rehabilitation work be generally realized. When that time comes, however, the social

doctor will stand on the same high plane in public opinion as the doctor of medicine does now.

The social worker and organized social effort are to-day as indispensable in a community as is the physician and organized medical service. The health of a community depends to a large extent upon the efficiency of its health department, which is in truth the organized preventive force of sanitarians and of physicians practising in that community. The social and economic standards of a community for the same reason are largely controlled by the effectiveness and activity of its social service agencies, which represent combined individual social and economic effort. The social welfare of a community depends as much upon the work of the expert visitors who go into the homes of needy families, socially abnormal, as the health of the whole community depends upon the skill of the physician in the treatment of patients physically abnormal. Misfortune and disease keep both busy.

An epidemic of avoidable poverty is as much a community disgrace as an epidemic of typhoid fever or any other preventable disease. The organized effort of social workers is as necessary to abolish destitution in a community as is the combined service of physicians to wipe out an epidemic of disease. When a contagious disease becomes prevalent one physician cannot stamp it out. Likewise one social worker cannot wipe out destitution in a community when it gets a foothold. However, because social ills as a general rule are more insidious, more complicated and deeper seated than those the physician deals with, the effect of combined medical service is more quickly and more easily discernible and therefore more appreciated by the general public than is the progress of organized social service.

The methods employed by a social worker to rehabilitate a family socially and economically are strikingly similar to those used by a physician to rehabilitate a person physically. An inexperienced, untrained visitor may do just as much harm to the social or economic well-being of his patient as an incompetent doctor or nurse may do to the physical condition of sufferers in his or her care. It is obvious then that incompetency should not be tolerated in the treatment of families, helpless because of

dependency, any more than in the treatment of individuals physically abnormal. Yet the incompetent poor must forbear until prejudice has run the same race with the social worker as it did with the clergyman.

The first effort of the social worker and physician is to alleviate the suffering, in the one instance from social ills and in the other from physical ills. The social worker uses the necessaries of life for this purpose, the physician gives medicine. Food, clothing, shelter, and any other kind of material relief are, therefore, to those social workers in family rehabilitation work what drugs are to the physician. Hunger and cold are simply social pains. They, like physical pains, are surface indications of deeper trouble. A basket of food will relieve the pangs of hunger, but unless supplied continually, it alone will not prevent the recurrence of hunger any more than a bag of ice on a patient's head will prevent the recurrence of a high temperature. If such relief were continued without any effort being made to determine and treat the real cause of the social pains, no progress toward rehabilitating the family would be made. Instead the patient would acquire an appetite for relief which might develop into chronic pauperism, just as a patient suffering from pain might acquire the drug habit if the physician continued to administer opiates to relieve the pain without eliminating the complication that caused it.

Not every family in dependency needs relief such as food or shelter, but all who seek charity or are referred to an agency need treatment such as advice, encouragement and sympathy. The great percentage of those who support charitable agencies, however, either do not know this fact or they do not appreciate its importance, for when asked to specify how their contributions shall be used they generally select some form of material relief, the most common being food, coal and clothing.

After the social worker and the physician have alleviated the suffering of their patients, the next step is for each to determine the cause of the suffering. The physician calls this a diagnosis; the visitor an investigation. Those who do not understand the work of organized charity, however, base almost all of their objections to its methods on the amount of time spent by the

visitor in ascertaining the facts about the condition of the family placed in his care. They do not appreciate, however, that it is as important for the social doctor to know everything about the family he is treating as it is for the doctor of medicine to know all the circumstances of his patient. The quicker society accepts the truth of this fact the better will those in misfortune fare, for it is prejudice against investigation, diagnosis, or whatever one may wish to call the inquiry, in family welfare work, that is retarding greater progress.

Having determined the cause or causes of his patient's distress, the social doctor formulates a plan of treatment which his experience has taught him will remove the complication and effect a cure. If food or some other kind of relief is needed to prevent suffering while this plan of treatment is being carried out the visitor does not appeal immediately through the agency to the charitable public for the necessary funds. He first seeks those who are obligated either legally or morally to assist the family in distress. These sources are revealed in the course of the investigation. Thus the very inquiry to which many persons object, because of the expense involved, is conserving the charitable resources of the community. The public is asked to contribute only the difference between the amount actually needed by the family and the total either contributed or pledged by relatives, labor unions, fraternal or benefit association, friends, former employers, the church or any other persons or organizations upon which there is any legal or moral claim. The field workers of the four largest social service agencies in New York City in 1912 gave to 20,777 families food, clothing, shelter, fuel and all other kinds of material relief amounting to $553,148. In addition to this relief much was given directly to these families at the solicitation of the visitors. If it were possible to ascertain the amount of relief secured by visitors from outside sources the total would be many times the sum paid for the services of this ministrant band.

As soon as the social patient is again on a self-supporting basis, the social doctor continues his treatment until he is satisfied that the family is safely beyond all social or industrial pitfalls.