1=^ k.^ ^\\F .^^^ .JO' i^vNlllBRARY^/;^ ^, ^1 i^# gi ir ^ ^>> g ^^OJIIVDJO"^ i/AOva- AWKn ''jua/uniiarv' ■■J ■ / ^ ' I K ^ 3 \J . / d : i : ■■ ; r ■ 1 n . k ^v\Eu^ SOCIAL WORK THE SOCIAL WELFARE LIBRARY Edited by Edward T. Devine, Ph.D., L.L.D. A series of volumes for the general reader and the social worker, designed to contribute to the under- standing of social problems, and to stimulate critical and constructive thinking about social work. 1 . Social Work : by Edward T. Devine. 2. The Story of Social Work in America: by Lilian Brandt. In preparation. 3. Community Organization: by Joseph Kinmont Hart. Price, $2.50 net. - 4. Industry and Human Welfare : by William L. Chenery. 5. Treatment of the Offender : by Winthrop D. Lane. In preparation. Social Welfare Library SOCIAL WORK BY EDWARD T. DEVINE 5Jm fork THE MACMILLAN COMPANY X/i r«gA/j reserved 1)5GG3 PRINTED IN THE U^^TED STATES OF AMERICA COPTBIGHT, 1922, Br THE MACMILLAN COMPANY. Set up and electrotyped. Published January, 1922 FERRIS Pri'NTING COM^A^fy NEW YORK T Cj J HV PREFACE 0~ ri This book is intended for use in the class-room and J for the general reader. It contains no sort of direct or indirect propaganda. Some subjects are so tech- nical and so intricate that the author must deliberately choose whether he will address himself to the specialist or to the general reader. In spite of the difficulties j^ encountered by those who study and by those v/ho engage in social work, this is not true of the subject with which this text-book deals. For this reason non- N technical, general terms are preferred, when there is a choice, to those which belong to the jargon of a small professional group. At the same time the dis- cussion sometimes oversteps the boundaries of the zones of agreement, and on controversial questions no attempt is made to conceal the author's personal views. Social work is the serious vocation of a considerable number of men and women, and an avocation of a larger nujnber who make their living otherwise but are desirous of doing what they can by the way to lessen poverty, ignorance, disease, and crime; to make the lives of their less privileged neighbors happier and more satisfying; to secure justice for individuals who vi Preface suffer from injustice and hardship; to advance the new social order which some visuahze as a decent place for human beings to live in, and some call the Kingdom of Heaven. The aim of this volume, and of the series in v/hich it appears, is to make clearer the relation between every-day, sometimes discouraging efforts to help others and those larger social movements in industry, education, and other departments of life and thought to which they are essentially related. There is inspira- tion for the familiar, manageable, even if difficult task in the idea that its full meaning is to be found in the national or world struggle to manage also, in one way or another, the less familiar, more difficult human task of which it is a local and typical instance. For twenty years or more I had the privilege of serving as executive officer of the New York Charity Organization Society. For a dozen years or more of this time I had also the privilege of giving instruc- tion in Social Economy in Columbia University and serving as a member of the teaching and administra- tive staff in the New York School of Philanthropy. On three occasions, for periods amounting to nearly two years, I was in Red Cross emergency service. I am free to draw upon these experiences, but have no actual or implied obligation to be the advocate of any policy, the spokesman of any cause, the enemy of any proposal, the representative of any movement. I am wholly untrammelled by any conscious limitations im- Preface vii posed by past or prospective institutional connections. This freedom leads inevitably to a certain revaluation of values. I do not mean to suggest that an academic connection or service as executive of a social agency necessarily restricts freedom of speech or action. Free- dom does not consist merely in the absence of limita- tions — which may be only the result of indifference of the public — but in the possession of opportunities, and in this respect an executive or teaching position may confer a sense of freedom greater than an unattached individual can easily attain. This certainly has been my own experience. Nevertheless there is some satis- faction, and there may be perhaps some advantage to students and the public, in an attempt to look at charity and correction, at social work, public and voluntary, from a detached point of view; with sympathy and understanding, but with a more critical and more inclu- sive vision. E. T. D. CONTENTS PREFACE V PART I: INTRODUCTORY CHAPTER I. PROGRESS AND SOCIAL WORK Needs; Institutions; Problems; Forces 1 Care of Individuals : Improvement of Condi- tions . . . 2 Slavery; Serfage; Guilds; Household Industry 4 Era of Individual Responsibility 6 Individualism in America 7 General Prosperity: Persistence of Misery. ... 8 — The Function of Social Work 10 Discredited Objections 12 CHAPTER II. THE SCOPE OF SOCIAL WORK Original Components of what is now called Social Work 15 Significance of the Term 17 Unifying Element: The Common Social Prob- lems 19 Poverty, Disease, and Crime 20 Meaning of Social Work 21 Making a Living not Social Work 23 Universal Social Institutions 24 Common Services of Government 24 ix X Contents Mutual Associations 26 Fluidity and Experimental Character 27 CHAPTER III. CHARACTER OF AMERICAN SOCIAL WORK American Economic Ideals 32 Religious Ideals 33 Social Ideals 35 Political Ideals 37 Distinguishing Characteristics 38 Tendency to Integration 42 CHAPTER IV. THE STANDARD OF LIFE New Meaning of the Right to Life 45 New Interest in the Standard of Living 47 What is a Reasonable Standard? 49 Findings of the New York Committee 51 Definition of the Standard of Living 54 The Prevailing American Standard 57 Influence of a High Standard 61 CHAPTER V, CLASSIFICATIONS OF SOCIAL WORK According to Auspices 62 According to "Process" 66 Other Classifications 68 According to the Social Problem 69 Relief of Dependence 70 Care of the Sick, Disabled, and Defective. . . 73 Treatment of Criminals 74 Improvement of Living and Working Con- ditions 75 Contents xi PART II: POVERTY CHAPTER VI. FAMILIES Normal Function of the Family 79 When the Family Fails 81 Institution or Home Service 82 Agencies for Home Service 84 Insufficient Income 85 Health: Physical and Mental Examination. . . 89 Varied and Complicated Tasks 91 Volunteer Service 92 Material Relief 93 Relief in Disasters 95 Extension of Home Service 96 CHAPTER VII. DEPENDENT ADULTS The Almshouse 99 Private Homes for the Aged 104 Old Age Dependence 106 Temporary Shelter 108 CHAPTER VIII. CHILDREN Natural Dependence Ill Primary Responsibility on the Family 112 Rights of Childhood 114 Protection and Placing-Out 115 Illegitimacy 118 Homes for Children 119 Child Welfare Allowances 123 Day Nurseries 127 Fresh Air Agencies 12^ xii Contents PART III : DISEASE AND DISABILITY CHAPTER IX. THE SICK Individuality Must Be Respected 132 A Positive Health Ideal 133 The Hospital . . ., 135 Maintenance of Hospitals 138 Public and Private Hospitals 139 Public Support of Private Hospitals 141 Value of the Modern Hospital 143 Home Care of the Sick 146 Treatment for All 147 CHAPTER X. THE HANDICAPPED Physical Handicaps 150 Needs of the Blind 151 Prevention of Blindness 152 The Deaf 154 The Crippled 155 Provision for Blind and Crippled 155 Pensions 158 Re-education and Economic Rehabilitation. . . 162 The Mentally Handicapped 164 The Mentally Defective 165 Insanity 167 PART IV: CRIME CHAPTER XI. CRIME AND THE COURTS The Law- Abiding Spirit 170 The Law-Breaking Spirit 171 Contents xiii The Criminal Courts 175 Respect for the Courts 175 Bad.Efifects of the War 178 Special Position of Courts in America 180 Specialization of Courts 181 The "Female Offender" 183 CHAPTER XII. TREATMENT OF CRIMINALS An Ideal Plan for the Treatment of Convicted Offenders 186 Reactionary Tendencies of the Moment 187 Early Education 188 The Need for Just Laws, Intelligently Admin- istered 189 Treatment of Offenders by Warning 190 Probation 191 Fines 193 Denial of Privileges as Penalties 195 Payment of Prisoners 196 Prisons : A Confession of Failure 196 The County Jail 197 Penitentiary and State Prison 201 The Goal: Elimination of the Fundamental Idea of the Prison 202 PART V: IMPROVEMENT OF CONDITIONS CHAPTER XIII. IMPROVEMENT OF CONDITIONS : I Preventive Case-Work 205 The Temperance Movement 206 xiv Contents Housing 209 Loans : Pawn-Broking and Its Kin 212 The Prevention of Tuberculosis 216 Infant Mortality 219 Health of Mothers and Infants 222 Prevention of Venereal Disease 223 Cancer and- Heart Disease 225 Public Health : The Health Center 227 CHAPTER XIV. IMPROVEMENT OF CONDITIONS: II Social Settlements 230 Institutional Churches 231 Foundations 232 Welfare Departments 232 Recreation 233 Racial and Social Groups 236 jWorking Conditions 237 Child Labor 238 Minimum Wage Laws 240 Standards for Women in Industry 240 Compensation Standards 241 Industry and Social Work 242 Other Causes and Problems 244 Common Features of the Educational Move- ments 245 PART VI : GENERAL CONSIDERATIONS CHAPTER XV. COORDINATION AND SUPERVISION The Social Service Exchange 250 Contents XV Societies for Organizing Charity 251 Community Conscience and Civic Memory. . . 254 Surveys 256 Councils and Federations of Social Agencies. . 257 Current Confusion and Duplication 258 Conferences 261 Official Boards 263 CHAPTER XVI. finances: I Governmental Social Work 266 The Lower Levels of Tax-Paying Ability. . . . 268 Enough for All Necessary Work 269 Defects of American Local Politics 272 Subsidies : Partnerships between Public and Private Agencies 273 Endowments 275 CHAPTER XVII. finances: II Earnings 281 Paying Occupations in Institutions 283 Current Contributions 286 Discrimination in Giving 287 Publicity 288 Drives 289 Financial Federation 292 Better Financial Methods and Policies 296 chapter xviii. preparation for social work General and' Technical Qualifications 298 College Training and General Preparation .... 299 xvi Contents College Teaching of the Fundamentals of Social Work 301 Relation to its Basic Sciences 302 Increase in Teaching Material 304 Courses in Social Work 304 Historical Backgrounds 306 Graduate Professional Training 309 CHAPTER XIX. THE FUTURE OF SOCIAL WORK Freedom of Individual Initiative: Its Results 315 Extension of Home Service : Through' Socie- ties for Family Welfare 317 Through the Churches 319 The Unique Function of Religion 319 Social Work and the State 322 Expansion of State Activity 324 The Principle that the State Should Bear the Burden 325 The Religious Problem 327 Present Tendencies 330 The American Ideal 330 INDEX 335 SOCIAL WORK SOCIAL WORK CHAPTER I PROGRESS AND SOCIAL WORK Social economics may be described as community housekeeping. Social work, to follow the analogy, is its salvage and repair service. needs; institutions; problems; forces Social economics deals with social needs and with the institutions through which they are met : with the need for education, for example, and the schools ; with the need for justice and the courts ; with the need of children for parental care and the family. Smoothly organized households may seem to the stranger to present no problems of household management. So prosperous and well managed communities may ap- pear deficient in social problems. The social economist, theoretically, would deal equally with the normal opera- tions of social forces working advantageously and equitably and with the pathological conditions which are evidence of friction or failure. Public and private agencies for the promotion of the common welfare alike fall within his scope. When the mechanism of government adequately and economi- 1 2 Social Work cally fulfills its function, the social economist would have to concern himself with it only as an instrument in accomplishing some definite result. When govern- ment is out of gear or misused for som.e partisan and anti-social purpose, so that a conscious effort becomes necessary to restore it to its proper uses or to increase its efficiency, a problem in social economics as well as in the science of politics is presented. The reform of the criminal law and of criminal procedure, for example, is of interest to lawyers, to criminologists, and to social economists, each of whom has a point of view different from that of the others, but all of whom must unite to secure the evidence and perfect the plans by which the reform is to be secured. Seeking first to understand social conditions and to become able to distinguish between such as are favor- able to social welfare and progress and such as, on the contrary, are socially destructive, the social economist does not rest content with this analysis, but attempts to estimate also the social forces operating in the community, his purpose being to furnish the informa- tion, the principles and the methods, which will enable socially minded, public spirited citizens to work effec- tively with others of similar aim. CARE OF individuals: improvement of conditions If from the broader term social economics we now turn to the narrower and more familiar expression social work, and if we think of the practical social Progress and Social Work 3 worker rather than the academic social ecoiioniisty we may at once hmit the scope of our study to those aspects of community housekeeping which have to do with getting rid of bad conditions or helping people who cannot help themselves. The broad object of social economics is that each individual shall be able to live a normal life according to the standard of the period and of the community. The narrower object of social work is (1) the care of those who through misfortune or fault are not able under existing conditions to realize a normal life for themselves or who hinder others from realizing it — dependent children, aged poor, sick, crip- ples, blind, mentally defective, criminals, insane, negli- gent parents, and so on — and (2) the improvement of conditions which are a menace to individual welfare, which tend to increase the number of dependents and interfere with the progress and best interests of others who may be in no danger of becoming de- pendent. Social work may be individual, spontaneous, un- organized, or it may be associated, deliberate, and organized. It may be carried on by the government or by a voluntary society. It may be the outgrowth of some older institution which exists primarily for some other function. It may be inspired by the altruistic or humanitarian motive; it may represent a responsi- bility accepted by the people in their corporate capacity and detailed to public officials; it may reflect rising standards of taste with reference to what it is decent 4 Social Work to allow in a civilized society, and rising standards of what constitutes justice. It includes everything which society does for the benefit of individuals because they cannot do it for themselves or because they have not yet seen the importance of doing it for themselves, from whatever motive it may be done, by whatever agency or whatever means. slavery; serfage; guilds; household industry In modern industrial Europe and America individual well-being is assumed to depend upon individual effort, thrift, and foresight. This assumption and the facts upon which it rests are comparatively new in the world. Under the primitive conditions of savage life, it fre- quently happens that an entire tribe may be reduced to want merely by the niggardliness of nature. Slavery and serfage had many hardships, but they had the advantage over savagery that they produced the neces- sities of life more uniformly and that they contained obvious safeguards against extreme neglect of the in- dividual. The slave and the serf as property have a value which the master's self-interest conserves. There may be cruelty, but at least the slave must be kept alive and able bodied if the owner is to derive benefit from the relation. The serf belongs to the master, but, as the Russian serfs were accustomed to say, the land belongs to those who cultivate it and live on it. The feudal manor gave a definite status to the most menial worker, and the merchant and craft guilds of the Progress and Social Work 5 thirteenth and fourteenth centuries gave an equally definite although a different security. Prices as well as wages were determined by well established customs. Sickness, old age, and misfortune were not the night- mares of our own time for the marginal workers, be- cause the craft unions were in effect a sort of social insurance against their financial burdens. This is not to take a sentimental or romantic view of life under the guild system. Death rates were higher, the average expectation of life shorter, epi- demics more deadly ; but the experiences of unprovided old age or chronic illness, of being cast aside without income or occupation because younger workers are preferred, are peculiar to an age of unlimited individual- responsibility. Medieval industry had many restric- tions which modern economics condemns, but it gave a certain protection and security to the worker and his family which the modern wageworker lacks. The household industries of a later period — just preceding the industrial revolution — retained something of that security, but most of it had disappeared by the eigh- teenth century, and the industrial revolution during the fifty years after 1776 completed the process. The new power machines, the growth of factory towns, the substitution of free contract for status, the rise of free trade, free competition, and the division of labor, revolutionized the whole process of wealth production, liberating the manufacturer and the worker from old restrictions, but with results which optimistic advocates 6 Social Work of liberty did not foresee and which statesmen did not guard against. ERA OF INDIVIDUAL RESPONSIBILITY In this new world of the end of the nineteenth and the twentieth century individuals are theoretically free to follow what occupations they choose, to work or not to work as they please, to change employment at will, to sell their labor in the dearest market, to buy the commodities which they require in the cheapest markets they can find, to move from a place where they are not needed to another where they may find work, to educate their children without arbi- trary limit and to prepare them for any occupation for which they may seem to be fitted, to combine in unions for collective bargaining, to insure their lives and their health either in mutual funds or in commer- cial companies. Women also gain the right to work wherever they like, overcoming in the process both legal obstacles and the mxore stubborn barrier of preju- dice and custom. When humane legislation seeks to prohibit women from working at night or for long hours or at physiologically injurious occupations, em- ployers come forv/ard ready to fight such restrictions on the ground of the sacred right of all to make what- ever labor contracts they believe to be to their interest. /Thus we have arrived at a stage of extreme individual- ism, unrestricted competition, the widest possible appli- cation of the principle of the harmony of economic in- Progress and Social Work 7 terests, i. e., that when each individual does that which is for his own best interest it automatically results that he is doing what is also for the best interests of society. INDIVIDUALISM IN AMERICA In the United States the general conditions, both in colonial times and in the century and a half of our national history, have been exceptionally favorable for the application of these modern ideas. Our physical resources have been practically unlimited. The con- tinent invited occupation. Transportation has become progressively easier and cheaper. Elementary educa- tion is well-nigh universal. Industry has been con- stantly expanding. The demand for labor has been insatiable. The standard of living has been high. There has been no social caste to prevent the rise of efficient individuals. There have been favoritism and graft, but no insuperable obstacle to the ambitious and determined individual. A national democracy of man- ners and an open market for ability have constantly raised men from the lowest to the highest station. There have been temporary economic classes, but no settled proletariat or aristocracy. It is true that all these possibilities for the individual are limited and relative. The occupation of the parent influences that of the child even when there is no legal obstacle to change. The circumstances of the family determine largely his opportunities and advantages. 8 Social Work The worker cannot escape the thousand influences around him which shape his decisions as to where he shall work and how long and how hard and in what temper. All that we can say is that he has a far greater range of freedom than in earlier times or in other lands or under other economic systems, GENERAL PROSPERITY : PERSISTENCE OF MISERY What now have been the results of this extraordi- narily favorable constitution of society in an exception- ally favorable environment? Has it resulted in the disappearance of poverty, in the sense of insufficiency of income; in a notable absence of individuals who suffer from personal afflictions such as insanity, mental de- fect, blindness, crippling organic disease ; in the lessen- ing of the number of anti-social, criminal, or unadjusted individuals, or in the number of orphans, abandoned infants, or neglected or ill-treated children who must look to society to repair the failure of their natural parents ? These questions cannot be answered affirma- tively. There has been immense progress, but poverty, disease, crime, misfortune, have not disappeared. The general level of living has been high, but far below this level — comparable to the least fortunate of those who lived in slavery, serfage, feudalism, guildism, or a system of small household industries — there have been human wrecks, tragic failures, misery unspeakable. No doubt this misery seems the greater because of the generally higher level of prosperity which is its back- Progress and Social Work 9 ground. No doubt even the poor of to-day have some comforts and conveniences which the cultivated Athen- ian or the thirteenth century craftsman did not enjoy. Men are not thrown into jail for debt or branded for vagrancy. Children are not deliberately exposed as in the ancient world. Many of those who now live to sufifer from some physical infirmity would earlier have died of neglect. Much modern restlessness is due to wants of which our ancestors were innocent. Nevertheless the fact remains, speaking affirma- tively and not comparatively, that many families of our time do find themselves without enough to eat, with no fuel even when it is severely cold, with no decent raiment, without shelter or furniture, with no substitute for earning capacity when this fails, with no insurance against the financial disasters resulting from unem- ployment, insufficient earnings, sickness, or old age. Some of those who suffer this extreme poverty — this economic insufficiency — are of vicious habits. They may easily be convicted of having called their troubles on themselves by criminal acts ; by strong drink or other indulgences; by laziness, foolish speculation, or sheer improvidence. But others are quite as far down whose lives have been virtuous and who cannot be charged with any serious faults. Saints as well as sinners may be improvident and inefficient. Poverty, in spite of much scepticism on the subject, creates no presumption of vice; even though, on the other hand, it no longer creates in our minds a presumption of superior virtue. 10 Social IVork The poor are of all kinds : wise and simple ; good and evil; temperate and intemperate, Christian and heathen, Jew and Gentile, white and black, individualist and socialist. Not, of course, in equal numbers. Statistics would show, no doubt, a larger proportion of mental de- fectives, drug addicts, ignorant and shiftless, a smaller proportion of sound minds and bodies and temperate lives, among the "poor" than among self-supporting industrial, clerical, or profesional workers. THE FUNCTION OF SOCIAL WORK That poverty and its kindred misfortunes persist in the midst of progress has been presented as an indict- ment of the social system under which progress is made. Progress Ufts the general level of life; it results in a happier and better life for the mass of man- kind; but the tragic failures cannot be philosophically accepted as inevitable incidents. Those who suffer vicariously from changes which are of general advan- tage must be rescued and incorporated in the advance movement, if the social system is to be succesfully defended. If social work can be made to function suc- cessfully as the means by which those who are unequal to the strain of free competition, to the complex demands of an industrial system intended for vigorous, intelligent, and alert workers, are enabled to find a sheltered place, a safe and congenial sanctuary, then it may redeem the industrial system, not by excusing, but by eliminating its injustices. Progress and Social Work 11 The modern industrial system is on trial before the bar of the world's aroused and critical public opinion. Communism is openly challenging it to mortal combat. Socialism in every country is seeking to gain control of the government in order to end capitalism by peaceful revolution. Guildism and syndicalism are trying to substitute a vocational for a territorial organization of society, securing to productive workers in each craft and profession the control w^hich now rests with the owners or representatives of invested capital. The conservative elements, taking alarm, are seeking to identify patriotism with capitalism; loyalty to the existing form of government with loyalty to the exist- ing economic system. This system, under which land, railways, banks, and industries, as well as consumption goods, are held as private property and exploited primarily for private profit, under which wage earners are employed by the owners of capital and are expected to have no further interest in their employment than to give a fair equi- valent for their wages, may or may not survive the present attacks upon it. That does not here concern us. What we have to do is to appraise the means by which, in such a system of free competition and contract, private property and capital, employment for wages without social insurance, society undertakes to provide for the relief of distress and the rehabilitation of those who fail. Men may differ as to whether the fact of poverty constitutes an indictment of any society in 12 Social Work which it persists, but there can be no question that neglected poverty, unreHeved misery, increasing dis- tress, are such an indictment. Social work must not be / content to make gestures, to demonstrate remarkable results in selected instances. What it has to do, if it is to have a fundamental relation to social progress, is to bring it about that life, health, and character shall not be destroyed by insufficient income, that the forces \ of exploitation and greed shall be controlled. DISCREDITED OBJECTIONS There is a certain type of evolutionary doctrine which has held that to care for the sick and weak and de- fective and unfortunate is to retard progress by inter- fering with the beneficial progress of natural selection. A naive kind of biology assumes that it is within the power of society to keep the unfit alive but not to make them fit, and that fitness in the technical sense is iden- tical with what is inherently worthy and desirable. But small-pox slays a Jonathan Edwards and typhoid a Wilbur Wright quite as readily as they slay a wife- beater or a moron. The same policy which prevents the exposure of a deformed infant prompts the oper- ation by which the deformity is cured. Much useful work is done by neurasthenics. It is good social policy to utilize the services of those who, like Charles Darwin or Alexander Stephens, are easily fatigued. This discredited biology has been reinforced by an equally false political economy, which has taught that •y Progress and Social Work 13 any interference by society with the freedom of contract is unwarranted. If children want to work or their parents want them to work, and employers want to hire them, then there is nothing further to be said. If men want to work on dangerous machines, and the owners of the machines want them to do so, then out- siders must not interfere. If employers want to pay less than a living wage, and workers want to take it, then the starvation wage has a natural right to survive.) The assumption is that economic self interest is a sufficient protection to the individual, and that any inter- ference with the operation of this principle is pernicious. This assumption has been carried into the field of charitable assistance. The poor, like others, must look out for themselves. When at work they must save for old age and illness and for any period of unemployment. If they do not earn enough to live on they must work harder or go without. The beneficent principle of self interest is in danger of being thwarted if the pros- perous give aid to the unfortunate. Those who are without employment or visible means of support are vagrants to be punished, not unfortunate persons to be helped. Even when a home in the work-house or poor relief is provided, the conditions under which relief is given must be made "less eligible" (i. e., more severe) than those which are attained by the lowest- paid, most sweated, independent workers. It was held, long after this general theory of economics had been discredited by a sounder analysis and shot to pieces 14 Social Work by indignant outbursts of human sympathy, that there is something pecuHarly dangerous about rehef funds; that they tempt to idleness and improvidence ; that they dry up the natural springs of benevolence; that they are a constant temptation to pauperism. There is some danger of this kind in carelessly administered relief funds, especially if they are widely advertised; but it may be greatly reduced, even eliminated entirely. Furthermore, it is now easy to see that a lack of the material essentials to a normal standard of living is in itself one of the most productive sources of the pauper spirit, and that there are other positively destructive forces — such as epidemic diseases, tuberculosis, malaria, hook-worm ; over-work and over-crowding ; child labor and industrial accidents ; gross inequalities and injustice in the distribution of the products of industry — which are far more serious than lavish giving as causes of human misery. CHAPTER II THE SCOPE OF SOCIAL WORK Although social work itself is as old as human society, the term has come into use only in this twentieth century. Before 1900 there was "philanthropy" and "charity" and "social reform" ; there were almshouses, orphan asylums, homes for the aged, charitable socie- ties for many purposes; there were prisons and reform- atories; there were hospitals and insane asylums and dispensaries; there were social settlements and missions; but there was no collective term in current use to designate them. ORIGINAL COMPONENTS OF WHAT IS NOW CALLED SOCIAL WORK There was little appreciation of the place which these various related activities occupy in the general economic constitution of modern western society. They were not ordinarily thought of at that time as component parts of a system. They had originated at different periods and in different ways, and the people engaged in them were more conscious of their affiliations with the churches, or with the state or local government, 15 16 Social' Work or with the medical profession, or with sociologists and political scientists, than with one another. They had been coming together in a national conference once a year, to be sure, for twenty-five or thirty years, under the double-headed title of "charities and corrections"; and this, though a little awkward, had been accurate enough until the settlement movement and the consu- mers' leagues in the 90' s brought in a group who, while recognizing the interests they had in common with those who were engaged in charity and correction, protested against identifying themselves with either. When in the first years of the twentieth century still another kind of undertaking came into existence — committees and associations for securing better housing and more playgrounds, for the prevention of tuberculosis and of child-labor — based primarily on an interest in raising the lower level of social conditions rather than in taking care of the poor and the sick and the criminal, the need for an inclusive term became imperative, and "social Vwork" was the result. It is difficult to say just when and how the name originated, but speakers began to refer to the members of the National Conference as "social workers," and to the interests represented in the conference as "social work," and by 1904 or 1905 the term was in general use,* though the name of the Conference was not changed until 1916. * The oldest of the training schools — the one in New York, dating from 1898 — kept its title "School of Philanthropy" until 1919; while the Boston school, organized in 1904, was called from the beginning "School for Social Workers." The Scope of Social Work 17 SIGNIFICANCE OF THE TERM It is not altogether satisfactory as a name, because both the words composing it have so wide a significance that logically it would include every human activity carried on in association. On the other hand, its very hospitality is a practical advantage during this period when new varieties of enterprise in this field are rapidly developing. It is at least preferable to the clumsy "social welfare work," and to "social service," since the sturdy Anglo-Saxon "work" carries no sug- gestion of the class distinctions associated with "ser-i vice"; to "uplift work," which is even more obviously pbjectionable for the same reason, and which is used chiefly with a shade of mild contempt, by those who do not take it very seriously. At any rate, "social work" seems now to be firmly established in current usage. There is not yet, however, an accepted definition of it, and the term is used, even among those who call them- selves "social workers," with a wide range of content. Some extend its significance to include all the activities of schools and churches and of any other organizations within their purview which they regard as contributing to the general welfare. Some limit it to work that is done by voluntary organizations, supported by voluntary contributions, excluding identical activities carried on by public officials and supported by taxation. Some regard a salary as the distinguishing mark of a social worker, and will say of a man who has been in- • 18 Social Work fluential In shaping social legislation and determining the policies of many social agencies, "But he is not a social worker; he never held a paid position." A psychiatrist may be heard to say of a relief society, "But of course that is not social work." It is not un- common, especially among the younger social workers, to hear "social work" punctiliously reserved for what they consider to be "preventive" or "educational" or "constructive," or for the latest developments of which they happen to know. Persuading a family to adopt a budget, getting a child weighed and measured or a girl "psycho-analyzed," is social work in their eyes, but providing a home for an old woman on the county farm is not; hospitals and dispensaries are not social work, but "hospital social service" is; courts and re- formatories are not, but the work of a probation officer in a juvenile court is; "mental hygiene" and "after- care" of the insane are entitled to the name, but not the care of the same individuals while they are in an institution. Others still are willing to recognize as social work only what is done according to the most approved methods with which they happen to be fam- iliar. An officer of the American Red Cross, for exam- ple, was in the habit of saying that when Red Cross Home Service was inaugurated there was "only one so- cial worker" in his state, meaning by this that there was only one person who fully understood and habitually applied the principles of "case-work." There is no agreement, naturally, even among those who wish to The Scope of Social Work 19 limit the use of the term in these ways, as to what is worthy to be included and what must be excluded, for their decisions are determined perforce by their indi- vidual knowledge and standards. THE UNIFYING ELEMENT : THE COMMON SOCIAL PROBLEMS If this perplexing combination of two simple words remains in currency as a term of special significance, it wi-11 gradually acquire a more definite content. For the present, those who use it are under special obligation to explain in what sense they accept it, doing whatever they can to establish the meaning which they think it should have. In this book it is used to denote the whole complicated net-work of activities which center around the social problems of poverty, disease, crime, and other socially abnormal conditions. The unifying element in social work lies in these common social problems with which it is concerned, rather than in a common method or motive. "Social problem" is another term in every-day use which has come to have a special sense hardly justified by the literal meaning of its component parts. Any question of common interest to the members of society — Who shall be president ? What kind of school teachers shall we have? How may production be increased? How may industrial unrest be allayed? Where is the milk supply of the cities to come from? etc., etc. — is a social problem, in the literal sense of those words. 20 Social Work But the combination has acquired a more restricted con- notation, and in this restricted sense it is used to mean some troublesome condition or difficulty, of such a nature and of such an extent as to affect appreciably the common welfare, which cannot be handled by the individuals immediately concerned or by the social and economic and political institutions which serve the gen- eral needs of the average member of society. POVERTY, DISEASE, AND CRIME The elementary social problems, in this sense, are poverty, disease, and crime. They emerge as social problems in the earliest stages of human society. From the beginning there are children and feeble old men and women without natural protectors ; there are individuals who require special personal care because of illness or mental deficiencies; there are individuals who cannot keep up with the group — cannot "earn their living" — because of physical or mental weakness ; and there are individuals who for one reason or for another do not keep the rules of the group. These individuals who can- not or will not contribute their share to the common life, and who need some special provision not afforded by the family or by the economic and political system in operation, constitute the elmentary social problems in every community. From the earliest stages of organized human society, also, there is more or less definite recognition that they are social problems — that people cannot be allowed The Scope of Social Work 21 to suffer and die and indulge their anti-social tendencies, without injury to the common interest — and there are corresponding efforts to do something about them. In other words, the germs of social work, in the sense in which we are using that term, are historically as ancient as the elementary social problems. But in modern society this dim recognition, these embryonic germs, become an essential and permanent function of social well-being and progress. At a much later stage, people begin to realize that the situation of these individuals requiring special provision is due in large part to certain conditions arising out of the unrestrained operation of individual self-interest, or out of unanticipated workings of the established so- cial and political and economic institutions, or out of the failure of those institutions to do all that is expected of them, or their failure to adapt themselves to changed demands. One after another these conditions take their place among the recognized social problems, along with the orphans and widows and other dependent poor, the sick and the criminal, and become the object of a new kind of social work. Measures are taken for the pur- pose of preventing poverty, disease, and crime, and of raising the general level of well-being by increasing opportunities and removing discouragements and hind- rances over which the individual has no control. MEANING OF SOCIAL WORK Social work, then, is the sum of all the efforts made 22 Social Work by society to "take up its own slack," to provide for individuals when its established institutions fail them, to supplement those established institutions and to modify them at those points at which they have proved to be badly adapted to social needs. It may have for its object the relief of individuals or the improvement of conditions. It may be carried on by the government or by an incorporated society or by an informal group or by an individual, or it may be a temporary ex- crescence on some older institution which exists prim- arily for some other function. It may be well done or badly; according to the most enlightened system which intelligence and experience and sympathy and vision can devise, or according to the archaic methods of careless and lazy emotion. It may be inspired by sympathy or expediency or fear of revolution or even of evolutionary change, or by a sense of justice and decency. It includes everything which is done by society for the benefit of those who are not in position to compete on fair terms with their fellows, from whatever motive it may be done, by whatever agency or whatever means, and with whatever result. There is social work which is so badly done as to de- feat its purpose. There is philanthropy which confirms dependence instead of relieving it; there are reforma- tories which educate to crime instead of away from it ; there are laws intended to improve conditions which make them worse. Such undertakings are social work, but of a low grade. On the other hand, by no means The Scope of Social Work 23 everything which does contribute to human welfare is social work. MAKING A LIVING NOT SOCIAL WORK Social work, in the first place, does not include what the individual does for his own benefit or that of his family. The making of a living is not social work. The factory, the farm, the bank, the commercial office, the retail store, and the other features of our economic life through which these individual efforts are made, are more important than hospitals and reformatories and child welfare committees, but what they do is not social work. The individual expects and is expected to pay his way. Otherwise he is a social debtor rather than a member in full and regular standing of the community in which he lives. It is when individual initiative fails for some reason, or when it is thwarted by some adverse condition which can be modified only by organized effort, or when the economic institutions develop injurious features and fail to take human re- quirements into account, that social work begins. Social work may have to discover what is lacking in an individual's earning power and may have occasion to make adjustments in his working relations; or it may have to search out the socially objectionable fea- tures in industrial development and secure remedies for them. These interventions become necessary, how- ever, because the usual and natural process has failed, temporarily or permanently, partially or wholly. 24 Social Work UNIVERSAL SOCIAL INSTITUTIONS Similarly it does not include the services rendered by those social institutions — the family, the church, the courts, the press — which have been slowly devel- oped through centuries of experimentation, to meet universal human needs. These, like individual initia- tive and the economic institutions, are of far more significance in our social economy than is social work. In fact, if they all functioned perfectly — if every indi- vidual had his place in a family which could give him all that is expected in theory of the family; if the church reached every individual, for consolation and discipline, and succeeded in developing his moral nature to a high degree; if religion always gave a "way of life" and those who profess it w^alked therein; if the courts dispensed even-handed justice promptly; if the school taught every child the essential elements of a useful education; if the press exercised unimpeachable judgment in the selection and interpretation of news, and superlative skill in telling it — there would be little or no place for social work. It is when they fail, and the consequences become apparent in suffering or hardship to human beings, that social work must step in. COMMON SERVICES OF GOVERNMENT Social work, furthermore, does not include those well-established undertakings of the government which The Scope of Social Work 25 are carried on for the benefit of all the members of the community alike, such as the cleaning and lighting of streets, provision for a water supply and for the disposal of sewage, inspection of foods, protection against fire, the educational system and the police sys- tem. These are co-operative undertakings, in which the welfare of all members of the community is at stake, and which are deputed to the government because on the whole that is considered more advantageous and more convenient than to leave them to private enter- prise. They too are more important to the general welfare than is social work, since they affect the daily life of all, but they are not social work. They may not, it is true, affect all in the same degree. The rich man may not use the public schools for his children; he may employ private watchmen to protect his house and his factory; he may pay high prices to make sure of getting pure milk. But even so he profits indirectly — through the higher quality of the labor supply he em- ploys, for example — from the minimum of education and safety and comfort and convenience which has been established for all. These facilities, on the other hand, may be so managed as to benefit the rich more than the poor : the streets where the rich live may be kept clean and well lighted and adequately policed, at the expense of the streets where the poor live ; the schools attended by children in comfortable circumstances may have better teachers and better janitors and better equip- ment. In so far as this is the case, the government 26 Social Work fails of that impartiality on which the citizens rely in entrusting these enterprises to it. MUTUAL ASSOCIATIONS Equally outside social work, as we conceive it, are those activities which are carried on by voluntary asso- ciations of persons with common interests, for their own mutual benefit. Trade unions, chambers of com- merce, social clubs, employers' and merchants' and bankers' associations, farmers' granges, war veterans' organizations, professional associations, mutual benefit societies for insurance against sickness or any other con- tingency, and the like, are not primarily agencies for social work, although they are useful organizations, and any of them may engage in social work inci- dentally. This they do, for example, when they initiate, or join others in promoting, movements for the general improvement of living conditions or working conditions ; when they contribute from their funds to causes outside their main purpose, such as a relief fund for the victims of a disaster; even per- haps, though this is not far from mutual insurance, when they aid sick or unfortunate members of their own organization who have not contributed to a fund for the purpose. Trade unions are not social work. They are organized by members of a trade for the purpose of increasing their wages and otherwise im- proving their conditions. There is, however, a Woman's Trade Union League, created for the purpose The Scope of Social Work 27 of promoting the organization of trade unions among women, which is a national body, supported by volun- tary contributions, and composed of men and women from various occupations whose common interest is the purpose of the League. It is clearly, therefore, according to our definition, an example of social work, FLUIDITY AND EXPERIMENTAL CHARACTER Social work, then, is distinguished from the socially beneficial undertakings prompted by self-interest, on behalf of oneself, one's family, or one's associates in a trade or a profession or a social group; and it is distinguished from the socially beneficial institutions which serve all members of society alike, in that it is undertaken by the stronger and more fortunate mem- bers of society in behalf of the weaker and less for- tunate. It may be undertaken from any one of a wide variety of motives, and it is usually directed towards promoting self-help in one way or another, but its object is to do something for the benefit of others, because they cannot do it for themselves, or because they have not yet seen the importance of doing it for themselves; to care for those who cannot or will not care for themselves and their natural dependents, to remove unnecessary obstacles and to increase oppor- tunities for those who otherwise could not reach the opportunities or overcome the difficulties. From what has been said of the function of social work, it is obvious that its content — or perhaps we 28 Social Work should say, its table of contents — is constantly chang- ing. The number of those who require care and the kind of care they require; the particular respects in which social institutions are inadequate; the nature of the adverse social conditions — in short, the precise com- plexion and contour and number of the social prob- lems which furnish its tasks — vary in different coun- tries, in different communities, and at different periods in the same community. Other factors also vary : the degree of public interest in social problems, the charac- ter and ability of the leaders in social work, the financial and intellectual resources available for it, and other circumstances which affect the amount and kind of social work that is done. A leader with prophetic vision may arise, or one with the capacity for realizing visions first seen by others. The habit of giving gener- ously may become established. Striking experiments may become contagious. One voice like that of Eliza- beth Fry or Jacob Riis or Jane Addams may give direction to innumerable individual impulses. Experi- ence condemns certain methods and they are aban- doned — sometimes. Scientific discoveries suggest new ones. Social work, therefore, is necessarily fluid, and never in equilibrium. There is no institution or method which long serves its purpose. Something of the Amer- ican readiness to scrap machinery, processes, and plants in industry is characteristic of American social work. Even when the name of an institution survives — as in The Scope of Social Work 29 the case of the hospital — the thing itself changes.* An institution Hke the almshouse comes into existence on a wave of reform. It is heralded with enthusiasm. In comparison with what it replaces it deserves that enthusiasm. But hardly is it accepted and in operation before it becomes in turn the subject of criticism, attack, and reform. Even in its character of guardian and care-taker of the failures and the wreckage of society, social work is constantly facing new needs and finding new methods. Still more marked are the changes which take place in its efforts to improve living and working conditions. On this side, social work is to citizenship as a good scout is to the regular soldier, a flying squad- ron to the fleet, an exploring pioneer to the permanent settler. It focusses attention on some neglected evil; or it seizes upon some unmet need, some unrealized possibility, and applies to it intensively the remedy which will ultimately be recognized as normal to social action in general. It has the courage of its convictions. It undertakes to demonstrate how it would seem if the community were actually to use common sense, a scientific method, and tested verified knowledge, In reference to the particular problem. In these under- takings, if social work does Its part wisely and thor- oughly, the problem may eventually disappear. Child * Though when we chang-e the name of an institution — as the Department of Public Charities or the Charity Organiza- tion Society — the thing itself frequently is unchanged. 30 Social Work labor may be abolished, for example, or knowledge of the essential facts about tuberculosis may become prac- tically universal, and facilities for treatment available for all. Or, if it is another kind of problem, the result may be that society decides that what was originally undertaken for its less favored members might well be provided for all, irrespective of their ability to provide it for themselves. Free schools, for example, originated in America as a charity provided for the children of the poor; and it is not inconceivable that the time may come when we shall consider the providing of competent medical service, free to all citizens, as a suitable undertaking of government, fin- anced by taxes, just as we came to that decision about educational facilities. CHAPTER III CHARACTER OF AMERICAN SOCIAL WORK Social work in America has exhibited a character of its own, different from the activities to which it corre- sponds in other countries. The United States is favor- ably situated by nature for an extraordinary agricul- tural, industrial, and commercial development. The sheer extent of territory under one political system, free from internal tariff boundaries, from passport restric- tions, and from octroi taxes such as have been relied upon to meet local expenses in European municipalities ; the rich mineral deposits and the fertile soils; the abundance of free or inexpensive land awaiting the slightest surplus of population in congested centers; the coast contours, with many excellent harbors, and rivers penetrating the interior; the abundant forests; the wild game with which it was originally stocked, the plenti- ful supply of salt and fresh water fish ; the cheap graz- ing on the western plains, and the easy transition to cultivated corn and other feed for cattle, sheep, and hogs raised for the market, — these may illustrate, for it would be tedious to enumerate all the advantages furn- 31 32 Social Work ished by nature for a prosperous social economy in this country. AMERICAN ECONOMIC IDEALS Our economic ideals have naturally reflected the abundance and variety of physical resources. We have expected every one as a matter of course to provide for himself and his family. Extreme individualism has flourished. Economic co-operation has been diffi- cult becaiise it has not been felt to be necessary. Vig- orous independence has sometimes degenerated into surly eccentricity. The isolation of the pioneer created a self-reliant and generally neighborly type, but one jealous of his rights and suspicious of those who pro- fessed altruistic aims. The prevailing protestantism in religion strengthened the confidence in private judg- ment and the inclination to exercise it in all fields. Sectionalism in politics was a natural result of the conditions of life, but there were influences to coun- teract it, chief of which was the all but universal use of the English language. Except for the disturbances caused by the anomaly of slavery, and a few minor differences, attributable mainly to a lack of ready com- munication, our economic ideals throughout the country have been singularly uniform. We have traditionally held that the skilled workingman should become easily and rather promptly independent of his employer, or able to bargain with him on equal terms ; that the farm laborer should become a farm owner ; that wages should Character of American Social Work 33 be kept high by these easy transitions and by the possi- biHty of moving out to where free land could be ob- tained; that every boy should be free to follow some other occupation than that of his father; that the wife should have some degree of economic independence; that some form of saving should be expected from every one earning a normal income ; that all occupations in which one can earn a living should be held in honor- able esteem — a farmer or a machinist, not merely theoretically, but in every sense, as good as a banker or a lawyer ; that every career should be open to ambi- tion and persistence. Some of these ideals have been rudely shaken, but they were scarcely questioned until very recently except by radical agitators, and even now they are tenaciously held by the vast majority of Americans. Social work^ as it is and as it has been in this country, cannot be understood without keeping them constantly in mind. RELIGIOUS IDEALS Religious ideals have been as formative in American social work as economic conditions. Christian charity has indeed been its corner-stone. To feed the hungry ; to shelter the homeless; to clothe the naked; to care for the widow and the fatherless; to visit those who are sick and those who are in prison; to console the afflicted ; to bury the indigent dead ; to find a home for the orphan; to lend to those who through a loan may 34 Social Work be enabled to preserve their self-respect; to teach the ignorant; to assimilate the immigrant; to befriend the friendless; to find work for the unemployed; to bring back the family deserter and persuade him to fulfill his family obligations ; to prevent indecent over-crowd- ing; to care for the sick in strict accordance with the nature of their infirmities, as well as to visit them; to secure appropriate disciplinary or educational or custodial care for those who are in prison, as well as to visit them; to minister in all things to the strength rather than to the weaknesses of those who are in dis- tress and trouble, — all this, to many of those who at- tempt it, is but the fulfillment of an elementary religious obligation. That is not to say, let us hasten to add, that these are disagreeable tasks to which one is held by some stern and external authority. No person who really acts from a religious motive ever so conceives the matter. These are the spontaneous, congenial ex- pressions of a sense of brotherhood, the good works for which one asks no special credit, which the right hand is to conceal from the left, which it would be unnatural and irreligious to refuse to perform. The stern and uncompromising Puritanism of New England ; its milder and more humanitarian Unitarian- ism; the Quaker benevolence of the middle states; the Catholic and Church of England influences; aggres- sive, pioneering Methodism; Baptist and Presbyterian insistence on private judgment and scriptural authority, and all the many other forms which Christianity has \ Character of American Social Work 35 taken among us, together with the perhaps equal diver- sity in Judaism as it speaks to American Jews, have confused, but also greatly enriched, our religious ideals. Americans would hardly wish to exchange the liberty, toleration, and vitality of religion in this country even for the unity which for example Henry IV by his easy conversion secured in France. That a real, as distinct from a formal unity may come, is no doubt devoutly to be desired; but that there has been gain from the very struggles which have taken place in the free arena, from the fierce clash of opinions and competition of ideas, even from the attempts at mutual conversion from one faith to another, ordinarily so fruitless in fact, will not be denied by those who are willing to accept the evolutionary idea as applied to human affairs. I Social work has often originated in the churches, but even when there has been no official connection whatever with any religious body it has nevertheless usually been inspired by religious ideals, and it has given to thousands an opportunity for a social ministry which they have felt to be religious in every sense. / SOCIAL IDEALS Our social ideals have been closely related to our economic and religious ideals. Our passion for democ- racy, though we may believe it to be as ardent as that of the French, has never been so severely tested, and it had a very different historical origin. We have 36 > Social Work accepted democracy, rather than achieved it. Our democracy is a gift from Heaven. We have had but to live in toleration, in freedom, in comfortable pros- perity, and under such conditions democracy comes easy. Some relics of persecution and class distinctions, imported from Europe, we have had to discard, but they were so obviously misfits that it seems almost absurd to glorify our ancestors for getting rid of them. William Penn and Roger Williams and Lord Calvert were only Admirable Crichtons of an earlier day. They deserve credit for recognizing a new order w'hen it was inevitable. Democracy is not our only, although it is our most cherished social ideal. America has always been a melting-pot. An English curate in the eighteenth cen- tury, after travelling in the colonies, pictured the col- lapse that must immediately follow from internal antag- onisms and discords if the central control of the mother country were withdrawn. It was not of differences among the colonies, but of internal conditions within the several colonies, that he was speaking. Each gen- eration, since Plymouth Colony failed with the Quakers and the Baptists, has had an increasingly difficult task of assimilation. Fortunately, in the process it has had the aid of the previously partly assimilated new-comers, and so has measurably succeeded. American social ideals, then, have never been those of any one "mother country." Our language and literature, our common law and courts of justice, our Character of American Social Work 2>7 conceptions of individual rights and mutual obligations, we have mainly, though not exclusively, from Britain. But the French Revolution had an immense influence on our early political history; the revolutionary move- ments of 1848 afifected our ideas; German education has influenced us, and not, as the war made it popular to say, unfavorably. Italians and Poles, Swedes and Danes, Irish Catholics and many others, have given, as well as received, in the assimilating process. Our psychology has ceased to be that of the frontiersman. We are no longer unmitigatedly individualistic. Our progress and our retrogressions have not been those of England or of any other European nation. Nor has our national life remained in water-tight compart- ments. Students of political institutions are far from the truth about America if they assume that we are not one nation, but, like the British Empire or the Swiss Federation, a group of nations. Americans feel about America as Englishmen feel about England and as Irishmen feel about Ireland — not as either feel about the still nebulous British Commonwealth; as Frenchmen feel about France, not as Genevans felt when they doubted, unjustly as it appeared, the loyalty of their German-speaking compatriots, POLITICAL IDEALS Our political institutions and the ideals which they imperfectly express are also among the conditions which 38 ' Social Work have determined the character of our social work.* The separation of powers — legislative, executive, and judicial; the existence of two governments — national and state; the reservation of certain sovereign powers to the people of the states; universal adult suffrage, without property or educational qualifications ; political supremacy of the white race in the south; the presence of millions of unnaturalized and hence unenfranchised aliens in the north and west ; our somewhat naive faith in what can be done by legislation and by "good men" in office; our tardiness in checking downright political corruption and in appreciating the importance of technical experts in the public service, are illustrations of the political facts which condition all our efforts to deal with poverty, disease, crime, and illiteracy. Broad- ly speaking, our political ideals may be said to have been inherited, our economic ideals to be in the making. DISTINGUISHING CHARACTERISTICS From the quality of our economic, social, religious, and political ideals it results that American social work * No attempt is made to press beyond the logic of current usage the distinctions between economic and social or be- tween social and political ideals. Generally speaking', the economic ideals are those which arise from work and income; social ideals, those which arise from association in groups ; and political ideals, those which are associated with the state. Of course the state concerns itself with work and income, and social groups frequently originate in economic relations. Almost any social ideal may be expressed in economic or political terms. Character of American Social Work 39 shows certain characteristics which distinguish it from the corresponding activities in other countries. (1) There is greater variety. In the field of pri- vate charity individual initiative has had free play, little hampered by legislative restrictions or by prece- dents, and comparatively little by the control of church authorities. In the administration of public institu- tions, and in legislation for effecting improvements in the conditions of life or work, it is not a question, as in England or France, for example, of passing one law by the national legislative body. These matters for the most part fall under the jurisdiction of the states, and even within the states the bulk of responsibility still lies with local authorities of city, town, or county. Forty-eight states with sovereign powers, with varying economic and demographic conditions and varying historic traditions, inevitably present differences in their poor laws and penal codes and in their institutions and administrative machinery. Even when a law is con- sciously copied, some modification is generally intro- duced, to meet local conditions or prejudices or predilec- tions. This situation has favored experimentation. Dif- ferent plans can be tried out in different states simul- taneously, instead of following one another in slow succession in the same state. Progressive states are not obliged to wait for the education of public opinion in more backward sections. The newer common- wealths can, and not infrequently do, begin at the point 40 Social Work reached by older states only after many years of experi- ence. It is a fair question whether this disconnected, jerky method of progress has not resulted in a higher average standard for the country than would have been attained by this time if jurisdiction were vested in the federal government. (2) The relative amount of social work undertaken on private initiative, as compared with that done by the state, is far greater than elsewhere. This is partly because of the individualism which until recently has been wont to regard government, "even in its best state," as Thomas Paine said, as "a necessary evil," and not as a useful mechanism for advancing the com- mon interests; partly because dishonesty, log-rolling, subserviency to the "interests," and inefficiency have in the past been so frequent in the conduct of public affairs that the instinct of "the best people" has been to keep everything possible "out of politics" ; but partly also — perhaps chiefly — because the social problems have been of more manageable proportions than in older or less prosperous countries, and have not demanded the resources and the authority of the state. (3 In private philanthropy, the relative amount car- ried on under religious auspices is far less. While the churches very generally have engaged in relief and reclamation, the absence of an established church and even of a single prevailing faith, has prevented the domination of any one church tradition, such as is found, for example, in the Latin countries of Europe Character of American Social Work 41 and South America or the Teutonic countries of north- ern Europe. Since the closing years of the eighteenth century, moreover, the "secular" or "non-sectarian" charity has been a conspicuous type, and it has been gaining in prominence in the twentieth century. (4) Throughout the whole system of charity and correction, both public and private, there is more hope and courage. In comparison with older countries, there has been less poverty and degeneracy in America at any period. Even in the oldest cities there is no such "pauper class" as in London or Liverpool or Naples. The characteristic American attitude towards poverty has been one of impatience, rather than concern. In the earlier years of our history — in fact, until toward the close of the nineteenth century — this impatience showed itself in relative apathy and neglect. It was taken for granted that everybody ought to be able to "get along somehow." In recent years it has shown a new and better aspect, in a disposition not to tolerate conditions which are responsible for poverty and misery and degeneracy ; and this has considerably modified the methods used in the care of individuals, and has in- spired the social movements which are the distinctive form of philanthropic activity in the United States in the twentieth century. (5) Finally, there is the rapidly changing charac- ter of our social work, which has been discussed in the preceding chapter. Each generation — each decade, almost — sees new types of agencies develop while older 42 Social Work forms disappear or become less conspicuous, sees a shift in emphasis and enthusiasms, a realignment of interests. TENDENCY TO INTEGRATION There is one other distinguishing characteristic of social work in America which must not be overlooked. It is not so much a consequence of the determining conditions which have been considered in this chapter as it is of the resulting vitality of social work itself and the character it has assumed. This is the tendency to regard as inter-related all the varied activities which center around the problems of poverty, disease, and crime, and other abnormal social conditions. In the United States public and private relief, charity and correction, the care of sick or criminal or indigent individuals, and the efforts to improve housing, to provide facilities for recreation, and so on, are coming to be regarded as component parts of an integrated sys- tem, not as separate and distinct departments in the social economy of the nation. The National Conference of Social Work, dating from 1873, with its member- ship of some five thousand representatives of these various activities, and an attendance of three to five thousand at its annual meetings in recent years, has no counterpart in any foreign country. Social workers are often naturally disappointed that the public does not respond more quickly and show a more sustained interest in their appeals. They should Character of American Social Work 43 rather be encouraged by the relatively large number who are open to appeal and who do maintain their interest. There is a steady increase in the number of Americans who are alert to relieve distress when they know about it, and to prevent its recurrence; and who are able to scrutinize proposals for reform with some measure of intelligence and with open minds. CHAPTER IV THE STANDARD OF LIFE Our forefathers demanded the right to life as one of those inaHenable poHtical rights to which men are born. The center of interest has shifted since then. It is never the rights to which we are born that are paramount in our estimation, but the rights which we are still to achieve. Political rights, achieved by our ancestors, include the right to liberty, the right to a jury trial, the right to a day in court, the right to equality before the law. We treasure these rights, and if they are threatened we will maintain them. They came to us through a long line of tradition, of common law broadening down from precedent to precedent. We take them for granted, like the air we breathe : freedom of worship, free speech, free assembly, the right to resist oppression. Because we take them for granted, because they are handed down to us from the past, we rather resent having to take the trouble to reassert them against the reactionary stupidity of the post-war psychology. We do it because we must; but we resent it as a sort of witch-baiting anachronism. Our real interests are elsewhere. We do not intend 44 The Standard of Life 45 to spill our blood, to waste our resources, in fighting over again for the principles of '76. NEW MEANING OF THE RIGHT TO LIFE What rights then remain to be established, com- parable with the right to life and liberty and equality before the law? Obviously, certain economic rights: the right to life in the only sense in which it has mean- ing to us, the right to a life of economic security and independence, the right to a decent standard of living. The positive right to the available sources of happiness must be made as secure as the negative freedom from interference in the pursuit of happiness. The right to be well-born, free from the poisons of alcoholism and venereal disease, free from mental defect or a diathesis to tuberculosis — is not this logically included in the right to life, as we understand it? — the right to a protected childhood, in order that life may have a richer meaning; the right to a prolonged working period, to a capacity for remaining active long after forty, when old age now so often overtakes workers; the right to an over-lapping of the generations, grown children becoming active long before their parents are laid on the shelf, so that from this accumulation of productive energy the standards of the race may be lifted above penury into the upper levels of prosperity. Modern social work then accepts as a worthy object of evolutionary, and if need be, of revolutionary effort, the assertion of the common right to a life correspond- 46 Social Work ins: to the standards which our economic resources permit, which our civilization demands, which our re- ligions sanction, which are in harmony with our sense of the dignity and worth of human hfe. There is no occasion to revive the old controversy about natural rights. Political philosophers may dispute as to whether the right to this economic life, this social life, this high standard of life, is inborn, natural, primordial, inseparable from the very conception of humanity; or whether it is acquired, a social achievement, built up painfully and consciously, by trial and error, by com- parison and judgment, by lessons learned in the school of Dame Experience. What is essential is that we come to think of it as a right: to be freely accorded by all socially-minded law-abiding citizens; to be claimed with passionate ardor by those to whom it is denied; to be sanctioned by appropriate legislation and court decisions; to be surrounded also by the sanctions of morality and religion; to be grounded firmly on scientific foundations. The right to life, not as an abstraction, not as a shell of half-forgotten struggles of the past, not as a political tradition, but as a con- crete reality: the right to be alive, to share the vital currents of our time, to be alive in every member, to know the satisfactions and the joys of life, to live upon the heights and to sound the depths of life; life with content, life with meaning, not mere physical existence — this might be the new Declaration of the Rights of Man. The Standard of Life 47 NEW INTEREST IN THE STANDARD OF LIVING The modern American struggle for the recognition of the standard of Hving as a practical measure of income, as a means of determining the rights of labor disputes, as a means of determining the policies of charitable agencies, as a means of deciding whether salaries paid to municipal employees are just and reasonable, as an aid in formulating measures of social justice, is about fifteen years old. It was no new thing for economists and statisticians to study family budgets. The French engineer Le Play, director of the first Paris World Exposition, did it nearly a century ago more intensively than it has ever been done since. His family monographs, describ- ing in great detail how families really lived, every possi- ble source of income, every slightest expenditure, every item of their accumulated possessions, every aspect of the routine of their lives, all their social, religious, and economic background, each one based on an intimate acquaintance, gained usually by residence in the home for weeks or months — such monographs are not pre- pared in these days of hurried preoccupation with many things. They required perhaps Le Play's faith in the religious factor in human lives, in the conservative elements in society, in the family and the other slowly developing social institutions whose function is to secure permanent individual welfare and social stability. We do not often find his large patience, his scientific .8 Social Work honesty, his willingness to use a professional man's vacation persistently through many years for a serious avocational purpose. Americans have collected and studied family budgets, as Germans and English and Belgians and others have done, and have tried to draw general conclusions from them.* But in the middle of the first decade of this century — about the time of the Pittsburgh Survey, about the time of the San Francisco fire, about the time when the Russell Sage Foundation was established — the subject of the stan- dard of living acquired a new interest for social work- ers, which was first clearly expressed at a session of the New York State Conference of Charities and Cor- rection in 1906. Several years earlier I had written a chapter on the subject — which I like to think was in harmony with what followed — in my Principles of Relief. I was giv- ing a course in Columbia University on the Standard of Living, based partly on a study of family budgets. Homer Folks, in an address before the Associated Charities of Boston, had explicitly demanded that we discard once for all the notion that charitable relief should supply the bare necessities of life, and should adopt instead as its guiding principle that it should * Work of this kind had been done by the Massachusetts Bureau of Labor Statistics, under Carroll D. Wright, and by the United States Labor Bureau, under the same commissioner and his successors, especially the very able recent occupant of that position, Royal S. Meeker, who resigned to accept a position with the International Labor Bureau of the League of Nations at Geneva. The Standard of Life 49 supply what is necessary to maintain a reasonable standard of living. Many had been interested in the idea, and some had tried to analyze and interpret it. Mr. Folks challenged the societies to take it boldly for their rule of action : to ask themselves, in the case of a widow with children, for example, not, what are their absolute necessities in the way of shelter, food, and clothing, but what variety of food, what changes of attractive and comfortable clothing, how large a house and with what conveniences, what recreation, what secondary or higher education for the children, what comforts and niceties of life are reasonable, that society may with justice claim to have been a father to the fatherless, rather than to have placed a double and impossible burden on the mother of fatherless children. This address was a sporadic event — a signal, perhaps, to the observant, of a change of weather impending. The change really came a few years later, when Frank Tucker, in 1906, read a paper before the New York State Conference, speaking what was, or what at least immediately became, the thought of many minds as to the relation between incomes and the cost of living, — i. e., the cost of maintaining a reasonable standard of living. WHAT IS A REASONABLE STANDARD? Who is to determine what is a reasonable standard of living? What is decency? What is comfort? 50 Social Work Shall the family have a small tenement, a small cottage,. or a commodious dwelling? What is a small house or a comfortable one? How long is a string? How large are the desires of man? Shall a labor commis- sioner, or a public welfare commissioner, or a jury of citizens, determine what is a reasonable standard of living for human beings? The difficulty is a real one, and it makes impossible the setting up of an arbitrary or authoritative standard which will be universally accepted. But it is not in- superable. It is at least possible to find out what man- ner of Hfe may now be obtained for a given income; to study incomes and expenditures and possessions; to inquire how many rooms and what conveniences, what diet and clothing, what recreation, what expendi- tures for health, for education, for charity, for religion, for savings, are possible; and if we describe concretely the actual life which we find among families liv- ing at a particular time, in a particular community, on a given income, we shall have at least a starting point for an understanding of the relations between incomes and the standard of living. This is what the New York State Conference of Charities undertook to do, and did. A representative committee was appointed, securing as executive secre- tary Professor Robert C. Chapin of Beloit College, who was spending a year in graduate study at Colum- bia University. We at the university agreed that Pro- fessor Chapin, independently of the findings of the The Standard of Life 51 committee, might present his own interpretation of the study, together with a suitable historical introduction, as his doctor's thesis, in partial fulfillment of the requirements of the university for the degree of Doctor of Philosophy. FINDINGS OF THE NEW YORK COMMITTEE The committee found typical families in New York City living on $600 a year — less than two dollars a day for every working day of the year; on $650, on $700, $750, $800, and so on up to $1,200 a year, be- yond which, for purposes of our inquiry, we did not think it advantageous to go. We were a committee of a conference of charities, and we were not seeking at that time facts about the aristocracy of labor, but merely wished to make sure that the inquiry extended above the line of economic independence. We studied those incomes and the manner in which they were earned, whether by one member of the family or more. We studied more minutely those expenditures. We tabulated and analyzed them. We tried to look at them from every angle : from that of health and physi- cal comfort; from that of permanent as well as imme- diate welfare; from that of family and social, as well as individual well-being; from that of education and morals. We drew our conclusions, but we presented also the facts upon which our conclusions were based, so that others with different ideas might deduce their own conclusions. 52 Social Work We arranged our descriptions and facts In a sort of sliding scale. We said: Here is the manner of life in general that a family of five may enjoy in New York at the prices prevailing in the year 1907 on an income of $600. There are individual differences, of course, springing from ability to manage, from training in the hard school of poverty, from racial and national likes and dislikes ; but we have sought to include enough families to justify a general description, and this is what we find. For $600 you may have so much space to live in, such food to eat, such and such clothing, and practically nothing else, save perhaps burial in- surance. In fact, unless you have relatives or friends to help you with gifts, or unless you apply to the relief agencies, you will not be able to meet the minimum physiological requirements for health and vigor. You will not be strong for work ; you and your children will be under-nourished. You will not have milk for the babies, or enough fruit and vegetables for the adults. You will take an excess of bread or macaroni, of coffee and tea, of stimulants and narcotics. You will have no savings for sickness or old age. Your income, especially if earned wholly or in part by mother and children, will be more hardly earned than is warranted, at the expense of the care of the home and the welfare of the children. In misfortune or old age you will become burdens on the community, so that the real cost of your living is not represented by your present expenditures. You are altogether a bad bargain for The Standard of Life 53 society — you $600 families — a still worse bargain, of course, if your income is less than $600, or is irregular. Society ought not to allow you to exist. Social debtors are a bad bargain, and the average family with an income of $600 or less, even at the prices of fifteen years ago is a social debtor. We found that incomes of $700 secured a little more room, a better diet, a nearer approach to independence. Ten years earlier that income might have represented economic sufficiency. John Mitchell, in his book on Organized Labor, had named $600 as the lowest amount on which, throughout the country, an American stan- dard of living could be maintained. I had given the same amount as the cost of supplying the necessities of a family dependent on charitable relief in New York.* But prices had advanced, and our ideas as to what constitutes a minimum normal life had also ad- vanced. Not until the income was well above $800 a year, earned in a regular and reasonable employment by the male head of the family, did we find a prevailing standard which in the least corresponded to our con- ception of comfort, decency, and a chance for the pur- suit of happiness. There were some, of course, who lived on less and lived decently. But their capacity for management was exceptional, or fortune favored them in some way which could not be generalized. Most of those who had less either undermined their health, so laying up burdens for society in the future, ' Principles of Relief, page 35. 54 Social Work or paid the price in other ways injurious to themselves and to their neighbors. In the dozen years since these conclusions were pub- lished in Chapin's book on Tlic Standard of Living in New York City* costs have doubled and trebled. Our statistics have only a historical value. Our results no longer apply. But the influence of the studies made among those few families by this temporary committee has been very considerable. The Pittsburgh Survey benefited by the experience. Estimates of the cost of maintaining a decent, an American standard, began to appear more frequently in labor disputes. Policemen, firemen, street cleaners, longshoremen, bank clerks, dis- covered that they too had standards to maintain and that traditional wages and salaries did not maintain them. Boards of Estimate, City Councils, mayors, governors, considered whether appropriations for higher salaries were not essential. The text-books in economics began to give more prominence to the stan- dard of living as an element at least among others in determining wages. That standards were not, in the long run, determined by wages or other incomes, but that on the contrary standards were themselves the dynamic factor in influencing incomes — is the startling paradox to which all serious study of the subject leads. DEFINITION OF THE STANDARD OF LIVING It is time, however, for a definition. What do we Russell Sage Foundation, 1909. The Standard of Life 55 really mean by the standard of living, in the sense that it becomes a dynamic influence in our lives, that it determines our income, that it modifies our plans, transforms a naturally lazy workman into an indus- trious one, a spendthrift into one who values and prac- tices thrift, that it postpones marriage, limits the num- ber of children, twists the choice of an occupation, and furnishes the basis for determining what relief is required or what action should be taken by a social agency which assumes responsibility for the family welfare? The standard of living, as it has significance in social work, must be expressed in comprehensible, general, but definite terms. We must think of it as the worker thinks of it, as the average newspaper reader would understand it. The standard of life includes only » those things which can be standardized. That is by no means the whole of life. yVe may standardize in- comes, but not so easily the ability to make use of income. We may standardize the amount of leisure time which the worker shall regularly have at his dis- posal, but not the use which he shall make of his leisure. We may standardize dwellings in their general character — number and size of rooms, security from fire, sanitary arrangements, light, ventilation; but only very generally personal furnishings, decoration, and not at all the subtler touches which differentiate one home from another. We may standardize the amount of money available for clothing, and such demands as 56 Social Work that it shall not be inadequate, indecent, fantastic, and — if we like — that it shall not be recognizable away from the place of employment as belonging to a particular occupation. Clergymen and policemen and a few others may retain a distinctive dress even when not on duty, or may be regarded as always to some extent on duty, but it is the ambition of most workers to look like other citizens when at home or on the street, and such change of clothing as will make this possible is a part of their ordinary standard of living. The standard of living is made up of those things which many men in common hold to be clearly essential -to them. On all sides of it there may be luxuries, pleasures greatly to be desired, morally better things, aesthetically more beautiful things, economically more valuable things, than those which make up the pre- vailing standard. We are human beings, not angels or saints or artists or "economic men." The standard of living embraces all those things which we want, and want enough to secure them; which have a vital im- portance for us; for which we are willing to make sacrifices. It includes those things which from our point of view belong in the daily routine of our lives. If deprived of anything which is really in our standard we will at once set in motion forces which will tend to bring it back. We will work longer hours, or more Intensely. Perhaps we will try to use force, resorting to government or collective action. The Standard of Life S7, THE PREVAILING AMERICAN STANDARD The Standard of living in American communities includes a dwelling with reasonable light, heat, ventila- tion, and privacy. It is expected to be built so that it will not collapse, and to be protected from undue fire risk. Four rooms is ordinarily regarded as a minimum even for a small family, and the tendency IS to consider that there is overcrowding whenever, besides kitchen, living and bath room, there are not sleeping rooms to give at least one for every two per- sons, with due allowances also for the proprieties of sex, age, and relationship. In cities where tenement and apartment houses are the rule, a rough formulation of the prevailing standard puts an average of two rooms for every three persons, including rooms used in common, but this cannot properly be applied to two or three room apartments, unless in the case of a married couple without children, for whom three rooms might not be regarded as inadequate, at least as a temporary arrangement.* As in the case of any other element in the recognized standard of living, the home must be as commodious, as well located, as attractive, as safe — in short, as desirable — as those of neighbors or associates. It may be at the top of a six story "walk-up" tenement, or in * The scarcity of houses at the close of the World War and the increase of Hprht housekeeping has at least temnorarily reduced these standards in many cities. 58 Social Work a suburb, with a garden and chicken-yard. It may be owned or rented. It may have been the dwelHng place of the family for generations, or it may have sheltered a rapidly changing succession of tenants. ' It may owe its desirability to its location near the place of employ- ment, to its physical surroundings, to convenience of transportation, to educational advantages, or to a mere whim of custom. The house must be fully furnished with beds, tables, chairs, cupboards, carpets or rugs, curtains and shades, and the modern conveniences of kitchen, laundry, and bath-room. Pictures and other ornaments are as much a matter of course as dishes and utensils. If there are not stoves it will only be because the house is heated by furnace or otherwise. Gas and electricity may be taken for granted in towns, and hot and cold running water in kitchen, bath-room, and laundry. Whether there shall be a vegetable garden, flowers, hedge, pave- ment, veranda, sleeping porch, garage, depends on circumstances. In many places an automobile is not far outside the standard of living, if not actually a recognized and secure feature of it. Nowhere would the right to a comfortable, sanitary dwelling, as an elementary basis for normal family life, be questioned. The diet in the American standard of living is rela- tively varied and abundant. It includes fresh fruit and vegetables in season, and dried, canned, or preserved fruits and vegetables when the markets do not supply them fresh. Meat, fish, and eggs are important ele- The Standard of Life 59 ments in the diet, and milk for children. Over-eat- ing is more common in America than under-nourish- ment. Waste at the garbage pail is more common than in European countries, even before the present scarci- ties in Europe and since the education in economies which the American house-wife received during the war. Too large a proportion of the population fail to get full value from what they spend for food, from lack of elementary knowledge of how to select and how to prepare it. The standard of living would therefore be improved if less attention were paid to quantity and more to quality, more to preparation and con- servation of food and less to favorite dishes, espec- ially those which are more appetizing than digestible. The standard is high, but qualitatively capable of im- provement, and it is in fact undergoing a rapid change for the better. Among those who are industrially employed, the eight hour day and one day in seven of complete rest from ordinary toil are now universally regarded as legitimate objects of desire and struggle. Although they have not been universally attained, it is fair to say that they are a part of the accepted standard of living of American workingmen and women. Em- ployers who refuse them, even though they may be among the great industrial corporations, are constantly on the defensive. The worker has a right to leisure for his own sake, for the welfare of his family, and in the interest of the community. This right is now most 60 Social Work frequently expressed in terms of the eight-hour day, although for women, for adolescents, and for men in certain arduous employments, the standard of living requires more than an average of sixteen hours of every twenty-four for sleep, meals, recreation, and other necessary demands. For them the working week must be correspondingly shortened to forty-four hours or less. Those who work on their own account — in the home, on farms, as independent artisans or small merchants, or in any of the professions — ordinarily observe no such limitations ; and those who have done their regular work in mine or factory may of course work about their own homes in their leisure hours. The standard of life requires income enough to sup- port the family without wage-earning labor by young children or by the mother who is responsible for the care of children. It consecrates childhood to nurture and education and play, to growth in freedom and under protection. It demands provision for health : both pro- fessional care in actual sickness and infirmity; and whatever precautionary measures are necessary to con- serve health, physical well-being, resistance to disease. Health does not depend entirely on income. It is primarily gained and held by the habitual practice of personal and public hygiene, and this may easily cost less than the indulgences which endanger health. But the care of teeth and of eyesight, periodical physical examinations, and the rigorous following up of any correctional action \yhich such examinations may show The Standard of Life 61 to be necessary, involve outlay, at times of very con- siderable amounts. Health, leisure, and elementary education belong with shelter, food, and raiment in the normal standard of life. INFLUENCE OF A HIGH STANDARD The relatively high standard of life has furnished the background for social work in America. It influ- ences everything that people do for themselves and everything that social workers do for them. Through an instinctive, or finally a fully conscious appreciation of what the standard of a particular racial or economic group is at a given time, the decision is made as to when social work shall step in and how far it shall go. On the other hand, it obviates the need for relief, for discipline, for outside warning, for treatment, by its own stimulating and healing influence. It furnishes motives, overcomes temptations, keeps the wayward steady, the inebriate sober, the genius at work. When the standard of life is clearly visualized and well but- tressed it ensures that many serious problems will be rightly solved within the home — without publicity, and it ensures that many others will be dealt with compre- hensively by the community, without humiliation or condescension by any, with hearty acceptance by all of social responsibility.* * The author's Normal Life (Part I of this text-book in Social Economy) is a study by age periods of the essentials of a reasonable standard of life as commonly held among us at the present time, and of the concrete problems which arise when they fail. CHAPTER V CLASSIFICATIONS OF SOCIAL WORK As we look about over the field of social work, it is obvious that there are several bases on which the vast number of heterogeneous activities might be classified. It is equally obvious that there is no "natural" classi- fication, logically inevitable and acceptable to all con- cerned. Whatever basis is selected, certain agencies will belong in more than one group, and on the other hand there will be in each group certain agencies which may not themselves recognize their affiliations with others in the same group. For purposes of our study the desirable thing is to find the classification which will help most to a comprehensive understanding of the way in which we deal with our social problems — of the questions and the principles involved, of the relations of the social agencies to one another and to the problems they have been created to meet, and of the relations of the whole fabric of social work to the rest of our social economy. ACCORDING TO AUSPICES One possible basis of classification is according to 62 Classifications of Social Work 63 the auspices under which the agency operates. A large part of the social work in America to-day is carried on by pubHc officials in the national, state, county, town, and city governments, and supported by revenue from taxation. Although there are no general statistics on the subject, and although until recently we have been reluctant in America, as com- pared with European countries, to expect much of the state in these matters, there can be no doubt that the greater part of the work of caring for the sick and defective and insane, the dependent aged and chil- dren, the criminals, and even those who are only temporarily in need of help because of bad luck or misfortune, is now done by public authorities represent- ing the voters and tax-payers. Institutions and out- door relief — providing care of a perfunctory nature for the classes which are too troublesome or too numer- ous or not sufficiently appealing to be provided for by private charity — are the forms of social work commonly associated in the public mind with the activities of government in this field, but there is hardly a known variety which may not be found going on under public auspices, and in quality it ranges through all the possible degrees of excellence. Historically much of our social work has a religious origin. Both education and healing formerly were largely functions of the churches. The care of orphans and the aged has throughout recorded history been regarded as more or less a religious obligation. It 64 Social Work is not surprising therefore to find Catholic and Protes- tant churches and the Jewish communities alike main- taining hospitals, homes for incurables and infirm, orphan asylums, and relief societies. In line with their traditions, and under the guidance of the very principles which were clearly perceived and acted upon by early law-givers and apostles, the churches have constantly put forth new agencies for the relief of the poor, for promoting the good life. While foreign missions have been especially fertile in this way, insti- tutional churches in the cities at home, and latterly community churches even in the open country, have participated in or originated such activities. Under the influence of the new ideas, or applying old ideas to new conditions, the churches have transformed some of their conventional charities into thoroughly modern and well-equipped agencies. Since the eighteenth century Americans have been accustomed to organize philanthropy also on a secular or unsectarian basis. Societies for the relief of widows and other special classes, for relieving destitution among particular national groups in our cities — such as the German Society, the French Benevolent Society, St. Andrew's Society — were established early in the nineteenth century, and before the middle of the cen- tury more general associations for improving the con- dition of the poor were created in the hope of asso- ciating together all citizens of good-will who might be disposed to give time and money through organized Classifications of Social Work 65 channels. The unedifying spectacles of over-lapping and competing charities, professional mendicancy, and withal neglected poverty, led to new attempts in the eighties to organize charity through a society incor- porated for that purpose under a variety of names, such as associated charities or charity organization society. A little later the social settlements also represented this unsectarian form of association ; and in the present century it has become increasingly fam- iliar through the hundreds of societies in the various educational movements for the prevention of disease and other evils, until it is perhaps the distinctive type of organization in American social work. While this classification offers perhaps the minimum amount of over-lapping, still the groups are not per- fectly clear-cut. Many private institutions, both re- ligious and secular, receive subsidies from public funds. In some cities there are working agreements which amount virtually to combinations of the department of public charities and the charity organization society. The American Red Cross, though supported by volun- tary contributions, is a quasi-official organization, subject to a degree of control by the government. The serious objection, however, to adopting this classifica- tion in the present study, is that it has little significance for our purposes. The division of responsibility between public authorities and private enterprise is haphazard and far from uniform throughout the country. It is the result of circumstances rather than 66 Social Work of any accepted theory of what the division should be. Whether any particular activity in a given community is carried on by the city, by a church, or by an unsec- tarian society, is largely an accident. ACCORDING TO "PROCESS" A second possible basis of classification would be according to the process employed. We might analyze the methods used by each agency, pick out similar processes wherever they may be found — whether under public or private auspices, religious or secular, whether in institutions or in societies which help the poor in their homes — and arrive at some such classification as : (1) "case-work"; (2) organization and administration of institutions; (3) teaching and organization of small groups for educational, recreational, and social pur- poses; (4) education of the pubHc; (5) co-ordination and organization of the resources of the community. A large part of all the social work which is done, whether under public or private auspices, religious or secular, consists in helping individuals who need in- formation or advice or financial assistance or encourage- ment or discipline : finding out what is "the trouble" in the individual's economic or social circumstances, physical or mental condition and endowment, character and equipment and surroundings, and trying to correct what is wrong and to supply the elements that are needed for a normal development. This is called "case- work." It includes not only the work of "family Classifications of Social Work 67 societies," of agencies for placing homeless children, of probation officers, officials in charge of mothers' allowances and other forms of out-door relief, social service departments of hospitals and dispensaries, etc.,' etc., but is also an essential element — or should be — in the work of every institution. In recent years the "technique" of case-work has been much discussed by those who are interested in it, methods have been elaborated, and some text-books have been written about it. A second process consists in the organizing and administration of the daily life of human beings living together in groups : in homes for children and for the aged ; in hospitals for the insane and for the physically disabled; in prisons and reformatories; in fresh-air homes and camps, and other institutions. In some respects all this work is similar to that required in boarding-schools and other institutions which are in no sense "social work," but in each case it is modified and conditioned by the special character of the persons who are housed together. A third process, which, like case-work, is more peculiar to social work, is that which is involved in "educating the public." The educational and preventive social movements of the present century have a com- mon method, consisting of research, publicity, and propaganda, which, while it has taken hints from commercial advertising and other sources, is fairly distinctive. The teaching done in clubs and settle- 68 Social Work ment classes, and the leadership of them, might be regarded as a fourth process; and there is finally the kind of work which has for its object the co-ordination and harmonizing of existing agencies, the organiza- tion of the resources of the community, as was done, for instance, to provide hospitality and recreation for men in service during the war, or to provide care for the sick during the epidemic of influenza, the kind of planning for future development of a community's social work which is done by the budget committee of some of the financial federations. OTHER CLASSIFICATIONS A third classification might be made on the basis of the locale of the work: whether it is carried on in institutions where the beneficiaries are brought to- gether; in their own homes; In the open air; in club- houses ; or in libraries and business offices. The series of four reports issued by the Thirteenth Federal Cen- sus covered respectively almshouses ; penal institutions ; institutions for the Insane and feeble-minded; and "benevolent institutions," this fourth volume Including institutions for the care of children, societies for the protection and care of children, hospitals and sanatoria, dispensaries, homes for adults or for adults and chil- dren, institutions for the blind and deaf. This, how- ever, is by no means a comprehensive survey of the social work of the United States, and the basis of the classification is not obvious. Classifications of Social Work 69 ACCORDING TO THE SOCIAL PROBLEM Any of these classifications might be useful for a particular purpose, but there is another basis — accord- ing to the social problem involved — which v^^ill be follov^ed in this book. On this plan we shall study contemporary social work in its relation to poverty, disease, and crime : the existing provisions for the care of individuals (1) who are "in need," (2) who are sick or disabled or defective, (3) who have com- mitted or are likely to commit crimes; and (4) the current efforts to diminish the amount of poverty, disease, and crime, and to raise the general level of conditions under which the mass of the population lives and works. As in the case of any other possible classification, this one is bound to involve over-lapping, and is bound to group together individuals and agencies who in their daily routine may be strangers — possibly even enemies — to one another. But it has the advan- tage of keeping always in the background a conscious- ness of the social problem which the social work under consideration is designed to meet, thus giving a stan- dard for appraisal which would otherwise be lacking. For the test of social work is the extent to which it meets these problems. We shall then study social work in four large divisions, according as it is concerned with (A) Relief of poverty: Chapters VI-VIII; (B) Care of the sick, disabled and defective: Chapters IX-X ; 70 Social Work (C) Treatment of criminals: Chapters XI-XII. (D) Improvement of living and v^^orking condi- tions: Chapters XIII-XIV. RELIEF OF DEPENDENCE Although "relief," like "charity," is a word curiously in disfavor of late years among certain social workers who are nevertheless giving it every day, and con- stantly more abundantly, still it is an unmistakable fact that economic dependence is the primary social problem which furnishes the work of a large number of social agencies. There are always, to be sure, rea- sons for the dependence, and it is these underlying causes in every case, not merely the dependence, which the agencies must "treat" if they do their work well; and it is true also that a "family society" or other social agency is consulted occasionally by persons "well above the poverty line" ; but still it is lack of the necessities of life which brings most of their applicants to them, whatever may be the difficulties which are discovered later; and it is, moreover, to pay rent and to buy food, fuel, and clothing, or to provide maintenance in institu- tions, that the bulk of the funds contributed voluntarily or appropriated by taxation is spent. If, as we fre- quently hear, an increasing proportion of the applica- tions to social agencies comes from "people who would never think of asking for charity — not at all the typical charity case, you know," this only means that the line between dependence and complete self-sufficiency is Classifications of Social Work 7\ rightly higher than it used to be. The rising standard of what is essential to normal life has revised not only the general conception of what can suitably be given by public and private relief agencies, but also the ideas of wage-earners as to what it is suitable for them to accept. What they get, however — this new type of "case" — special diet, professional services, advice, or whatever it may be — is still charity, even though it does not stand between them and starvation but rather enables them to maintain their standard of living or to improve it. Payments from the public treasury to women who need help in supporting their children are still "out-door relief," even though they may be called "pensions" or "allowances" or "compensation." Children are by nature economically dependent on some one, and when relatives fail their place must be supplied in some Way by society. Old people are naturally dependent on their children or their savings, but when these fail they too must look to society for maintenance. Aside from these natural dependents at each end of life, there are family groups and individuals in the active years who find themselves from time to time, or once for a longer or a shorter period, unable to make both ends meet. It may be because of illness, making an unusual demand on resources or cutting off wages ; it may be because of lack of training or a low grade of intelligence which means a precarious liveli- hood at best, and serious want as soon as there is no market for labor of this grade; it may be because of 72 Social Work drink or improvidence or laziness or some other bad habit; it may be because of some unfortunate accident of circumstances — bad luck — or because of a general business depression which throws many men of average ability out of work. Whatever the cause of the difficulty, the essence of the situation, from the standpoint of the family or the individual, is that the rent is over-due, or the coal is all gone, or there is no food in the house, or the children's shoes are worn out, and there is no money, and they must have some sort of help from "outside" to keep going. From society's standpoint, also, the obvious and inescapable element in the situation is that they must be fed and housed and clothed. The agencies which belong in this group are varied and numerous : public almshouses and private homes for the aged; temporary shelters; out-door relief by overseers or other public authorities. Home Service sections of the Red Cross, charity organization socie- ties, "family societies," church relief funds, St. Vincent de Paul societies, and scores of other agencies, official and voluntary, religious and secular, which give help to families in their own homes; institutions for the care of dependent children, placing-out agencies, homes for foundlings, public bureaus of child welfare, and all other agencies which deal with normal, healthy babies, children, and adolescents. These general relief agencies now usually recognize their common interests, though there are still unfor- Classifications of Social Work 73 lunate cliques and arbitrary separations, often arising in some accidental way, which prevent the interchange of experiences and ideas where it might be very advantageous. Family welfare is tending to become the favorite term to express the central aim of these agencies, and the phrase is now frequently used in the name of the agency. They are of course interested in all the other forms of social work, and some of them have departments which actively engage in one or more of these other forms, and in such cases they belong in more than the one group. Among the children's agencies cleavages are more marked. Formerly insti- tutions and placing-out agencies were hardly on speak- ing terms, but this has happily changed to a considerable extent. CARE OF THE SICK, DISABLED, AND DEFECTIVE Disease and defect — mental and physical — is a second great social problem of primary character, like economic dependence. Illness may make anyone helpless, whether economically dependent or not. Because of the ex- pense involved in securing proper treatment and care, and because of its interference with the normal occu- pation both of the one who is ill and of members of his family, it tends to produce economic dependence. Society provides for the sick, however, not because^ they are dependent but because they are sick, and even though maintenance is provided incidentally for the sick poor in hospitals, it is not in order to be main- 74 Social Work tained that they are admitted, but to be cured or relieved of their physical or mental disease. Physical and mental disability have come to be recognized as a social problem, irrespective of the financial status of the afflicted. Hospitals and clinics, with many special- ized varieties of each, and nursing services for patients in their own homes, are the agencies which we have for the care of the sick. Certain physical defects also, and certain degrees of mental deficiency, require special provision for education, oversight, or guardianship, which the individual and his family are not usually in position to provide. TREATMENT OF CRIMINALS Crime is the third of the great elementary social problems. In all human societies there are individuals who do not keep the rules and who thus become an embarrassment to their fellows. What to do with them — how to restrain them from injuring others, how to secure reparation from them for those whom they have injured, and how to change their spirit into one of cordial acquiescence in the regulations for the com- mon good — is a question which has puzzled society from the earliest days. The agencies for the treatment of criminals which we use in America to-day include prisons, penitentiaries, jails, houses of correction, reformatories for adults and for children, parole and probation, and societies for the aid of discharged prisoners. Courts, in their Classifications of Social Work 75 character as the common agency for securing justice in civil controversies, and for discovering the truth and applying the law in criminal cases, are not a form of social work. They must be so considered, however, in so far as they have discretion in determining how the individual convicted criminals shall be treated. The police force, in the same way, as the common agency for preserving order, is not engaged in social work; but it is in so far as it influences individual criminals and prevents or encourages the committing of crimes. IMPROVEMENT OF LIVING AND WORKING CONDITIONS The first three groups include the social agencies which provide for the individual representatives, so to speak, of the three great social problems — the men and women and children who are in want of the neces- sities of life, who are sick or insane or physically or mentally defective, who have broken the laws. The fourth is composed of all the agencies which have for their object the diminution of these social problems — the prevention, to put it negatively, of poverty, disease, and crime; and on the positive side, the improvement of the conditions under which people live and work. There is of course a sense in which all the agencies have this object in view. In all relief work the ideal is to relieve in such a way as to prevent the recurrence of need in that family and to prepare the children to take a creditable part in the life of their generation. In the care of the sick the ideal is not only to cure 76 Social Work the patient, but to improve his chances of health in the future, to render sources of infection harmless, and even to promote hygienic habits in other members of the family. In the treatment of criminals the ideal is not only to make a law-abiding citizen out of a law-breaker, but to discourage others from breaking the laws. All this, however — aside from the fact that the ideal is not everywhere realized in practice — is but incidental to the main purpose of taking care of unfortunate individuals who for one reason or for another have to be taken care of. Many of the agencies in the first three groups carry on also certain educa- tional and preventive work, and such departments of their work belong also in the fourth. This kind of social work is comparatively new. Interest in the causes of misery comes after interest in miserable, unhappy human beings, and the idea that "prevention is better than cure" is relatively Abstract ^d academic, and therefore late in developing. So strong a hold has it taken in the present century, how- ever, that it is now the dominating principle in Ameri- can social work. The desire to raise the general level of life, which is also a prominent motive, is but the positive aspect and logical consequence of this principle. Some of the work in this group is in the nature of a direct attack on one or another of the three great social problems. Disease, especially, has been the object of such attacks. There is much work for the preven- tion of tuberculosis and of venereal disease, for the Classifications of Social Work 77 reduction of infant mortality, for the control of cancer, for the promotion of the health of children and young people, and similar purposes. There is a little — such as that done by protective associations — which is directly intended to reduce the amount of crime. There may be none at present which announces as its express pur- pose the prevention of poverty; but that is one of the objects in almost every form of work in this group. A second kind of work in this group consists of efforts to abolish conditions recognized as undesirable. Certain conditions — such as unsanitary houses and fac- tories, work for wages by children, night work by women, unduly long hours of work by any one, con- gestion of population, inadequate food, and so on — have been suspected of a tendency to produce poverty, disease, and crime. They have then been "isolated" and studied, like germs in a bacteriological laboratory, and the suspicion already attaching to them has been substantiated. This has led to the organization of agencies expressly for the purpose of eliminating or at least diminishing one or another of these evils. Still another variety among the efforts to prevent poverty and disease and crime is found in the agencies which provide opportunities for recreation and social life, which seek to remove special social or economic disabilities under which certain groups of the popula- tion sufifer, and which undertake to improve neigh- borhoods, both in their physical and in their social character. These include both the pioneer agencies in 78 Social Work preventive work and some of the newest developments: social settlements, clubs for boys and girls, village improvement societies, organizations for securing parks and playgrounds, baths, swimming pools, recreation piers, etc. ; Boy Scouts and Camp Fire Girls ; associa- tions for advancing the interests of Indians and Negroes and immigrants; "community service" and rural social centers. CHAPTER VI FAMILIES Foremost among the means for securing and promot- ing individual well-being is the institution of the family. Its starting point is marriage. Its essential elements are the relation of husband and wife and that of parent and child. The first of these involves a civil contract, of which the laws take cognizance,* and also a recipro- cal moral union, ordinarily made the more sacred and binding by religious sanctions. ^The second is a natural, biological union, of which also the laws and customs are well aware, and upon which society mainly relies for protection of the individual in helpless in- fancy, for nurture and training, for care in sickness and misfortune, and for maintenance in the infirmity of old age. NORMAL FUNCTION OF THE FAMILY The family group normally has its own physical *_This is not to ?nc:gcst that marriage is solely or essentially a civil^ contract. The conception of marriage as a sacrament, a joining together in an indissoluble union not to be ended by voluntary choice, is the foundation of the Christian home, and the surest guarantee of individual welfare. 79 80 Social Work dwelling-place, its home, where in privacy and security the more intimate family life goes on. Traditionally the home is the scene of the main activities of the wife and mother, the nursery of the children, and the resort during their leisure hours of those who have their daily occupations outside. It is for sleep, for meals, for social intercourse, for recreation, for worship, for the better part of education, for affection; and family solidarity, not conscious self interest, provides the social cement, the motives for whatever efforts and sacrifices are necessary to create and keep the home. The family could never have been deliberately invented. It could not be perpetuated if it were necessary to do it by legislation, by renewed individual agreement, by conscious calculation of its costs and rewards. The family persists and performs its beneficent purpose because it is a social institution, deeply embedded in our inherited psychology, slowly changing indeed under the influence of evolutionary forces, but stronger than any artificial human contrivances, because correspond- ing to the deepest needs of our spiritual and physical nature, to necessities which overleap the mortal life of a single generation and unite us with the past and the future. The family conserves not only our biological inheritance. It is at the same time the chief depositary of the social heritage which distinguishes human frorri lower animal life. We develop means of supplementing the family: kindergarten, playground, school, appren- ticeship, club, governmental services — but it remains Families 81 to the family to start and to make the largest contribu- tion to the process by which each generation stands upon the shoulders of those that have preceded it. WHEN THE FAMILY FAILS The family, however, in practice frequently breaks down. The community must then in some way come to the rescue. The history of all charity from the time when Moses was rescued by Pharaoh's daughter and restored to the care of his mother, from the time when the code of Hammurabi made provision for the care of foster children, from times far more remote than recorded history or surviving legend, has been one of such substitution for natural parental or marital or filial care. It is the widow and the orphan, the stranger and the homeless, who have always aroused sympathy and given the objective for the display of the altruistic impulse. It is so still. By whatever name they may be called, the most essential agencies of social work are those which seek to conserve family life, to strengthen or supplement the home, to give children in foster homes or elsewhere the care of which some tragic misfortune has deprived them in their natural homes, to provide the income necessary to family life when self-support for any reason fails, to instruct mothers when necessary in the proper care of their children, to restore broken homes, to discover and if possible remove the destructive influences — such as 82 Social Work overcrowding, filth, sweated labor at home, strong drink, infectious disease, excessively long hours at work — which interfere with normal family life and the reasonable discharge of conjugal and parental obliga- tions. The institutions which exist for the benefit of those individuals who have no home or who need care of a kind which cannot well be supplied in a home, only emphasize the importance of conserving family life when its essential elements are present. INSTITUTION OR HOME SERVICE In most American communities, when the case of an individual or a family in need of relief presents itself, there is frequently a choice between sending the individual or one or more members of the family to an institution and giving them help in their own homes. The advantages of institutional care as a disposition of the problem are obvious. It is a definite solution. It does not involve the continuing and harassing un- certainty of home service. Financial and legal details are swept away. The mind is freed for the next case. There is an air of finality, of adequacy, about the transaction. This feeling, however, is pure illusion. The foundling may live, and if so the decision to place it in the foundling asylum may have an influence for good or ill through a long life. The orphan may be separated from brothers and sisters or other relatives by commitment; may be put in the way of securing a particular kind of training or education which may Families 83 have a decisive bearing on his welfare. The friendless old person may be thrown among congenial associates, or may be subjected to excruciating loneliness and neglect. The children temporarily taken from their own home because of their mother's illness or father's desertion may be permanently injured or permanently benefited by their experience in the institution. No decision about commitment to an institution can be made without incurring responsibility, nor made wisely without imagination to foresee consequences and sym- pathy for those whose fortunes are at the mercy of these events. Nevertheless the question arises and the decision must be made — either by the social workers or by the person concerned, if of mature years and sound mind, or if this is not the case, by his friends or those who stand in some relation of legal or moral responsibility. In a reaction against the actual or assumed monotony and rigidity of institutions, social workers sometimes develop an institutionphobia, a hostility to the institu- tional method of caring for those who are dependent, which is as unwarranted as it is unreasoning. Institu- tions differ nearly as much as domestic hearths. Their atmosphere may be cheerful and their comfort often far superior to any which can be secured for the par- ticular person in a family home. Whether or not an institution is the desirable disposition for any particular case depends upon many individual circumstances. They should be weighed promptly, and the decision should 84 Sodal Work not be unduly delayed merely from lack of courage or from prejudice. AGENCIES FOR HOME SERVICE The churches, through pastoral counsel, the labor of deaconesses, and otherwise, have occupied them- selves with these tasks from earliest times. The state, through local overseers of the poor, county commis- sioners, township trustees, municipal departments of public welfare, courts of domestic relations, and other appropriate local organs, has accepted the responsibility for dealing with the grosser cases of failure in the fam- ily and for the support of those who have no individual or family resources. The mutual insurance principle has had some application, through trade unions, lodges, industrial establishments, etc., in obviating the need of applying to relief agencies when sickness or unemploy- ment cuts off the usual family income. Employers frequently look after the families of their employees. In addition to all such means of strengthening the family or taking its place, there have been from very early times voluntary charitable associations for visit- ing and ministering to the needs of those who are in trouble. These agencies, which have a bewildering variety of names and are under all sorts of auspices, are sometimes said to be engaged in organizing charity ; sometimes to be relieving or improving the condition of the poor; sometimes to be engaged in home service, or social service, or even public service. The present Families 85 tendency is to think of them as occupied with family - welfare, thus emphasizing the fundamental fact that the normal reliance is on the family to safeguard the inter- ests of its own members, and the obviously sound pol- icy of directing social effort, when this is required and when such a course is possible, towards bringing or restoring the family to self-support. INSUFFICIENT INCOME Social work directed towards family welfare con- cerns itself then in the first instance with income.' Are the earnings of the working members of the family sufficient to provide for the elementary needs of shelter, household furnishings, food, clothing, and fuel? Are the members of the family well nourished? If they are homeless, or about to be dispossessed, how may they be housed; if insufficiently clad and hungry, how may they be fed and clothed ? Even these elementary ques- tions are not always to be answered off hand. Lack of income or inadequate income may be due to the shutting down of industries and general unemploy- ment. It may be due to the loss of a job by the indi- vidual worker through some fault of his own, or incom- petence, or physical unfitness. In the latter case the social worker may have his task cut out for many a day. To overcome the fault, incompetence, or physi- cal disability, to find a suitable job, to encourage the worker to keep it and to develop his capacity, may be a very tedious, but a very necessary, contribution to 86 Social Work the family welfare. If the lack of income is due to an absolute shrinking of employment, so that there are no jobs to be found for the time being, it may mean removal to some other place where there is work which the idle worker can do; or it may mean tiding over the period of unemployment with relief, perhaps with some kind of emergency public employment. The problem of unemployment which is due to seasonal irregularities or to industrial depression is essentially one for industry rather than for social work, Unem- plo3aTient insurance, administered or enforced by the state; voluntary or enforced compensation for loss of employment due to the shutting down of mills or mines, would be the logical remedy. The organization of needed public work, and its distribution in such a way as to take up the slack of unused labor, would also help. Even if in general the broad problem of recurring unemployment should be solved, the exceptional case will arise with which social work will still have to deal. Social work aims to find suitable employment for the individual, educational tasks for the young, light tasks for the afflicted, appropriate tasks in each case in which intervention is necessary; but it also aims to bring out the unused abilities, the artistic, creative impulse, the joy and satisfaction of willing work; for its aim is to contribute to the good life of the individual and to family welfare as a means to that end. That the only end in view is to make the family self-support- families 87 ing is a narrow and inadequate view of social work. Self-support may be accomplished at too great a price. That the family is to be petted and enabled by some special favor to live with less than the average amount of downright hard work and foresight is equally inad- missible. The motives which influence and determine tlie actions of families under the care of charitable agencies are as diverse and complex as those which in- fluence other accidental groups. To isolate one or a few motives and harp upon them constantly is bad psychology. The social worker requires imagination and resourcefulness and a knowledge of the human mind. Reflection upon the reasons for his own choices and for the decisions of his own friends, superficially illogical and unaccountable as they often are, will be suggestive as to the range of motives which may operate in the minds of the less fortunate. Race psychology, group psychology, and neighborhood psychology are illuminating in social work; and individual differences, even in a single family, need to be considered. On the other hand, there are also dangers against which psychologists in social work — whether trained or instinctive — need to guard. The good family life requires an income, and the earning capacity of the workers depends only in part on their physical and mental endowments. It depends also on their educa- tion, training, and opportunity. If the economic en- vironment is right the individual peculiarities may disappear as obstacles to normal living. The social 88 Social Work worker may have to try to change the individual, but it is easier, and more frequently desirable, to take the individual as he is, and by changing his occupation or his income allow his individuality to redeem its ap- parent failure. The important thing is not only to dis- cover what is obviously lacking, but also to find what those whom we are trying to help themselves feel to be lacking; what are the obstacles of which they are aware; what is it which, as they see it, would enable them to attain their perhaps modest goal. With this knowledge as a starting-point, progress may be initiated, and perhaps in time a higher goal may replace the lower or more immediate one, and indeed the social worker may find that his own ideal, however clear it may have been in his mind, is after all less worthy, less an expression of the good life, than that which the applicants for aid have themselves cherished. It will take a very human and open-minded social worker to make such a discovery as that. More frequently the social worker will have to be in some sense a protector of the poor. Between the ideal of social work — a good life for all — and the property ideal of maximum money profit, there is eter- nal and irreconcilable conflict. The ideals of social work are those also of religion, of education, and of good citizenship. The social worker is bound by his ideal of individual and family well-being not to be a party to the exploitation of any worker for the em- ployer's or the stockholder's profit. In the individual Families 89 case he must stand for a living wage, for reasonable hours, for protection of life and limb, for a secure income, for leisure to discharge family and civic duties. He must of course stand equally for honest and effi- cient work, for an interest in the job, whatever it may be, so that the worker may get from it the satisfaction appropriate to the worker, and his family the income essential to family welfare. Hard and continuous work is not necessarily an evil, if there is sufficient motive and a reasonable return. HEALTH : PHYSICAL AND MENTAL EXAMINATION The difficulty may not be chiefly one of inadequate income. Perhaps it is the health of one or more members of the family that is in question. A physical examination of all who are ill or suspected of being so, even of those who are w^ell, in the interest of their remaining so, has now become an almost routine feature of social work in families — at any rate in theory. The multiplication of clinics, health centers, and public health services has facilitated this practice. Insurance companies have found it good social policy to provide physical examinations and nursing service for their policy holders. Social workers may find some mem- ber of the family in need of an operation or of sana- torium care. They are often in position to persuade a reluctant invalid to accept an offer of hospital treat- ment, or to give up work for a time in order to profit by treatment at home. Since the welfare of the family 90 Social Work as a whole is the aim in view, the sdcial worker can sometimes use an offer of material aid as a means of inducing desirable action, such as going to a hospital, separating a tuberculous patient from other members of the family at night, wearing a needed brace, or giving suitable kind of food to a child. The rent may be paid on condition of removal to a more sanitary dwell- ing. Clothing may be furnished on condition of send- ing children to school regularly. Of course in extreme cases more severe measures may be necessary. The Health Department may force the removal of one ill with contagious disease, or the cleaning up of rooms which are so offensive as to be a nuisance. The attend- ance officer may summon a recalcitrant parent to court. But for every such disciplinary case there are scores calling not for threats or coercion but for explanation, persuasion, moral influence, and opportunity. The imperative need, from the standpoint of social work, is that the sick shall have medical or surgical, convalescent or preventive, care, according to their needs, and that the needs shall be discovered and ap- preciated in time. Many suffer from nervous, digestive, and other ailments, without timely and therefore effec- tive relief. Many resort to patent medicines or popular remedies because they cannot afford or do not know the value of more radical and professional treatment. Many keep on working at exacting and injurious occupations because they have no alternative. They cannot afford to quit altogether, and they must do that or go on in Families 91 the usual way. Many are suffering from some unnec- essary strain of eyesight, or from fiat-foot, or from improper diet, merely from lack of the most elementary and the most accessible information. Social workers have the opportunity to discover such instances, and to deal with them as aspects of family welfare. It is in line with their usual procedure to advise and press for a physical and mental examina- tion whenever they have reason to think that it would be advantageous. By hypothesis there is something awry in the homes which they visit. The social worker is there because the family is in some sort of difficulty and has invited them — or allowed them — to come and help. They are there to find out what is wrong. They are there for the kind of service which the situa- tion, in the home requires. Therefore they may havs to find a job or adjust a worker better to his work or the work to the worker, to furnish money to pay the rent, to watch over an invalid or a probationer or one tempted to crime, to get children into school, with or without the help of an attendance officer, or an offender into court, with or without the help of a policeman or district attorney or judge. VARIED AND COMPLICATED TASKS If there is no question of securing institutional care, or of supplementing income, or of adjustment to occupation, or of improving the health, there may still be some special service required, such as legal 92 Social Work aid, the settlement of some claim or controversy, find- ing an absent member of the family, reconciling- estranged relatives, obtaining a loan on security, or selling some property to solve a temporary financial difficulty. Imprisonment for crime, desertion, intem- perance or drug addiction, waywardness of a daughter or bad companions of a boy, may create a problem in which the family needs help. How to get whole- some and congenial recreation for the young may be as serious and as difficult as how to get remunerative and appropriate work for the father. Instruction of housewives in cooking and marketing, in the making or mending of clothes, in the furnishing of the home, in the care of children, opens an illimitable field of home service. Budgeting of income and expenditure, which is a mark of intelligent household management in any economic class, has become a frequent feature of the social treatment of dependent families. The end of it all is a good life, and the means are as varied as the elements, material and spiritual, which enter into this all-inclusive end. VOLUNTEER SERVICE Among all the varieties of social work, the care of dependent families in their homes has given the largest and most fruitful scope to volunteer service. At the beginning of the charity organization movement one of the most important societies, the Boston Associated Charities, grew out of an existing society for friendly Families 93 visiting. The use of volunteers, both as friendly visi- • tors and as members of working committees, has always been a conspicuous feature of organized charity. In some societies the establishment of permanent friendly relations between families who have been in need and friendly visitors able to help them has been accepted as a principal end to be attained. In others volunteers are used to a more limited extent, for such specific purposes as they can best accomplish, or to the extent to which they may be available. Settlements, churches, and even public welfare departments, depend upon vol- unteers, and there are no limits to the extent to which the useful influence of the agencies for home service may be enlarged in this way, except their own capacity for enlisting, retaining, and directing such volunteer service, and the readiness of volunteers to enlist and to prepare themselves for practical usefulness. MATERIAL RELIEF The place of "material relief" — groceries, fuel, cloth- ing, and money — as contrasted with advice and "per- sonal service" in those forms of social work which are related to family welfare, has been much discussed, sometimes over-emphasized and sometimes underesti- mated. The giving of relief may easily become a substitute for the more difficult and more beneficial process of developing self help. It may take the place inadvisedly of help which should come from a relative 94 Social Work or former employer or 6ther "personal source." There may be instances in which a lazy or improvident per- son and his family should be allowed to "go without" in order that he may learn to the limit what is the natural consequence of improvidence and laziness. Re- lief funds may be direct incentives to these and other vices, like intemperance, family desertion, such care- less and inefficient work as results in losing the job. Not many of those who have had first-hand contact with poverty will draw from these demonstrable dan- gers the inference which occasionally finds academic expression — that it would be better to abolish all relief funds. Chalmers, in his Glasgow parish a century ago, accomplished this, believing that institutional relief "dried up the natural springs of human benevolence" ; but he developed these natural springs of benevolence and organized his parishioners as perhaps only a genius would have been able to do. For good or ill human beings have left permanently behind the stage of civil- ization in which the old, the weak, the ill, the inefficient, can be cast aside to die from exposure and starvation. An evolutionary conception which ignores sympathy simply would not survive. Group conflict against nat- ural obstacles tends to replace individual conflicts. Re- lief funds are an essential feature of group organiza- tion. We must learn how to use material relief with a minimum of encouragement to laziness, thriftlessnes.s and other undesirable traits, recognizing that the risk of some such injury is always present. There is no Families 95 benefit — not even education — which does not carry its dangers. Material rehef, of an appropriate kind, in adequate amount, at the right time, in pursuance of a definite plan of social treatment, changed as developing cir- cumstances require, discontinued at the earliest moment when it has become unnecessary, obtained from per- sonal sources when practicable, regarded as a loan to be replaced by the beneficiary when this would be reasonable — adjusted, in short, to the needs of the beneficiaries and not to the amount which happens to be on deposit in the fund from which it is drawn — is a necessary instrument, an indispensable resource, of social work. It is not more dangerous than drugs in the hands of the physicians, books in the hands of the teacher, the hope of salvation on the lips of the evangelist. RELIEF IN DISASTERS Just as unforeseen misfortunes occasionally over- take individuals and families, so an entire community may be overwhelmed by a disaster which presents a relief problem of an extraordinary kind. War, earth- quake, flood, fire, famine, or pestilence may temporarily bring to dependence those who have been far from anticipating any such experience. Relief in such an emergency, except for the scale on which food, clothing, shelter, or medicines may have to be provided, involves principles familiar in all social work. Registration, 96 Social Work discrimination, co-operation, are as imperative as in any other good relief work. The rehabiHtation of families, and eventually of the community, involves these factors and others also within the ordinary experience of social workers. An adequate plan based on accurate knowl- edge and resources sufficient to carry it through are the prime essentials. A channel for the organization of emergency and rehabilitation relief in disasters is provided in the Amer- ican Red Cross, and through this agency humanitarian aid may be extended to foreign countries when the needs are sufficient to justify it. In Europe and Asia post- war relief problems have required the continuance of a Relief Administration created especially for this purpose, and also of several special relief funds, such as those for relief in the Near East, in China, in Ireland, and in Russia. The ideal would be an Inter- national Red Cross so neutral, humanitarian, and well- supported that even for disasters in foreign countries such special relief funds would not be required. EXTENSION OF HOME SERVICE Some of the difficulties which social workers en- counter in the families under their care occur also in the homes of the self-supporting, even of the most prosperous. Embarrassment in caring for an incom- petent, nervous, inebriate, narcotic, feeble-minded, or insane relative may arise not from lack of financial Families 97 resources but from lack of knowledge. Should he be kept at home or sent to an institution? If the former, should a specialist be engaged; and if the latter, to what institution and on what conditions? What occu- pation, if any, is best for him? How may his recovery be promoted, or at what point shall that be assumed to be out of the question? Numerous and geographi- cally well distributed centers of advice and informa- tion, to which people might come for consultation on such questions, are desirable, and — like a hospital — they might charge those who are able to pay for their social treatment. Lawyers, family physicians, and clergymen have been consulted traditionally on such personal and domestic problems, and it is conceivable that social workers might develop a similar practice. If they follow the path of the medical and legal pro- fessions in making this practice to any extent lucrative they would then have clients — a term which has recently been somewhat inaptly applied generally to those who are under the care of the charitable societies. If the service is unpaid and incidental — like that of a pastor, a politician, or a neighbor — then, even though it may be very sound and useful, it would seem better not to describe the relation by a term so misleading. Clientage in ancient Rome was indeed a very different relation from that with which we are familiar in the legal pro- fession, but social work would hardly wish to revive such a wretched and degrading conception as that de- scribed by Martial in the early Empire : 98 Social Work "Gatherings of idlers, sycophants, and spend- thrifts, at the levees and public appearances of those whom, in their fawning servility, they ad- dressed as lords and masters, but whom they abused behind their backs as close-fisted upstarts — and all for the sake of the sportida, the daily dole of a dinner, or for a few pence wherewith to procure one." The probability is that the prosperous and well-to- do will continue to solve their own family problems, with the advice of friends and of such business, legal, and medical counsel as they may think it necessary to obtain; and that the social agencies will not greatly develop their earnings in this direction. The proba- bility is that social work will continue to find its field of usefulness mainly where the income is inadequate, the earning power impaired by ill health or misfortune or misconduct and not replaced by inherited wealth or otherwise. Not by unloading individual responsi- bilities on social agencies or on a new professional group are we to make progress; but by an education which will increasingly prepare individuals to solve their own problems, by the increase of earning power, by the lessening of accidents and the removal of the social dangers to life and health, by the protection of standards of living, by constantly increasing in such ways the proportion of those who, with health and in- come reasonably assured, can take care of themselves. CHAPTER VII DEPENDENT ADULTS The infirmity of old age as a social problem is not yet taken as seriously in America as it deserves. More intimate acquaintance with the almshouse as it now is, throughout the country, will contribute to an understanding of its importance. But it will do more. A visit to almost any almshouse will be a profitable introduction to social work. However attractive its exterior, and however well administered internally, it will inevitably present a view of the human wreckage of our social and industrial system not to be obtained elsewhere. It will speak eloquently of the failure of preventive medicine, the failure of education, the failure of marriage, the failure of filial obHgation, the failure of employers, the failure of religion and mor- ality. These are they for whom nothing remains ex- cept the kindness of strangers, the impersonal charity of the tax-payer, the patient waiting for the final release, the hope and consolation of the chaplain's ministrations. THE ALMSHOUSE In the greater part of the country, and especially in 99 100 Social Work the more populous states of the east and north, the almshouse has long been the ultimate refuge of those who have no other resource. Into it have come the infirm and friendless, the blind, the paralytic, the epileptic, the mentally defective, the senile and those who are afflicted by chronic nervous ailments, when these conditions result in complete dependence and there are no relatives or private agencies to offer care. Even if there are relatives or friends the affliction may be so disabling, or the feeling of obligation on the part of relatives so slight, that application is made for alms- house care and the officials may feel warranted in giving it. The undifferentiated almshouse of two generations ago had also insane patients, mothers in child-birth, orphans and half -orphans, hospital patients for surgical operations and in acute fevers, victims of contagious diseases, and even able-bodied men and women who preferred idleness at public expense to working for a living. The almshouse is still often undifferentiated, and exceptional instances of any of these classes of inmates may still be found. Generally speaking, how- ever, vagrants are now sent to correctional institutions rather than to the almshouse, or at most receive tem- porary lodging, with or without something to eat, in a temporary shelter or police station. Surgical opera- tions and the care of the acutely sick have been assumed by hospitals, although one or more hospital wards are still to be found in most almshouses, and the present Dependent Adults 101 difference between hospital patients and almshouse in- mates is not so much one of the difference between the sick and the able-bodied as it is that between acute illness and chronic invalidity. Many children are still born in almshouses, notwithstanding the great increase in special lying-in hospitals; and chronic insane are still to be found in them, notwithstanding the general assumption of the care of the insane by state hospitals established for that purpose. It is now forbidden by law in many states to keep children over two years of age in an almshouse ; and even the mentally defective and epileptic and consumptives — the latest groups to receive separate special care — are now in principle, al- though unfortunately not yet in practice on any very large scale proportionately to their numbers, the bene- ficiaries of suitable care in colonies or institutions especially planned to meet their needs. The removal of insane, epileptic, children, vagrants, and acutely ill, has affected, but has not after all funda- mentally changed, the almshouse. Nor has the substi- tution of other designations — such as county infirmary or home for aged and infirm — made as much difference as those who attach importance to names might expect. The almshouse may be changed for the better when a capable and humane superintendent or matron is in charge of it, with an appropriation sufficient to keep it comfortable, sanitary, and attractive, and with a policy which controls admission and discharge in accordance with the best interests of candidates and their relatives 102 Social Work and in accordance with the best interests of tax payers and the community. These interests are not incom- patible. Numbers should not be kept down by niggard- liness. It is by investigation, visits to relatives, former employers, neighbors, friends, ingenuity in utilizing outside resources when they exist, in discovering suit- able employment w-hen there is any to be found, in transferring to some other institution when it would be advantageous, in the direct personal influence of the social worker in favor of any rational alternative, that any necessary deterrent influences may be applied. The humane and enlightened administration which would be known by such measures as these is unfor- tunately very rare. The county almshouse, like the county jail of which we shall have to speak in a later chapter, suffers from too little publicity. County com- missioners and the officials responsible to them receive too little credit for good work, too little public censure for neglect. The modern well-administered county home for aged and infirm will still have need of special attention on the part of public-spirited and kind-hearted citizens, however clean and sanitary and comfortable it may be; however many of the groups which w^ere once sheltered in it have gone to better, more specialized institutions. After all removals from it and all reforms within it, it remains a relatively undifferentiated, ultimate refuge for many kinds of people — all who are not yet touched by the many generous schemes for prevention, by the Dependent Adults 103 special provision in private institutions, by allowances or pensions. It is still the shelter of the most pathetic and most appealing of all public charges. The feeble old men and women, the chronic invalids, querulous * and crotchety though they may be, outliving their use- fulness, surviving their children and grand-children, cherishing in their infirmities the memory of their active years, are yet entitled because of their need to sympathy, to the best of physical care, to the social pleasures which they can enjoy. And the fact is that they may not be more, but less trying, quarrelsome, and unreasonable than groups of individuals collected together in other institutions, such as hotels or col- leges or factories. They are apt to be curiously patient, tolerant, often interesting. Those whose infirmities are so great, whose friends are so few, whose mis- fortunes are so overwhelming, that they come to this refuge, are not beyond the need for respect and affec- tion. They are not beyond the capacity to respond to them. Some of them should be helped to go else- where. Some of them should have little luxuries or comforts, suggested by their particular infirmities or their earlier lives. All of them should have the oppor-' tunity to make on the public mind the impression which a knowledge of their collective life would make. Per- haps they should be cared for dififerently. Perhaps old-age pensions would be a more humane and reason- able method of supporting them. Probably this is not the case, for there are probably relatively few who could 104 Sodal Work live as comfortably at home, even with an allowance to pay for their food and rent. In other words, most of them probably need personal service as well as main- tenance; but this cannot be taken for granted. PRIVATE PIOMES FOR THE AGED Homeless old age has frequently in the past century made a strong appeal to private benevolence; with the result that there are in New York City some sixty private homes for the aged and infirm, and in the entire country about eight hundred. They are not exclusively for the poor. Some of their guests pay from savings the full cost of their maintenance, and others are paid for by relatives. Generally, however, what is paid by or on behalf of candidates for admission covers only a small part of the expense, and the large majority of the beneficiaries are quite without means. Many of these homes are supported by churches, and some of these limit admission to communicants of a particular religious faith. One in New York, for example, admits only those who have been members of a particular religious denomination for ten years and of some city church of that denomination for five years. Their purpose, generally speaking, is to care for those for whom it would be a special hardship to go to the almshouse. One for "gentlewomen" expressly excludes those who have lived as servants. Another, Dependent Adults 105 defining more explicitly than usual a policy which is generally enforced without such definite rules, denies admission to those suffering from infectious diseases, • cancer, or urinary incontinency ; and to consumptives, ' epileptics, idiots, blind persons, paralytics, helpless crip- ples, and those requiring constant personal attendance. Such provisions as these indicate the general difference between the private homes and the almshouse which must take those who cannot find care elsewhere; al- though of course even in the almshouse contagious diseases are usually treated in separate hospitals or wards, and there is often further classification. On the other hand, there are private institutions intended especially for consumptives, incurable cripples, blind, and other classes not usually cared for in homes for the aged and infirm ; but the tendency is for these heavier ! burdens to be transferred to the state, and for private charity to direct its efforts either to home service or to such institutional activities as are likely to change the condition of the beneficiaries. The chief exceptions are the church homes for the more refined and respecta- ble, who have been accustomed to the comforts of life and who are bound by some ties of religious or other association to the communities which contribute to their support ; and the homes for old soldiers, in which the national government or the states maintain war veterans in comfort and respect, even though their present infirmities may have little connection with any injuries or hardship of such service. \ 106 Social Work OLD AGE DEPENDENCE Familiarity with the private homes for the aged, and especially with their frequently very long waiting lists, strengthens the impression made by the almshouse that old-age dependence has not yet received the attention which its importance warrants. The American ideal has been to die in harness ; or to lay by something for old age ; or to have a share in the prosperity of children or grand-children. That there should normally be need for some kind of provision by the community for the aged, as there is for the orphan, the sick, and the insane, is an idea much more familiar in other countries than among us. Elsewhere it has led to systems of old-age pensions, supplementing public and private institutions for those who have no one to care for them at home and who cannot care for themselves, so that a pension would be useless. High wages have made these less necessary in the United States; but a high standard of living presses hard against the incomes of the working families, even when wages are high. Some industrial establishments have created retiring and invalidity pension systems, but these are not likely to care for any very large number of the aged. The conclusion seems inevitable that veterans of industry must be cared for when necessary either at the expense of tax payers or at the expense of industry, on a plan which affords universality and security. In- stitutions will be necessary for those who cannot live Dependent Adults 107 at home or at board, and pensions for those who can. The institutions might result from a further differentia- tion of the almshouse or from a development of the existing private homes for the aged. Whether the provision for old age should be contributory — i. e., whether prospective beneficiaries should be required to meet from their wages in advance a part of the ex- pense, or whether it should be met entirely by the employing corporations and indirectly by their cus- tomers — is a question which has respectable arguments on both sides. Society has no escape from the burden of old-age dependence. The amount of it may be re- duced by such improvements in health and vigor as prolong the working age, by the encouragement of thrift and foresight, by increasing the sense of responsi- bility on the part of children or collateral relatives. It may be thrown back heartlessly on the aged and infirm, so that the burden is translated into the suffer- ing and hardships of individuals. It may be met by general taxation. It may be met in part by private generosity. It may be met by social action which ensures a pension or home when necessary, safeguard- ing against abuse by investigation, and putting the cost on the undivided surplus of the industry in which the worker has been employed. All these alternatives need searching study and analysis. The most favorable condition for an enlightened and humane policy lies in the increase in the number of young and middle-aged citizens who have some knowledge of the problem of 108 Social Work old age as it shows itself in the county or township almshouse, in the private homes for the aged and infirm, and in the daily lives of those who are struggling against losing odds to keep out of both. TEMPORARY SHELTER In the open country men who are out of money and employment may usually find shelter for a night either as a courtesy or in return for some odd job on which the farmer can use the extra help. At worst a barn loft or a hay-stack will serve. In towns and cities the homeless man may have to walk the streets or sleep on a park bench. In the cities also there are odd jobs, but they are generally paid for in money, and they go to the alert and experienced street waif rather than to the stranger who finds himself homeless and jobless. Charitable societies and missions may furnish tickets for meals and lodgings at a lodging house, or the lodger may be so fortunate as to get credit for the night or may be able to make himself useful about a low- priced hotel in return for his keep until something better turns up. But in times of depression and unem- ployment all these resources may fail, and there may be no alternative to the furnishing of free shelter and meals to those who cannot find work. The accommoda- tions provided in mission shelters are frequently very inadequate, and when offered in return for what may be hypocritical "testimony" they represent about the lowest known type of social work. Dependent Adults 109 Sometimes police stations are used as lodgings for the homeless, partly on the theory that the community is safer if those who are in this desperate position are under lock and key for the night, or at least under the eye of the police. Sometimes a woodyard especially maintained for the purpose offers a chance to do a stipulated amount of work in exchange for shelter and a meal or two. The best provision is a well-equipped public lodging house, in which all who need shelter ' are received under regulations which are to some extent a deterrent against abuse. For example, a bath is | required, and the disinfection of clothing. A state- ment is taken of the occupation, last residence, last li regular employer, etc. A physical examination is made. Those who need medical care may be sent to a hospital ; insane and feeble-minded sent to suitable institutions ; runaway boys sent home; deserting husbands detained for court action on a wife's complaint; newly arrived aliens turned over to the immigration authorities ; and those who, after care for a reasonable time, are unable to find employment or other means of livelihood, finally sent to court as vagrants. Such a sifting out of the homeless is expensive, but it is humane and has the rewards and satisfactions of other kinds of social work. It aims at rehabilita- tion of those who have ambition and personal assets; the reconciliation of estranged relatives; the suitable care of the sick and infirm; the prevention of actual suffering from exposure and starvation while looking 110 Social Work for work. The danger is that the administration will become perfunctory, the personal contact with lodgers unsympathetic, the more difficult and expensive kinds of treatment neglected, and the repellent features em- phasized until even those who are most in need of the lodging house will refuse to go near it. It is not an ideal state of affairs when there are able-bodied homeless men or women needing shelter. The ideal is of course to be sought in such an organiza- tion of industry and agriculture that there shall be no surplus labor, any enforced idleness being provided for, like illness and old age, either from an undivided surplus of industry or from surplus social wealth. CHAPTER VIII CHILDREN In their character as the most responsive subjects for both "preventive"' and "constructive" social work, children have in recent decades acquired a new and scientific interest; and this, combined with their un- diminished appeal to the affections and sympathies, has made this indeed "the century of the child." NATURAL DEPENDENCE Children, like the aged, are naturally dependent, whatever their financial circumstances. All our thirty million children may be described as dependent. Who it is that they are dependent upon is an interesting question in social philosophy. Are they dependent upon the state or upon their parents? The more rational view perhaps is not that parents exercise delegated authority derived from the state, but that both the state and the family are social institu- tions deriving equally their authority, their influence, their power, from the social need of man. The state is in position to exercise coercive authority, and may compel the acceptance of its decision in case of a 111 112 Social Work difference between the family and the state, but the state is held in check by public opinion, if by nothing else — by fear of revolution. This public opinion puts direct responsibility for the physical welfare of the I young child upon the family ; primarily, in the earliest years, upon the mother. The primary and elementary responsibility for the moral welfare of the child also, for the development of character, rests upon the family. In infant mortality and child mortality there is an index of the extent to which the physical need of the child is met. In extreme cases of failure to meet these needs the result is death, and the number of deaths in proportion to the number of children born is an index to the health and vigor of the infant and child popula- tion. In the same way we have in the criminality of the community an index or symbol of the success of the parents and of the educational influences of the community in providing for the moral welfare of the children. It is not a complete index any more than a death-rate is a complete index for the physical well- being. It is merely a symbol which stands there to indicate to us the relative success or failure of the family, failure in the end involving the necessity for some kind of reformative action. PRIMARY RESPONSIBILITY ON THE FAMILY Upon the family in the first instance rests the re- sponsibility for both the physical and moral welfare of the children. The school is only a secondary agency Children 113 in both of these primary purposes. The health de- partment is only a secondary agency on the physi- cal side; just as the courts are a secondary agency on the side of law-abidingness and regard for the rights of others and the aspects of moral character which show themselves in civic and social relations. The family, in other words, is the support of the school and the health department on the physical side, and the support of the school and the courts on the moral side ; but neither the school and the health department, on the physical side, nor the school and the courts, on the moral side, can be regarded as primary agencies in the physical and moral well-being of the child in the sense in which the family is. This is the modern view of the family. It is not the old Roman idea. In the Roman law dominion sums up in a word the central thought of the relation of par- ent and child. The father had power in life and death over the child and was responsible for the child's acts. The modern conception puts the word protection in place of dominion as its central thought. It is guardianship of the child, exercise of trusteeship. Protection is its main idea, and when we speak of parental authority we are 'quite as apt to have in mind maternal as paternal authority. We think of the two as more nearly equal, and in so far as we distinguish between them we would put first the maternal responsibility, because of the physiological relations, because of the greater ex- tent to which the mother in modern society manages 114 Sodial Work the internal affairs of the family and is responsible for the domestic economy upon which the well-being, the health, and the moral character of the children de- pend; and that responsibility, that authority, that trusteeship, does not end with infancy, but continues through childhood and the whole period of minority. And so when the state intervenes it is not our idea that the state is re-assuming some authority which it had delegated to parents; but that the state represents I our social relations as a whole; and that, having in itself the resources which the family does not have for dealing with the emergency, it is called upon to inter- vene, to recognize that this parental protection, this guardianship, is, as a matter of fact, lacking, and that i some substitute is called for — some rougher and more mechanical and more drastic authority, not so inherently well fitted for normal child care, but nevertheless hav- ing a certain rough and ready capacity for doing what in the emergency needs to be done. We may, there- fore, think of state intervention in a family when parental authority is broken down for any reason, as an emergency action in a disaster, an attempt by society to repair that disaster. RIGHTS OF CHILDHOOD The Child Welfare Standards published by the fed- eral Children's Bureau say on this subject : The fundamental rights of childhood are normal home life, opportunities for education, recreation, Children 1 1 5 vocational preparation for life, and moral, relig- ious, and physical development in harmony with American ideals and the educational and spiritual agencies by which these rights of the child are normally safeguarded. Upon the state devolves the ultimate responsi- bility for children who are in need of special care by reason of unfortunate home conditions, physi- cal or mental handicap, or delinquency.* Partic- ular legislation is required to insure for such chil- dren the nearest possible approach to normal development. PROTECTION AND PLACING OUT For the prevention of cruelty and neglect by parents, and for dealing with "unfortunate home conditions" in general, special societies have been established to I supplement the courts, prosecuting officials, and policet' officers, and in some instances these societies for the prevention of cruelty to children have a broad program of child welfare. From their familiarity with court procedure they often have great influence in legislation relating to the punishment and prevention of ofifenses by children, as well as in that enacted for their protec- * The responsibility of the state is by no means limited to those who are thus in need of special care. The Children's Bureau Standards, in the section on the public protection of the health of mothers and children, deal with the obligation of the state in regard to the health of school children and adolescent children. 116 Social Work / tion. Children's aid societies, or — as they are called in some states — "home and aid" societies, whose orig- inal function was the placing of orphans or neglected children in foster homes, show a similar tendency to extend their services to any aspect of child welfare not already receiving attention in their territory. The Children's Bureau Standards insist that "unless unusual conditions exist, the child's welfare is best promoted by keeping him in his own home," and that "no child should be permanently removed from his home unless it is impossible so to reconstruct family conditions or build and supplement family resources as to make the home safe for the child, or so to super- vise the child as to make his continuance in the home safe for the community." \ Foster homes may be used in providing for children who must be removed from their own homes, as the Standards point out, to a much larger degree than at present. The principles governing child placing can hardly be stated more clearly or more concisely than in the language of the Standards : Before a child is placed in other than a tempo- rary foster home, adequate consideration should be given to his health, mentality, character, and family history and circumstances. Arrangements should be made for correcting remediable physical defects and disease. Complete records of the child are necessary to Children 117 a proper understanding of his heredity and per- sonaHty, and of his development and progress while under the care of the agency. Particular consideration should be given to chil- dren who are difficult to place and who require provision adapted to their peculiar need. Careful and wise investigation of foster homes f is pre-requisite to the placing of children. Ade- quate standards should be required of the foster families as to character, intelligence, training, abil- ity, income, environment, sympathetic attitude, and their ability to give the child proper moral and spiritual training. When practicable children should be placed in families of the same religious faith as the parents or the last surviving parent. A complete record should be kept of each fos- ^ ter home, giving the information on which ap- proval was based. The records should show the agency's contacts with the family from time to time, indicating the care given to the child en- trusted to it. In this way special abilities in the families will be developed and conserved for children. Supervision of children placed in foster homes -^ should include adequate visits by properly quali- fied and well-trained visitors, who should exercise watchfulness over the child's health, education, and moral and spiritual development. Periodic ) physical examinations should be made. Supervi- 118 Social Work / sion of children In boarding homes should also in- volve careful training of the foster parents in their task. Supervision should not be made a substitute for the responsibilities which properly rest with the foster family. The transfer of the legal guardianship of a child should not be permitted, save with the con- ) sent of a properly designated state department or a court of proper jurisdiction. In all cases involving the legal adoption of chil- dren, the court should make a full inquiry into all the facts through its own visitor or through some other unbiassed agency before awarding the child's custody. ILLEGITIMACY The child born out of wedlock presents a serious problem, for which our present bastardy proceedings furnish only a very unsatisfactory solution. The Standards demands that each state shall make suitable provision of a humane character for establishing paternity and guaranteeing to children born out of wedlock the rights naturally belonging to children born in wedlock. Care of the child by its mother, particularly during the nursing period, is highly desirable; and the father should be under the same financial respon- sibilities and the same legal liabiHties towards his child as other fathers. Children 119 HOMES FOR CHILDREN Orphanages, asylums, homes, shelters, and protec- tories for children have been intended to serve various purposes aside from that of general relief; but their main common purpose has been to provide a substitute for the family when it fails because of death, dis-l ability, incompetence, indifference, or poverty. As the aged go into the almshouse or the private home for aged and infirm, so children are received into an orphanage or a home for half -orphans or neglected children. This is their primary, original function. However far they may develop a special character::, of one kind or another, the children's home at any rate must give shelter and nourishment and nurture. Institutional care for dependent children has long been one of the principal means by which the churches and philanthropic people inspired by religious altruism have dealt with poverty. When the home must be broken up something has to be done for the young children, and to place them in an institution is the thing w^hich seems to meet the need most definitely and completely. To be sure, there have always been alternatives. Relatives or neighbors may take them. A free home may be found for them in a family which has no children or in which room can be found for the strangers with a view to adoption. They may be boarded at public expense or by a children's agency in carefully selected private families under supervision. 120 Social Work Of these three methods the first is most common in the sparsely settled open country, where food comes largely from the farm and garden and all are living in such a way that population does not press hard against the means of subsistence. The second permits a certain desirable shifting of the surplus dependent children from town to country, from more populous to less populous states. It is susceptible of abuse, however, and has led to the enactment of legislation intended to protect the newer states from careless placing-out. The third becomes a necessary supplement to the others in any general use of the placing-out system : to care for those who are less eligible for adoption, or who for any reason need to be kept under closer supervision, in the hands of specially qualified house mothers. The institution has some advantages as a place for tem- porary care, for intensive study, for discipline, for preparation of the child for a foster home, and even those who prefer foster homes eventually for homeless children generally recognize that they cannot dispense with the receiving home for such purposes. Moreover, the need for separation from the natural parents may pass with re-marriage of a widowed father or mother, or a recovery from illness, or increased earning power in children of working age, or any other of several changes which are constantly taking place, especially in the rapidly shifting conditions of American industrial workers. With efficient home service such situations may be met without even a temporary commitment Children 121 of children to an institution, but in some instances this appears to be the most satisfactory, and indeed sometimes the only practicable way, of providing for an emergency. In city "orphan asylums" there are many children who are neither orphans nor even half- orphans, but are merely spending a few weeks in the institution at the city's expense to meet the convenience of their parents, just as other children might be sent to visit an aunt or a friend. The Children's Bureau Standards declare : The stay of children in institutions for depen- dents should be as brief as possible. The con- ditions of all children in such institutions should be carefully studied at frequent intervals, in order to determine whether they should be restored to their own homes, placed in foster homes, or trans- ferred to institutions better suited to their needs. While they do remain in institutions, their condi- tion should approximate as nearly as possible that of normal family life as to health, recreation, schooling, and spiritual, aesthetic, civic, and voca- tional training. Children's homes, just because they are substitutes for the family in its most essential function, have a far greater responsibility than any home for adults. They have to take into account the need for education, moral and religious and social as well as intellectual, 122 Social Work and in due time vocational. They have to teach grow- ing children how to live, how to live together, how also to fall back upon their own resources ; how to use books, but also how to use tools and how to use their senses. Institutions have to plan more deliberately and conscientiously than ordinary schools or natural par- ents, if they would do as well by their wards, for some things which the child living at home in a family and at large in the community can hardly escape do not automatically come in the way of the institutional child. It is frequently assumed that the child in the institu- tion must necessarily miss these educational experiences, but that depends on the imagination and skill of the officers and teachers in the institution. Initiative and resourcefulness may be developed if the institution re- fuses to be "institutionalized." There are indeed some opportunities inherent in the institution which the average family life misses altogether. It is easier to organize the life of the child as a whole, to co-ordinate formal teaching with recreation, work with play, in a way that may produce remarkable and excellent re- sults. The whole curriculum may be so planned as to encourage freedom of the spirit, to stimulate curios- ity, to bring out individuality, as well as on the con- trary principles. It may be more expensive, and it may recpire greater intelligence and skill, but there are instances to show that it is possible. Children's institutions have had a phenomenal growth in certain places because of local conditions. New Cliildrcn 123 York, for example, is the principal port of entry for immigration, and large numbers of newly arrived immi- grants are drawn directly into industries which in the past have been underpaid and have had a disastrous effect on health. It is a manufacturing city, with its central borough on an overcrowded island packed with overcrowded tenements. Without general public relief in the homes of the poor, the only recourse of the authorities, when income is insufficient and private agencies do not come to the rescue, has been to commit the children. It does not follow that public out-door relief as usually administered would have lessened such commitments. Indeed, in the seventies of the last cen- tury lavish out-door relief and careless commitments to institutions seemed to go together. The child v.'el- fare allowances or mothers' pensions of recent years, however, have certainly obviated the necessity of many commitments, and in 1921 there are only about two- thirds as many children in institutions as there were five years earlier. This is, of course, affected by gen- eral industrial conditions, but at this v.-riting there is much unemployment, strikes are in progress in the clothing and shipping industries, and real wages are not appreciably above the level of 1916. CHILD WELFARE ALLOWANCES Over a century ago some active benevolent ladies were carrying on a society for the relief of widows 124 Social Work and small children in the city of New York. They were giving them month by month during the winter such assistance as they thought necessary, accompanied by such conditions as they thought would be beneficial. Some of the ladies, however — probably the younger ones — were dissatisfied with what they were accom- plishing, and made up their minds that they would like to do something preventive, constructive, more in ac- cordance with their dynamic social ideals. So they established the New York Orphan Asylum. In our own time, when large numbers of children have been cared for in asylums and institutions, and very large sums of money have been expended for their maintenance and support in this way, some peo- ple — perhaps the younger ones, at least in spirit, among those interested in the care of dependent children — having a similar dissatisfaction and impatience with the results that are being accomplished, feeling that they would like to do something constructive, something preventive, something more in accord with our dynamic social ideals, have advocated — what? Nothing less than the giving of relief to mothers in their own homes, just what the voluntary society was doing, from which the orphan asylum split off in Jefferson's administra- tion. This reversion illustrates the relativity of all programs, the cycles in which relief moves, the way in which we come back to an idea, a plan, a method, which had been abandoned because it was obsolete, in- consistent with the ideals of the times; and come back Children 125 to it properly, because as a re-action against particular things which are done at the moment it represents progress. Widows' pensions, mothers' pensions, funds to parents, or — in the term which more accurately ex- presses their purpose — child welfare allowances, were inaugurated in four-fifths of the states in the decade between 1910 and 1920. This policy is now well established; but in many states the allowances are inadequate in amount and there is a notable absence of that "careful and competent case study" which the Children's Bureau's child welfare standards regard as essential, and which, as they say, "must be renewed from time to time to meet changing conditions." The common purpose of these allowances is to pre- vent the breaking up of the home when the natural breadwinner is removed by death or disability. In some states the allowances are made only to widows, in others also to mothers whose husbands are im- prisoned or incapacitated or have deserted. In the conditions on which aid is given, the persons to whom it may be given, the source of the funds (i. e., whether state or county), the character of the supervision, and the agency through which the funds are administered, the laws of the different states present extraordinary variation.* * Publication Number 63 of the federal Children's Bureau presents a compilation and analysis of these laws to the close of the legislative sessions of 1919. 126 Social Work Opposition to mothers' pensions was made on the ground that they were not needed; or that, when they are needed, it would be better for the voluntary socie- ties to give them, as they always have, or that they should be supplied by the overseers of the poor or commissioners of public charities in the regular course of their administration of public relief funds. Such objections were lightly brushed aside in the face of the indisputable consideration that mothers of young chil- dren cannot as a rule earn a living for themselves and their children and at the same time give them the care which they need. It was believed that the resources of the private societies were inadequate, and their point of view too unsympathetic to the whole idea of state pensions, and that the methods of public relief were inappropriate, even if the funds had been sufficient, to permit the acceptance of either of the alternatives. To the very different objection that "pensions" were only out-door relief under another name, and that social insurance is really the alternative which our modern ideals demand, it was replied that the pensions were intended to be a half-way step towards social insurance. The demand for pensions rather than poor relief for the aged, the disabled, and widows, has represented a wholesome revolt against inadequate, perfunctory, and demoralizing public out-door relief on tlie one hand, and class-conscious, superior private charity on the other. Nevertheless the demand has been short-sighted, and therefore misses the mark. What is wanted is not Children 127 a pension, but social insurance. If death, old age, and disability were fully provided for by compensation when they are a legitimate charge on industry, and by insurance when there is no undivided industrial re- source, all that the hot champions of pensions desire would be realized, and the heated arguments of their opponents would be dissolved into thin air. DAY NURSERIES The day nursery or creche represents a compromise, a working adjustment, made necessary by the employ- ment away from home of the mothers of young chil- dren. They were established to care for infants who were neglected while their mothers worked; or else, according to the point of view, to enable mothers who would otherwise be kept at home to go out to work in order to earn a living for themselves and their chil- dren, or to enable them to keep their children with them instead of consigning them to an institution. Ideally mothers of young children should not go out to work. Their children have first claim — something in the nature of a monopoly claim. But in the first place mothers are needed. It would be difficult in other homes to get the family washing and the house cleaning done if these day nursery mothers were not free to come in for day's work. Then these mothers may be more successful workers by the day or in factories than as caretakers of their own children. A girl trained to office or factory work or as a laundress 128 Social Work before marriage may find a tenement home very tedious. She may really prefer to work for wages somewhere else, and she may need the income. The day nursery may do better for the children than the hard pressed mother could. The food may be better in quality and better prepared and more regularly administered. The play may be safer and more educational. The nap may be more regular and beneficial than one at home. The nursery may teach the mother some of the things about the care of the infant which she needs to know. Home visits supplementary to the service in the nursery may give an opportunity to the social worker to exer- cise a good influence on other members of the family. Day nurseries have their own problems. In offering care for the young children throughout the working day at a nominal charge they assume a degree of responsibility for the mother's being at work. They should therefore be sure that it is justified. They should be sure that the work of the mother is not resulting in the neglect of other children, that it is not a means of lowering rather than raising the family's standard of living. If the father is Hving, the question whether his earnings should not be enough to support the family is always present. The presumption is against the employment outside her own home of the mother of a young child. The burden of proof that it is advisable rests on those who employ her and on those who make her employment possible, as well as on herself and her natural supporter. Children 129 FRESH-AIR AGENCIES The seaside, mountain, and country camps to which ailing children are sent, and tired mothers, conval- escents, or others in need for any reason of a change for a day, a week, or a fortnight, might be regarded as preventive rather than remedial agencies, although they are both. Some of them are merely for recreation, the sort of holiday which the most robust are entitled to have if they can. Some of them are distinctly hospitals for the better treatment of those whose illness requires elevation or salt air or whatever other special advantage the favored location offers. Between these extremes are all sorts of places where children may have a happy day, a chance to recover from an illness or to lay up surplus energy in anticipation of the city's heat and humidity. Instead of a camp or home devoted exclusively to fresh-air work, children may be sent for a visit to farmers' homes in the country, where they will have a chance to see what life on the open land is like. So extensive has the fresh-air work of the cities become that central registration has been found to be advisable to insure the widest distribution of the avail- able opportunities and the best possible selection of candidates. There is in general, however, less rigid formality in these excursions than in other forms of relief. Sometimes the outing is a mere incident of a church or settlement association which extends through- 130 Social Work out the year. Sometimes it is a reward of school attendance. On whatever basis, it is a very useful and delightful development of social work, a means of increasing happiness and physical resistance, of education and refreshment of spirit. The withering heat of the city is a strain on the best physique. In rear tenements, in basements, in alleys, in stuffy^ bed- rooms and kitchens which are also living rooms, the children crumple under it. The escape from the hot pavements and the stench of the gutters for a breath of country air in the hills or of salt air at the seaside means for the children revival and preparation for a struggle in which they are at best handicapped, and to see the magical results of such a change is for the observer a prophecy of a time when children will live all the year round under better conditions than those of the congested tenements of the modern city. CHAPTER IX THE SICK The history of social work in the past generation has been largely one of transferring attention from moral to physical weakness. The charity worker of an earlier day did not deny the fact of illness, but seldom got rid of a suspicion that probably shiftlessness or some other moral delinquency was at the bottom of it. The mod- ern social worker does not deny the fact of moral delinquency, but is always on the alert to see whether there is not some physical explanation of it. The earlier tendency was to divide human beings into the respectable and others. The later tendency is to think of the normal and the deficient. Both attitudes have their drawbacks. Both classifications are far too sim- ple for the facts. Saints and sinners there are, no doubt, at the extreme limits, but from the moral point of view most people are complex, with faults and virtues, and the attempt to base decisions in social work on worthiness, desert, respectability, as a simple prin- ciple of classification, had to be abandoned. This is hot to say that specific elements of character, or par- ticular experiences or associations or habits, can be 131 132 So(^ial Work ignored. Each demonstrable factor must be taken into account for whatever it is worth, and utiHzed in diag- nosis and treatment — in the making of a definite plan for promoting the well-being of the one whose welfare is in question. INDIVIDUALITY MUST BE RESPECTED In our present pre-occupation with physical and mental health, this lesson learned by our predecessors should be kept in mind and applied. Human beings are not sick or well; normal or deficient. They cannot be relegated to two or more such simple, unqualified cate- gories. A one-armed man is not a "cripple,'' to be henceforth treated as one of a class, along with one- armed and one-legged; no-armed and no-legged; rheumatic and paralytic. He is rather to be regarded as an individual human being, whose working and living habits must be modified, very slightly in some cases, radically in others, to take his particular limita- tion into account. One may be short-sighted or color Wind; nervous or irritable; deformed of figure; deaf or lame ; excessively plain or heavier than is convenient. These physical characteristics may be very conspicuous to superficial observers, even to friends, and yet, on fuller understanding, they may be so overshadowed by other qualities as to be almost or quite negligible. We do not think of them as a basis for classification. Some ailments and defects may be completely disabling, destroying the possibility of any useful occupation or TJic Sick 133 rational enjoyment. Between these extremes o£ negli- gible peculiarities and completely disabling infirmities are all conceivable degrees of bodily and mental afflic- tion. The point is that the advantageous and sensible attitude for the social worker is one which emphasizes personality, and regards the disability as an incident; one which refuses to lump together the consumptives, the rheumatics, the paralytics, the neurasthenics, and to treat them indiscriminately on the basis of their ailment; one which insists instead on thinking of par- ticular individuals who have many interesting and im- portant characteristics, among which may happen to be some pulmonary or nervous limitation which in their interest needs to be taken into account : for cure if possible; for alleviation; and for recognition as a fact, neither to be minimized nor to be exaggerated. A POSITIVE HEALTH IDEAL One natural result of this view should be to increase public concern for the adequate treatment of the sick, and to intensify the demand for the elimination of those diseases which are preventable. We come to think of sick and disabled people not as invalids but as people who are ill; to appreciate the interference of ill health with the normal life of human beings; to recognize that illness is a nuisance, a subtraction from enjoyment and useful activity ; to see that the duration of acute illness, the degree of discomfort caused by 134 Social Work chronic ailments, the number who succumb to infectious disease, the mortahty caused by an epidemic, are meas- urably within public control; to learn the significance of the dictum that health is a purchaseable commodity; and thus to take a more hopeful and more determined view of public health activities, a more intelligent atti- tude towards the work of hospitals, dispensaries, sana- toria, district nursing, industrial medicine, school hygiene, and all the other means by which physical and mental ailments are discovered and treated, and physical vigor and resistance to disease are increased. We visualize health as the normal, ordinary, and ordinarily attainable condition. We think of it in terms of what can be done by vigorous workers; of what happiness and satisfaction are possible when the limitations of preventable disease are removed. We do not become hypochondriacs. Quite the contrary. We become human. We are preoccupied with disease only as an obstacle to be overcome, as a bad habit to be outgrown by the race, if not by the individual, as a swamp to be drained, a dry land to be watered, a mountain to be tunnelled. We train our children in the habits of personal and public hygiene as in good manners, in order that they may forget them, not in order that they may become an end in life. Bathing, exercise, erect carriage, deep breathing, rational diet, cleanliness, temperance, are in themselves nothing. They are an incidental routine, obtruding themselves offensively only in those whose civilization is imperfect. The Sick 135 whose early education has been neglected. When the laws of health are observed tacitly, as a matter of course, without undue advertisement, with no feeling of conscious virtue, as well-bred people everywhere do observe them, there is time to live worthily and happily. To guarantee this is of course not within Hygeia's power, but we may at least be grateful for her part in making it easier and more probable. THE HOSPITAL The hospital-is the natural center of social provision for illness. Into the hospital comes an increasing pro- portion of those who are seriously ill. Religious feel- ing, elementary philanthropy, mutual inter-dependence, and a sense of civic responsibility, have all in turn or in union inspired the founding and support of hospitals and dispensaries. The necessity for clinical facilities in teaching, and the needs of well-to-do patients who are ready to pay in full both for board and for their professional care, have been important factors in the development of the modern hospital system. The care, however, of those who cannot pay at all or anything like the full cost of their maintenance, except as they contribute incidentally to the education of physicians and nurses, has been the main purpose of the public hospital and of most of those which are conducted under the auspices of religious bodies or by voluntary corporations. The private commercial or professional 136 Social Work hospital exists, but as compared with the public and quasi-philanthropic institutions their number and social significance are negligible. What is a hospital? It may be housed in a many- storied, architecturally imposing building, or a group of many such buildings ; but, as in the famous definition of a college — a log with a Mark Hopkins at one end and a boy at the other — it is better to forget the great buildings, the beautiful chapel, the marble halls, and spacious grounds which are sometimes associated with hospitals, and fix attention on its essentials. The typical hospital ward — a large room with beds for several patients of the same general class : men's surgical cases, for example — will quickly reveal these essentials : a comfortable bed, higher than that used in a hotel or at home, to facilitate the work of nurse and physi- cian, scrupulous cleanliness, quiet, good ventilation, correct temperature, meals and treatment at prescribed periods, discipline, order, cheerful confidence. The patient is the center of interest. His temperature and appetite, the condition of the organs affected by the illness, the functioning of the excretory organs, and any other s3aTiptoms which will throw light on his prog- ress, are carefully noted and recorded. He is not, however, merely a case, presenting interesting pro- fessional aspects. His personality is also in question. His family and business or professional interests, his politics and religion, his likes and dislikes, his friend- ships and social relationships of any kind, may be of The Sick 137 very considerable importance to the doctor and nurse before he leaves. Perhaps an operation is to be performed. In a small room reserved for the purpose an anaesthetic is to be administered. But if the patient happens to have an opportunity to look into the operating room before this is done, he may chance to see very elaborate and care- ful preparations for his reception. The surgeon washes his hands with a thorougl>ness for which there is no parallel elsewhere. Not only all visible dirt, but all dangerous germs, must be removed. The antiseptic fluid in which he scrubs them must leave them aseptic. He may not wipe them afterwards on a towel, for that would be to frustrate the process of securing the degree of surgical cleanliness which he requires. After the cleansing he may not pick up instruments from where they happen to lie, even though they also be sterilized. They must be handed to him on a tray, or perhaps he will touch a lever with his foot which will brinsr the required implement within reach without contamina- tion. Scalpel, sponge, bandage, needle, catgut for sew- ing, — all must be as clean as the unexposed nerve or blood vessel or muscle to which they are soon to be applied. He means to do a clean job, and to have no septic poisoning. The light must be ample and from the right direction. His eye demands conditions appro- priate to his delicate task. If the operation is an instructive one there will probably be accommodations within seeing and hearing distance for associates or 138 Sodial Work students. Close at hand — probably in an adjoining room or alcove — the sterilizing apparatus is installed, and perhaps a pathological laboratory will be near enough to permit the examination of specimens while the patient is on the table, to determine whether a sus- pected grov/th is or is not malignant. MAINTENANCE OF HOSPITALS Public hospitals are maintained by the federal, the state, the county, and the municipal governments. The federal Public Health Service, which has extended in many directions and now affects many millions of persons, originated in a Merchant Marine Hospital Service, which it still conducts. The states maintain hospitals for the insane; institutions for the feeble- minded; frequently for those who suffer from tuber- culosis, especially in the early, curable stages; and some- times for other classes, such as crippled children or epileptics. Counties have their hospital wards in alms- houses, sometimes an independent general hospital. In New York every county is required by law to main- tain a special hospital for tuberculosis or to make other provision for such patients. In some states the insane are cared for by counties, under state supervision. In some of the largest cities it is the county which carries the burden of providing the main institution for the care and treatment of the sick poor, while in others it is the city administration, and in some instances the city and county are virtually consolidated. Some of The Sick 139 the city hospitals, like those of Boston and Cincinnati, have been generously planned and have enjoyed a con- tinuity of management such as is more frequently found in private institutions. New York has great hospitals in each of three distinct city departments. One of these, known as Bellevue and Allied Hospitals, governed by a slowly changing board of trustees, has been emancipated from the sudden changes incident to changes in the municipal administration, but is of course dependent on the appropriating branch of the city government for its financial support. PUBLIC AND PRIVATE HOSPITALS Public hospitals have had an immense development in the last few decades. Their number has been in- creased; existing institutions have been enlarged; standards, professional and administrative, have been established in many of them, which offer the most re- freshing contrast to those of earlier years; social service to patients and to their families has been introduced; foolish popular prejudices and delusions in regard to hospitals have been overcome; public appreciation of their value has increased, so that necessary appropria- tions are more easily secured ; special services of many kinds — for crippled children, for nervous cases, for mental cases, etc., etc. — have been established; thera- peutic employment has been introduced; pathological laboratories and research laboratories have been created ; the nursing service has been improved through 140 Social Work training schools; and above all, the medical and surgi- cal service has advanced, perhaps even more relatively than in private practice. The war naturally has checked some of this progress. Building has been so expensive as to prevent new construction and even to impede necessary repairs. Doctors and nurses have been called away to more urgent and more interesting fields. Even the ordinary up-keep has suffered from increasing costs. These set-backs are temporary, however, and are already in some cases overcome. The war will com- pensate in the long run for such temporary hardships by the discoveries, the improvement of surgical tech- nique, and the spread of knowledge about disease and injuries to which it has given rise. For the actual injuries, the disease, the under-nourishment, the ner- vous strain, and the disappearance of vigorous young lives resulting from the war, there are alas no com- pensations. The growth in the importance and usefulness of public hospitals has found its full counterpart in the development of the private hospitals. There is as yet no clearly defined division of work. Generally speaking, where both exist, the tendency is for the public hospitals to care for fewer patients, but to keep them longer. This is due in part to the transfer of patients suffering from chronic ailments from private to public hospitals. Public institutions, supported by taxation, have naturally rather less choice than the former in the reception of patients. They must take The Sick 141 any who come, if there is room for them and if their illness is such as to make hospital care necessary or advisable. The same thing might be true of a private hospital in a community in which there is no public hospital, but if there are both, the former is freer to select and will ordinarily give preference to acute illnesses, leaving the more chronic or lingering cases to the public hospital. The private hospitals have enjoyed some advantages. They have been more free from the blight of politics. They have had the devoted service of able and skillful physicians. They have been more attractive to nurses. They have often had cordial relations with good medi- cal schools. They have had the benefit of high grade volunteer service on boards of managers and advisory committees, as well as on the professional staffs. Their financial difficulties have been appalling, but some have attracted large endowments, and some have shared in the success of the new movement for financial federa- tion of welfare agencies. PUBLIC SUPPORT OF PRIVATE HOSPITALS Maintenance of non-paying patients in private hospi- tals is sometimes met wholly or in part by payments from the public treasury. Lump sums have at times been appropriated for this purpose to private hospitals by legislatures or local appropriating bodies, under authority given in the charter of the institution or by general laws. The tendency, however, is to pay hospi- 142 Social Work tals a per diem rate for the care of such patients as are accepted by local authorities as proper public charges, both admission and duration of treatment at public expense being controlled by the city or county officials. This system is better than that of lump sum appropriations, in that it eliminates the scramble for public subsidies with the implied expectation of some political advantage in return for the financial favors thus conferred by the legislative committees and mem- bers. It substitutes an enforceable contract, which implies official inspection and quick correction of any neglect or ill treatment. Even when payments are made on the per capita per diem system, there remain many occasions for friction. If the city has its own hospitals, the authorities will naturally prefer that patients should be cared for in them rather than at the city's expense in private hospitals. It will prob- ably cost less; but, even aside from this, in order to make the medical and nursing service attractive, in order to justify appropriations adequate to maintain a bal- anced and comprehensive hospital system, in order to keep the prestige of the public hospital on a par with, if not above, that of the private hospitals, the city administration will naturally insist upon the use of its own hospital facilities to their full capacity before ap- proving payments for care in private institutions. Patients may, however, prefer to go into the private hospitals, possibly for merely sentimental reasons, but possibly also for very legitimate practical reasons. The The Sick 143 superintendent of one great private hospital goes so far as to insist upon the right of any sick patient or his family to choose, when his life may be at stake, whether he will be cared for in a public or in a private hospital. This view would not be generally approved. As a rule, when public subsidies or payments are made to private hospitals at all, it would be only for those patients who cannot be cared for satisfactorily to the authorities in public hospitals, because they have no vacant beds, or because, in an emergency, the distance would be so great as to endanger the life or well-being of the patient, or for some similar reason. Even more general, and in the author's opinion more justifiable, is the complete separation of the financial support of public and private institutions, reserving public revenues for public hospitals, controlled and managed by public authorities, and expecting private hospitals to be sup- ported by voluntary contributions, endowments, and payments of patients. That voluntary gifts may also be made to public hospitals goes without saying. VALUE OF THE MODERN HOSPITAL The modern hospital, well equipped and administered, is one of the most remarkable and creditable of the institutions to which science and philanthropy have given rise. It is at once a nursery of the art of healing, a laboratory of research, a co-operative enterprise in which surgeons, pathologists, and others who serve in 144 Social Work the various fields of medicine, touch elbows with public spirited men and women who provide funds, look after investments, or participate in shaping and carrying out the educational and social policies. Operating rooms, sterilizing apparatus, research laboratories, lecture rooms, ambulance service, nurses' quarters, administra- tive offices, are usually features of the equipment, in addition to the wards for each class of patients and the private rooms when provision is also made for them, and the kitchens, special diet kitchens, laundries, heating and lighting plant, and any other necessary services. All this involves large investment. As the hospital is usually located in or near a populous center, the cost of land and buildings, wages to labor, and the cost of living both for personnel and patients, is on the upper rather than the lower levels. The demands of aseptic surgery are exacting. Many of the drugs and remedies required — salvarsan, for example — are ex- pensive. The gift of a gram of radium to Madame Curie, costing $100,000, illustrates the dependence of progress in the underlying scientific knowledge on ade- quate financial resources. Fortunately the appeal, both to humanity and to the sense of civic responsibility, may be made commen- surate with the need. The cost is great, but not rela- tively to the value of the service. The hospital saves life, prolongs the working period, lessens the sum total of human suffering, restores the bread-winner, the mother, the sick child, to those who would consider no The Sick 145 price t6o great to pay for such a service. As the importance of prompt and skillful attendance in critical illness is appreciated; as the advantages of hospital care in lingering fevers and in maternity confinement are better understood; as the quiet, the regulated diet, the continuous observation, the authoritative discipline, of a hospital make their record in the recollection of the increasing number of patients who profit by them, the public opinion on which both requests for appropria- tions and appeals for gifts must rely is steadily devel- oped and confirmed. No hospital is perfect, since it is a human institu- tion. People sometimes even yet are neglected, exposed to infection, fall into the hands of incompetent physi- cians and careless nurses. But the ideal is more and more clearly seen. Standards are established. An ex- cellent special literature of hospital administration and service exists and is constantly increased. Official in- spection exposes and corrects grosser abuses, and humane, sensitive, and efficient professional and lay workers are found both in public and in private hospi- tals everywhere. A fine tradition of religious devo- tion has come down through the centuries in Catholic, Jewish, and Protestant hospitals. An equally fine pro- fessional spirit, interwoven with the religious motive, has its historical origins far back in antiquity, but has transformed the hospitals under the influence of the new medical schools into veritable temples of science. The 'conception that the community has a responsibility 146 Social JV.ork to prevent preventable disease, to assume the burdens of illness which the individual cannot carry, to free social progress from the reproach that the very proc- esses which mean prosperity and well-being for the strong may mean the destruction of the weak, this new view of health as in large part a social responsibility, is in complete harmony with true religion and with the best traditions of the medical profession. The hospital at its best, with its social services, embodies this three- fold program, religious, medical and social. Consola- tion, comfort, relief for bodily suffering, reassurance as to the needs of the family if they are involved, as they usually are in serious illness, lessening of the danger of infecting others with contagious disease, ad- vancement of knowledge and skill, training of those who are to treat or nurse the sick in their homes, re- lease of relatives for their regular occupations, but above all the cure or alleviation of disease by surgical or medical treatment under the most favorable condi- tions — such are the objects of the modern hospital, and it is doubtful whether, with all its imperfections, any other comparable institution — university, law court, public press — comes nearer to fulfilling its legitimate purpose. HOME CARE OF THE SICK Dispensaries, health centers, medical services in in- dustrial establishments, and other adaptations or differ- entiations from the hospital, carry a similar program The Sick 147 into homes and places of employment. Visiting nurses' associations are the most important and among the most widely diffused of the social agencies which thus care for the sick at home, usually without charge if neces- sary, frequently with a modest charge on an hourly basis, proportionate to the ability of patients to pay. Such associations are of course dependent on voluntary contributions for a large part of their expense. Health departments now frequently have a large corps of visiting nurses to supplement their physicians. Indus- trial hygiene may include home visiting of the families of the workers. School hygiene may include home vis- iting of the families of pupils. Psychiatric clinics may include home visiting of mental patients and their rela- tives. The hospital itself may do a very substantial part of its work in visiting discharged patients and in such advice and instruction in their homes as may lessen the probability of the need of hospital care for other members of the family. TREATMENT FOR ALL Formerly much was heard in the cities aboat the "abuse of medical charity." Complaint was made that many people came to the free clinics and dispen- saries who could well afford to pay a private physician. Laws were passed requiring dispensaries to be licensed and authorizing state boards of charities to prescribe rules under which free dispensary treatment should be given. These rules usually called for a registration 148 Social Work of patients and a visit to their homes in doubtful cases, or at least a signed declaration of their inability to pay for treatment. Such complaints have some basis, but are not to be taken too seriously. Most of those who are able to pay are not so much in search of free or even cheap medical service as they are in search of competent, skillful service, and the fact is that better service is frequently available in the free clinics than could be obtained by those who can pay only moderate though reasonable fees. The matter has largely adjusted itself, partly through the registration of patients and partly through the home visits which are made not to expose wrongful demands for free treatment but to follow up the examination and prescriptions of the clinic with appropriate advice in regard to diet, sleeping arrange- ments, dressings, baths, sanitary arrangements, occu- pation, or any other matters on which instruction is needed. The extension of health care is far more necessary than restriction. The principle that all who can should pay their own doctor and nurse is sound enough until some better plan is devised, but the principle that all who need professional attention should have it, and should have it promptly, and that it should be as good as the existing state of the science of medicine permits, regardless of the patient's financial circumstances, is making its way to general acceptance. Whether this will lead to a general system of state medicine, com- The Sick 149 parable with the pnbhc school system in education, or to a system of health insurance, which deals with the financial aspect of sickness, or to some entirely different plan, is still uncertain; but that there is to be a radical change which will emancipate health in some way from the fetters of the existing acquisitive economic system, as we have already emancipated elementary and second- ary education, seems reasonably certain. In any social- ized system of public hygiene, there will be provision for free periodical examination, regardless of known ailments, and there will be some financial provision for the families of those who, like the tuberculous, may need long continued sanatorium care or a complete change of residence or of occupation. CHAPTER X THE HANDICAPPED Most of us are more or less handicapped physically. The industrial and intellectual work of the world is done by persons suffering more or less from eye-strain, headache, indigestion, imperfect hearing, bronchial af- fections, flat-foot, or some of the other numerous limi- tations to which man is subject. Even in recruiting an army physical perfection cannot be required, but only a relative degree of freedom from those defects and diseases which would especially interfere with mili- tary service; and even with such allowances, only sev- enty per cent of the American men drafted for service in 1916-18 were found to be fully qualified. PHYSICAL HANDICAPS (Whether an individual needs help in overcoming the handicap of his physical disability depends on the degree and nature of the disability and the endowments he has which may be drawn upon to off-set it. There are some kinds of affliction, however, which presume the need of some special provision, even independently of financial circumstances. Chief among these are 150 The Handicapped 151 blindness, deafness, and serious crippling of the body. The deaf, the blind, and the cripple usually need above all an education and such vocational guidance and voca- tional training as will make them self-supporting and valuable members of society. They may be able to take advantage of the ordinary schools, or in a populous neighborhood there may be enough of them to justify forming special classes for those who like the blind or deaf mutes require special facilities. NEEDS OF THE BLIND There are obvious advantages in a special institution for the blind, where they may be protected from the dangers resulting from lack of sight, and where, along with instruction in the Braille system of raised charac- ters to be read by touch, and such teaching as they might obtain at home or in an ordinary school, they can also master a trade or prepare themselves more easily and satisfactorily for whatever profession or occupation they are fitted to follow. Gifted individuals may soon exhaust these special advantages and speedily reach a position in which they would gain more from association with seeing persons interested in their own field. Even from the beginning some have relatives or friends who are in position to engage the services of teachers, readers, and attendants who can do more for them than the staff of an institution. Such indi- vidual attendance and tutoring, however, will be rare, and will seldom be necessary. 152 Social Work If the loss of sight occurs after one already has the elements of a general education, the problem is different from that of educating and preparing for useful life one who is blind from birth or infancy. Many in- stances occur of the successful prosecution of ordinary vocations — teaching, business, even the practice of medicine — by those who become totally blind, and one of the most beneficial services to the blind is to acquaint them for their encouragement with such instances, with due care, of course, not to excite false and unreasonable expectations. That blindness justifies a life of de- pendence, whether by mendicancy or by becoming a burden on relatives, or even by living on inherited or otherwise unearned income, is an utterly unwarranted assumption — one which has been widely accepted and has done incalculable mischief. PREVENTION OF BLINDNESS Social work interests itself in the blind, first, to restore the sight if possible; second, to develop the physical and mental capacities of the one who is de- prived of sight, for the sake of his own satisfaction and happiness and in order that like others he may be a social creditor rather than a debtor; and third, by finding out about the causes of blindness, to prevent it in others. It has become known that congenital blind- ness is often due to a gonorrheal infection at birth, which can be prevented by washing the eyes of the newly born child with a solution of nitrate of silver, The Handicapped 153 and this simple and harmless precaution is now com- pulsory in some states. Eye-sight is frequently de- stroyed by occupational injuries against which protec- tive measures are possible. Factory laws prescribe such protection, and in addition compensation laws give to employers financial inducements for diminishing such dangers. The "safety -first" movement has decreased the chances of blindness, as of the loss of life and. limb. Prompt and skillful surgical attention when accidents do occur will often save the sight of one eye if not of both. Increasing attention to defects of vision in children, with provision of corrective glasses or other appropriate measures for overcoming the defect, should eventually reduce the number of cases of blindness, while it also increases general efficiency and health and the sum total of "eye-power" available in the world. Thus the prevention of blindness, the best education and vocational guidance of the blind, the correction and improvement of defective vision, the surgical or medical care of any injured or diseased organ of sight, and the suitable maintenance of the unfortunate ones who by reason of age or other infirmity in addition to loss of sight are necessarily dependent, are typical aspects of a social program in reference to one kind of physi- cal disability. In the almshouses and other institutions for aged and infirm, and living alone at home on some meagre public or private allowance, are some who are greatly 154 Social Work in need of friendly visits in their loneliness and of aid in finding such occupation as will enable them to pass their idle time agreeably or in some way modestly use- ful to others. THE DEAF The deaf are less obviously, but often in fact quite as seriously, handicapped as the blind. They need to learn lip-reading and speech as the blind learn Braille. They require special teachers skilled in overcoming the difficulties which arise from lack of hearing, and special guidance in the choice of a vocation. As with the blind, there are advantages in a period of residence in a specialized institution. In both cases, however, these institutions should be regarded as schools, not as asy- lums. It is pupils, not ''inmates," for whose needs they provide. The state has an interest in making the best possible citizens of them, just as it has in making good citizens of ordinary day pupils in the public schools. Food and lodging are only incidental, just as maintenance is a necessary incident but not the main purpose of hospital care in acute illness. The prevention of deafness, by the fullest possible investigation of injuries resulting from illness or acci- dent and of the conditions under which deaf -mutism may be inherited, is a part of the task of society in this, as in the analogous social problems of blindness and other physical handicap. The Handicapped 155 THE CRIPPLED Those who have suffered amputation of an arm or- a leg, or who are crippled by rheumatism, by tuber- culosis of bones or joints, by infantile paralysis, or otherwise, may require social action analogous to that for the blind or the deaf. The great war has left millions of young men in European countries and thousands in our own unable because of such injuries to return to their previous occupations. It has been necessary not only to treat their wounds and injuries, and to fit them with artificial limbs or other appliances, but to give them a new vocational education, through which they may regain an honorable place in the avoca- tions of peace, in lieu of that for which their war service unfitted them. PROVISION FOR BLIND, DEAF, AND CRIPPLED The classic method by which society has chosen to provide for the blind and the crippled and others with serious physical handicaps has been to allow them free- dom — even encouragement — to beg in public, supple- menting this to some extent, especially in the case of disabled soldiers, by institutional care and pensions. Although generally discredited in theory, begging still as generally persists in practice, and is countenanced by the unthinking public. While the outlines of a program which would provide intelligently and ade- 156 Social Work quately for them are now visible, comparatively little of it is yet in operation. We have done most for the deaf and blind children of school age. All the states have broadly recognized their obligation to give elementary instruction to them. There were 72 state institutions and 53 under private auspices in 1910, and the editor of the latest Census report on Benevolent Institutions goes so far as to say that "there is probably no one class of persons for whose education and training such complete provision is made'' — as for the blind and deaf under twenty-one years of age, that is to say, who are so deaf or so blind as to be clearly unfitted for ordinary schools. There are many border-line cases, however, who fall between the two kinds of educational institutions; and there are many more all along the line from lack of sight or hearing to normal use of those senses w^ho need some special kind of care or attention which is not available. Little children below school age, more- over, have been generally neglected. Institutions have made a practice of receiving them only after they have reached an age at which it is thought reasonable for them to be removed from their home for this purpose — i. e., at nine or thereabouts. In many respects it is desirable that they should take at an earlier age the first steps in the special instruction which they need as distinct from seeing or hearing children. Ac- cordingly, special kindergartens for blind and for deaf- mute children have been established, both in some of TJie Handicapped 157 the institutions and independently. Facilities for this pre-school training should be extended until it reaches all who would benefit by it. For crippled children much less has been done than for the blind and deaf. After medicine and surgery have done their part in curing or supplementing their disability they do not need so much. They do not need a special kind of education, but special facilities for transportation, and special desk and chairs and other furniture, to make the ordinary educa- tional facilities accessible to them. They do need, like the blind and the deaf, intelligent vocational guidance and assistance in getting good prepara- tion for an occupation in which their particular disability will not be a handicap. Orthopaedic treat- ment, with incidental general education, is still avail- able for only a small proportion of those who need it. Some efforts have been made in the larger cities to hunt out the crippled children and make it possible for them to get to school and to be comfortable there, and to have some social life and diversions outside their own homes and more interests at home. The epidemic of infantile paralysis a few years ago stimulated in- terest in all these questions. Maintenance is incidentally and necessarily provided for all the blind and deaf and crippled children who ^re cared for in institutions. For these hospital or institutional children even greater individualization is desirable, more intensive and painstaking and long- 158 Social Work continued concentration, Laura Bridgman and Helen Keller illustrate what extraordinary returns may be obtained from such intensive effort. Many less familiar and less striking but still instructive instances could be supplied from the records of institutional teachers and from the experience of private instructors and pro- fessional practitioners with individuals of good native ability, handicapped by what would 'have appeared to to be an insuperable disability. At the other end of the usual school age, the existing facilities for the social care of the blind, deaf, crippled, and epileptic are also inadequate. Commissions for the blind have been established in a few states to make a registry, to give information about special opportunities for employment, to promote the welfare of those whom they find to be in need of any kind of service, to co-ordinate existing activities, to investigate the causes of blindness and encourage meas- ures for its prevention, and for other similar purposes. Individual vocational training and guidance and the diffusion of information about suitable occupations are the best service which such commissions, and the well- disposed citizens whose efforts they are intended to stimulate and co-ordinate, can render, PENSIONS For those who become blind or deaf or crippled in acfult life even less has been done, except in the way The Handicapped 159 of providing a money payment in certain cases. Pen- sions for disabled soldiers have been the rule in the United States since the earliest days of the colonies, and in the last ten or twelve years compensation for those injured in industry has been established by law in nearly all the states. Allowances from the public treasury are in some places provided for the indigent blind. A pension, however, or compensation, does not of itself ensure that a disabled man will not take the easy downward path to discouragement and deteriora- tion. By no means all, moreover, of those who be- come disabled in adult life, receive their injury in mili- tary service or in an industrial accident. The efforts which have been made to help the disabled adult to keep his place as a productive member of society or to restore him to that place after he has taken the easy path to chronic dependence have been modest and few. Individual employers and friends and social workers have given thought to individual cases. Charitable societies have supplied artificial Hmbs and have tried to find employment. Work-rooms have been main- tained for the blind, and one or twq classes to give instruction in selected trades to the crippled. Several social agencies have conducted special employment bureaus for the handicapped. Whether the blind and others who are equally handi- capped by some physical disability, such as paralysis or amputation of both arms or both legs, should re- ceive a pension from the state merely by virtue of their 160 Social Work disability, is a question on which there are sharp differences of opinion. It is similar to the question of old-age pensions and child welfare allowances (see pages 107, 125). Pensions to the blind are established by law in a few states and are given in others by local authorities under their general power of taxation for poor relief. It is true that what society gives to a blinded man or woman is not a pension, in the sense in which that word is properly used for an ex-soldier or an ex-civil- service employee. It is not a deferred wage payment. It is also true that a money allowance seldom fully solves the problem. The blind, like others, need also occupation, the chance to earn, the satisfaction of being useful. They often need counsel, encouragement, aid in making new adjustments. They are quite as often able to give such counsel and encouragement to others. They have worries, temptations, baffling obstacles. They have also resources which the shrewdest investi- gator would never discover. These experiences they have not, however, as blind persons, but as human beings. It is absurd to try to standardize their "treat- ment" as "blind dependents." Different things need to be done both by and for different persons. A uni- form doling out of fixed annual or quarterly or weekly pensions without discrimination, with no knowledge of the individual capacity of the pensioner in the use of the money, with no effort to discover whether there are physical or mental or economic or social difficulties The Handicapped 161 which might be removed, has the stupidity of the worst poHtical poor reHef. The reformer's energy and passion should be directed against the uncompensated loss of eyesight in mines or factories by occupational injuries; against the failure of society to give to children blind from birth the best education and vocational training which they are cap- able of receiving, whatever its cost; and against any failure to make use in later life, either in an ordinary trade or profession, or if necessary in an institution or special workshop, of the developed powers of the disabled adult in return for the means of livelihood. It is a question of far more than a pension, not less. What the normal human being without eyesight has a right to expect is participation in the social life of the community. During infancy, childhood, and adol- escence society should be investing each year more than any pension allowance now made or proposed would be likely to cover. Normally this investment will make unnecessary an allowance after the earning age has been reached. If through other cause — nervous in- stability, social incompatibility, physical weakness — the educated blind person requires either financial or professional assistance, this should of course be the more promptly and more generously forth-coming because of the original handicap, but it should not be expected or invited by special advance provision. After becoming an independent worker, the blind, like others, may wisely insure himself against physl- 162 Social Work cal breakdown, and the state, in administering and supplementing the insurance funds collected from in- sured employers and wage-earners, may take a liberal view of the benefits w^hich should be provided in par- ticular instances. Even if insurance funds are con- siderably enlarged by taxation, it might be more eco- nomical, if they are administered strictly and wisely, than the care of the same patients wholly as public charges, and it would certainly be more economical than the neglect of early cases which is common in the absence of any system of health insurance. Pensions for the blind are therefore less than their due and in the wrong direction. Education with main- tenance, self-supporting occupation, compensation in the case of industrial accident, insurance in case of ill- ness, professional treatment when necessary, and respect for personality under all circumstances, are their right- ful due, and they have the same obligation as others to help to create the public opinion which will secure such rights for themselves and for others. RE-EDUCATION AND ECONOMIC REHABILITATION The war, by forcing on our attention unprecedented numbers of disabled men, under the most appealing circumstances, made us realize how sadly we had ne- glected those who are maimed and blinded in the ordinary routine of civil life; and out of the attempts to meet the needs of the men disabled in the war has developed a new ideal and a new program of action The Handicapped 163 equally applicable to disabled civilians. The new pro- gram includes not only a money "compensation," but also the completest possible physical restoration, includ- ing functional re-education and provision of the desir- able prosthesis; and economic rehabilitation, including when necessary re-education for earning a living, and help in finding employment or in becoming an inde- pendent proprietor of a business or farm. These principles found fullest expression in the measures adopted for the benefit of our disabled soldiers and sailors, but the incredible inefficiency of administra- tion has obscured them, to speak with moderation, and has made our actual treatment thus far of those whom the system was intended to benefit a national disgrace. It is confidently expected that the new ideals born of the war will affect favorably our provisions for those disabled in civilian life. Thus far the chief evidence of this is found in the federal aid which is now granted to the states, in proportion to their population and the amount they appropriate for the purpose, for the re- habilitation of industrial cripples, and in one or two attempts by private philanthropy to give vocational re- education to crippled adults, to place them in positions, and to help them in other ways to re-establish them- selves in economic and social life. It is inevitable, however, that ultimately the advances in technical and professional skill due to the experiences of the war, which have revolutionized the possibilities in the way of artificial arms and legs and eyes and faces and of i 164 Social Work functional re-education, and the new glimpse which we have had of the possibihties of economic re-educa- tion and re-estabhshment, Avill eventually result in a more general acceptance of the new ideals and more adequate social agencies for making them effective. The human individual has so varied an assortment of endowments, and modern society can utilize such frag- ments of an individual, that even "half-men," much more three-quarter men and ninety-per-cent men, can frequently, if there be will, energy, and resourcefulness, be as useful as they were when they were whole — some even more useful. A man who is lame or blind or deaf or handicapped by a racing heart or scarified lung tissue may still, ordinarily, lead a productive life and have his honorable place in society. THE MENTALLY HANDICAPPED The insane, the feeble-minded and the epileptic, and the mental and nervous cases which may end in suicide, insanity, or other tragedy, if not wisely treated, present a wide diversity of special problems — institutional, domestic, and individual. It is wholesome to remember that, just as few of us are completely able-bodied, so most of us go through life more or less mentally handi- capped. Between the mental disability of which the possessor may never become conscious and complete imbecility or incurable insanity there are all the possi- ble gradations. The Handicapped 165 THE MENTALLY DEFECTIVE The insane are suffering from illness : acute or chronic, curable or incurable. This illness affects their reasoning powers; their mind has lost itself, wholly or partially, temporarily or permanently. The feeble- minded or mentally defective are in a different state. Their mind is congenitally sub-normal. No recovery is to be expected. Their mind cannot find itself, for, like the eyes which have had no sight from birth, something is definitely lacking. Intelligence is limited by the endowment of nature, and from moron to idiot this endowment is in varying degrees lacking to all those who are called feeble-minded. This does not mean, however, that they are incapable of learning. They may be taught, trained, developed, within limits. What those limits are can now be deter- mined for each individual with reasonable assurance. On the basis of their "intelligence quotient" and their response to early training, they may readily be classified as needing permanent custodial care, or close oversight after institutional training, or merely special considera- tion in the choice of a suitable occupation and perhaps protection from time to time in some crisis. Some high-grade morons may never be recognized as such. Good fortune may guide them through home and school life without any special untoward incident. They may slip into a sheltered position and continue to get along as well as most of their neighbors. Disaster \\\\\ come, 166 Social Work in such cases, only when a situation too complex and too difficult arises. Their resistance to temptation may- be less than normal. Inability to care for their chil- dren — who may because of their inheritance be more difficult than the average to care for — may be the first indication of their sub-normal endowment. They may be merely the first to be out of work in a season of unemployment, the last to find work when employment is resumed. They easily become petty criminals, va- grants, prostitutes, drug addicts, inebriates — not be- cause they are vicious, but because they are unstable and non-resistant. They are easily victimized. As they may be strong of body and pretty of face they offer prizes to cupidity. They may make very good soldiers under skillful command. They may do very well at common labor, where initiative and judgment are at a discount. They may even succeed in clerical positions where routine work is required and the think- ing is done by some one higher in authority. The high-grade defective provides a very large part of the task of social work, both institutional and non- institutional, and this is likely to continue to be the case. It will be advantageous to discover those who need to be kept in a colony or other institution, both for their own sake and as a means of preventing them from propagating; and to discover the border-line cases who require some guardianship while living and work- ing at large in society. We need to increase many times the available institutional facilities. Probably five times The Handicapped 167 as many as are now in institutions should be cared for in that way, and this could probably be brought about without any new compulsory powers. Although legal commitment in extreme cases would be wholly justified, our present limitation is not in that direction, but in the lack of accommodations. These two develop- ments — an increase in institutions, and guardianship for the demonstrably defective who can still safely be left in their homes — would greatly diminish depend- ence, illegitimacy, and minor crimes — probably also serious crimes. INSANITY The insane have benefited more perhaps than any other sick or disabled class from the advance of knowl- edge and of humanitarian feeling in the past century. ,We now fear them less and treat them better. This is fortunate, for there are influences at work which tend to increase insanity, and these would have had appalling results if the cruelty and neglect of an earlier day had not been mitigated by a better understanding and a more humane sentiment. Modern civilization, as it is trite to say, is much more complex than any which has preceded it. We have more noise, more hurry, more congestion of population; more intricate machines to tend, more things to learn at school; more occasion to apprehend quickly all the day's news of the world ; more obliga- tions to state, lodge, union, club, church, party, land- 168 Social Work lord, fellow tenant, fellow passenger in elevator, subway train, suburban railway, Pullman coach, or automobile. It takes a very alert and adaptable mind to make all these adjustments. The strain is sometimes too great. When a partially civilized mind, in this modern sense, is thrown into the solitude of an isolated farm or ranch, the absence of contacts, the loneliness, may prove to be an even greater strain. The disappoint- ments of business, the pressure of ill-health when this creates imminent danger of professional or business failure, the unstable home with its frequent infidelities, desertions, divorces, are among the numerous illustra- tions of the strain of modern life to which the race has hardly had time to become adjusted, — to much of which it may be hoped it will never be necessary to make a permanent adjustment. The world war has brought all this to a tremendous climax. Death, in- juries, bereavement, privation, dislocation, burdensome taxation, violent fluctuations in prices, have accentuated the difficulties under which individuals were already carrying a heavy strain. Social work has only a modest place in the social reconstruction which a recognition of this world situa- tion implies. When individuals seek to be useful and happy rather than rich and powerful; when industry is judged by the function which it performs rather than the profits which it earns ; when waste is systematically prevented and cities are intelligently planned; when in short society becomes rational and human relations The Handicapped 169 moral, the number of the insane, of suicides, of the nervously disturbed, will be appreciably less. In the meantime the state must provide hospitals for the men- tally sick, psychiatric clinics for mental and nervous cases who do not need to be admitted to the hospital, after-care for discharged patients, vocational direction, psychiatric home service, and whatever other facilities may be found necessary. CHAPTER XI CRIME AND THE COURTS Governments are instituted among men, according to the all but sacred instrument through which our independent national life was inaugurated, in order to secure the rights of life, liberty, and the pursuit of happiness. The American Federation of Labor at its Denver Convention in 1921 restated this principle in language to which no exception can be taken : Govern- ment is instituted for the common good, for the pro- tection, safety, prosperity, and happiness of the people, and not for the honor or profit of any man, family, or class of men. To this they added that the prime pur- pose of government is to give security to life, liberty, and enjoyment by the people of the gains of their own industry. THE LAW-ABIDING SPIRIT Governments, through their legislatures, and also — to an extent which is seldom recognized in theory but is very obvious in practice — through their courts, com- missions, and executive departments, make laws, ordinances, regulations, decrees, and decisions which 170 Crime and the Courts 171 all people within their jurisdiction are bound to obey. The laws and decisions should be obeyed, not because of any fear of punishment, but because they are in the public interest, because they correspond to the gen- eral sense of what is reasonable and right, and because the mass of the people have a law-abiding spirit. They enforce themselves by common consent as to the vast majority. However, penalties are prescribed for viola- tion, in the laws themselves or in the penal codes or elsewhere. Crime is the general name for any act which is thus punishable as in violation of a valid existing law, and those who are thus punishable are called criminals. THE LAW-BREAKING SPIRIT There is the making of a criminal in most men and women. ; The automobile driver casting a furtive eye over his shoulder for the motor-cycle policeman; the tourist returning from abroad with dutiable articles concealed; the income tax payer who forgets some important item; the dealer who is so accommodating as to make out a false bill of sale in order to defeat the luxury tax and the purchaser who accepts it; the senator who accepts presents from those whose hills he has put through the legislature ; the ex-service man who breaks up a lawful meeting; the citizen who con- dones lynching, to say nothing of the one who takes part in it; the maker or purchaser or the thirsty would- be purchaser of alcoholic beverages in violation of law 172 Social Work — are all at or beyond the margin, and they illustrate the nature of the criminal problem in the making quite as well as the gang of street boys with their look-out ready to give warning of the approach of the policeman. The understanding student of crime is not necessarily the one who has most studied the inside of jails and prisons; but more probably the one who knows most oL human nature. It is no more important to understand the criminal act than to understand the secret sympathy for it, the suppressed inclination to commit it, which lurks in the mind of many an unconvicted, unsuspected, and technically quite innocent citizen. A complete criminal psychology would startlingly resemble ordinary psychology, and one who has looked into the heart of an ordinary human being sees little to disturb his com- posure when he looks into the heart of the criminal. Given these all but universal tendencies and frailties, h is easy to understand why both juvenile and adult delinquency becomes a serious problem; why there is more of it in certain places and at certain times. Pov- erty increases temptations and lessens resistance — not for all crimes, but for those which are most apt to result in exposure, arrest, and conviction. Fear and uncer- tainty; lack of wholesome recreation and amusement; overcrowding and lack of normal domestic privacy; forced intimacy of association in house or street, re- gardless of whether the people against whom one is thrown are congenial ; the rasping psychological effect of being unable to escape from such crowding; the ner- Crime and the Courts 173 vous excitement of tenement and factory and street ; the absence of real quiet, relaxation, repose, even in sleep, all lead quite inevitably to the street gang and to a sort of persistent, constant warfare with the police authori- ties — a pitting of wits against force. The motives are not vicious, merely human. The impulse to do the things which society, in all the circumstances, cannot permit is a creditable impulse, and the conflict is its natural outcome. If a particular neighborhood has more than its average handicaps and disadvantages — because of a bad reputation, because the more pros- perous and enterprising move away and a dispropor- tionate number of the discouraged and hopeless re- main — the intensity of the pressure, of the inducement to violence, may be correspondingly increased. There may be a "crime wave" because of particular influences which for a time affect large numbers of those in many places who would ordinarily be quite law-abiding, respectable citizens, The World War has such obvious results. Millions of men become accustomed to fire-arms, and of these a certain propor- tion are nervous, excitable, mentally unstable, either by nature or because of injuries or hardships. Those who have naturally vagrant inclinations are up-rooted and find it difficult to re-establish themselves. In the wide-spread readjustment of industry many naturally become unsettled. Chronic unrest, pathological in- stability, is an inevitable result of the war, and the upheavals which accompany and follow it. The worst 174 Social Work feature of a crime wave is that it induces a hysterical inability on the part of the public to deal with it. As soon as life and property seem to be a little less secure because of an outbreak of crimes of violence, there springs up a demand for indiscriminate and drastic vengeance, which carries the administration of criminal justice back into the dark ages from which it has slowly emerged. Hanging, whipping, and even lynch- ing become popular again. Reformation, indeterminate sentence, the discriminating attempt to adapt disciplin- ary treatment to the nature of the offender, are dis- credited. The idea that one "might as well be hung for a sheep as for a lamb"' again takes root in the under- world. Rather than be caught and punished for larceny, the petty offender tries to cover his tracks by murder. Judges lose their sense of perspective, and those who are not viciously criminal get the penalties which society demands for those who are, but who are not caught. Crime has, then, everywhere this double aspect. Legally and technically it is the act which the laws forbid and the courts condemn. Socially it is the inevitable reaction of erring human nature to adverse and crime-provocative conditions. The individual is responsible for rising above those conditions, for react- ing honestly, and if need be heroically, instead of crim- inally. Society is responsible for making such a fav- orable reaction possible, and even for making it easier and more natural than the contrary. Crime and the Courts 175 THE CRIMINAL COURTS Courts, which are historically older than legislatures and whose functions have never been fully confined within statutory enactment or codes, have various other duties, but among them, from highest to lowest, there are certain courts which have criminal jurisdiction. The lowest of these — justices of the peace, city magis- trates, etc. — decide the most numerous and, from the point of view of maximum penalties, the least serious offenses, such as disorderly conduct, vagrancy, and pub- lic intoxication. These justices may act also as exam- ining magistrates to determine whether persons charged with more serious crimes should be held for a county court or some other district court in which such crimes as assault, burglary, and murder are tried. Above these are courts of appeal, to determine whether there have been miscarriages of justice in the lower courts. The names and precise functions of these courts differ in different states, but the three stages are always found. The county court, or what corresponds to it, may act independently of any lower committing magis- trate. Offenses against the laws of the United States are normally tried in federal criminal courts. RESPECT FOR THE COURTS Unfortunately this simple statement of one side of the part played by government, laws, and courts in our social life, while it is justifiable as a statement of our democratic ideal, requires considerable modification if 176 Social Work it is to bear any relation to current facts. Laws will enforce themselves by common consent only when the great body of the people feel that the acts for which men are punished are in fact odious acts, contrary to the general interest; only when the laws are clearly designed to protect the people in their life, liberty, and enjoyment of the gains of their industr3^ Some of the recent acts of our own governments appear to many to have had no such intent. The increasingly acute in- dustrial conflict, which profoundly affects the attitude of both investors and industrial workers towards the government, and the abnormal conditions of war, re- leasing passions which do not quickly subside, and upsetting or twisting many minds which would have been thought most law-abiding, are among the com- plications which make the study of crime at the present moment both more difficult and more interesting than usual, and more essential. Some law-makers and some public officials have ap- parently been more concerned about the security of the existing political and the existing industrial system than about securing to individuals the rights of life, liberty, and the enjoyment of the gains of their own industry. Not that the legislatures and officials ignore these individual rights. They continue to protect them in large measure, else society would dissolve. But in numerous instances when they come into conflict with what are assumed to be the higher rights of the govern- ment itself, or the rights of property, they are dis- Crime and the Courts . \77 regarded to a degree which has unfortunately caused a large part of the population to become suspicious of the good intentions of the state and federal governments in reference to their original and primary purpose. Many persons have been thrust into prison whose offenses are political or economic rather than criminal. The security of private individuals in speech, assembly, and even opinion, has been denied. In some places only those who think, speak, and act in accordance with the views of public officials have been secure, and this is of course to substitute absolutism for democracy. The Attorney-General and the Postmaster-General in the Wilson administration, in extraordinary contrast with other members of the cabinet and with what was supposed to be the spirit of the President himself, became arbitrary censors, gaolers, deporters, and pro- vokers of lawlessness. Some ex-service men, in local posts of the American Legion, abused the confidence and regard in which they were naturally held, to break up meetings called for purposes with which they were not in sympathy, and assaulted speakers of whose views they did not approve. Newspapers were denied second-class mailing privileges even when there was nothing in them which offended the laws. Aliens were held unlawfully in custody, and in some instances with outrageous injustice, pending proceedings for deporta- tion. Private correspondence was seized, headquarters of organizations under suspicion were raided without search warrants. No doubt quite sincerely, but never- 178 So dial Work theless quite unjustifiably, zealous prosecutors became agents of the interest of a particular class — the pros- perous, employing, investing class — as if this were identified with the public interest. Those who spoke or acted for organized workers, especially if the. type of organization was of the more militant or aggressive type, but in some instances — notably in the steel strike in Pennsylvania — even when they represented the ordinary craft unions, were treated as if they had no rights which governments were bound to respect. BAD EFFECTS OF THE WAR The war accustomed us to violence. Fire-arms be- came familiar. Life lost something of its sanctity. Sadistic impulses had ample chance for development. Hatred was cultivated for patriotic purposes as a virtue. The impartial examination of evidence became almost a lost art. Outrages the most fiendish were readily be- lieved to have been committed by enemies on the slight- est evidence, while it was regarded treasonable to accept even the possibility that our own soldiers could have been guilty of any similar acts. The legend of a bol- shevist Russia, capable of all deviltry but of no good action, quickly took the place of German militarism when the latter was defeated on the field and over- thrown at home, for the war psychology, whipped up by long insidious propaganda and regarded as essential to victory, had not had time to spend itself on the legitimate object of its fury. A culminating illustra- Crime and the Courts 179 tion of this irrational war psychology may be seen in the voluminous report of the Joint Legislative Com- mittee of the State of New York Investigating Sedi- tious Activities, whose chairman, Senator C. R. Lusk, and counsel, Archibald E. Stevenson, belong with Palmer and Burleson as the most extreme representa- tives of the tendencies which serve to bring the laws into contempt and courts under suspicion. Appro- priately enough, it is the leaders in the church, in the teaching profession, in journalism, and in social work who appear to the inflamed partisan imaginations of the authors of the report as dangerous to society. They are quite right in recognizing an irrepressible conflict of ideas between such leaders and themselves. Their error is only as to which it is that are the enemies of society,* These paragraphs are not irrelevant to a discussion of crime in a text-book of social work, even though the particular controversies shall have become of merely historical interest before the book is published. It is desirable that courts should be respected, and to that end judges should so interpret and apply the laws as to be worthy of respect. Crime should be odious, and to that end the laws should pronounce as criminal only * Since the above was written, a fittinc? climax to Senator Lusk's post-war activities appears in his admission before a friendly investigating committee of which he is a member that he and his wife and daughter had received "presents" from police detectives whose objectionable bills he had rescued from defeat. 180 Social IVork those acts which are in fact odious. When innocent and even heroic persons are crucified, burnt at the stake, imprisoned, scourged, deported, lynched, tarred and feathered, it confuses the public opinion, blurs the dis- tinctions between right and wrong, tempts the people to think that government is only a weapon in the hands of privilege, and creates the myth that force thus en- trenched in courts, constabulary, and armies can be met only by violence. Revolutionists are openly de- sirous of creating just this myth and rejoice at every instance which seems to justify it — and they have had much cause for rejoicing. SPECIAL POSITION OF COURTS IN AMERICA In America the courts have a higher and more diffi- cult role than in other countries, for it is our custom that courts shall decide whether particular legislative acts are or are not constitutional. The Bill of Rights is in the Constitution. There are also in it certain phrases — chief among them one which declares that property shall not be taken without due process of law — which have had very extraordinary judicial elab- oration. The.xourts are on trial before the bar of a slowly forming public opinion as to whether they will become the bulwark of property or the bulwark of human rights. They will profess to be both, but in the conflicts which are impending they will have to become mainly one or the other. They cannot be both. Property is making claims which cannot be justified Crime and the Courts 181 by any function which it performs, any service which it renders. If nevertheless in all its forms it is held sacred, if the rights of those who receive large incomes without corresponding service are held inviolate, and legislatures are unable to create new legal forms which correspond to the living realities of our own time, then the public good-will on which courts depend will be undermined and there will be a need for new organic laws, in which governments will be recalled to their primary functions and courts will be created which contribute to the legitimate ends of government. \ In contrast with the anti-social and partisan tenden- cies which some courts have shown, there have been encouraging developments. The United States Su- preme Court and some of the state supreme courts have shown an inclination to apply the rule of reason, and have admitted evidence for their enlightenment and guidance which has been gathered from the literature and experience of the social agencies, SPECIALIZATION OF COURTS The creation of specialized courts — such as juvenile court, family court, bastardy or filiation court, night court, small claims court, court of industrial relations, and courts to determine cases of alleged violation of municipal ordinances — represents an interesting differ- entiation of judicial functionsT/ Some of these are wholly experimental, and may be modified or abandoned after trial. Duties at first assumed by juvenile courts 182 Social Work may be transferred to family courts or to public school authorities. The necessity for a night court may dis- appear through the disappearance of the particular abuses which it was intended to correct. Industrial relations may prove to be more suitable for the juris- diction of a commission than a court. The tendency, however, to create a special court whenever there is work enough of the particular kind in the existing courts of a given jurisdiction to justify it is to be en- couraged. Both judge and court officers, by specializing on a particular kind of case, naturally become more skill- ful in adjusting or deciding them. Procedure adapted to the rational treatment and the prevention of the offence is developed. The public more easily absorbs the lesson to be learned from experience, since this experience is isolated from the general mass of court work and concentrated where those interested in the particular problem may come and study it. Thus juvenile courts have caused the problems of juvenile delinquency to be better understood. They have had a wholesome iniluence on parents and on the juvenile reformatories. They have permitted a much wider use of probation and "big brothers." They have facilitated the scientific study of the mental peculiarities of juvenile delinquents, j, They have re- vealed more clearly the intimate relation between mental defect and delinquency, and the importance of voca- tional schools and the improvement of secondary schools generally in the prevention of truancy and Crime and the Courts 183 juvenile offenses. This progress has been made here- tofore mainly in the cities. The extension of juvenile court methods, including probation, to the smaller towns and the open country is clearly essential. In order to protect the victims it might be advisable to extend the jurisdiction of juvenile courts to sex offenses against children committed by adults. THE FEMALE OFFENDER Criminal statistics indicate that in general there are comparatively few female criminals except for one class of offenses. So true is this that the phrase "female offender" when unqualified is usually taken to mean a prostitute. The "female offender" in this sense is presented by a school of "s cientific" criminolog ^v as corresponding to the typical male "criminal," and is believed to be similarly characterized by definite physi- cal stigmata and mental traits. This predominance of women in sex offenses is of course technical — the re- sult of the artificial distinction under which legal pros- titution consists in offering the body to indiscriminate sexual intercourse for hire, and does not include the offer of money in payment for such intercourse, thus outlawing only the woman's half of a transaction in which from the social or the moral standpoint there is no perceptible difference. The legal distinction is sim- ilar to that which leads to a similar injustice in con- nection with bribes. The bribe-taker is far more apt to be punished than the bribe-giver. The latter is in 184 Social Work fact often represented as the rather innocent victim of coercion, just as the frequenter of a house of prosti- tution is held to be the victim of temptation. A very good case can be made for precisely the opposite view in both instances. The beginning of corruption is in the demand, the desire of the one who can pay, rather than in the supply, the offer of the body or of official favors for hire. It does not follow that much is to be expected from the mere outlawing of the male patronage of disorderly houses. The results of treating the women in them as criminals has not been reassuring. The persistent sup- pression of commercialized vice, prosecution of pro- prietors, procurers, owners of premises used for prosti- tution, of those who live from the proceeds of prosti- tution, male and female, as vagrants, have been recom- mended by all careful students of the subject. The sex discrimination should cease, and energy should be con- centrated on the rescue and training of individuals, the treatment of disease, the protection of the mentally defective, a persistent attack on all the degrading con- ditions which tend to make female offenders of girls and women who have less than normal resistance or more than the ordinary pressure to resist. CHAPTER XII TREATMENT OF CRIMINALS In the broad field of crime three general classes of offenses are recognized : felonies, misdemeanors, and violations of local ordinances. The word crime may be restricted to the first two of these categories, or, more broadly speaking, may include also the third. The felon was supposed to be malignant, vicious, infamous. His offense under early English law was one for which lands or goods might be forfeited, with of course addi- tional and more severe penalties according to the par- ticular act of which he was found guilty. <^ In New York at present any crime is a felony for which the offender may be put to death or imprisoned in a state prison, and this rneans a sentence of imprisonment for one year or more.^ Lesser crimes, usually punishable by incarceration in a county penitentiary or work-house or by fine, are misdemeanors. Violations of municipal ordinances or disorderly conduct, although punishable, are not regarded as criminal in the sense of exhibiting moral turpitude. The elaborate classification of criminal acts, and the careful gradation of penalties, each to fit some particular 185 186^ Social Work act or the circumstances under which it was committed, represent progress away from cruel and arbitrary pun- ishments of an earHer day, but they have ceased to correspond to the social treatment of crime as modern penology conceives it. The offender rather than the specific act is now regarded as the center of interest. Social defense rather than vengeance furnishes. Jhe sanction for the treatment which the offender is to re-, ceive. Prevention and reformatiOTr"aTe-p«me consid-" erations. If these are impracticable then segregation of the incorrigible offender, not on a brief sentence for each offense, but permanently, is the logical alter- native. If the offender cannot be prevented from corn- mitting criminal acts by due warning, education, and discipline, it is probably because he is morally perverted or mentally defective, and in either case hospital care, in his own interest and in that of society, rather than repeated arrests and convictions and punishments, is what he requires. AN IDEAL PLAN FOR THE TREATMENT OF CONVICTED OFFENDERS The end towards which the reforms and experiments of the last few decades seem to point is the transforma- tion of all our jails, prisons, penitentiaries, and re- formatories into a closely knit series of three institu- tions — all under state rather than local supervision : (1) A place of detention for all convicted offenders, for physical, mental, and social exam- Treatment of Criminals 187 inatlon. Here a competent commission with ade- quate facilities would decide what treatment the offender requires, due consideration being given to the public interest as well as to his own. From this temporary place of detention all would be passed on to probationary oversight at home or elsewhere or to one of the two permanent insti- tutions. (2) A school, or reformatory, which in its several departments would be equipped appropri- ately for every teachable, reformable offender, (3) A colony, or hospital, for those who are unimprovable, or whose offenses are so revolting and unnatural that society cannot — at least for a time — tolerate their presence at large, however completely they may seem to have reformed. REACTIONARY TENDENCIES OF THE MOMENT No mention is made of the death penalty or of de- grading punishments. At the time when these words are written the tendency is towards a revival of capital punishment, the infliction of severe deterrent penalties, and frequent resort to swift and summary "justice" without trial for certain offenses. But these tendencies are due to temporary causes and can be regarded only as a lamentable retreat over ground which has been slowly and painfully won in the past, and which will have to be regained, it may be at grievous cost. 188 Social Work The objection to hanging, electrocuting, burning, and to whipping posts, stocks, and other degrading or humiHating forms of punishment, is that they do not accompHsh their purpose as deterrents and that they do have a debasing effect on those who inflict and on those who witness or tolerate them. Men cannot treat even criminals brutally without becoming for the time being brutes themselves. They cannot treat those who are merely suspected of crime, or perhaps wrong- fully charged with it, in a vengeful and cruel fashion without whetting the latent primitive lust for cruelty and laying up a store of blind vengeance for future victims. - EARLY EDUCATION Crimes have their origin in undisciplined human passions — lust, cupidity, anger; or in maladjustments which involve too great a strain on a low intelligence, an undeveloped personality. To say that many petty thieves do not know the difference between mine and thine might be misleading. They may have the knowl- edge which the law assumes to be essential for criminal responsibility and still not have had such a clear and convincing explanation of the reasons for the distinc- tion as even children can understand. The fact of the distinction is most easily inculcated in earliest infancy, by a parental authority, especially if there is fraternal co-operation. But the personal and social advantages of respecting the property of others may be set forth Treatment of Criminals 189 more and more clearly as the children grow older, until the time comes when there is a harmonious ad- justment between the instinct of possession on the part of the one and the instinctive recognition of the sacredness even of unprotected property on the part of the others. These developing and complementary instincts become the natural basis of the social treat- ment of crimes in respect to property, such as larceny, burglary, forgery, obtaining goods under false pre- tenses, infringement of copyright or patents, cheating in trade, conversion of trust funds to personal use, fraudulent misrepresentations of the value of securi- ties, unlawful monopoly, restraint of competition, coer- cion in trade, and oppression through economic privi- lege. THE NEED FOR JUST LAWS INTELLIGENTLY ADMINISTERED The laws and regulations in regard to property have been slowly developed through the generations for a good social purpose. They are intended to promote security in the possession and enjoyment of the fruits of industry. They are intended to secure life and lib- erty and to promote the happiness of individuals in society. What is essential is that the generality of men should find in their own experience that they are working to these ends. It is not enough that they be assured of this by their teachers. In the long run they will not believe it unless it is true. The laws 190 Social Work must be founded on well established principles; they must correspond to our inherited and instinctive needs. They must be flexible and adaptable to new needs, or to those newly recognized.- — 'They must be ethical, equitable, just. They must be impartially enforced and intelligently administered. Assuming these funda- mentals, we may expect that those who knowingly and wilfully violate the laws will at once come under public disapproval. They may have excuse. If so, we will take it into account. They may have been uninstructed. If so, we will instruct them. They may have some physical or mental twist which requires expert skill to correct. If so, we will put skillful experts at the task. They may have unique temptatiofis. If so, we will either remove the temptation or seek to strengthen the will to resist. They may have unreas- onable burdens. If so, we will if possible lighten them. What we cannot tolerate is that they shall con- tinue to disobey the laws. TREATMENT OF OFFENDERS BY WARNING Society has discarded many forms of discipline and punishment which were formerly used. The pres- ent reliance is, first, upon warning, with or without a technical arrest. Policemen and other peace officers in practice deal with a very large number of small offenders in this way. Fast driving, ball playing in city streets, cruelty to horses, obstructing fire escapes, and many similar misdemeanors or irregularities, are Treatment of Criminals 191 likely to lead to a sharp reprimand rather than to an ar- rest, although repeated offenses, or even a first offense under certain circumstances, as when police officers are under some constraint to make a record for arrests, may bring the unlucky offender directly into court for a fine or worse. Judicial admonition and rebuke may follow or take the place of the policeman's warning. Such counsel and advice are a very important part of the duties of the Juvenile Court judge. Parents may be W'arned in this way concerning their responsibility for the conduct of their children or their obligations to their children, Man and wife may have a very beneficial lecture from the judge in a court of domestic relations. Foreign-born residents whose delinquencies may be due to their ignorance or to a racial prejudice of their neighbors, may thus get a friendly lesson under circumstances which will impress it upon their memory. They will be fortunate if they do not instead have the disservice of a complete lack of understanding, resulting in some flagrant injustice, or at least in a failure on the part of the court to take advantage of the opportunity for promoting the process of American- ization. PROBATION If it appears that a crime has been committed by the accused and that imprisonment would be warranted by law, recourse may still be had to what is called probation. This, as at present understood, is something 192 Social Work more than a mere understanding between the judge and the probationer. It is a system of discipHne and correction implying probationary oversight, exercised by a probation officer. "^This may be a man or a woman, paid or unpaid, with or without ordinary pohce powers. The duty of the probation officer is to see that the conditions under which sentence is sus- pended are carried out; that the probationer shall forsake his evil ways and conduct himself in a law- abiding fashion, especially as to the offense of which he has been found guilty, but also generally, in other re- spects ; that any necessary aid is given in finding work or in cutting away from bad associations or in overcom- ing bad habits. The probation officer is expected to see his charge regularly, and also, if necessary, irregularly; to visit his home, and perhaps his place of employment, being careful however not to cause him in this way unnecessary embarassment ; and to report to the court at stipulated times until the end of the probationary period whether his conduct is satisfactory. ^The pro- bationer may be re-arrested and even imprisoned on the original charge if he violates wilfully the conditions of his probation, or the new misconduct may be the occasion for new charges, and trial, with the probability of losing the probationary privilege. The probation system is now used extensively both for children and for adults. It is of course less expen- sive than imprisonment, and in a large proportion of the cases of first offenders it is effective in its main purpose Treatment of Criminals 193 of preventing a repetition of the offense. It avoids the positive evils of prison hfe, its bad associations, its hardening of a young offender into a professional criminal, its embittering of the soul of the young pris- oner who may have been far less of a criminal in intent, in spite of his illegal act, than many who are not caught and prosecuted and convicted. FINES Warnings and probation are substitutes for pun- ishment, but the fine, which we have next to consider, is a penalty, one of the means by which the lesser crimes are punished. The imposition of a money payment as a penalty for the violation of law goes far back into ancient customs. It still carries with it something of the idea of expiating a fault, satisfying a claim which originally might have been regarded as a private, personal grievance rather than a claim of society. Res- titution of what had been wrongfully seized, perhaps two-fold, and several other historic penalties from one or another source of our existing public law, have left their traces on the fine system. Fines have survived and have replaced most other penalties except imprison- ment mainly because they afford a simpler, easier, more universally applicable form of punishment than whip- ping, ducking, branding, or any of the other penalties which have been tried. If incomes were equal, so that the marginal value of a given sum of money would be the same subjectively for all, the fine would be more 194 Social Work equitable than it is under our actual conditions. The famous fine of $29,000,000 which Judge Landis im- posed on the Standard Oil Company and did not collect was not in fact a more severe punishment than many a five dollar fine imposed on a poor man or woman who has to borrow it before paying it, or go to prison for lack of it. To some extent courts take into account the circumstances of the defendant in fixing the amount of a line, within the Hmits of their discretion. These limits are narrow, however, and the alternative of imprisonment has often to be accepted by the poor, when persons in better circumstances will be able for the same offense to pay a fine which involves little or no hardship, except the humiliation and perhaps trifling inconvenience of appearing in court. The probationary fine, i. e., release under probationary oversight until the fine is paid, giving a chance for the probationer to earn the amount, is a mitigation of the hardship for those who have no money which they can spare and who cannot borrow it. At best the pen- alty of a fine bears very unevenly on different offenders according to their means. Courts sometimes aggra- vate rather than lessen the hardship. For example, after the exposure of the Lockwood Committee in New York in regard to the amazing frauds, coercion, black- mail, and corruption in the building industries, at a time just after the world war, when because of the scarcity of dwellings such practices were especially atrocious and detestable, the labor leaders who were Treatment of Criminals 195 convicted were as a rule sentenced to prison, with uni- versal approval, while the courts punished only with fines the equally guilty contractors who to their own pecuniary advantage had engaged in these corrupt and illegal practices. Technically the crimes of which they were guilty would be described in somewhat different words, but from the moral point of view, to which, as we have said, the administration of the laws must conform if they are to be respected and willingly obeyed, the contractor who buys the services of a corrupt labor leader with profit to himself is certainly just as guilty as the one who is bought, and a fine which takes only a small portion of his illgotten gains is a very inadequate penalty, whether from the point of view of the vindication of outraged law or from that of preventing similar injury to society in the future. DENIAL OF PRIVILEGES AS PENALTIES Fines are sometimes supplemented by the withdrawal of some privilege, as for example a driver's auto- mobile license, in case of repeated convictions for reckless driving, or of the privilege of renting apart- ments in a tenement house which has been built in violation of law or which is not kept in a sanitary condition. In this direction there is an opportunity for a beneficial development of penalties which fit the offenses and which are likely to be exceptionally effec- tive as correctives and preventives. 196 Social Work PAYMENT OF PRISONERS After the probationary fine, a next logical measure for those imprisoned is their employment in such a way that payment can be made to their families or to the prisoner himself on discharge. Several attempts have been made in this direction, especially in cases in which a man is imprisoned for non-support or ill treatment of his wife and children. Obviously it is a sorry remedy for non-support — as it used to be for debt — to put the delinquent in such a position that he cannot support his family if he will. Sometimes this is preferable to the presence in the family of a nom- inal head who makes no effort to play the part, but compulsory work of a disciplinary or educational kind which will yield some surplus income for the family is clearly better than imprisonment which is punishment and nothing more. PRISONS : A CONFESSION OF FAILURE To most persons the word crime suggests at once the word prison. Criminals are thought of as normally incarcerated, or as on their way to or from prison. If they are not in prison they are probably not receiving their deserts. If they have been in prison they will probably eventually go back. There is something very naive in this association of criminals with a prison. It can hardly have arisen because of any con- spicuous success of the prison as a means of dealing Treatment of Criminals 197 with crime. It has not reformed many of those whom it has sheltered. It has certainly made criminals of many of them in whom the process had hardly begun. It has put a brand indelible as that of Cain upon the mmds of a large proportion of those who have been its inmates?) The prison is in reality the ultimate Con- nies, v ofso fession of^social failure. It is an expression of fear. Society knows of no other protection from these bur- glars, thieves, forgers, wife beaters, gunmen, and therefore we lock them up, put armed guards over them with orders to shoot if they attempt to escape. We are uncomfortable when they come out at the end of a sentence and breathe more freely wdien they go back again. We establish shops and classes for them, but without real expectation that it will make much difference. We parole some of them and shorten the term for good behavior in prison, and now and then a sympathetic voice is lifted in their behalf — speaking as if some kind of kinship with ourselves were recog- nized, some of the ordinary qualities of humanity, in the boys and men who are now in the prison or have recently been there. But most red-blooded men regard this as a sort of sentimental lunacy or a conventional fiction allowable to chaplains and women but rather out of place in a warden or law-abiding male citizen. THE COUNTY JAIL At the bottom of our prison system is the county jail or town lock-up, which serves the double purpose 198 Social Work of a place of detention for those charged with crime who cannot furnish or are not allowed to give a bail bond for their appearance for trial, and a place of imprisonment for those whose terms are too short to make it worth while to take them to a penitentiary or state prison or who for any reason are sentenced to serve their term in the jail. Of all our prisons the jail, with few exceptions, is the worst and most con- spicious failure. No institution can properly serve the two purposes above mentioned. If we had a com- plete registration of the whole population, constantly corrected with every change of address, it would seldom be necessary to lock up any unconvicted persons except those charged with the gravest crimes. During the war we had such a registration of all men of mili- tary age. Through tax departments, school authorities, health services, automobile licenses, etc., we already have numerous partial registrations, most of which might be consolidated into a single complete registry, through which health or police or tax department might easily and quickly locate any person desired. It is absurd to assume that any one would become a fugitive from justice rather than take the chances of trial and punishment, if throughout the country there were everywhere facilities for identifying strangers and if it were the custom for all who change their residence to report that fact at once to the local bureau of reg- istration. Even without this change, desirable on many other grounds, imprisonment in a jail before trial Treatment of Criminals 199 could easily be avoided in many cases. The night court was established largely for the very laudable purpose of avoiding detention over night and preventing the extortions of those who hang about the city police stations to furnish bail for persons awaiting trial. A prompt hearing on all minor charges is an obvious right of the accused. The graver faults of the jail, however, are associated with their imprisonment of petty offenders. These inmates, sentenced repeatedly for vagrancy, disorderly conduct, intoxication, prostitution, and other ofifenses, become often regular habitues of the jail. They corrupt one another and any youth who may get into jail, whether awaiting trial or serving a short sentence. The whole system is wrong from the ground up. The imprisonment of human beings as a punishment for crime is a very serious proceeding. It should not devolve upon the county, but, as far as it is necessary at all, upon the state. County commissioners have a variety of duties to perform in connection with roads, bridges, elections, poor relief, schools and courts and other matters, and they are seldom expert in any of these directions. The county is a very important unit of government, but few citizens realize it, and there are few safeguards for the adequate performance of the functions devolving upon the small board of commissioners who constitute its legislative and to some extent its executive organ. We read in the daily press of the proceedings of state legislatures and of 200 Social Work city councils. The mayor and other city officials are much in the public eye. For some reason county commissioners and those who are responsible to them receive relatively scant attention. The jail may be dirty, infested with vermin, a lire trap, a place of forced indiscriminate association, a breeder of crime, and these facts remain unknown to the public. A casual visit to the jail may not disclose them. The sheriff and his family may live under the same roof and not realize all that goes on under that roof. The jail is not large enough to permit classification, or important enough to be kept under rigid supervision. It is a back eddy of social neglect : a place where human beings are punished, innocent with guilty, unfortunate with vicious, and yet, because it has ordinarily only a few inmates, because it is local, informal, a personal enter- prise oftentimes of the jailer, because the inmates are assumed to be there only for a short time, and mainly because nobody cares, it is a sad blot — not by any means the only one — on our treatment of criminals. These facts have often been pointed out. They are well known to penologists and reformers. Some jails have been so constructed and are so managed that they are models of sanitation and architecturally above reproach; but the fundamental errors remain of confining in one l)Iace those who are awaiting trial and are assumed to be innocent with convicted offenders, however brief their sentence, and of entrusting any part of the grave responsibility of imprisoning men and women as a Treatment of Criminals 201 punishment for crime to a local government as unfitted to bear such responsibility as a county or town. PENITENTIARY AND STATE PRISON The penitentiary, as its name implies, was orig- inally invented as a place of retirement for penitents. It was conceived in a spirit of reform. The work- house, as its name suggests, was also intended to be a place in which a beneficent change should be wrought in the character of those who are sent to it. It was to be a house of industry, of correction, of disciplinary training. The reformatory has been christened even more recently with the same hope of substituting reformation for punishment, and this theory still per- meates to some extent its regime. We have juvenile reformatories and others intended for adult felons or misdemeanants, usually technically first offenders, although in fact a large proportion of those who are sent to an institution like the Elmira Reformatory are already very familiar with criminal courts and their penalties. There is now no generally accepted distinction between prison and penitentiary. The state prisons are in some states called penitentiaries and the term is also used for federal prisons, while in New York it is a county institution, distinct from the state prisons, in which the graver crimes are pun- ished. Reformatories have come to be so much like prisons that institutions which might formerly have been called by that name are now often known as 202 Social Work industrial schools, or by some non-committal name, such as Whittier School or Children's Village. The attempt to make prisons useful to their inmates is never quite given up, although the results are sadly discouraging. Society cannot afford to give up the attempt. The prison is a sober reality of our existing social order — one of the most stubborn and dominating realities. To condemn the thousands of prisoners to isolation and also to neglect is impossible. . Therefore we have voluntary prison associations and other agen- cies, which are constantly seeking to improve the penal codes and criminal procedure and the management of prisons, to secure the appointment of capable and honest superintendents and wardens, to keep the prison ad- ministration free from corrupt politics, and to make it serve its professed purpose of social defense against crime. We have also official state commissions and frequent legislative committees, whose function it is to advise the legislatures, to report on the conditions in the prisons. We have a variety of prisoners' aid so- cieties, to help discharged prisoners and the families of those who are in prison. We have an increasing number of private citizens who independently or in as- sociation with the official or voluntary agencies strive to the same worthy ends. THE GOAL : ELIMINATION OF THE FUNDAMENTAL IDEA OF THE PRISON The dimly recognized goal of social reform in the Treatment of Criminals 203 field of crime is such a transformation in our system as will eliminate the fundamental idea of the prison altogether. While that idea persists each new institu- tion — penitentiary, workhouse, reformatory, or what- ever it may be called — will gravitate toward its level. Let the responsibility for fixing terms of imprison- ment be taken away from the judges altogether, leaving to them only what they are well qualified to do, viz., decide whether a crime has been committed and whether the person charged with it is in fact the one who has committed it; and let all subsequent pro- ceedings be transferred to a wholly different group, who in consultation would be qualified to decide the medical, educational, economic, and social problems involved in the rational treatment of the convicted offender. They would need, as has been suggested, a detention place for the study of their charges, and there, taking whatever time might be necessary, they would determine whether they are in reality normal but untaught, or patients to be treated or permanently segregated. From detention laboratory they would go either into a school or a hospital. The prison, and all the degrading associations which belong with it, would disappear. Few would ultimately prove incor- rigible, and they only because they are insane. This is not an easy-going view of crime. On the contrary, it is to take crime seriously, and to bring to bear upon the criminal all the regenerative, educational, and coer- cive forces of society. CHAPTER XIII IMPROVEMENT OF CONDITIONS: I Poverty, disease, and crime furnish the bulk of the social work undertaken by individuals, by voluntary associations, religious and secular, and by the govern- ments, federal, state, and local. Social service may be necessary or desirable for an individual or a family not actually dependent, if there are reasons to fear that the earning capacity is diminishing or that in some other way the line of economic insufficiency is within sight. It may be necessary or advisable for those who are not already so ill as to require hospital care, if there are reasons to anticipate a break-down, physical or mental; if there are discernible dangers to health which a social worker could remove or diminish. It may be necessary or essential to anticipate the intervention of the police; to intervene in the spirit of social work to break up associations and influences which are likely to lead to criminal conduct. The churches, clubs, lodges, settlements, craft unions, political organiza- tions, and other social institutions which bring people together on some other basis than that of failure in life, have innumerable opportunities to do what a set- 204 Improvement of Conditions: I 205 tlement worker has called "second-story case-work," i. e., social work similar to that which charitable agen- cies do for their families, but before the crisis is reached which would justify application to a charitable society. Finding a job of a suitable kind for a boy or a girl just out of school, reconciling man and wife or parent and child, keeping an inebriate or a drug addict away from temptation, counselling an immigrant in regard to the locality where his labor is needed, advising a tenant as to his rights and his duties, secur- ing bail for an accused person awaiting trial, and countless other services, may be needed by almost any one, and they are far more typical than the traditional giving of an order for groceries or fuel of the activi- ties of the social w^orkers in the families which come under their care. The technique which the latter acquire should therefore become familiar to the largest possible number of people, and the common sense and knowledge of ordinary affairs which plain people dis- play in their relations with one another should permeate social work, to disinfect and correct what Bishop Brent calls "the crippling conceit of undue specialism." PREVENTIVE CASE WORK Social work in families may be called preventive quite as justifiably as that which is done to improve social conditions. The main purpose of home service and of much institutional treatment is preventive. To prevent the recurrence of illness or dependence is in 206 Social Work the mind of the physician and social worker ahke, even while they are relieving present distressing symptoms. Probation of an offender is nothing else than an attempt at prevention, and police departments are specifically charged with the prevention of crimes. It is a very short-sighted or perverted view of a police force that gauges its efficiency by the number of arrests and convictions. It is an equally inadequate test of a relief society to ask how much money it spends for relief as compared with what is often mistakenly called "overhead" or "administrative" expense, but should be regarded as cost of service. Relief societies do have administrative expenses, properly so-called, but they do not include the salaries paid to social workers en- gaged in home service. These visitors, if qualified for their duties, are engaged primarily in preventive work, and whether they should spend much or little for material relief depends entirely upon circumstances. 11ie cost of their service is as little overhead or ad- ministrative expense as is the cost of the relief. THE TEMPERANCE MOVEMENT In addition to all that social work does or should do for the poor, for the sick, and for those who have offended against the laws, and all that is done by social workers or others for particular individuals and families who, although not dependent, have difficult problems analogous to those which arise in dependent families, there remains the kind of social work which Improvement of Conditions: I 207 is concerned with the neighborhood or the nation as a whole, with handicapped groups as distinct from indi- viduals, with working or living conditions which re- quire correction. One of the oldest and most widely diffused illustra- tions of this kind of social work is what is known as the temperance movement. It has had two main divi- sions : the moral appeal for personal temperance, eventually for total abstinence; and the political agita- tion for the control, eventually for the entire prohibi- tion, of the manufacture and sale of alcoholic beverages. The one side has on the whole reinforced the other, though there have been some temperance advocates who have not been prohibitionists. The history of the temperance movement in America is instructive. The idea that it has been merely the expression of a puri- tanical view of life, of a fondness for sumptuary legis- lation, of a desire to dictate the food, dress, or amuse- ments of neighbors, has very little foundation. The evils of strong drink are too obvious, too wide-spread, too intricately mixed up with every other evil which social workers encounter, to permit temperance advo- cates to be described as social meddlers. The inebriate is the enemy not only of himself but of his family and his community. He increases disease, vice, poverty, and crime. Not his ill will but his weakness is his undoing. He cannot protect himself. Society must protect him by removing the opportunity for his indul- gence. Not the prospective victim, but the one who 208 Social Work would profit by exploiting his weakness, is the objective. The movement naturally came to a head in the Anti- Saloon League. It was the saloon, with its attractions, its glitter and sociability, its club life concealing and camouflaging its evil, that was the legitimate object of attack; but the brewery and the distillery, of which the saloon was only the retailing outpost, had to go also. The enactment of national prohibition does not end, although it brings to a dramatic climax, the temperance movement. There will still be occasion for educational campaigns, different from, but not less extensive than those in the past. Scientific instruction in the effects of alcohol will still be desirable. Substitutes for the social life of the saloon will be desirable, even though the effects of the disappearance of the saloon in this respect may have been exaggerated. -, Persistent and reasonable enforcement of the prohibition laws will require the enlightenment of public opinion and the vigorous support of courageous officials. Pessimism in regard to the possibility of such enforcement will easily arise, and against it law-abiding citizens will need to be on their guard. The prohibition of the manufacture and sale of alcoholic beverages is a sound public policy, because it is the only known method of getting rid of alcoholism, a disease comparable only to tuberculosis; the only known method of destroying the saloon, the greatest curse which our American social life has developed; the only known method of eliminat- hnprovement of Conditions: I 209 ing that vast amount of poverty which results from the intemperance of men and women whose hard-earned incomes have yielded fortunes to distillers, brewers, and owners of saloon properties, rather than the necessi- ties and comforts of life to the wage-earners on the margin of subsistence. Exploiting employers may well be disturbed when underpaid workers, instead of gather- ing in the saloon to indulge in drunken cursing against the boss, gather instead in their homes or their unions, with clear brains, to think out their economic prob- lems, and to decide thoughtfully how they may trans- form their drudgery into such work as rational human beings may enjoy. HOUSING The housing movement is largely an effort to over- come the recognized evils >f city tenements : over- crowding, dark and ill-ventilated homes, danger from fires and from insecure construction, lack of toilets and running water, bad housekeeping in the common services, such as the removal of ashes and garbage and the care of halls and stairways. To these evils, which housing laws or ordinances now fairly control in many cities, there has been added after the war, at a time when the cost of living is in other respects going down, excessive rentals, caused in part by in- creased expenses of landlords, but also in part by con- spiracies on the part of producers of building materials to extort excessive prices, and by complicated labor 210 Social IVork situations which have gravely threatened the public interest through making the construction of houses unduly expensive, if not impossible. The housing reform movement rests on the ideas that the physical basis of the home is decisive of the character of family life, and that after houses are once built, they will be occupied; that a safe, decent, and comfortable dwelling is the first essential of a normal standard of life; that the laws may properly prevent the construction of unsafe, ill ventilated congregate dwellings, however profitable they may be to specula- tive builders or owners; that supervision by experts over each stage of construction is essential, and subse- quent official inspection to discover unsanitary or unsafe conditions; and that an enlightened public opinion among tenants and citizens generally is the only safe- guard for the maintenance of good conditions. The erection of model tenements, and smaller dwell- ings, for one or two families, by public-spirited philan- thropists, has shown that it is possible to make a reasonable return on such investments ; and the manage- ment of old properties after putting them into good condition, on the plan originated by Octavia Hill in London, has shown that housing reform need not be limited to new and expensive buildings. The rent collectors have under this system become social workers, with unique opportunities for useful service in the homes of their tenants. The logical first step for a citizen's committee or Improvement of Conditions: I 211 association bent on improving housing conditions is to make a thorough investigation of the local conditions. The particular evils to be remedied may be very dif- ferent from those which had been the object of reform elsewhere. There may be ample light and air in all homes, but dangerous privy vaults or cesspools. There may be windows, but the dwellers may not appreciate the importance of opening them. The houses may be scrupulously swept and cleaned, but from unswept and unsprinkled streets there may be a constant sifting in of dust and dirt. There may be piles of rubbish to be removed. Real estate taxation may be obsolete, oppressive, or inequitable. There may be no town plan, or it may be a very bad one. From the National Housing Association or other source expert advice may now usually be obtained in the making of this initial investigation. On the strength of the knowledge thus obtained it will be decided whether new laws or ordinances are necessary, or merely the enforcement of existing regulations and the education of builders, landlords, and tenants. There are many natural allies in any such educational movement. Architects are naturally interested. Civic bodies like the Chamber of Commerce should be. The press should be sym- pathetic. Sermons might well be preached on the rela- tion between decent homes and a wholesome family life. Women's clubs are natural leaders in this sort of social work. There is need also of the individual enthusiast who is willing to run the risk of becoming 212 Social Work a nuisance, but who has the tact and good sense which will enable him to keep up the agitation without actual offense, unless to those whom it is finally necessary to coerce. We are only at the beginning of this task. The com- plete re-planning of our cities, the creation of beautiful, sanitary, and well located homes, is the large goal of social work in the field of housing. LOANS : PAWNBROKING AND ITS KIN Pawnbroking, chattel mortgage loans on furniture, and salary loans have given rise to a reform movement to be accomplished through public education, legisla- tion, and Avhat may be called socialized or public-spirited investment. These forms of credit business are quite as legitimate in themselves as the loans on real estate, stocks and bonds, or similar collateral security or com- mercial paper, which form the staple business of banks. The pawnbroker and the "loan shark" have a bad name, not because there is anything inherently degrad- ing in their kind of banking, but because there have been no recognized standards for carrying it on, no public interest in the prevention of unfair and extor- tionate practices, no means of protecting the borrower in his rights. The pawnshop and its three gilt balls had come to be associated with the "fence" of stolen goods and the usurer's sharp practices. The family that borrowed money for living expenses on the security of their furniture; or that bought furniture on the Improvement of Conditions: I 213 installment plan, leaving title in the dealer until the last payment was made, was very apt to lose the furniture in the end or to pay far more than its value. Worst of all was the position of the clerk who, without either pawnbroking or chattel mortgage securities to offer, entered into a soul-enslaving contract, often one which he could not afford to have either his family or his employer know about, and then, under blackmailing threats, paid and paid, each renewal bringing him further and further into the mire. The European Monts de Picte are institutions — usually municipal — for meeting the demand for small loans on a pledge of clothing, jewelry, or other per- sonal property. There are advantages and serious dis- advantages in governmental management and the use of public funds in this field. The Provident Loan Society of New York — a sort of philanthropic pawnshop — undertook in the early nineties to combat the recognized evils of the old unreg- ulated pawnshop by the method of competition. Sev- eral well-to-do and public-spirited citizens, no one of whom would perhaps have cared to go into the pawn- broking business individually, formed a corporation, for which the legislature granted a special charter, to make loans on the sort of personal property which pawnshops ordinarily accept in pledge. They limited profits to six per cent on the money secured by the issue of certificates, and they also raised funds by bond issues at a lower rate. They fixed interest charges 214 Social Work much below the maximum rates allowed by law, and eliminated the practices through which the pawnshops exploited their customers and evaded the law. They have extended their business through branches into all those parts of Greater New York where such facilities are most needed, and have demonstrated on a large scale that the reputation of a business which had been made disreputable by the manner in which it was carried on can be redeemed by fair practices and sound social policies. The Society now owns the numerous buildings in which its business is conducted, has accumulated a large surplus, and loans annually many millions of dollars. If the rate of interest on secure long-term investments permanently remains above six per cent the Society may have difficulty in obtaining, under its present charter, the capital re- quired for an expanding business. The Russell Sage Foundation has made an exhaus- tive study of this subject and effected far-reaching re- forms in the field of industrial loans. From its exam- ination of actual conditions the Foundation reached the conclusion that loan sharks thrived chiefly because existing laws were too stringent to attract legitimate capital into the small loan business. It was seen that the only effective way to remedy the situation was by legislation which would permit a sufficiently high rate of interest to encourage open competition among lenders and at the same time provide machinery for enforcement of the law. The Foundation therefore Improvement of Conditions: I 215 recommended the adoption of the so-called Uniform Small Loan Law, which legalizes an interest rate of 3y2 per cent per month on loans up to $300, and places the business under the supervision of the state banking department or other form of state control. This law has already been enacted in nine states of the union, and efforts for its extension are being made each year. Acting in concert with the Foundation in its en- deavor to redeem the small loan business and to stan- dardize legislation pertaining thereto^ is the National Federation of Remedial Loan Associations, whose membership is composed of semi-philanthropic so- cieties, operating in the leading cities of the United States, which make small loans upon the pledge or mortgage of personal property at reasonable interest rates and limit their returns to shareholders in pro- portion. They have also aligned in support of the Uniform Small Loan Law most of the former high- rate lenders, now organized as the American Industrial Lenders Association, whose declaration of principles is substantially the same as that of the National Federa- tion; except that it contains no provision for limita- iton of dividends. A similar movement has recently been started by the National Federation for the enact- ment of a uniform law to regulate the business of pawnbroking. The problem, as in the case of housing reform, has three distinct aspects: (1) legislation, to determine^ the level below which no one shall be allowed to con- 216 Social Work duct the business at all; (2) public education in the principles on which the legitimate needs should be met, and as to the evils which can and those which cannot be remedied by legislation; and (3) the encouragement of investment on a sound but not an exploiting basis, as a means of bringing to bear beneficent competition. In housing "philanthropy and five per cent" gave a certain number of model dwellings which answered once for all the dishonest plea that safe and decent houses could not be built to rent for a reasonable sum. Public education is indispensable. The fundamental essential, however, is a comprehensive housing law and effective administrative machinery for its enforcement. Reform of the small loan industry and some other kinds of social work may be summed up in three stages : public-spirited or socially minded investment — which does not necessarily mean creating a new busi- ness; legislative and administrative control of extor- tionate, exploiting practices; and an educational cam- paign, based on accurate knowledge and unquenchable enthusiasm for justice and the social welfare. -4^ THE PREVENTION OF TUBERCULOSIS Social work has found a congenial and fruitful field in the prevention of disease. For special reasons the prevention of tuberculosis has offered the most appro- priate and the largest opportunity. Tuberculosis is a chronic disease; communicable; and susceptible to treat- luiproz'cmcnt of Conditions: I 217 ment. It is especially prevalent in the early years of adult and married life, when earnings are especially im- portant. It is aggravated by poverty, under-nourish- ment, over-crowding, continuance of work after symp- toms of the disease are discernible — especially indoor work. Public knowledge of the means of prevention and of the means of cure is more essential than in the case of any other disease, merely because of its prevalence and because the measures required are largely within reach if they are known. Cleanhness, pure air, freedom from injurious food and occupation, and an abundance of simple, nourishing diet, are the principal remedial measures. To secure these and to educate the public in regard to the disease are the main objects of the tuberculosis associations. Educational campaigns have been carried on through public lectures, newspaper articles, pamphlets and leaflets, sermons, exhibits and lantern shows, motion pictures, home visits by physicians, nurses, and social workers, circulars from health departments, from trade unions to their own members, travelling demonstrations through country districts, and every other ingenious device which will compel attention, arouse and satisfy curiosity. Probably no other form of organized social work has utilized so great a diversity of methods or has such positive results to show. This educational work has commanded larger resources and has been prosecuted with more sustained energy in this country than in any other. For lack of it France, although the 218 Social Work pioneer in certain aspects of the anti-tuberculosis move- ment, found the ravages of the disease in her hastily- mobilized armies greater than would have been neces- sary. The Rockefeller Commission on the prevention of tuberculosis, with the American Red Cross, inaugu- rated a campaign in the civil population of the interior of France, with the full approval and co-operation of the French authorities, as a legitimate means of prose- cuting the war and relieving its victims of some of its unhappy consequences. In Italy also inter-allied activi- ties of this kind were carried on, partly with funds contributed voluntarily by American citizens for pat- riotic war purposes. The public had to be taught the importance of cleanly habits by the consumptive, the necessity of preventing the sputum which contains the germs of the disease from becoming a source of danger to others, the truth on the other hand that the cleanly and conscientious consumptive is not a source of danger to his neighbors, the danger of quack remedies and the falsity of the hopes which their advertisements create, the advan- tages of early and competent diagnosis and the bearing of this on the professional training of physicians in general practice, as well as of those who are to engage in public health service and of those who are to become specialists in this field. The public had also to be persuaded that large expenditures from taxation are necessary for sanatoria, hospitals for advanced cases, clinics, instructive nursing, inspection of lodging houses Improvement of Conditions: I 219 and of dairy herds, and for the relief of the families of patients under treatment. Private funds are also given for some of these purposes, especially for the treatment in sanatoria of early cases and for home relief, but one of the earliest and most convincing lessons of the campaign v\/as that private enterprise was wholly inadecjuate for the main task, and that its great- est contribution would probably lie in the education of the public to the necessity for competent well-financed public health departments, municipal and state, for a great increase in the provision for institutional treat- ment, state and county and city, and even in the educa- tional campaign, for a very active participation by vigorous, non-political public health services, federal, state, and local, under new and more comprehensive health laws./_In supporting these policies the tuber- culosis movement has not only served its own imme- diate purpose, but has given an immense impetus to the cause of public health. INFANT MORTALITY Next In importance to the tuberculosis movement, in the field where preventive medicine and social work unite, is that for the prevention of infant mortality. Here also the greatest need has been for instruction; but it is especially young mothers and prospective mothers who require to be taught. In no other field are the results so instantaneous and so gratifying as 220 Social Work in this. The welfare of the unborn and newly born infant is so completely dependent upon the knowledge, the character, and the resources of one person — the mother — and the mother has so powerful a motive for responding to instruction, that startling results almost invariably follow any active and well-directed attempt to lessen miscarriages, still births, and sickness and death in infancy. Inadequate income and a low standard of living are a main cause of infant deaths. Work by the mother just before and just after confinement is one of the direct causes, but this is of course ordinarily a con- sequence of low income. Artificial feeding instead of maternal nursing is partly due to the oceupatiOTT-or mothers, but much more frequently to custom, failure tcrappreciate the difference which it will make to the child, and a lack of knowledge as to how to overcome initial difficulties. The prevention of infant disease and mortality involves above all aid to mothers in the care of well babies. In Portland, Oregon, to take a random example, there is a "Well Baby Clinic," thronged with young nursing mothers — Jewish, Italian, Negro, and of every other description represented in the neighborhood — eager for competent advice about their own diet and the right care for their infants; watching their gain in weight, the correction of ana- tomical or functional defects, the establishment of normalcy ; giving ample evidence that they are profiting by such instruction, and that the next baby will get Improvement of Conditions: I 221 even more benefit than the one now in arms. In such a clinic young doctors get the kind of post-graduate observation and advice which even the best lying-in hospital or babies' hospital cannot give them, to the great advantage of the mothers and babies who will come later under their care in private practice. The question irresistibly arises why such clinics and centers of teaching should not be multiplied a thousand-fold. However, prompt and skillful professional care for sick babies, especially for the intestinal ailments of the hot summer months, fresh air facilities quickly available, provision of sufficient and proper food for mothers, freedom from the necessity of earning a living while nursing and caring for young children, and more generally, everything which favorably affects the standard of living of the family, have to be con- sidered in connection with the campaign to prevent unnecessary deaths of infants. Foreign-born mothers who learn to read and speak English and who adopt the American manner of life are more likely to take better care of their young children — not because the English language or the American standards are neces- sarily inherently better than those with which they have been familiar, but because they are better in American communities, and because they are the chan- nels through which increased facilities, larger resources, are likely to come. Bottle feeding, however, when there is mother's milk, is not among the American customs to be recommended to foreign-born women. 222 Social Work / HEALTH OF MOTHERS AND INFANTS ' Perhaps the most important outcome of the Chil- dren's Bureau Conferences of 1919 to which reference has been made in other connections was their formula- tion of minimum standards of public protection of the health of mothers and children. These Standards call for maternity or pre-natal centers sufficient to pro- vide for all cases not receiving pre-nataLsup£rvisiQii from private physicians, and outlinelTTe work of such centers ; for dental, venereal, and other clinics for treat- ment needed during pregnancy ; for maternity hospitals or wards, and free or part-payment obstetrical care in every necessitous case at home or in hospital ; for train- ing, Hcensing, and supervision of midwives; for ade- quate income to allow the mother to remain in the home through the nursing period; and for education of the general public as to the problems presented by maternal and infant mortality and their solution. The Standards call for birth registration; children's health centers; home visits by public health nurses to all infants and children of pre-school age needing care; dental and other clinics for children; hospitals or beds in general hospitals for all sick infants and young children; state licensing and supervision of all child-caring institu- tions and homes in which young children are cared for; and general educational work in the prevention of communicable disease and in hygiene and feeding of infants and young children. Improvement of Conditions: I 223 PREVENTION OF VENEREAL DISEASE In the toilet rooms of railway clay coaches and sleepers throughout the country during and just after the war a neatly framed poster informed the public that "the government has declared war on venereal diseases." Even before the government declared peace with Germany, some of these posters disappeared, on the return of the railways to their owners; but the war they announced has not been won. The information and advice of this poster and of similar publications of the federal Health Service, the medical services of the army and navy, the state and city boards of health, and of the very active voluntary agencies like the American Social Hygiene Association, are still needed. The venereal diseases — chief of which are syphilis and gonorrhoea — do not rank high in mortality tables, but they are nevertheless among the most crippling and destructive diseases. They result in blindness, paral- ysis, and sterility. They cause unhappiness and suffer- ing to wives and children, and — because of the manner in which they are usually communicated — shame and disgrace to the men who acquire them. That entire continence is not injurious ; that the best and only secure reliance against these diseases is to avoid the kind of personal contact through which they are communicated ; that charlatans with quack remedies are equally to be shunned; that those who have been infected, whether 224 Social Work innocently or not, should seek the immediate advice of a reputable physician in private practice or else apply to a clinic for venereal diseases, in either case with the maximum guarantee of complete privacy; and that commercial vice should be steadily and persistently sup- pressed, with a view to its elimination, are the principal planks in the platform of the campaign for the preven- tion of venereal disease. This campaign, so conceived, has a negative and relief aspect; but the whole cam- paign for sex hygiene has also its brighter, preventive, educational aspect. The biological processes of genera- tion, birth, puberty, may be so taught as to inspire re- spect for parenthood and a feeling of responsibility for preparing for it in purity and self-restraint. Life and health, reproduction and growth, rather than vice and disease, are the natural subjects of instruction in the field of sex hygiene. The sex impulse, in normal, healthy children and adolescents who have the occupa- tions and recreations natural to their changing minds and bodies, will rec|uire little conscious "repression" or "sublimation." It requires frank explanation, without over-emphasis, protection from artificial stimulus and unnecessary exposure to temptation; but for the most part modest reserve, in confidence that nature will keep healthy and unspoiled the instincts on which the very perpetuity of the race depends, if we do not allow them to be perverted. Social work has its task in helping to establish a single standard of morality for both sexes; in rescuing Iinprovemeiit of Conditions: I 22S girls from prostitution and boys from its patronage; in the protection and education of those who because of their occupation or their personal weaknesses are especially exposed to temptation ; in establishing special clinics and securing the provision of hospital facilities for the treatment of venereal disease; and especially in promoting judicious instruction in sex hygiene by parents, physicians, and teachers. CANCER AND HEART DISEASE Cancer is another disease the control and prevention of which invites the methods of social work. Less is known of its causes, and less spectacular results are obtainable from direct effort. Nevertheless there are some things which the authorities feel warranted in saying about its symptoms, which may lead to earlier diagnosis and to treatment by operation or otherwise at a stage in which favorable results are to be expected. Such information is printed in leaflets obtainable from the American Society for the Study and Prevention of Cancer. Hospital or home care of patients who are without means, and the further support of research, appear to be the main policies which can be recom mended with confidence in regard to this bathing and increasingly prevalent disease of maturity and later life. Organic diseases of the heart now account for more deaths than any other of the causes listed in the official mortality tables. Neither pneumonia nor tuberculosis 226 Social Work in all Its forms claims as many victims.* Heart disease is also among the increasing, rather than diminishing causes of mortality; and it is not limited in its inci- dence to advanced age. Many children have per- manently damaged hearts. The disease is not trans- missible, like tuberculosis, but there are nevertheless many facts about its relief and prevention which should become more generally known, and there are ways in which voluntary contributions of money and of service may be used to great social advantage. Among the methods to be advocated are : special heart clinics, which have already been opened in connection with many hospitals and dispensaries; convalescent homes in which special occupations are taught ; aid in securing suitable employment; vocational guidance for young people who have weak hearts, to prevent their enter- ing what are for them dangerous trades; supervision of the play as well as the work of those who have heart lesions; treatment of tonsils, adenoids, abscesses about the roots of teeth, to prevent the rheumatic infection which is a principal cause of heart disease ; and finally, as in every kind of preventive social movement, the co-ordination of efforts, the integration of the various parts of the program for the relief and prevention of heart disease, and of this program as a whole with other related movements. The pioneer in this move- ment for co-ordination and education is known as the * Census Bulletin Number 144: Mortality Statistics for 1919. Improvement of Conditions: I 227 Association for the Prevention and Relief of Heart Disease. PUBLIC HEALTH : THE HEALTH CENTER The public health movement as a whole, of which those for the prevention of particular diseases are integral parts, is concerned with the control and pre- vention of infectious diseases, the education of the public in the principles of personal and public hygiene, the enforcement of sanitary codes, and the collection and interpretation of vital statistics. The American Public Health Association, through a committee, has formulated standards for a public health code applicable to cities of 100,000 inhabitants or more.* The enact- ment of comprehensive state laws with adequate provi- sion for their local administration through qualified, non-political, health inspectors and public health nurses is most essential and there are as yet only a few states which can boast such laws. The health center — to the development of which the American Red Cross has been devoting much of the energy and money released by the gradual diminution of its war work — seems likely to bring medical care, useful information, and nursing service, within reach of many who have not heretofore had the benefit of them. It has also the aim of co-ordinating public and voluntary health activities so as to prevent overlapping * These tentative standards are published in the Journal of Public Healthy March, 1921. 228 • Social W_ork and the neglect of the more urgent or essential work. The extension of home treatment, including nursing, to rural communities; the prompt discovery of those who need operations or other treatment; placing in- formation about available resources — sanatoria, asy- lums, special hospitals or clinics, material relief — at the free and equal disposal of all who would profit from such information, however remote they may be from centers of population ; and elementary .hygiene and sanitary instruction, through lectures, leaflets, and personal conferences, offer one of the greatest fields of usefulness; and it is most earnestly to be hoped that the nation-wide extent of the chapter organization of the Red Cross may result in supplying this need. In some states district health boards, operating over a county or combination of counties, and in others county boards of public welfare, are working to the same end, either independently on their own initiative or in co- operation with Red Cross chapters. The final index of the intelligence of the public in relation to health is the death-rate. A general death- rate, however, important as it is, tells less than the death-rate for particular ages ; or one which reveals the facts in regard to some particular racial or occupational group; or which tells what is happening with regard to particular diseases. The problem of infant mor- tality is wholly different from that of old age, the tuberculosis death-rate from that of cancer. A high but diminishing death-rate is less ominous than a some- Improvement of Conditiuns: I 229 what lower, but persistently too high, rate. A low death-rate in a relatively new country may be due to an abnormal age-composition of the population. The death-rate from tuberculosis may fall because of the immigration of races who have a low mortality from that particular disease. For these and like .reasons great caution should be exercised in drawing conclu- sions from crude general death-rates. Birth-rates, and the facts about the prevalence and duration of disease, are necessary to illuminate the central, crucial facts re- vealed or concealed in the general death-rate. There is a growing conviction that the assembling of vital statistics for small territorial units — districts, say, con- taining not more than 8,000 residents — is a necessary foundation for a sound health program, since this makes possible the direction of activities to localized causes and areas with much greater precision. CHAPTER XIV IMPROVEMENT OF CONDITIONS: II Social settlements, institutional churches, philan- thropic foundations, and public welfare departments of government, are so many different approaches to social work. Among the various agencies through which society attempts to prevent poverty, disease, and crime, or to mitigate their effects, or to understand their causes, these four, having quite different origins, stand out above the earlier relief societies, hospitals, asylums, churches which are for worship alone, clubs which are merely for the enjoyment of their members, rigid endowments for specific purposes, governmental services of a traditional kind. SOCIAL SETTLEMENTS They have certain features in common. They are experimental, relatively free from the dead hand. They have few inherited obligations. The settlement is the most elastic, unconventional, irresponsible. It may do what its hands find to do. Its residents have unusual license to be as sympathetic with the poor and oppressed, as indignant against injustice or corruption, as any 230 Improvement of Conditions: II 231 radical. The war gave a temporary handle to those who were hard pressed by such criticism. By posing as a super-patriot, an apologist for industrial evils might gain the right to put the names of such women as Jane Addams and Lillian Wald in a proscribed list of radicals, but such lists, as the Secretary of War in the very administration which carried on the war recog- nized, became thereby rolls of honor in which any man might well aspire to deserve to have his name inscribed. INSTITUTIONAL CHURCHES Institutional churches give the opportunity to ex- plore social needs under the direct inspiratiott of reli- gion, and to bring the religious point of view to bear on particular needs, as for fresh air outings, clubs, relief employment, or whatever kind of social work may be selected. They are sometimes a specialized kind of settlement. They do not necessarily represent the ideal, or at any rate the only ideal relation between religion and social work, though they are an excel- lent means of producing evidence as to what that rela- tion should be. The church has its wholly distinctive function in relation to social work, in the inspiration, the moral incentive, which it gives. Whatever its members do in the non-sectarian social agencies or in their capacity as citizens should be regarded as the discharge of obligations, the performance of duties, the realization of privileges sanctioned by religion and enforced by the teaching of the churches. Institu- 232 Social Work tional activities — educational, hygienic, charitable, or whatever they may be — are justified, provided of course they are well done, if they illustrate and re- enforce such teaching of the social obligations in gen- eral. If they distort or confuse such obligations they may become an actual hindrance rather than a help to the performance of the imperative task of organized religion in its entirety. FOUNDATIONS Philanthropic foundations, like those established by the Carnegies, the Rockefellers, the Sages, the Hark- nesses, and the Hartleys, and the community founda- tions like the Boston Permanent Charity, the Cleve- land Foundation, and the Chicago Community Trust, represent a new and carefully devised plan to devote large wealth, either during the life-time of the giver or after his death or both, to such purposes as are from time to time regarded by carefully selected trustees as the most important and most promising of beneficial re- sults. They differ from the pious foundations of an earlier day in covering a far wider range of interests, and in leaving the trustees a much freer hand both in the choice of specific purposes and as to the means by which they are to be promoted. W^ELFARE DEPARTMENTS Public welfare or social welfare departments may be created in the municipal, county, state, or federal gov- Improvcmevit uf Conditions: II 233 crnment. A proposed federal department of public welfare contemplates the consolidation of the various existing and proposed welfare activities, including edu- cation, health, and compensation to disabled soldiers and sailors. State boards of charities have been re- christened boards of public welfare, and additional functions assigned to them. Local departments of pub- lic charities have been similarly re-named, with or with- out new duties. The idea represented, however, by this new nomenclature is that the government in the several jurisdictions has responsibility for more things, has more means at its disposal for attending to them, and has fewer arbitrary limitations on its powers, than was formerly assumed. The Department of Public Welfare is expected to study the problems of crime, poverty, ill health, to prevent as well as to relieve human misery, to co-ordinate its own activities with those of voluntary agencies, to have a rational theory of social welfare and to act upon it. RECREATION Plav is natural and indispensable to human beings, like sleep and food. Recreation is the supplement to work in adolescents and adults, as play is the royal means to securing muscular development and nervous co-ordination in children. Fish in the sea, monkeys in the branches, lambs in the fields, birds in the air, have room for play and seem to make the most of it. Unfortunately human beings, taking their work and 234 Social Work their personal security too seriously, have greatly cir- cumscribed the play of their children and their own opportunities for physical recreation. We have there- fore in social work a playground movement, as we have housing and temperance movements. This is not because the play instinct or the recreational instinct has failed, but because of two rather accidental devel- opments of modern civilization : the congested tene- ment life of cities, permitting no such spontaneity of movement as we see in field, forest, sea, and air; and the isolated farm, where there is indeed room, but there is lacking the other incentive — association with fellows of the same age and proclivities. The policy of providing playgrounds — on roofs, if necessary; by shut- ting off traffic from certain streets, if necessary; by sacrificing grass in public parks, if necessary; by con- demning small tracts in congested districts, if necessary, even at large expense, the necessity arising from earlier neglect — has been the fundamental aim of this move- ment. Apparatus and play directors are essential to the success of city playgrounds. From the simplest equip- ment, like swings, slides, and wading pools, up to the municipal golf course and tennis courts and boulevards for automobiles, there is no break in principle. Royal parks of an earlier day became the public property of nation or city, and so familiarized us with the idea of recreation for the leisure of the well-to-do. The playground movement seeks to make sure of ample Improvement of Conditions: ^ 235 recreational facilities for those who are too young to walk long distances and who do not go out for their airing in automobiles. The small playground in a neighboring block is only the first, however, of a series, which includes ball grounds in large parks, skating ponds, and eventually all of the free out-doors. The use of leisure time for recreational purposes extends to libraries, museums, theatres, motion pictures, lectures, music, travel. Society is as much concerned that leisure time shall be used profitably for living in freedom as that working time shall be used profitably for living at work. Character takes form under relaxation quite as much as under the strain and stress of the day's occupation; The social organization of the means of recreation — whether it is to be commercial, philan- thropic, or civic — leads to the broader program of community organization, and it is significant that the voluntary national society which before the World War was called the Playground Association of Amer- ica, played a large part in the recreational organization of the war camp communities in the interests of the men in service and of those who were engaged in the production of munitions, and that since the war it has occupied itself with community service, giving special attention to leisure time activities. The problem of safeguarding public morals in dance halls and other places of amusement has led to the demand for their licensing and public regulation; and even for the official censorship of motion picture films. 236 Social Work Sharp opposition to this arises not only from pro- ducers, but from Hberal opponents of state regulation. The step from censorship of motion pictures to that of the press and public platform is not a long one. Indeed, it is alleged that official censors have already, in a time of sharp industrial disputes, objected to the showing of the homes of strikers, made for no more "immoral" purpose than to show the low standards of living which their wages allowed. The laws against indecency, if actively enforced, would probably be a safer reliance than a censorship, against the dangers to which a democracy should always remain sensitive. The need for promoting healthful recreation is a part of the problem of country life as well as of the urban population. Juvenile delinquency and ill health will be lessened by the development of sports and of rational occupations for leisure time. The educa- tional, religious, and other social forces of the nation may well give additional attention to the encourage- ment of play and recreation. RACIAL AND SOCIAL GROUPS Social work may occupy itself with special racial or social groups, such as Indians, Negroes, Jews, or Moun- tain whites, instead of with those who suffer from a particular disease or misfortune or who live in a par- ticular neighborhood. This distinction, however, is more nominal than real. The reason for giving atten- tion to the needs of a particular group of this kind Improvement of Conditions: II 2Z7 will usually be because in fact they suffer from common disadvantages, due as a rule to some far reaching change which has made necessary a new adjustment. The Jew does not, for example, present a problem of social work as such, but as newly arrived immigrants, as swer,:.ed garment workers, or as common victims of some similar condition which affects a sufficiently large number to make it convenient or advantageous to organize relief for them, vj^egroes need special attention — schools, inter-racial committees, etc. — not because their ultimate needs are different from those of others, but because of the slavery of the past, the prejudices which deny them equal educational facilities, even-handed justice in the courts and in industry, and on their own part at times an ignorance, superstition, and lack of those particular qualifications which are especially prized in advanced industrial communities and which it may require some generations to over- come. WORKING CONDITIONS The re-planning of towns and the re-organization of industry so as to eliminate waste and satisfy the creative instincts of workers are the two great tasks of social organization. They far transcend the scope of social work, as the latter is presented in tliis volume; but social work is an integral part of social organization, and its own part will be the more adequately performed 238 Social Work if it does not fail to discern the larger tasks with which our generation must concern itself. The re-organization of industry is mainly the task of engineers, financiers, and industrial workers. In the child labor committees, however, consumers' leagues, associations for labor legislation, women's trade union leagues, and similar organizations, there are types of social work the ultimate results of which may be far reaching for the basic reconstruction of industry. Their immediate aim is specific, and directed, like all social work, at evils which can be described, circumscribed, and to some extent corrected independently of any larger plan of social reconstruction. CHILD LABOR Children are at work who should be in school or at play : therefore let us outlaw their employment and ^ keep them in school. The evidence for this legislation '^ is partly physiological, partly educational, partly social. This evidence is all in and the case has long since been presented. There are no longer advocates of child labor. There are merely obstructionists and those who have not considered the evidence. There are children at work in the cotton fields, sugar beet fields, and other agricultural occupations. There are unsettled questions about the employment of adolescents from fourteen to eighteen. The constitutionality of federal legislation has still to be decided. But the central task for which the National Child Labor Committee was Iijiprovcnicnt of Conditions: II 239 created in 190-1 — the conversion of the pubHc opinion of the nation to the idea that children under fourteen should not be gainfully employed, may fairly be said to have been accomplished. Children under fourteen are still employed, but it is known to be an an achronis m and one which can probably be completely overcome only by the improvement of elementary education and attention to child welfare in general. Both the National Child Labor Committee and the Children's Bureau Conference of 1919 have formulated minimum standards for children entering employment. They agree on the main essentials, but the Child Labor Committee, as a continuing expert and propagandist agency in this particular field, has naturally formulated its standards in more detail and on a somewhat higher level. The Children's Bureau standards call for an age minimum of sixteen in a.nj occupation, except that "cHTldferi T3et\veen fourteen and sixteen may be em- ployedln agriculture and domestic service during vaca- tion periods^, until schools are continuous throughout the year. 'J^ '^ Higher limits in certain occupations, an educational minimum, and a physical minimum, are also demanded ; and maximum hours and a minimum wage. The Child Welfare Standards call for a central agency to deal with all juvenile employment problems. Both the Child Labor Committee and the Child Welfare Conferences attach great importance to the administra- tion of the school attendance, factory inspection, and child labor laws, the co-ordination of the official agen- .\ /- 240 Social Work cies responsible for enforcing them. The conditions under which employment certificates shall be issued are carefully prescribed. MINIMUM WAGE LAWS Minimum wage laws, prohibition of the employment of women at night and in physiologically injurious processes, the legal limitation of the hours of labor by women in stores and factories, and other restrictions in the interests of health and family welfare, have been brought about largely by the consumers' leagues, working with other civic bodies, and by trade unions. Between 1912 and 1920 minimum wage legislation was enacted in thirteen states and in the District of Colum- bia. A standard minimum wage bill, based on the most effective existing statutes, is published by the National Consumers' League. STANDARDS FOR WOMEN IN INDUSTRY In December, 1918, the United States Department of Labor issued a statement of standards governing the employment of women in industry, calling upon the industries of the country to co-operate with state and federal agencies to maintain them "as a vital part of the reconstruction program of the nation." Under these standards no woman would be employed or per- mitted to work more than eight hours in any one day or forty-eight hours in any one week; every woman worker would have one day of rest in every seven; Improvement of Conditions: II 241 three-quarters of an hour would be allowed for a meal ; and no woman would be employed between 10 :00 P.M. and 6:00 A.M. Women doing the same work as men would receive the same wages; the minimum wage rate would cover the cost of living for dependents, and no' merely for the individual; wages would be established on the basis of occupation, not on the basis of sex. Women would not be employed in occu- pations involving the use of poisons which are more injurious to women than to men, such as certain processes in the lead industries. No work would be given out to be done at home. Many other less im- portant matters are covered in these standards, and it is held that workers should share with the manage- ment the responsibility for their enforcement. COMPENSATION STANDARDS The enactment of compensation laws in substitution for the discredited employers' liability laws as a means of insuring to workers prompt and reasonable com- pensation for industrial injuries, and the current agita- tion for health insurance, are to be credited mainly to the American Association for Labor Legislation. Stan- dards for compensation laws have been prepared by the Association. This body is affiliated with an inter- national association, the main object of which has been to standardize protective labor laws. This function has now been assumed to some extent by the more official International Labor Conference, with a per- 242 Social Work manent office at Geneva, created under the Treaty of \"ersailles. INDUSTRY AND SOCIAL WORK The improvement of working conditions is naturally in the first instance the responsibility of industry itself. Some natural resentment is felt by employers w^hen voluntary associations like those named begin, as they say, to interfere with their business. Labor unions also show a certain impatience when "reformers" take it upon themselves to discover what labor needs, rather than accepting without question the official pronounce- ments of organized labor on the subject. Social work has nevertheless justified its intervention. Its move- ments have been largely on behalf of workers as yet, unorganized and for the removal of conditions which are demonstrably and flagrantly contrary to the [)ublic interest. They are harmful to industry, however profitable in the short run to individual employers. Nothing is more essential to industry than healthy, vigorous and willing workers. The employment of children, over-work by women, underpaid, sweated labor, night work by women or by children, industrial accidents for which the worker and his family have no compensation, and industrial disease, are inimical to industry, if by industry we mean the organization of society to produce the goods needed by society, and not merely a means of making profits for individuals. Workers and organizers of industry should therefore Improvement of Conditions: II 243 welcome well-conceived programs of social work which will help to create a sound public opinion on these sub- jects, to secure needed laws and their enforcement, and to facilitate the gradual transformation of the whole industri.r; system to one in which the present frightful amount of waste is much reduced, in which the man- agers of industry are freed from their subserviency to financial profit-making interests, in which Vv-orkers have a voice in all matters which concern them, including the means of increasing productivity, in which demo- cratic operation may have a chance to demonstrate whether it is, as its advocates claim, more likely to be efficient than the autocracy wdiich still prevails. Social workers have a reciprocal obligation to under- stand the point of view of industrial financiers, en- gineers, and workers, and the natural limitations of their own reforms. They have more than the ordinary occasion to recognize the larger forces which are work- ing with and against them. They go into politics, and when they do they encounter and must reckon with the hidden political influences. They go against judicial assumptions and precedents, and have to produce social evidence that the precedents are no longer binding, the assumptions contrary to the facts. They find corrupt labor leaders and employers only too ready to buy them. On the other hand, programs which the workers themselves have originated, or public officials, or em- ployers, may be better than any invented by outside reformers. There is no presumption against a program 244 . Social Work because it comes from the Inside of industry. All this the national agencies which have especially occupied themselves with the improvement of industrial condi- tions fully understand, and it is emphasized here not in criticism of their attitude, but only as a caution to those who enter this most inviting and difficult of all kinds of social work. OTHER CAUSES AND PROBLEMS The improvement of living and working conditions is a department of social work which from the nature of the case is unlimited and illimitable. New plans are constantly being made and existing agencies are fluid, subject to currents of public opinion, to influences springing from scientific discovery or political change or mere fashions of thought. The war checked some very praiseworthy movements — as for example the anti-nicotine, especially the anti-cigarette agitation — and encouraged others, as for example the very neces- sary travellers' aid service at terminal railway stations, etc. The legal-aid movement has had a noteworthy impulse from the publication of the Carnegie Corpora- tion's monograph on Justice to the Poor. The mental- hygiene movement, the need for which has been em- phasized by the condition of many ex-service men, has already produced some very useful and informing "lit- erature." There are many broad movements, as yet not fully crystallized, like those for the prevention of the congestion of population, or, affirmatively expressed, Improvement of Conditions: II 245 for the better planning of towns and cities ; for the im- provement of country life; for the control of immigra- tion and the assimilation of immigrants ; for community organization; for constitutional government in indus- try; and for disarmament. Whether such "causes" and problems as these belong in social work depends on the breadth and definiteness which are to be given to it. From the point of view of the present text-book, the deliberate and conscious promotion of any specific solution of the recognized problems, whether by legislation, by public education, or by influencing the policies of those involved, would be fairly included. The participation of investors, workers, or citizens from the ordinary economic or political motives would not. Social work, in other words, would have a part to play, but not the principal responsibility, in any one of these or similar move- ments. COMMON FEATURES OF THE EDUCATIONAL MOVEMENTS Those forms of social work which deal with general conditions have much in common with the agencies which help individuals and which do preventive work through their contact with individuals; but they have methods of their own. The investigation of social problems extends to their historical antecedents; their causes in current methods of wealth production, educa- tional systems, or wherever they may lie ; their remedies in coercive or voluntary social action ; the theories, con- 246 Social Work troversies, social cleavages to which they may have given rise. The universities have to some extent organized or encouraged the scientific study of social problems, especially in their graduate schools of politi- cal science, economics, philosophy, or education. The foundations have used their resources in part in social research. / The specialized agencies have studied prob- lems like mose of child labor, women in industry, in- dustrial accidents, fatigue, tuberculosis, infant mor- tality, housing, town planning, congestion, remedial loans, immigration, recreation, or whatever else may have been their particular interest, and there has been some, though far too little, interchange of ideas and experiences among universities, foundations, and social agencies thus engaged in similar inquiries, which should yield comparable and mutually complementary results. The same problems may be studied by law-makers on their own account, by judges called upon to interpret or pass upon the constitutionality of new laws, or by journalists and independent investigators who give the public the benefit of their studies through books, magazines, or newspapers. The patient and disinter- ested investigator may be found in many places, and scientific research such as the universities do for the purpose of training and developing their students is no different in spirit or in method from that which the social agency, the law-maker, or the journalist practices in order to secure a sound foundation for his practical program. The natural result of Improvement of Conditions: II 247 this research is the creation of a technical or special literature — periodicals, reports, books, pamphlets, proceedings of conferences, etc, and material to be presented in public addresses, through the press, in sermons, legislative debates, or wherever it can appro- priately be used. A third common feature of the organized movements for the improving of conditions is a national and often also many state or local headquarters, which usually serve both as executive offices for the direction of field work and as centers of information to the public. These agencies frequently have a very large corres- pondence, numerous callers, frequent inquiries from the press, from authors, lawmakers, reference libra- rians, college and high school students who are debating or writing essays on the subject. The budget of any national social agency is certain to contain an item to cover a liberal response to all such inquiries. They furnish one of the best methods of propaganda. To write careful letters in order to give the facts to one already interested enough to ask for them, whatever his motive, is better than to send many times the same number of letters to those who may have no inter- est in them. For lack of such a recognized and properly equipped headquarters some of the best of causes have languished. Better sifted and more authoritative infor- mation, adapted to the local needs of the community from which an inquiry comes, can better be supplied from such an office and at less expense than from 248 Social Work the several local sources which would otherwise have to be approached. There is no such national source of information, for example, in regard to remedial loans or in regard to financial federations. In some instances — e.g., charity organization and the prevention of tuberculosis — the movement has first spread from one locality to another, perhaps across the ocean, and later a national office of some kind has been established, either through federation or through independent asso- ciation of those already interested. In other instances — e. g., the Red Cross and the Young Men's Christian Association — the movement has been organized out- ward from a center, or downward from a national headquarters to the states and localities. Research, publication, central headquarters and stafiF, are obvious and almost indispensable features of any social movement. The enlistment of appropriate co- operating agencies, such as the press, the pulpit, the civic bodies, the trade unions, the government, is an equally obvious and universal procedure, although there will naturally be some variations in the list of agencies, according to the nature of the facts to be made public or the remedial action to be secured. It is astonishing what a large number of unsuspected allies can be dis- covered in connection with any sincere attempt to make life easier and happier, to put an end to any cause of unnecessary suffering or hardship. CHAPTER XV CO-ORDINATION AND SUPERVISION Nothing would seem to be more obvious than that charitable activities will be more effective for their purpose if they are co-ordinated ;* that there is waste in overlapping and in unrelated efforts to relieve dis- tress or combat disease or prevent crime. The tragedy of competing, isolated, unorganized philanthropy has been apparent from earliest times to discriminating ob- servers. Individual help to individuals in trouble is better than indifference, but it is not sufficient. Two or several persons may help one unnecessarily while another misses the help which he desperately needs. The two or several may be working at cross purposes and so fail to be of any real assistance even to the one whose needs have attracted attention. One person may have found out how to help, and others may continue to blunder. The helping ability may be distributed geo- graphically or seasonally very differently from the need to be relieved. Pretty much all the people who are ready to help may be wholly ignorant of and indifferent to the underlying conditions in human society which are responsible for the misery which excites their sympathy. 249 250 Social Work THE SOCIAL SERVICE EXCHANGE The simplest and perliaps the best means of starting an improvement in this disparate, uninformed, un- organized situation, when it exists, is to organize what is known as a social service exchange. This is the best first step because it is so simple, and so completely- free from interference with any course which the individual or agency that uses it may wish to take. The exchange is essentially a card index of persons or families who receive or ask for any kind of social service. It is impersonal and harmless. By consulting the exchange — through a personal call, telephone, or mail — one finds out whether the family which he in- tends to help is known to others, and if so to what others. He then consults these others or not as he likes. These others, if there have been any, are in turn informed of the new inquiry, and if they like they may consult the one Avho has made the inquiry, or they may consult the family, to find out why the new inquiry is made. No confidential information is recorded in the card index, no statement as to what has been found out or what has been done by this or that individual or agency. Such information is contained in the con- fidential case records of the agencies, and is imparted in their discretion to such as have a legitimate interest in it; but the social service exchange does not have case records. It is, like a telephone exchange, merely a convenience for making connection between those Co-ordination and Supervision 251 who ask for it or are receptive. This modest role enables the exchange to be used by many who would very properly be averse to putting their information at the disposal even of other social agencies. It is a safeguard against foolish, isolated, unco-ordinated ac- tion for those who are merely far enough along to prefer not to act foolishly when they can just as well be sensible. The social service exchange involves some expense for printing, equipment, and service, and this can be shared by those who use it or met either by a federation of social agencies, if one exists, or by a department of public welfare, or by some single agency, if there is one which can afford it and which has the confidence of others, so that they will use it. SOCIETIES FOR ORGANIZING CHARITY An entirely different method of preventing the waste and harmful results of unco-ordinated individual activi- ties is to establish an association which all may join, or an official system in which all, or a large part of those who are qualified, may participate. The Association for Improving the Condition of the Poor, founded in New York City by Robert M. Hartley in 1841, was an attempt to move in the first of these directions. The Elberfeld system, widely adopted in Germany, is an instance of the second. While each of these plans has merit, neither became inclusive of all social work. Mr, Hartley's hope that the smaller societies would be absorbed in his new association was not realized, and 252 Social Work after forty years another attempt at organizing the charity of the city on a different plan was initiated. The charity organization society, impressed by the importance of a thorough investigation of each case of distress, adequate and appropriate rehef on a def- inite plan, co-operation among all who have a respon- sibility or an interest in the premises, development of personal sources of relief and of the self-supporting capacity to the utmost reasonable extent, created in its district committee or case conference an appropriate mechanism by which citizens of good will could actually co-operate in carrying out these ideas. Previously collected relief funds were deprecated in the charity organization movement, and the organ- ization of relief on the case plan preferred. The societ- ies did not confine themselves to the investigation and organization of relief in individual cases of distress, but promoted the co-ordination of charity through public meetings, leaflets, periodicals, and otherwise ; stimulated social and sanitary reforms; initiated under their own auspices or as independent enterprises what- ever forms of social work they found to be desirable and not already under way — such as industrial employ- ment, municipal lodging houses, remedial loan societies, fresh air work. These societies were sometimes called Associated or United Charities, although they were not often a federation. Such names, like charity organization society, suggested the aim rather than described the Co-ordinatiun and Supervision 253 actual constitution of the society. The aim has always been the close association of those who are interested in helping the poor in accordance with tested and approved methods, the organization of charitable effort in order to make it more effective and less wasteful. Of recent years some of these societies have changed their names, and new societies having the same ends in view have taken different names from those of the earlier societ- ies. Although there is no more uniformity in the new names than in the old, they tend to agree in emphas- izing in their titles family welfare or social service rather than the association of charities or the organiza- tion of charity. The national federation which has been established to promote the movement and to stand- ardize the work of the societies is known as the Amer- ican Association for Organizing Family Social Work. As this Association is a mutual body, supported mainly by contributions or assessments of its members and by appropriations from one of the foundations, it has no doubt a right to determine its own qualifications for membership. By not including Catholic or Jewish agencies engaged in "family social work" it becomes in a sense itself sectarian, even though its constituent societies may deal to some extent with Jewish and Catholic as well as Protestant families. Its earlier policy of not admitting other general agencies for relief and family welfare in a city in which there is a "family social work society" made a distinction where there was little or no discernible difference. It is 254 Social Work true that this latter question would arise only In two or three places, since in most of the large cities which formerly had two general societies of this kind they have united, and the combined society has been regarded as eligible, and in New York City both the Charity Organization Society and the Association for Improv- ing the Condition of the Poor — which remain apart in spite of all the convincing reasons for union — are both members. The American Association has a staff of field secre- taries who are available to aid interested persons to create a society for family social work where none exists, or to improve the work of an existing society, or to survey and attempt to bring order out of unco- ordinated, unorganized, or w^astefully and improperly organized communities. COMMUNITY CONSCIENCE AND CIVIC MEMORY One function which charity organization societies share with several other voluntary agencies is to serve as a connecting link between successive municipal ad- ministrations, a permanent depositary of facts and ex- periences, a persistent influence for continuity in de- velopment. In American town and cities, with their frequent change of local officials, this becomes an exceedingly important function. The community needs a conscience and a civic memory, and the machinery of local government ignores this need. It may be supplied by a chamber of commerce or a bureau of mun- Co-ordination and Supervision 255 icipal research or, better than either, by such a dehbera- tive council as Joseph K. Hart suggests.* In particular departments of local administration this function of maintaining advances already gained, sustaining public interest in essential problems, is best discharged, in so far as the public service does not itself provide for it, by the voluntary agency which operates in the same field: a public education association supplement- ing the public school system, for instance ; or a prison association, the penal system. The agencies for social work in families have a natural relation with the county and municipal relief of the poor in their homes. These relations are usually co-operative, sometimes competitive, and under what is known as the Iowa plan they have taken the form of an actual partnership: i. e., a social worker is en- gaged at joint expense — by county commissioners to do the public relief work, and by the voluntary society to do the social work which would fall to it. When the total amount of work to be done is sufficient to justify the employment of only one qualified executive, with a modest staff and office equipment, this com- bination may work well. The principal valid objection to it is one which arises from the considerations to which we have just referred. The voluntary agency cannot be a connecting link, an independent means of carrying over progress from one good public adminis- * In Community Organ!::afion, Qiapter IX, Developing Com- munity Deliberation. 256 Social Work tration to another, through a period of inefficiency or reaction — a civic memory and a civic conscience — if its own fortunes are too closely bound up with those of the official administration. When both voluntary and official bodies are alert, efficient, and progressive, the Iowa Plan works admirably. If an election goes badly, a low-grade politician gets into office, and the city or county can no longer keep the pace of virtue and intelligence which the team-work requires, then the yoke with unbelievers may be a grave handicap, and there may be no means of insuring even a saving remnant for a new start under more auspicious skies. SURVEYS The social survey, of which there are many varieties, is usually directed towards the making of a program, the better co-ordination of agencies, and the increase of their efficiency. Its immediate method is to put the community in possession of facts with respect to social conditions and the particular services under scrutiny, in order that a program of development may be made. It may be a survey only of schools or of courts or of health services or of charities or of housing or recreation. It may be a community survey, in which any or all of these and other aspects of the life of the community are included. In the light of the facts assembled and analyzed, and of the recom- mendations of the surveyors, the community is ex- pected to reach its own conclusions as to what reforms Co-ordination and Supervision 2S7 and changes are necessary and what policies should be continued. To make known and to conserve the good elements of strength in the situation is no less important than to expose and correct the evils. COUNCILS AND FEDERATIONS OF SOCIAL AGENCIES A comparatively recent plan for promoting order and harmony is that of effecting an organization among the social agencies themselves, either a financial federa- tion or a council of social agencies. The financial aspect of the federations is discussed in a later chapter (page 292), but their incidental services in acquaint- ing the agencies with one another and in co-ordinat- mg the social work of the community perhaps con- stitute their greatest value. In a council of social agencies the directors, staff, and members of each agency may through their representatives come into helpful contact with those of other agencies, for the discussion of their common problems and for the making of a common program. In a large city it may be necessary to create several departments : one perhaps for health, one for child welfare, one for neighborhood work, and so on. The council may, as in Boston, follow several partial unions previously created by the coming together of agencies working in the same field. There may be certain functions which such a council can perform for its members in common, such as central purchase of supplies or the operation of a social service exchange. It may appoint 258 Social Work standing committees to consider legislation in which all are interested, or to promote public education on some subject of common concern. The council may, as in Boston, Chicago, Saint Louis, and Columbus, have a paid executive and staff, and it may, among other functions, assume that of a financial federation, as in Minneapolis and Cincinnati. Through such a council or federation the community may be made in- creasingly conscious of its common responsibility for discovering and meeting in a rational way, with a due sense of relative values, whatever needs may exist; for developing a program of social action. CURRENT CONFUSION AND DUPLICATION Each of the movements for the improvement of liv- ing conditions or of working conditions, whether it begins locally or nationally, is ultimately represented by a national agency. It may be a federation, or merely a central educational or propagandist committee. Both the local agencies and the national bodies tend to broaden their scope by adding to their original func- tions now one and now another activity to which the directors or the staff find themselves attracted. They display another tendency — to use names of a pleasant sound and vast implications, which rather express the aspirations of the organization than describe concretely what it undertakes to do. These tendencies together result in blurring outlines, not merely in appearance but in reality. It would puzzle even the average well- Co-ordination and Supervision 259 informed contemporary worker to say whether a given "pubHc welfare bureau" or "social welfare board" is part of the city administration or a private society; to know that a "community service organization" is affiliated with the American Association for Organiz- ing Family Social Work and not with Community Service (Incorporated). The National Tuberculosis Association is "headc|uarters for the Modern Health Crusade." There exist contemporaneously an "Ameri- can Child Hygiene Association," a "Child Health Or- ganization," and a "National Child Welfare Associa- tion," while the National Child Labor Committee, despite a name which seems to indicate a tangible and limited task, advertises its scope as including also "education; delinquency; health; recreation; children's codes." A list has been compiled of sixty national organizations which deal with one aspect or another of child welfare, and the number concerned with health or with "Americanization" must be nearly as formid- able. This confusion and duplication among national organizations is reproduced in the localities to which their influence extends. There is, in short, among the educational social agencies, a situation very similar to that which existed among the relief societies in the 70's and 80's, and which led to the movement for the organization of charity. The National Information Bureau is attempt- ing to apply to national organizations the principles of the endorsement bureaus of the local chambers of 260 Social Work commerce, and several gestures toward co-ordination have been made : a "National Public Health Council," for example, has been formed, and similar movements are on foot in other fields. Whether these hopeful efforts will result in a genuine co-ordination (which would involve a limitation of function on the part of many organizations) or will merely add to the confu- sion by creating new national bodies charged with "co-ordinating" the others, remains to be seen. An actual integration — a daily routine of practical co- operation — is what is required both in local communi- ties and in the nation. As a means of reducing the confusion in the national social agencies to some sort of order, and lessening the number of appeals which they now make to the comparatively few people who are in the habit of giving to national causes, it has been proposed to associate them in a national financial federation similar to those which have been established for local purposes in several cities. In these cities, however, the local welfare feder- ation might not welcome such a proposal. In several cases the local federation includes a local quota for such national agencies as they approve. It would complicate rather than simplify matters for the Welfare Federation in Cleveland, for example, if it had to decide what to raise for the National Child Labor Committee by negotiating with a national welfare federation of which the Child Labor Committee is a member instead of directly with that Committee. A Co-ordination and Supervision 261 national federation might conceivably find a field of usefulness in a common presentation of the national agencies in the communities where there is no local federation; but an expansion of the movement for local federations seems likely to be in the line of less resistance. CONFERENCES For half a century the National Conference of Social Work, until 1916 known as the National Con- ference of Charities and Correction, has had a unique influence over the whole field of social work. Orig- inally a small gathering of members and officers of state boards of charities, promoted however by the American Social Science Association, through the happy accident that F. B. Sanborn was secretary both of the Association and of the Massachusetts State Board of Charities, it has steadily expanded until its membership, running into the thousands, represents every conceivable kind of voluntary and official action for the social welfare. Like the social service exchange, its usefulness is believed to depend upon a self-denying practice. It is for conference only. It eschews resolu- tions of a propagandist nature and has no platform. It seeks to secure for its programs those who have ideas or experience or both, and its papers are thrown open to discussion. It has a departmental organization, by which those who are engaged in the various fields of social work are brought together for more concen- trated discussion of their particular problems than is 262 Social Work possible in the general sessions of the Conference, while before, during, and after its week of sessions many organizations known generically as "kindred groups" hold independent meetings which are in effect supplementary to the Conference program. In several states there are similar annual conferences, and there are also district and city conferences in which the discussions often rival in interest those of the national body. In these local conferences the members, having all in mind the same general background, may sometimes come closer to the actualities and difficulties of their task than in a national body whose members have indeed common interests, but also very different environments to consider. The printed volumes of proceedings of the national and state conferences are constantly adding to the use- ful technical literature of social work. The discussions and informal personal consultations among those who attend help to make interesting developments and ex- periments more quickly known, to subject doubtful theories to a more critical examination, and above all, to pass on to the constantly increasing body of profes- sional and volunteer workers the common traditions and standards of social work. Training schools, period- icals like The Survey for social workers in general, and special periodicals in particular fields, serve this purpose also, but it would be hard to over-estimate the service which the National Conference has rendered in this respect. Co-ordination and Supervision 263 OFFICIAL BOARDS State boards of charities and correction, of control, of public welfare, have an official relation to the co- .ordination of institutions and welfare agencies. The earliest of these boards, created just after the civil war, were fortunate in many of their members and executives. They had a long vision, and their work began in a heroic period. The National Conference was due to their recognition of the need for exchang- ing views and experiences, and state conferences have usually been due to their encouragement. Charged by law with the inspection of state charitable institutions, and of private institutions which receive public funds, if not others, and with the duty of making recom- mendations to the governor or legislature, the state boards of charities — and in some states separate prison commissions and commissions for the insane — are naturally important agencies of co-ordination and su- pervision. The state has sometimes established a board of control or administration, which replaces the board of managers for separate institutions, and the board of control may or may not replace also the state board of charities. For some years a vigorous controversy raged over the relative advantages of a supervisory state board, with the powers only of inspection and recommendation, and the board of control, which should administer rather than inspect. In a few states 264 Social Work a single state official, known as fiscal supervisor or commissioner, has been given large administrative powers, or even the entire responsibility under the governor for managing the state charitable institutions or the prisons. The general consensus of qualified opinion at present is that, however the institutions may be administered, there should be an independent state board with powers of inspection, supervision, and recommendation; and charged also with the duty of searching out the causes of insanity, criminality, and dependence, and their remedies. CHAPTER XVI FINANCES: I Social work is supported by (1) taxation; (2) in- come from endowments created by bequests or gifts; (3) earnings, i. e., payments made by or on behalf of beneficiaries; and (4) current voluntary contributions. Bequests, current contributions, and appropriations from public funds may be restricted so as to be avail- able only for specified purposes. In the absence of any contrary stipulation, bequests may be used, like other contributions, for current expenses, or they may be placed in a reserve fund to be drawn upon in emergencies, or they may be kept as permanent funds, of which only the income is regarded as available for current work. Either bequests or gifts from a living donor may be made through a trustee instead of directly to the social agency; and the trustee may be, or may be associated with, a community trust or founda- tion created for the very purpose of receiving and ap- plying such gifts and bequests. Amounts thus con- tributed through a community trust, like others, may be either restricted to specified purposes or given freely to be applied to any appropriate purpose as the trustee 205 266 Social Work or foundation may decide. Funds needed for current work may be obtained by the social agency directly from the donors, as has been the usual practice from time immemorial, or they may be obtained on behalf of several or all of the social agencies through a welfare federation or community fund, like those recently estab- lished and in successful operation in many American cities. Temporarily work may be carried on by bor- rowing, or by using up inherited permanent funds. The term voluntary contributions covers receipts from a great variety of motives. It might indeed be extended to include bequests and the income from permanent funds; public appropriations to voluntary agencies; and even sums paid by hospital patients or by parents to meet a part of the expense of the care of their children in institutions, since in one or another sense all of these are voluntary. Obviously, however, they differ from the ordinary contributions of the private citizen or corporation. On the other hand, some of the income included in voluntary contributions — such as that secured by charity balls, card parties, or by strong social pressure — may reflect only a modicum of interest on the part of the giver in the cause to which the income is applied, and to describe him as a voluntary contributor requires a certain leniency of language. GOVERNMENTAL SOCIAL WORK Tax payers support both institutions and home serv- Finances: I 267 ice from much the same motives which bring voluntary contributions to private agencies. Not that all the motives which influence citizens as tax payers and those which influence them as voluntary contributors are identical; but increasingly the appeals for adequate public funds for welfare work and those for voluntary contributions are found to bear a striking family resem- blance. Sympathy, humanity, generosity, such charity as the ancient Jews called justice and the early Chris- tians called love, civic pride, a sense of common decency, and similar chords are played upon quite as effectively in a state legislature or before county com- missioners or city aldermen as in the letters of appeal sent out by settlements or relief agencies. The argu- ments before congressional committees in favor of maternity aid through federal appropriations, and be- fore state legislative committees for mothers' pensions, might equally have been used to persuade some one of large means to establish a foundation for similar purposes, or a community trust to include them in its appropriations. Although the line between governmental and volun- tary activities is not easily drawn, it is easier to separate those who instinctively favor and those who persistently oppose the expansion of the functions of government. Probably voluntary agencies are expanding quite as remarkably as the social welfare activities of govern- ments, but from the nature of the case this does not create political issues — at least not so directly and im- 268 Social Wmk mediately — and therefore attracts less attention. The limitation of voluntary social work lies in the imagina- tion and knowledge of its promoters and in the amount of support they can secure. The limitation of govern- mental work lies in the conception held by the people and their representatives of the proper scope of govern- ment and in the revenues obtainable from sources which have been recognized as legitimately subject to taxation. In practice, however, these distinctions tend to dis- appear. Social workers with knowledge or imagination may be quite as successful in persuading executives and legislators to forget their political creeds in the face of some urgent need which has been neglected as in coaxing new wealth from those who have not learned the pleasure of giving. Nearly all barriers are down. Old age pensions, widows' pensions, maternity aid, eye glasses and braces for children who need them, meals for under-nourished school children, bonuses for ex-service men, are likely to be supplied or withheld not on any theory as to what is or what is not in accord- ance with our political traditions, but in accordance with the strength of the case made out by their advocates. THE LOWER LEVELS OF TAXPAYING ABILITY Excess profit taxes, income surtaxes, general sales taxes, to say nothing of franchise taxes and inheritance taxes, have added enormously to the public revenues; and in addition funds which could logically have been taken as taxes were found for the war loans. To repay Finances: I 269 these loans war taxes will have to be continued ; although some of the war burdens and the special taxes levied to meet them have already been reduced. The enlighten- ing discovery of the unsuspcted fertility of these lower layers of tax-paying ability, made once for all, must have its influence on future policies. Unearned incre- ments on land values, arising from the mere develop- ment of industry and increase of population, independ- ently of any service rendered by the landowner, have never yet been applied to common purposes to the extent which sound principles of taxation require. Excess profits in banking and in such industries as oil and steel production are now so clearly matters of record that they cannot be denied ; nor should such abnormal profits escape taxation on the theory that there may be losses as well as profits. Rather than admit such a plea the nation might be forced to consider the plan for state insurance against loss of investments which has been seriously proposed. Certainly it would be a doubtful experiment. The risk of bankruptcy has been an in- centive to business enterprise and a safeguard against reckless ventures, but the income tax returns indicate that a heavy price is paid for this incentive and safe- guard. ENOUGH FOR ALL NECESSARY WORK Twenty years ago the fear was frequently expressed by conservative financiers that expenditures for pur- 270 Social Work poses of the social welfare might be near the margin of ability to pay; that further drain on the public revenues for health, education, improvement of the standard of living, might encroach upon capital neces- sary for investment, might threaten the prosperity on which any further progress depends. The war ex- perience reduced such fears to absurdity. For war purposes billions of dollars were instantly forthcoming. Nor is this all. Even when the national demands made it a patriotic duty to conserve wealth and to apply the productive capacity of the nation strictly to the com- mon welfare, this was not done. Personal fortunes increased enormously and profligate waste, in spite of all attempts to prevent it, was more conspicuous than conservation. The one undeniable outstanding fact is that, whatever may have been the case in other periods, or whatever may be the present situation in Europe or Asia, the people of the United States have vastly more wealth than they have realized, and apparently as much as they are ever likely to need for any purpose of social well-being which they regard as important. Wars have to be paid for on the spot; but if their lessons in finance are not taken to heart and applied they may be paid for twice over. Through disarmament the nation can save many billions. Through such pre- vention of waste as the engineering societies are point- ing out we can save many more. If we wish the people of the nation to have life and to have it more abundantly these public revenues, augmented by the Finances: I 271 saving of waste and preparations for future wars, will be applied to the relief and prevention of poverty, the prevention of hardships from unemployment, the care of the sick and the eradication of disease, the re-plan- ning of cities and towns to make them less ugly and more comfortable, the re-location of industries, the pro- tection of the standards of workers, and the education of children on broader lines, including physical, techni- cal, moral, and religious training. We can make enough useful commodities to permit a comfortable and rational life for all if we plan our agricultural, industrial, and commercial life with that end in view. Such a rational life implies freedom for the individual, not a slave state. It implies, however, that this freedom may be sought in social, co-operative action, and that the political government may be its instrument. Social work as a part of governmental action will demand, as far as we can foresee the future, a con- stantly increasing share of the taxable national, state, and local wealth : not to endow inefficiency, but to reduce it; not to thwart evolution, but to give it pur- poseful direction; not to increase parasitic life, but to make us conscious of its various forms so that we may eliminate them; not to take from the strong and provident and industrious for the benefit of the lazy, improvident, and criminal ; but to control crime instead of merely playing with it, to promote provident thrift by giving it a chance for exercise, and to put even the lazy and shiftless under conditions which will give 272 Social Work them motives for exertion and inducements to develop socially desirable habits. DEFECTS OF AMERICAN LOCAL POLITICS Inadequate financial support is not the only handicap of social work in the municipal, county, state, and federal governments. It has suffered also from the well-known defects of our politics. We have not suffi- ciently valued expert service. We have changed offi- cials too often, and have underpaid them. We have tolerated the appointment of inferior politicians to positions for which they are quite unfitted. We have given to courageous and competent executives, judges, and commissioners far too little of that indirect and inexpensive, but precious reward which lies in public recognition of the value of their services and loyal support of their policies. We have not always pro- tected them from the hostility or revenge of selfish persons whose designs they have opposed in the public interest. Such obstacles and stupidities as these may greatly limit the usefulness of a health or probation service, a child welfare bureau, or an institution for the insane or the sick. It is no exaggeration, however, to say that more liberal expenditures have been the crying need of nearly all public agencies charged with responsibility for crime, disease, or poverty, and that larger appropriations would in some measure eventually overcome the other obstacles which have interfered with their greatest success. Finances: I 273 SUBSIDIES : PARTNERSHIPS BETWEEN PUBLIC AND PRIVATE AGENCIES Voluntary social work is in some measure supported by taxation. The state may prefer to pay private insti- tutions for the care of children whom it accepts as public charges, or for placing them in foster homes; for medical and surgical care of patients whom it would otherwise have to provide for in public hospitals; for the service which a private charity may be able to perform in prosecuting cases of cruelty against children or animals; or for conducting a library or museum. Such arrangements as these — subsidy, subvention, con- tract, or whatever they may be called — have played a large part in the educational and charitable work of a few states, such as New York, Pennsylvania, and California, while in the large majority of states they have been entirely unknown, public funds being ex- pended through public channels, and voluntary agencies being supported entirely by voluntary contributions or bequests. Exemption from taxation, which is general in all the states, is not regarded as a subsidy. Historically appropriations to educational, religious, or philanthropic agencies have usually been made first as subventions. When there is a contractual basis — payment on a per diem and per capita basis in proportion to the service rendered — this has usually come afterwards, as a 274 Social Work method of reforming or improving the system. PubHc grants have usually — though not always — had the effect of diminishing or entirely replacing income from volun- tary sources. There have been instances in which a private institution originally supported by voluntary gifts has become a state institution. There are in- stances of private gifts for some special department or activity in a public institution or associated with it. All such arrangements must be judged on their merits. They may be more economical, freer from politics, than a straight governmental or a straight voluntary institu- tion. Personal considerations may be the determining factor. Possibly the work to be done is necessarily located in or alongside a public institution because of its character, like the social research bureau at Bedford Reformatory for Women or the institute for the study of diseases of old age conducted for a time on Black- well's Island, while at the same time they are so experi- mental or so specialized that it is impracticable or even undesirable to secure public appropriations for them. Private support for a period may lead to the adoption by the state of the experiment. Frequently, however, even such promising experiments develop more fric- tion than co-operation. Public support of a private institution may be better than that it should be sup- ported by begging or inadequately supported. In a given situation, as for example when large investments have been made from voluntary gifts in buildings and ecjuipment, it may be more economical to continue to Finances: I 275 pay for the care of children or patients in them than to build parallel plants at public expense. The difficult problem of religious instruction in a country which believes in the complete separation of church and state may seem to justify a contract or subsidy system, but unless for such special or local reasons the sound princi- ple would seem to be that which we have followed in the case of education : public expenditure in public schools, voluntary support of voluntary schools. This, except for tax exemptions, is the general policy which has been pursued in all except a few states. ENDOWMENTS The second source of support for voluntary social work to be considered is endowments. Along with in- vested funds which yield an income for current work we may put investment in buildings, grounds, and other permanent equipment owned by the agencies. Expenditure for such purposes is said to be made on capital account. Even when bequests and other unusual gifts are regarded as permanent funds they may usually be invested in necessary plant, as this avoids the cur- rent expense of rent. Bequests may not be received each year, but if received at all they may be expected within the lifetime of a permanent building, and their use in such investment will therefore not unduly disturb financial calculations. Bequests for endowment have played a large and not 276 Social Work always beneficial part in the history of philanthropy. The reproach that they are made at the expense of heirs and cost the testator nothing is not entirely justi- fied, as the owner might of course have used his wealth instead of becjueathing it, and a desire to give in his will may often be a distinct motive for earning, conserving, carefully investing and saving. A will may be so dis- criminatingly drawn as to express, perhaps better than any other overt act in the donor's life, his personal judgment and preferences as to what shall be done with his fortune. Bequests which are not merely acquiescence in the traditions of a class, but a genuine expression of the giver's personality, especially if he has accurately informed himself concerning the need which he proposes to meet and the agencies through which he intends to work, may represent one of the best possible uses of wealth. An unconditional bequest to the endowment funds of a well established library, museum, orchestra, university, hospital, or similar in- stitution intended for the common use of all, is hardly open to criticism or question. The institution is en- riched for its useful service and is as free as before to change its methods when its trustees so decide, whether under the pressure of outside public opinion or as a result of their own observation and study. By complete endowment such institutions might be relieved from the obligation to justify their existence in each generation by their results, and this might be a great and irreparable misfortune. But such institutions are Finances: I 277 not likely to reach this state of complete saturation. Competition or public supervision may save them if they become too complacent. A more serious danger is that of relative conservatism, and against this there is no adequate protection except an alert public opinion. Bequests for the endowment of relief and of remedial reforms are of more doubtful utility. Relief and reform-promoting agencies should be above all plastic, responsive to changing conditions. If endowed at all, it should be under conditions which create no presumption whatever of spending money in a particular way or of continuing to spend it for a particular purpose. If by undue age, either physiological or mental, or by inbreeding of a particular social set or class, the trustees of an orphan asylum or a relief society or a dispensary have become unfit to appreciate a new situa- tion, or to see that ideas on which they have been acting are no longer tenable, an endowment may be a terrible handicap. They have not only to change their own minds, which is difficult, but also to get over the feeling that any change would be a sort of disloyalty to their old associate. If they have not known the founder personally they may still feel a peculiar trustee- ship to continue the policies, approval ©f which perhaps induced him years ago to select this particular board of trustees to carry out his .desires. Faithful trustee- ship is a very valuable social asset. An imputed or assumed trusteeship, however, may become an obstacle to the best use of wealth. A very prominent banker 278 Social Work who was treasurer of a charitable society once argued seriously that by pursuing the policy of putting un- restricted bequests in the permanent fund for a few years, even though no public declaration was made that this policy w^ould be pursued, an implied contract was created with all future testators. They would have a right to assume that their bequests, although wholly unrestricted, would be preserved intact in a permanent fund, only the income being used, merely because, at the time when they made their will, they understood that the society treated its bequests in this way. What the one who is drawing a will thinks at the time when he is engaged in this solemn undertaking is probably better known to lawyers than to others. It would be advantageous if lawyers with experience in will-making would take the public into confidence more frequently, which of course they could do without violating pro- fessional confidences. Probably something depends on whether the will-maker is accustomed to thinking most of funds or of folks; of institutions or of the people whom institutions are intended to serve. If it is the latter, an unrestricted legacy is probably visualized as expended, as used to help people. He probably looks for his permanent memorial elsewhere than in a per- petual investment of this contribution in gilt-edged securities. Useful work on the largest scale which his gift permits, so obviously beneficial that it will stimulate other gifts to be used in turn as the conditions require when they are made or when they become available, Finances: I 279 might well be regarded one of the best monuments which any particular gift can create. Endowments for research or for education may be defended, although even in these fields appropriations to universities from public funds raised by taxation are now competing with endowments and seem likely to overshadow them. Endowments for relief or for social reform, for housing, for prosecuting particular offenses, for child welfare, for propagating particular opinions, are of very doubtful utility. This is not to disparage bequests to such forms of social work, but only to sug- gest that neither the donor nor the beneficiary society should make them into endowments or permanent funds. There is much to be said for distributing bequests over a few years, in order to avoid the em- barrassment which might come from unequal receipts. A moderate reserve fund is justifiable, and bequests might be used for such funds rather more freely than regular annual contributions. The whole subject of the posthumous use of wealth needs to be more freely and openly discussed. Testators should have all the latitude compatible with the public interest. Variety which will give ample expression to personal differences is to be encouraged. It would be a mistake to adopt a formal community program to which all who are making bequests would be expected to conform. The state has a right to see that nothing prejudicial to the public interest is done. Subject only to that limitation, nothing but good may be expected to result from the 280 Social Work greatest individual initiative in bequests for social work, provided they are made not for endowment in perpetuity but for expenditure, principal and interest, within a reasonable period. CHAPTER XVII FINANCES : II EARNINGS Earnings constitute a substantial part of the income of private hospitals, homes for aged, and some other agencies; a smaller, but from the point of view of the self-respect of the beneficiary an important element in the income of day nurseries, visiting nurse associa- tions, and other agencies; and a negligible element, or none at all, in that of agencies engaged in home service, housing reform, prevention of tuberculosis, etc. Even in those cases a national or state agency may render a service for which compensation is made by a local agency, or other inter-association arrangements may be made which would be reflected in what might be called earnings; but income, however many times it may be transferred from one treasury to another, is best described in accordance with its original source, and it is earnings in the proper sense only if it has come from the ultimate beneficiary in whole or part payment for the service which he has received or in the marketing of the product of work done in or under the auspices of the institution. 281 282 Social Work Amounts received from the public treasury for ^he care of those who have been formally or tacitly accepted as public charges may be regarded, as we have already seen, as earnings, i. e., payment on contract for the performance of a public service, or as subsidies, sub- ventions, public gifts made in general recognition of the value of the service. Charges in a hospital, dispensar}', home for aged, day nursery, or for the services of a visiting nurse, may be according to a fixed scale or may vary with the ability and disposition of the one who pays. A well- to-do patient in a private room may pay an amount w^hich yields a profit ; but usually such accommodations represent only a small part of the hospital's service, and so-called pay patients, like college students, are usually beneficiaries of philanthropy if their only con- tribution is what they are charged. The collection of small amounts from those whose standard of living is low and whose incomes do not provide for a surplus is of doubtful social advantage. It is vexatious and expensive. Those who pay may know that others as well situated as themselves have received free treat- ment. In as far as the charge acts as a deterrent it is objectionable, since the important matter from the standpoint of the public interest is that the sick shall be treated, the helpless aged receive appropriate atten- tion. The commitment of children, or their retention, should not turn on the success of a collecting agency, but on the welfare of the children, which may best ! Finances: II 283 be promoted by insisting on their remaining in their own homes or putting them in boarding or foster homes even though the parents are ready and able to pay what would be charged to care for them in the institution. On the other hand, it may be better for them to have institutional discipline even if the parents want them at home. It is quite right for parents to be required to pay if they can, but not to rely upon the enforcement of payments as a deterrent against applications or as an easy method of deciding questions which should turn upon entirely different considera- tions. PAYING OCCUPATIONS IX INSTITUTIONS The employment of children in juvenile protectories, of young women in reformatory institutions, and of adult prisoners in occupations which yield an income, presents even more difficulties and objectionable fea- tures. Shop work may have educational value, but if the value of the product becomes an appreciable ele- ment in the income of the institution its educational character may be, and is likely to be, neglected. The making of white goods, the running of a commercial laundry, are good illustrations of the kinds of work which are commercially profitable but which soon ex- haust their educational value. The manager of an institution which is supported by public funds or by voluntary contributions should not be placed in the 284 Social Work delicate position of having to decide how to reconcile two such conflicting and incompatible aims. The occu- pations of children and of adolescents should be such as have the maximum educational value, whether this yields a marketable product or not. Reformatory or prison labor which competes with free industry places the latter at an unfair disadvantage. The commodities produced by prison labor could be sold at a low price merely because in their cost of production there are no items corresponding to 'rent, wages, supervision, and taxes ; and the occupations which would yield a salable product are very apt to be those in which there are the lowest wages outside the prisons, so that society, in training for them, has done the worst, rather than the best, to prepare the prisoner for self-support on discharge. For such reasons the prisons are now ordinarily debarred from producing goods for sale in the open market, although employment on the manu- facture of things which the state itself would other- wise have to buy is generally permitted, and prisoners are also used in such public work as road building. In the case of children the problem is simple, as there should clearly be no marketable product whatever. Manual training and technical trade teaching should be provided as in the ordinary schools. In many in- stances, in fact, institutional children may advantag- eously be taught in the regular public schools, while other institutions may be so fortunate as to have funds, teachers, and plant to set the pace for the most pro- Finances: II 285 gressive specialized education and to try out experi- ments from which pubHc schools themselves may profit. Older persons who are confined in prisons and re- formatories, if teachable, are also candidates for edu- cation, both academic and vocational; and the public interest will be most clearly promoted by organizing the routine of prison life in such a way as to get the maximum educational result in the briefest time. This will not be inconsistent, however, wdth their spending a considerable part of their time in productive labor. The greatest cruelty of the prison regime, and the most stupid — and this is saying much — is the idleness in which prisoners spend a large part of their period of incarceration. The best middle ground between the system of contract prison labor, with its obvious evils, or any other system which brings prison labor into direct competition with free labor in the open market, and idleness or artificial employment, appears to be a state-use system, under which roads are built or furni- ture, clothing, etc., manufactured, not for general sale, but for use in state institutions. It is true that this reduces by just so much the demand for these articles or services in the open market, but on the other hand the labor applied to them is likewise withdrawn from the labor supply. The prison itself is abnormal and obsolete; and the task of deciding how to relate prison labor to free labor, and the earnings of prisoners to the finances of the institution, is incapable of any ideal solution. 286 Social Work CURRENT CONTRIBUTIONS Contributions from interested individuals are the back-bone of the financial support of voluntary social work.* They are sometimes called membership dues, and may be nicely graded from regular or annual or minimum subscriptions up to a sum which would make the contributor a life member or patron or founder. Various terms are used for intermediate amounts, such as sustaining or contributing or asso- ciate membership. Some agencies make a point of regarding any contribution, even the least, as estab- lishing membership. Others carefully restrict their membership by election, in addition to the usual pay- ment of dues. As members have generally the right to elect directors, some such control is felt to be necessary, even though election to membership may usually be a matter of course for all who show their interest by a contribution, and even though the election of directors in turn may be perfunctory, the directors in fact usually assuring the re-election of those whose terms expire or deciding upon their successors. There are few closer corporations than the boards of directors of relief societies, settlements, and orphan asylums. This makes for continuity of policy, consistent and sustained effort to accomplish the purposes for which * For an interesting discussion of philanthropic giving — current practice, motives, and ideals, and their historical background— see How Much Shall I Give?, by Lilian Brandt, published by The Frontier Press, 1921. Finances: II 287 the directors conceive the society to exist, and congenial working relations among the directors and staff. On the whole social work makes a stronger and more successful appeal to-day than ever before. Its appeal is fundamentally to sympathy. Hunger and cold, stifling heat, sickness and accident, unforeseen or un- preventable misfortune, helpless old age, widowhood and orphanage, unemployment, insufficient earnings, are — as they have always been — grounds on which their victims may demand sympathy. If modern social work makes a less naive or sentimental appeal than its precursors the difference is not very great, and it is a question whether the agencies which revert to the oldest and simplest forms of appeal do not on the whole get the more generous response. It does not follow that the social worker in the agency which has made such an elementary and successful appeal will be engaged in doing the same things or doing them in the same way as the monk of the twelfth century or the deacon of the first. We have changed our practice more than the language of our appeals. DISCRIMINATION IN GIVING The modern contributor differs from his prototypes in one important respect. He does often expect to know what has been done with his money. He may give in the first instance for much the same reasons that have led altruistic people to respond in the past to appeals for charity; but he has been trained to expect 288 Social Work an account of stewardship. The annual report and the numerous other pubHcations through which the agencies make their work known to the pubHc have changed the relation between social work and the contributor. The appeal itself has been modified to some extent by becoming at the same time a program for the future ?nd a summary account of previous work. The success of modern social work is predicated upon the discrim- inating intelligence of the citizen. PUBLICITY The newspapers often give generous space to the work of social agencies. Some of them which have religious affiliations are discussed and commended from the pulpit. Public meetings are held, either independ- ently or in connection wath an annual meeting for the transaction of official business. Opportunities are sought and obtained for presenting the needs of a society at a civic luncheon, in the inter\^als of a theatri- cal or motion picture program, or wherever else poten- tial givers are gathered and managers are hospitable. Directors and interested members or friends of a social agency may call personally on their friends, or the telephone may be utilized in a systematic effort to reach a large number of prospects in a given time. The letter of appeal, sent through the mails, both to regular contributors and to those w4io for any reason are re- garded as proper subjects for persuasion, furnishes on the whole the most widely used and the most reliable Finances: II 289 means of securing support. The preparation of the maiUng Hst, the formulation of the appeal, the typo- graphical appearance of the letter, the timeliness of its dispatch, the follow-up by a second or third letter or by a call, the acknowledgment of a contribution or of a declination and the subsequent cultivation of the interest of those who show an interest by a contribution or otherwise, are all matters which have received the most painstaking attention of executives. The finan- cial secretary has appeared in the large societies, with the particular duty of devising and carrying out meas- ures for securing contributions and such other duties as are related to this function. There have even arisen firms of financial experts, whose services may be secured for a special drive or campaign by any college, Y.M.C.A., or other institution which contemplates rais- ing a large sum or whose finances have fallen seriously behind their current needs. DRIVES "Drives" or "whirlwind campaigns" are a compara- tively recent device for breaking into new circles and for cashing in potential support. Colleges and churches have resorted to them. The war perfected this inten- sive and carefully prepared campaign method and re- vealed to all its immense possibilities, assuming a pub- lic reasonably sympathetic with the cause for which the drive is made. Posters, shop-window exhibits, booths in public places, parades; brief telling addresses; 290 Social Work pressure from associates, employers, teachers, clergy- men, the press ; tagging the giver ; and every other con- ceivable means of attracting attention and forcing a favorable response, was exploited to the utmost by offi- cial and unofficial war drives. A few sensitive souls early revolted against these methods, but on the whole they continued to be productive. After the war the colleges and universities, whose burdens were great because of increased attendance and whose incomes had shrunk because of the rise in prices, fell into line in a series of drives, organized somewhat differently from those of the war appeals, but equally insistent to their more limited audiences, and in many instances, though not in all, equally successful. By such means some of them substantially increased their building and endowment funds. The churches had in the mean- time shown themselves equally apt students of the psy- chology of the drive. The Methodist Episcopal Church, for example, had been securing before the world war about $3,000,000 a year for its eight general boards : those of foreign missions and home missions having much larger incomes than the other six. The Centenary Fund, initiated primarily as a means of increasing the funds of these two missionary boards, was planned with great care and foresight. Thorough surveys were made of the purposes for which money was required, and a five-year program was laid out. In each of twenty areas a local organization was effected. The campaign began with well-devised plans Finances: II 291 for Interesting the people, not in the raising of money, but in the work to be done, in the means of grace by which it was hoped to accomplish it. The tithing sys- tem was revived. The net result of the campaign was to increase the contributions for the church boards from three millions a year to fifteen millions. This was not at the expense of other denominational activities. On the contrary, all of these benefited, some of them relatively even more than the missionary boards. Church congregations and Sunday Schools expanded; the resources of local churches and of the annual con- ferences were enlarged. From the point of view of the present volume it is of interest to note that con- temporaneously this church has been taking a more and more aggressive stand on measures of industrial justice and social welfare. This was also true of other Protestant churches and notably of the Roman Catholic Church ; but it is not without significance that the social creed of the churches, adopted by the Federal Council on behalf of some thirty evangelical protestant bodies, originated in the Methodist Federation of Social Service, and that Bishop McConnell of this church was chairman of the Interchurch World Movement's Commission which made the famous report on condi- tions In the steel Industry. No doubt from other re- ligious bodies equally striking Illustrations could be cited of the success of financial campaigns Inspired by faith in a great cause and characterized by the diligent application of sound principles of organization, both 292 Social Work to the general plan and to the details. In accordance with its own genius and traditions, the Roman Catholic church created associations of charities in some of its most important diocesan jurisdictions, and also a National Catholic Welfare Council, and through these and other means greatly enlarged its financial resources for social work. The Red Cross Roll Call and the Christmas Seal Sales of the Tuberculosis Association are familiar examples of modified drives on a national scale, repeated with striking even if somewhat fluctuat- ing success year after year. FINANCIAL FEDERATION During the war an idea which was not entirely new, since in a primitive form it had long been in operation in Denver and in a much more developed plan for a time in Cleveland, was applied on a large scale in many cities. This was the idea of a common financing of the voluntary agencies through what was variously known as a War Chest or Patriotic Fund or Com- munity Chest or Community Fund. In some cases the war chest financed only the patriotic or war relief funds. In others they included the principal local charities. In still others the war chest gave some assistance to local agencies from its surplus. More important than any such direct grants of money was the stimulus which the example of the war chests gave to the idea of uniting the financial campaigns of the social agencies and entrusting them to a permanent rep- Finances: II 293 resentative federation or union of which all should be members and through which there should gradually evolve a community program of social work. In Cleveland, Detroit, Cincinnati, Louisville, Grand Rapids, and many other cities, federations of this kind were created, not on any uniform model, but embody- ing in various ways the central conception that the social agencies have common interests, not only financial but of many other kinds, which justify — or indeed, as soon as they are understood, logically compel their association in a welfare federation. This is not in the least like a consolidation in which the individual agencies disappear, but neither is it a mere conference for discussion. Among the important functions which may be delegated to such a federation is that which the war chests performed for their constituents, the raising of funds. This concentration of finances has many advantages. If the method of intensive campaigns is utilized, it substitutes one campaign for many, with much saving of expense and great relief to the public. It permits a comprehensive organization for this cam- paign, whether it is a brief and intensive drive or more deliberate and extended. In such an organization the ablest and best qualified citizens may easily be enlisted, since it is for the whole city, without religious or politi- cal or institutional distinctions. On the financial side of the work of such a federation there are two dis- tinct functions to be performed : the establishment of the budget and the raising of the fund. The former is 294 Social Work a delicate and responsible, but not — as might have been imagined in advance — an impossible one. Each agency prepares and submits to a carefully selected budget committee an estimate of the amount v^hich it requires. There is a hearing, in which opportunity is given to explain and defend the budget. Suggestions may be made as to possible economies or readjustments. Expenditures for particular purposes are compared with those of other agencies which have comparable items of expense. Common standards of salaries may be established if this is considered advisable. The federation does not, if it is wise, undertake to decide internal, domestic policies of any agency member, but it gives an opportunity for those questions which con- cern the common welfare to be decided in accordance with a common judgment based on common knowledge and open discussion. The general budget is made up of these several esti- mates, due allowance having been made for prospective earnings, income from endowments, anticipated appro- priations from city, county, or state, balances on hand either in current or in reserve funds. The budget has generally to be approved by larger board, which has somewhat the character of a representative legislative assembly, to which it is presented by the budget com- mittee. Those whose estimates have been unduly re- duced or changed by the budget committee or who have other grievances may appeal to this legislative assembly. If their grievances are not redressed they Finances: II 295 may always withdraw from the federation and collect their funds independently; although in a city which has become accustomed to federated giving they may find this up-hill work. After the adoption of the budget the responsibility passes to the campaign organization. Very different capacities are required here from those which have been appropriate in the budget hearings and adjustments. What is necessary is to present the program of social work to the entire citizenry, to convince them of its needs, to arouse the public sympathy, to induce every possible contributor to give, not according to the old saying "until it hurts," but, as the president of one federation happily expressed it, "until it feels good." For a city-wide campaign, made once a year, the news- papers will give space, the merchants their display windows, the churches their pulpits, the theatres their stages, the lunching clubs their attention between courses, the factories a part of their intermission. The appeal will have a variety of human interest to touch every sympathetic chord. The citizen's pride will be enlisted. The element of competitive emulation is not lacking. The federations have not been in operation long enough, nor have they been sufficiently general, to afford solid ground for prediction as to their per- manence or their adaptability to all conditions. They have, however. In a score of cities, and In a few of them for some ten years, demonstrated that such co- 296 Social Work operation in finances is advantageous. They have greatly increased the number of givers and the total amount raised, without corresponding increase of cost. They have made the social work of their cities more intelligent. They have promoted understanding of the broad elementary facts in regard to social needs and how to meet them. This can of course be done in other ways and, whether federated in finances or not, the social agencies have a primary obligation to engage individually and jointly in the education of the public in regard to the causes of poverty, disease, and crime and the means of relief and prevention. BETTER FINANCIAL METHODS AND POLICIES Financial federation has given an impetus to the demand for better accounting methods and for the independent audit of institutional accounts. This im- provement, however, was well under way in many places before the federation movement began. It should be regarded rather as the result of better administrative and financial standards in general than as a result of federation; although it is true that without careful financial records and budgeting federation in financial campaigns would be impracticable. The influence of the profession of the public accountant has shown itself in the social agencies as in business and in educa- tional enterprises. Allied to the efiiciency which results from better accounting is that which lies in the demand for less Finances: II 297 extravagant and showy construction and for competent expert service. It has been found that for the care of tuberculosis patients an inexpensive shack may give as good results as an imposing and costly building. For sick children a modest cottage with a few patients may be a much better place than a large and expensive hospital. The war has made building expensive, and along with its severe lessons of sacrifice and economy it has unfortunately encouraged reckless wastes. Vol- untary self-sacrificing work enormously increased, but incidentally even this resulted in some instances in wasteful extravagance through lack of knowledge. Salaries of paid social workers have properly and necessarily increased, but not always consistently, and the overhauling and reconstruction of policies in the social agencies will raise questions as to the propriety and necessity of the readjustment of salaries as of other expenses. Social work has the same need as education or industry for adequate salaries, sufficient to maintain a reasonable standard of living for the workers, and the same obligation to supervise its finances rigidly and to eliminate waste and extravagance. CHAPTER XVIII PREPARATION FOR SOCIAL WORK If the preceding pages have succeeded at all in mak- ing clear the character of social work it is evident that it requires qualifications of no mean order in the men and women who do it. Sympathy for those who are in trouble and a desire to help them are as important in the paid pr unpaid social worker of to-day as they ever were, but they can no longer be considered all- sufficient, as they were not so many years ago, Deal- ing as it does with, the very fabric of human lives and the weak spots in human institutions, social work has need of the highest degrees of native intelligence and acquired wisdom. GENERAL AND TECHNICAL QUALIFICATIONS Qualifications for social work, as for other callings, may be either general or technical. Among successful engineers, according to the composite judgment of seven thousand of them who answered an inquiry made by the Carnegie Foundation, it appears that "general qualifications" account for 75 per cent of success in that profession, and "technical qualifications" for 25 298 Preparation for Social Work ^ 299 per cent. Under general qualifications were included character, which is put down at 24 per cent, or nearly one-third of the general characteristics; judgment, at 19^ per cent; efficiency, at 16)^ per cent; and under- standing of human beings, at 15 per cent. These four items make up the three-fourths attributed to general qualities. Character is interpreted to mean integrity, responsibility, resourcefulness, and initiative; efficiency, to mean thoroughness, accuracy, promptness, courtesy, and industry; judgment, to cover both common sense and scientific attitude. On the technical side the 25 per cent is subdivided : knowledge of the fundamentals of the science having 15 per cent, or three-fifths of the credit, and mere technique of the science ten per cent, or two-fifths. Without attaching too much im- portance to these exact percentages, or assuming that a tabulation of the opinions of successful social workers would yield identical results, we may at least be reason- ably sure that social work is not more highly technical than engineering, and that what are described in the study of the Carnegie Foundation as general character- istics and as fundamentals of the science — accounting together for ninety per cent of the qualifications of the engineer — are relatively quite as important in social work. COLLEGE TRAINING AND GENERAL PREPARATION Colleges and universities, building on whatever their students bring with them, have a responsibility for 300 Social Work adding to their general qualifications : to their charac- ter, judgment, efficiency, and understanding. If, as the engineers' report finds, these cover three quar- ters of what mining, mechanical, electrical, and civil engineers require for success, it is certain that social workers cannot afford to under-value the studies which may contribute to such endowments. What are these studies ? All that give breadth to the mind, emancipate it from crippling conceits and prejudices ; that add to th^ materials of thought and to the power of discrimination. The scientific attitude is the natural result of association, in research and discussion, with those who have it. Common sense may be developed in historical studies or in the appreciative reading of poetry or the analysis of economic problems. Understanding of human beings may be gained anywhere — at home, on the street, or in fraternities; but it may be refined, confirmed, or cor- rected in the study of psychology and of sociology. IWhat the social worker requires in the way of general preparation is knowledge and the capacity for using it, and the more he knows — provided he keeps a sense of proportion — the better his professional equipment. Integrity and a sense of responsibility are pre-requis- ite, but even these may be fortified. Resourcefulness and initiative are to be cultivated, and the college studies may well have these ends in view. What they must do, however, or miserably fail, is to cultivate the habit of study, of pleasurable exercise of the mental faculties, of reading and observation and intellectual Preparation for Social Work 301 conversation. All studies which have this result are profitable. Nothing of human interest can lie outside the range of the general preparation of one who is to find his work in correcting the faults, supplying the deficiencies, meeting the needs, protecting the standards, lightening the burdens, adding to the joys of human beings. COLLEGE TEACHING OF THE FUNDAMENTALS OF SOCIAL WORK But the college may do more than develop the gen- eral qualifications. Following their long practice of giving to a large proportion of their students — those, for example, who become teachers, business men, or housewives — an opportunity to learn something about the fundamentals of their profession, they are now inevitably and properly considering what they can do, even in their undergraduate courses, to prepare students for usefulness in social work. They can at least deal with those fundamentals which all citizens should know about — those facts about human nature, the essentials to a normal life, the nature and extent of poverty, disease, and crime, and the character of current social work, remedial and preventive — which will suggest to them where their interest lies and the field in which they may wish to engage as volunteers, and which will help them to decide where they will place their finan- cial contributions and what attitude they shall take 302 Social Work toward public policies. Social wOrk is not a closed trade or profession. On the contrary, it courts the widest possible diffusion of acquaintance with its prin- ciples. Much of the wisdom which it garners should be- come the common property of all educated or partly educated people, rather than the exclusive professional equipment of a limited group. There is nothing occult or esoteric about the principles and methods of social work which would make this inherently impracticable, and it is easy to see progress in this direction. RELATION TO ITS BASIC SCIENCES Social work is sometimes thought of as applied soci- ology. So it is, but it is none the less applied economics, applied psychology, and many other branches of knowl- edge applied to the task of studying and improving social conditions. Sociology studies the laws of human society as a naturally developing group of conscious beings,* explains social phenomena in simple terms, traces the origins of social institutions, and on its historical side seeks out "those universal or constant portions of ever repeated history that admit of exam- ination by scientific methods."! Economics is the science of man in relation to wealth. It deals with wants and their satisfaction through the production and consumption of goods, i. e., commoditites and service. t * Giddings : Principles of Sociology. t Giddings : Inductive Sociology. $ Seagcr : Introduction to Economics. Preparation for Social Work 303 Psychology is the science of consciousness. It deals with human behavior, with instincts and habits and' manners ; and social psychology treats of the principles involved in those expressions of mental life which take form in social relations, organizations, and practices,* ' Biology, physiology, geography, history, and the applied sciences of sanitation and engineering, may be named especially among the sources from which we derive ideas and knowledge of value in social work. There is scarcely any department of human knowledge which will not have its quota of available material for the social worker w^ho is qualified to apply it. Social work appropriates from all sources whatever will be useful in the rescue of individuals or the amelioration of adverse working or living conditions. Evidently, therefore, it is not only the courses on social work, but all studies which deal with useful knowledge, that pre- pare for social work. Nevertheless, courses in social work have their particular function, and a most impor- tant one. The fundamentals of law and medicine are often recommended as valuable disciplines for those who do not intend to practice them. The fundamentals of social work may be recommended with confidence, precisely because it is highly desirable that all should practice them. They are interesting, and they are of general concern. Social work, then, is an entirely appropriate subject for undergraduate instruction. It is the general experience that courses dealing with social * Angell : Psychology. 304 Social Work problems, whether called applied sociology or by any other name, are in eager demand wherever they are offered and competently conducted. INCREASE OF TEACHING MATERIAL Twenty or thirty years ago, when courses in char- ities and correction were first offered in American uni- versities, teaching material was comparatively scarce. While they began well, it was sometimes difficult to sus- tain the interest w'hich they aroused. There is now — in the reports of governmental departments and commis- sions, institutions, foundations, and societies, in special periodicals and text-books — an abundance of such ma- terial. It is possible to study the social aspects of epidemic and other diseases, insanity, mental defect and nervous disorders, over-work, child labor, con- gestion of population, unsanitary housing, an antiquated prison system, either historically or descriptively, with- out being led astray by sensational or superficial ac- counts. COURSES IN SOCIAL WORK The analytical study of the conditions which create social problems, and of the remedial and preventive social work to which these conditions give rise, is the natural starting point of college and university instruc- tion in social work. The chapters in Parts II — ^V of the present volume will suggest what these conditions and problems are and the principal agencies which are Preparation for Social Work 305 dealing with them. Instruction will if possible include visits to these agencies; examination of their records, under proper conditions to protect confidential infor- mation; a study of their methods and of any recent developments or changes in them; comparison of dif- ferent agencies which to any extent deal with the same or similar problems; the setting up of standards or criteria by which their efficiency may be estimated; consideration of the extent to which, quantitatively, they fulfill their purpose; sympathetic scrutiny of the obstacles w^iich they encounter — financial, political, or personal; and above all, an attempt to get a sharp, clear, lasting impression of the actual purpose and function of each organization, so that its name will thereafter stand for this definite impression — to be supplemented and modified if necessary by other im- pressions — and of the degree in which the existing social agencies meet, or fail to meet, the existing social problems. While such a course dealing concurrently with social problems and social work in American communities would not be primarily a statistical study, it would of course make use of the available statistical material, acquainting students with the main sources of infor- mation, both government reports and private surveys and investigations, about the nature and extent of the more important social problems. It would take into account rural as well as urban communities. In some instances students in this course might partici- 306 Social Work pate in local surveys of social conditions, but under- graduate students will usually get more profit from carefully arranged visits to social agencies than from the kind of field work which takes them individually into homes or imposes upon them prematurely the delicate responsibilities arising from contact with fam- ilies in trouble. The primary object of this instruction is not merely to give information, which is only the raw material of learning, but to make clear the nature of the problems and to cultivate in the student the critical faculty; to lay the foundation for just estimates of policies and methods in dealing with the particular problems involved. HISTORICAL BACKGROUND Either before or after the current social problems and social work, or even contemporaneously, the history of social ideals and relations in ancient, medieval, and modern nations might profitably be studied. The historical background of social work is fully as import- ant as its current operations, and the neglect of this historical background is the sufficient explanation of much that is superficial — even if pseudo-professional and pseudo-scientific — in the social work of the present generation. Serious thought about human welfare did not begin the day before yesterday. The ancient Jews under- stood the difference between justice and charity, and what was implied in a decent respect for the personality Preparation for Social Work 307 of the poor; and their prophets had a fundamentally sound conception of social ethics. Plato dealt courage- ously, even if not finally, with problems which are pressing to-day and which we shrink from discussing. The Roman family and the Roman civil law are integ- ral parts of the social heritage of modern western na- tions, and familiarity with them is essential to an under- standing of the modern family and even of our own statutory laws. The idea of service and all-embracing charity is best studied where it was most completely and beautifully exhibited — not in the vagrancy laws of Elizabeth or the poor law reforms of the 30's, but in the early years of Christianity. Medieval charity is an essential element in modern social work, and it becomes intelligible in the teachings and labors of St. Bernard, St. Francis, and St. Thomas. Both monastic- ism and scholasticism are landmarks in the history of the attempt to reach fundamentals in helpful social relations. The Protestant Reformation and the secular organization of relief which accompanied it, the devel- opment of municipal and state systems of dealing with pauperism, have an intimate relation to modern public relief and voluntary secular charity. The radical flow- ering of proposals of the revolutionary period, some of which are realized, marks the transition to nine- teenth century problems. If the historical course occupies an academic year, this might close the first half of it. The second half might be devoted to the develop- 308 Social Work nient of social work in the United States,* with appro- priate attention to contemporaneous movements in European countries : such as factory legislation and the reform of the poor law in England; the Elberfeld System and social insurance in Germany ; the develop- ment, in France, of voluntary and especially of religious agencies, modified by the conflict with a radical secular- ism. The review of American developments should include the great social movements of the nineteenth century — for the restriction and abolition of slavery, for the promotion of temperance and later the establish- ment of prohibiton, for free general education, and for "woman's rights" ; the methods by which the colonists dealt with the problems of dependence and crime; the introduction of the English system of out-door relief in the northern states ; the place of slavery in the south- ern states; the creation of the almshouse as a reform institution, and the gradual evolution from it of various specialized institutions — for the insane, for children, for the deaf and the blind, the feeble-minded, acutely sick, tuberculous, and so on; the formation of private societies of various kinds; the attempt at co-ordination of relief which was made by the Associations for Improving the Condition of the Poor in the 40's; the creation of official boards for supervision in the 70's; the charity organization movement of the 80's; the * A volume on The Story of Social Work in America will be included in The Social Welfare Library, and is now in preparation. Preparation for Social Work 309 settlement movement of the 90's; and the educational and preventative movements of the past three decades.* GRADUATE PROFESSIONAL TRAINING The suggestions thus far made are intended to apply equally to students who are looking forward to social work as a career and to those who have an interest in it merely as a subject of general education. Those who expect to engage in social work professionally will naturally wish to have a larger amount of such instruc- tion and will select, more consistently than others, even from the beginning of their college study, the courses which have a bearing on such preparation. A graduate school of social service offering a one year or a two year professional course would aim to give technical preparation for one or more of the sev- eral recognized kinds of social work. Students who have not had the undergraduate courses above outlined should take them as a part of their professional graduate training. When it comes to the technical courses in social work, we may jdistinguish two radically different ways of approaching the' decision as to what the content of such courses should be. One tendency is to isolate distinct processes in the different kinds of social work now in operation. The technique of these processes then becomes the subject of instruction, regardless * A compact review of the main developments since 1900 may- be found in a pamphlet published by The Frontier Press: Ameri- can Social Work in the Tzventicth Century, by Edward T. Devine and Lilian Brandt. 310 Social Work of the agency engaged in them or the need which the agency is trying to meet. We might thus have courses on the technique of social diagnosis, the tech- nique of treatment, the technique of research, the tech- nique of organization, quite divorced from any con- sideration of the purposes of the agencies which make use of such diagnosis, treatment, research, or organ- ization, or of the larger aspects of the evils which have given rise to the agencies. It is doubtful, however, whether there is yet, or is likely to be, enough crystal- lized "technique" in social work to make it desirable that such courses should form a large part of the cur- riculum; and there is a positive danger of promoting mediocre uniformity and rigidity, and discouraging open-minded experimentation, by over-emphasizing the value of methods which have been tried and have had a measure of success, by formulating and teaching rules for action in situations which almost inevitably will contain incalculable elements and combinations. The other approach would not be, as might hastily be inferred, that of a mere apprenticeship in which the novice would learn by imitation or demonstration how to do particular things in a highly specialized field, without reference to general principles. This, of course, would not deserve to be called professional training. The alternative to a subtle and artificial over-refine- ment of technique would be based on the idea that prog- ress in social work lies in regarding and treating as a unit all the varied forms of it which are carried on Preparation for Social Work 311 to the same end, which deal with the same problems, rather than the processes or operations, more or less similar, which may be found scattered through the var- ious fields ; in synthesizing efforts, and relating them to their object, rather than in isolating and re-grouping processes. The student should therefore be expected to choose for specialization — after he has acquired such a general knowledge of the entire field as has been emphasized--^ not a process, such as case-work, but one or more of the departments of social work, and his entire time might be spent in intensive study of his chosen subject, including a suitable amount of field practice. These larger departments are : — I. General Relief : Family Welfare and De- pendent Adults. 11. Child Welfare. III. Care of the Sick and Plandicapped and Prevention of Disease. IV. Treatment of Offenders and Prevention of Crime. V. Improvement of Working Conditions. VI. Improvement of Living Conditions. This division, while subject to modification in ac- cordance with the demands of students, the available teaching staff, and other circumstances, has the advan- 312 Social Work tage of using terms that are familiar. It corresponds roughly to the great social problems which, although not mutually exclusive, are nevertheless fairly distinct : poverty, disease, crime, industrial exploitation and mal- adjustment, exploitation of tenants and consumers. In the last of these fields there is less unity than in the others, but still there is a family relationship in the problems of the settlements, neighborhood associations, recreation commissions, housing committees, and of those who are striving to improve markets or other- wise protect standards of living. This field, if desired, could be divided: for example, in such a way as to separate those which originate in a problem of exploita- tion from those which do not. Work for children is collected from the other groups and distinguished from work for the family unit for the practical reason that that is the way it is now thought of. In all forms of work for children, the tendency is to regard the state of childhood as the controlling factor, whatever the accidental circumstance that brings the child to atten- tion, and to transform it all into "child welfare" work, rather than to treat it as correction or relief or pro- tection. The first four groups all have the two-fold aspect of support or care of some sort of individual, and attack on the social causes back of the individual's need. They are both remedial or disciplinary, and educational or preventive. The fifth and sixth are primarily educational and preventive, but they too in- clude more or less "case-work," and the social worker Preparation for Social Work 313 in those fields needs to know the fundamentals of investigation and treatment as practiced in child welfare and home service. Breadth of knowledge and abiUty to r eason clearly, c^i^^^r\U^ for rprogniyincr n f f^rt^anrMntprprptinp- if, n. "s^ ^Wd~ m !Ahi c t f ^r dftrr t ing- fraud "and fq l l^t^y, th^Z protection of common sense agamst plausible absurdi- ties, and a quick understanding such as springs from human sympathy and good-will, are among the neces- sary characteristics of the successful social worker. A vocational course may properly be directed con- sciously toward the development of all these qualities. With this in view, the great masterpieces in the litera- ture of all languages may well be drawn upon as a part of the required or suggested reading in a profes- sional course of this kind. The most profound reflec- tions on social relations are often to be found in the poets, the essayists, and the scholars, in the religious prophets and the philosophers, rather than in our techni- cal literature, useful as this is for purposes of instruc- tion. Leaders in social work must be prepared through scholarship and the infectious influence of leaders. To these fundamentals one other — that which we have discussed at length — is to be added : an intimate knowledge of one or more of the specific kinds of social work, both of the problems with which it deals and the efforts that have been made in the past and are now being made to solve them. This is the ten per cent of technical knowledge, as distinct from the funda- 314 Social Work mentals of social work as a whole and the general characteristics of character, efficiency, judgment, under- standing of human beings, which, as far as preliminary- study can do it, will prepare for usefulness in social work. CHAPTER XIX THE FUTURE OF SOCIAL WORK Hospitals, dispensaries, homes for aged and infirm, child welfare agencies, and many other kinds of social work, are in the United States partly governmental activities, supported by taxation and managed by public officials, and partly private activities, supported by voluntary contributions and managed by boards of elected managers or trustees or by self -perpetuating boards. Courts, police, prisons, reformatories, proba- tion commissions, and other social agencies for dealing with crime, are for the most part governmental, from the nature of their functions, although there are private reformatories for women and for children, generally imder religious auspices, and there are numerous volun- tary agencies which are occupied with one or another aspect of the relation of society to the criminal. FREEDOM OF INDIVIDUAL INITIATIVE : ITS RESULTS Complete freedom for voluntary initiative in all de- partments of social welfare has been the American policy, modified only by the practice in a few states of 315 316 Social Work conferring on some such body as the State Board of Charities the responsibihty for deciding, after hearing and investigation, whether a charter should be granted to certain kinds of agencies, and for supervising the work of certain agencies — such as those for placing out children — where vital interests may be involved. A charter may also be revoked by judicial action if cor- porate powers are abused. While this freedom of initiative has led to com- petition and over-lapping, and to haphazard growth of institutions and activities, it has on the whole re- sulted in some sort of remedial provision, often several sorts, for almost every conceivable hardship. The re- sources of some agencies have been inadequate for their ambitious programs, and this has been quite as true of municipal, county, and state activities as of the private societies. There is, for example, no greater discrepancy at present than that between the acknowl- edged responsibility of the states to provide for the feeble-minded and the wofully inadequate provision actually made for them. The test of social work, public and voluntary, lies in what is done to meet the crises in family welfare. Home service is a field so varied and so boundless that it is never fully cultivated; but in some large areas, especially in the south-west, and also in rural districts of the east, there is an entire absence of agencies for social work. Many smaller cities and towns are still without any efficient resources. In many places it is a The Future of Social Work 317 question of not rcachir.g, rather than of over-lappin^^. How shall this need for family social work be supplied? EXTENSION OF HOME SERVICE THROUGH SOCIETIES FOR FAMILY WELFARE One way is to increase the number and at the same time standardize the work of the charity organization societies or other agencies, whatever name they may bear, for family v/elfare. This is the purpose of the American Association for Organizing Family Social Work and of the Charity Organization Department of the Russell Sage Foundation. These voluntary socie- ties are everywhere supported by a small fraction of the population and they serve another small fraction. This is true of all social work, but the democratic, socializing principle demands the constant substitution of mutual aid for philanthropic aid; the transforma- tion of the public-spirited act into the civic or coopera- tive act. In their campaigns against disease, loan sharks, or overcrowding, the charity organization so- cieties or associated charities may rise to the com- munity point of view, but in their individual case-work they do not often escape, and from the nature of their financial support and management they are hardly able to escape, from the class distinction between the financially comfortable and the poor. They do not make appreciable progress in making themselves un- necessary. In the process of liquidating the emergency war 318 Social Work service of the American Red Cross the proposal was made that the Home Service which had been developed in nearly every county in the several states to give patriotic service to the famihes of soldiers and sailors might be continued as centers of similar home service to civiHans in general. Objections were made to the general extension of Red Cross Home Service on the ground that it would be competing with existing volun- tary societies, and also on the ground that it might threaten the usefulness of the Red Cross in wars or disasters. There is still nominally a policy of "extend- ing home service" to civilian famihes, on the initiative of the local chapter, in places where there is no danger of competition with established relief agencies, on the approval of Division and National Headquarters. Whatever is done in this direction is just so much to the good, but as a national system the policy was doomed to failure from the moment when it was de- cided to exclude from it all of the three or four hun- dred larger cities and towns, largely in the east and north, in which recognized agencies of some kind exist. A national movement from which the more populous centers are excluded — and it is in these com- munities that the older movement for organized charity had taken root — is anomalous from the start. If it could have been agreed, in all these larger and wealthier communities, to call a conference to create a new and more democratic agency, retaining the re- sources of the older societies and the interest of those The Future of Social Work 319 who had been active in them, this might have per- petuated the vokmtary basis on which family welfare work has been so largely carried on. This opportunity seems to have been lost. THROUGH THE CHURCHES The question might be raised as to whether the churches, once the sole recognized institutions for the relief of poverty as well as the chief centers of educa- tion and culture, could once more undertake this func- tion. Some attempts have been made in this direction : for example, in Bufifalo, where a comprehensive plan of districting the city and assigning each district to a religious organization was some years ago inaugurated. The church district plan had some measure of success, and is still utilized, with modifications; but neither in Buffalo nor elsewhere* has there been any such exper- ience as to give warrant for thinking that the churches, under existing conditions in America, are any better prepared than the secular agencies to assume exclusive responsibility for family rehabilitation and relief. THE UNIQUE FUNCTION OF RELIGION The churches have indeed e:?ctraordinary advantages in their approach to the problems of social work in families. Their approach is more than patriotic; it is catholic. The equality of all men in respect to their sonship of a common father is more than democracy; it is brotherhood. The passion for rescuing a human 320 Social Work soul from destruction, from the irreparable tragedy of a deliberate preference for evil, is the strongest motive which the history of human relations has revealed. Parental love, romantic attachment, filial affection, ex- cept as they are transformed and purified by religion, do not express the best in human nature. The religious motive, consistently prompting and insisting at whatever cost on the highest and best for those whose lives we touch, is the strongest motive conceivable in social work. The churches inculcate this love among men. Our infants are baptized in it. Our youth are instructed in it. Our worship exalts it. Our solemn covenants bind us to its exercise. Our sacraments and ceremonies and rituals are designed to make it habitual and natural. The churches are thus the best of all agencies for ac- complishing those disciplinary and remedial and con- solatory tasks which poverty, illness, and crime present. They are in fact everywhere engaged in performing those tasks. Social workers who ignore this are blind to their most obvious and powerful allies. The spiritual resources of religion are simply indispensable in social work. Wherever their personal membership may hap- pen to be, social workers might well demand a special standing in the membership in the churches to which their families belong. Two obstacles appear on the side of the churches to their taking their natural place in relation to social work. Some churchmen seek to draw an impossible line between religious and social problems. They would The Future of Social Work 321 have the church refuse to have anything to do with low incomes, bad housing, epidemics, and the like. They would have it concern itself only with sin and redemption as personal problems. Others, recognizing a social obligation, content themselves with developing institutional features within the church — orphan asylums, hospitals, homes for aged, or relief funds — all supported and controlled within the church, and ex- panding to whatever dimensions and varieties the funds available may permit. Neither of these policies is tenable for churches which face realities. Co-operation of the churches with the public and voluntary agencies for social work, an- nexing them all for the promotion of the good life which religion inspires, and generously pouring out their own life to promote the legitimate purposes of the social agencies — religious and secular — is the only conceivable way of dealing successfully with the social evils of which both churches and social agencies are well aware. The churches need not provide the mechanics of social work. Whether in a particular instance institutional activities should or should not be under the direct auspices of the church is a question of expediency, and is often quite immaterial. That the churches should permeate and inspire all social work is fundamental; and that close practical working relations should be cultivated be- tween the churches and the unsectarian and official agencies is elementary. 322 Social Work SOCIAL WORK AND THE STATE Aside from the churches there is only one universal, democratic, and financially competent resource. This is the state itself. Public relief has always been an ultimate resource. Although the laws in American states do not uniformly recognize what in England is called a right to relief, there is nevertheless a tacit as- sumption that any kind of misfortune which threatens life or actual physical well-being should be provided for; and that if relatives, friends, or voluntary agencies do not or cannot make such provision, the state in some way must, or at least should, do so. From this assump- tion there has been developed a whole series of public institutions and agencies, many of them by a process of repeated sub-division from the old undifferentiated almshouse. Public provision has been most successful for those who can be cared for most advantageously in groups; for those who need control or restraint of some kind as well as maintenance and professional treatment; for those whose condition warrants either permanent or temporary removal from their homes, whether in their own interest or for the sake of others. The state has however gone beyond such institutional provision. It has very generally given out-door relief in the form of groceries, fuel, clothing, and sometimes in money. Of late mothers' pensions or child welfare allowances have become common. Children's courts have extended The Future of Social Work 323 their functions through probation officers to deal with many abnormal family situations. Courts of domestic relations have also assumed responsibility in some in- stances for straightening out family troubles, even when they are primarily economic. From another direction the state has even more extensively entered the field of family welfare. Educational authorities have examined the physical condition of the children in the schools and found it very unsatisfactory. Defec- tive eyesight which glasses might correct ; adenoids and enlarged tonsils which should be removed; imperfect hearing, curvature of the spine, fiat-foot, and similar ailments, often easily curable, to say nothing of unclean teeth, scalp, and other parts of the body, obviously re- quire attention as a part of any complete educational system. But in such respects children cannot be saved independently of their parents and relatives. Home visiting from the schools thus leads directly into every aspect of family welfare. The cause of the child's neglect may be mental defect in the mother, a lack of earning capacity in the father, low sanitary standards in both, low neighborhood standards in general, or, farther back, it may lie in part in the greed of land- lords, or the dishonesty of sanitary food inspectors, in an inadequate water supply, or in low wages, long hours, waste and incompetent management of the industries in which the parents are employed. Home inspection and instruction originating in a health depart- ment instead of a public school system ultimately, of 324 Social Work course, runs across exactly the same phenomena and the same bewildering complex of causes, personal, social, and economic. EXPANSION OF STATE ACTIVITY Inspired by the beneficent results of health inspec- tion and home teaching by physicians, sanitary officers, nurses, and social workers — whether from a depart- ment of education or a health department, and by similar work done by what is sometimes called a de- partment of public welfare, county or municipal, we are thus fairly compelled to consider whether general social work in the family should not fall upon the state, rather than upon voluntary agencies, whether religious or patriotic or charitable — that is to say, of course, as far as it is not successfully attended to by the family itself or by some one who recognizes a personal obliga- tion to do what is necessary and can meet it. In the past there has been, as in many places there still is, considerable friction between official and volun- tary agencies, which has made difficult a candid and open-minded discussion of this subject. Motives on both sides have been misrepresented. On both sides there has been unfortunate dogmatism. Voluntary social agencies have shown a self -righteousness, an aversion to "politics," an assumption of superior motive, which hard-working and conscientious public officials find very trying. On the other hand, some of those who are in the public service, in their contempt of The Future of Social Work 325 amateurs, their persistent neglect of sound principles, their arbitrariness and lack of a co-operative spirit, often become an easy mark for criticism. Enlightened opinion at present strives to counteract both these faults, and assumes that both public social service and volun- tary service are needed, and that the main problem is to find a modus vivcndi, a rational division of work which will promote a mutual understanding and a socially beneficial co-operation. While this assumption is sound, the question arises whether the division of work should not be cjuite differ- ent from what is ordinarily found, and yet one for which we already have abundant precedent. If the voluntary agencies, instead of trying at great expense to carry mdefinitely a large part of the relief burden, would confine their activities largely to the field of experiment, retaining only so much of the responsibility for actual case-work as is necessary for experiment and for the training of workers, they might do this kind of work far more thoroughly than it is now done, and might by fixing responsibility clearly on the appropriate public agencies increase also their efficiency and indirectly contribute to the enlargement of their revenues. THE PRINCIPLE THAT THE STATE SHOULD BEAR THE BURDEN The support of the aged and infirm, the care of the sick, both chronic and acute, and of the insane and 326 Social Work feeble-minded, the maintenance of orphans and of children whose parents cannot support them, the pro- vision of an income for widowed or deserted mothers and for those whose husbands are disabled, and all similar well recognized relief burdens, already fall, to a large extent, upon the tax-payers. ]\Iight it not be sound public policy to place the whole of it there in principle, always recognizing that it belongs in the first instance upon the family of the individual afflicted, if the resources of the family are sufficient to meet the burden, and that near relatives and friends are always to be permitted and expected to come next in succession? It is when these immediate personal re- sources fail, and a social as distinct from an individual or family problem arises, that the choice which we are now discussing fairly occurs. If it be accepted as de- sirable that we should have something like a national system, uniform in its broader outlines, and adapted to local needs and traditions in its details, adequately financed, authoritative, democratic, generous, and flexi- ble, it is to the state that we shall have to look for the performance of the task. That politics may be corrupt or bureaucratic, clumsy, and inefficient, is not a fatal objection. The public service must, in reference to social welfare, as we already recognize in reference to education and public health, two of its main sub- divisions, be kept uncorrupted and incorruptible; free from the recognizable and preventable evils of bureau- cracy and routine. An enlightened and alert public The Future of Social Work 327 opinion, operating it may be in part through vokintary agencies created for this very purpose, Hke the New York and New Jersey State Charities Aid Associa- tions, the Pennsylvania State Charities Association, the housing associations or committees in various cities, the child labor committees, the American Association for Labor Legislation, the consumers' leagues, the tuberculosis associations, the public health associations, and various other bodies which exist not to help indi- viduals, except incidentally and as object lessons, but to bring organized pressure of public opinion to bear upon legislatures and executives, and even upon courts, to ensure that the necessary institutions are provided, the appropriate protective measures undertaken, the relief required by individuals forthcoming. THE RELIGIOUS PROBLEM If this fundamental idea should be accepted, there are many problems arising in its application which would require careful consideration. For example, there is the question of religious education for de- pendent children. The American principle of religious liberty, and its corollary, the separation of church and state, do not involve indifference to religion. Quite the contrary. Within its own sphere the churches are to be as free from political interference as the state is free in its sphere from ecclesiastical dictation. But child welfare, whether in institutions or in foster homes, the relief and consolation of the sick and the afflicted, 328 Social Work the re-establishment of broken families, the reclama- tion of the wayward, and many similar tasks, require religious and moral elements, as well as the financial resources, the authoritative control, the trained and expert service, which the state may be in position to give. Even in general elementary education, although the existing non-sectarian school is as firmly established in our American social system as any institution could well be, there is nevertheless lacking an element which we may find some way of introducing without sur- rendering its fundamental principle. The Gary Sys- tem has sought to provide for religious instruction by setting apart a certain period for this purpose in the day's curriculum, which the churches are invited to supply, each child going to the place designated by his parents or guardians for suitable instruction during that period. When children have to be cared for outside their own homes, the need for some systematic provision for moral and religious training as a part of the public care becomes imperative. In the past this has been met in part by voluntarily supported asylums for children under religious auspices, or by privately conducted institutions supported wholly or in part by subsidies or by per capita payments from the public treasury. When the child is placed directly in a boarding or free foster home this need is met by the stipulation, sometimes in the law and sometimes only in the general understanding, that a family shall be selected of the same religious faith as that of the Tlie Future of Social Work 329 child or its parents. On some plan, which could be worked out only in conference with authorized repre- sentatives of the various religious faiths, this principle of preserving the natural religious birthright of children and adolescents, and of securing even for adults the ■instruction and consolations of the religion of their choice, would have to be respected. Without sacrificing the American non-sectarian principle, it might be prac- ticable to place the laboratories and trade school equip- ment of the public school system at the free disposal of parochial or other private schools in which acceptable standards are maintained. Such equipment is costly, and its use by certified schools maintained at private expense would no more violate the fundamental prin- ciple of American free non-sectarian education than does the use of assembly halls and playgrounds for the common benefit of the community. The maintenance from public funds of privately owned and managed institutions is unsound in principle, and at best a temporary compromise in practice. No permanent national system will ever be created on such a basis of support from one source and control by another. Public monies should be expended by public officials, chosen by the people or their elected repre- sentatives. Institutions for the care of children who are entirely dependent upon public support and institutions for the education and training of other children raise identi- cal questions of fundamental principle. Both should 330 Social Work be entirely managed and controlled by public servants rather than private employees, but both should give an opportunity for a genuinely religious and moral training, according to parental choice. PRESENT TENDENCIES Whether the voluntary agencies accept some such division of work as that suggested above, or continue to compete with one another and with the public relief agencies, there is no doubt that the expansion of public relief will continue. Its development in the recent past has been phenomenal. The insane, feeble-minded, epileptic, and tuberculous ; widows with dependent chil- dren; families in which the wage-earner has deserted or is in prison or is disabled; disabled veterans of the war; industrial cripples; the aged infirm; the un- employed; are all increasingly establishing their claim on the sympathy of the government, state or national. Their needs are not alike, but they are alike entitled to social consideration. The state or the nation is creating services, one after another, to meet each of these and other emerging or recognized demands. Voluntary agencies are encouraged to do what they can, but the sense of public responsibility is steadily rising to provide ofHcially the minimum stan- dard of relief and protection. THE AMERICAN IDEAL It has frequently been said that the ultimate object The Future of Social Work 331 of all social work is to make social work unnecessary. This is true, and it is the most important ideal for social workers to keep in mind. Every form of social work is a criticism of one or more of the great funda- mental institutions of society — the family, the school, industry, the courts, the press, the government. It is no part of our American ideal that there should be forever groups of the population who are so handi- capped by one thing or another that they are not able to bear a normal part in the community or to live their own lives without special assistance; and that there should be a special profession made up of men and women whose business it is to guide and direct these unfortunates and incompetents. The ideal would be pure milk without a milk committee, protected child- hood without societies for the prevention of cruelty and child labor committees, recreation without a play- ground association, rational charity and family welfare without a family welfare bureau or a charity organiza- tion society, justice to the poor without a legal aid society, social religion without a social service commis- sion in the churches, industrial democracy evolved from industry itself — in short, communities in which each individual, in an enlightened way, works hard to ad- vance the interests of himself and his family; in which each natural group works together, in a social spirit, to advance its own interests; in which all citizens con- cern themselves intelligently and actively in the conduct of the public business ; in which investors and workers 332 Social Work alike interest themselves in all aspects of their joint enterprise; in which the schools teach all children to be efficient and to use their income to the best advantage and to enjoy what it will buy; in which the newspapers compel attention to events of genuine social importance; in which the churches provide moral training and the support of religion for all; in which all the natural bonds existing in human society are strengthened and enriched, instead of being relaxed and sundered by overwork, by overstrain, by overcrowding, by foolish kindness, by social temptations ; in which new situations are faced habitually by the citizenship working through familiar institutions; in which every profession and craft has a sturdy pride in solving the problems it creates — solving them preferably without the enact- ment of new criminal statutes, but always ready to apply coercive measures and heroic remedies if in the last analysis they are unavoidable. This ideal is, to be sure, a long way off, and it will recede as we approach it — as new knowledge provides new tools and suggests new methods; as increasing sensitiveness reveals suffering of which hitherto we had been unconscious; as rising standards of decency find intolerable what has hitherto been endured with indif- ference; as successful accomplishment of first steps inspires courage and ambition to go on. As long as there are individuals in need of aid and comfort which their immediate relatives and friends cannot give; as long as there are obstacles and injustice hampering The Future of Social Work 333 individual progress which can be removed only by con- certed action; as long as there are gaps between the intentions ^f our established institutions and their accomplishments, between what we know and what we do, what a few know and what the many know, what all would like to do and what with their resources and under their limitations they can do — so long will there be need for social work. That is to say, it will be needed as long as there is such a thing as human progress. But the particular agencies which do the social work of to-day will give place to others, the particular methods in use will become obsolete, and the better they are the faster this will happen. It is desirable that this should be so, and it is desirable that as fast as possible the tasks of social work should either become unnecessary, through the correction of the abuses which have created them, or should be assumed by those on whose behalf they are undertaken or by the entire body of citizens. It is only by realizing the place of social work in relation to the rest of our social economy, by keeping in mind the ideal of a community in which social work shall have a very inconspicuous place, and by demand- ing of every social agency that it shall work for its own extinction, that the social work of to-day can accomplish what it has undertaken. And it is by reason of this Intimate relation to all the permanent features of our social and economic life, with the de- mand this makes for wisdom and for knowledge of 334 Social Work every kind and the stimulus that comes from the con- sciousness of working in harmony with social prog- ress — it is by reason of this dynamic quality that social work deserves the serious attention of all men and women who from any angle are interested in the common welfare. INDEX PAGE Abandoned infants, sec Children "Abuse of medical charity" 147 -Accounting methods in social agencies, Improvement in, 296 Addams, Jane 28, 231 Administration of the criminal laws 190 Administrative expenses of relief societies 206 Adoption, of children 118 Adults, dependent Chapter vii Aged poor 3, 71, 83, 99-108 Almshouses 15, 29, 73, 99-104 America : Individualism in 7 Favorable conditions 7, 31 General prosperity 8 Persistence of misery 8 Economic ideals 32 Religious ideals 33 Social ideals , 35 Political ideals 37 Distinguishing characteristics of ^social work in 38-43 American Association for Labor Legislation 241, 3Z7 American Association for Organizing Family Social Work 253-4, 259, 317 American Child Hygiene Association 259 American Federation of Labor 170 American ideal of social organization 330 American Industrial Lenders Association 215 American Legion 177 American Public Health Association 227 American Red Cross VI, 65, 72, 96, 218, 228, 248, 292, 318 American Social Hygiene Association 223 American Social Science Association 261 American social work, Distinguishing characteristics 38-43 American Social Work in the Tzventieth Century 309f.n. American Society for the Control of Cancer 225 American standard of living 57-61 Angell, James R 303f.n. Anti-nicotine movement, checked by the war 244 Anti-Saloon League - 208 Appeals for funds 287, 288, 289 Appropriations for social work from public funds 265, 266-275 335 336 Index PAGE Associated charities 252 Associated Charities of Boston, The 48, 92 Association for Improving the Condition of the Poor, the New York 251, 254 Association for the Prevention and ReHef of Heart Disease 227 Bastardy court 181 Baths 78 in public lodging houses 109 Bedford Reformatory 274 Bellevue and Allied Hospitals *... 139 Bequests, sec Endowments "Big Brothers" 182 Birth registration 222 Blind, The 3 Needs of 151, 161 in almshouses and homes for the aged 153 Provision for I55ff. Commissions for 158 Blindness 223 Congenital 152 Prevention of 152, 161 Bonuses for ex-service men 222 Boston Council of Social Agencies 257, 258 Boston Permanent Charity 232 Boston School for Social Workers 16f.n. Boy Scouts 78 Brandt, Lilian 286f.n, 309f.n. Brent, Bishop Charles Henry 205 Bridgman, Laura 158 Budget committee of a financial federation 293-5 Budgets, Family 47 ff. Budgets of social agencies 293-5 Buffalo, Church district plan in 319 Building, Tendency to economies in 297 Bureau of Municipal Research 254 Burleson, Albert S ' 177, 179 Campaign organization of a. financial federation 295-6 Campaigns for funds 289-292, 295-6 Camp Fire Girls 78 Cancer, Control of 76, 225 Care of individuals 2, 3, 20, 22, Chapters VI-XH, 204-6, 249, 250, 311-2 Carnegie Corporation 244 Carnegie Foundation 232, 298, 299 Index 337 PAGE Case conference 252 Case-work 66, 311-2, Chapters VI-XII passim "Second-story" 205 Preventive 205 Causes of misery 14, 76ff., 264 Censorship of motion picture films , 235-6 Census, Federal, Classification of social work 68 Centenary Fund of the Methodist Episcopal Church 290-1 ' Chalmers, Thomas 94 Chambers of Commerce < 211, 254, 259 Changing character of American social work 41 Chapin, Robert Coit 50 Character of American Social Work Chapter III Charity balls 266 Charity Organization Department of the Russell Sage Foundation 317 Charity organization movement 92, 248, 251-4 Charity organization societies 72, 251-4 Charity Organization Society of New York, The VI, 254 Chattel mortgage loans 212ff. Chicago Community Trust 232 Chicago Council of Social Agencies 258 Child Health Organization 259 Child labor 77, 238-240 Child welfare 311 Bureaus of 72 Child welfare allowances .^ 123-7 Child Welfare Standards, of the federal Children's Bureau 114, 115, 116, 118, 121, 125, 222, 239 Childhood, Rights of 114 Children Chapter VIII Children, Dependent 3, 71, 72, 83, Chapter VIII, 327-9 Children : Naturally dependent „ Ill Responsibility for their welfare .; 112-4 Foster homes for 116fF. Institutions for .*. 119flF. Support of 273-5 Religious education in 327-9 Children's aid societies 116 Children's Bureau, The 125f.n., 222, 239 Conferences of 222, 239 see also Child Welfare Standards Children's Village 202 Christmas Seals 292 Church, The, and social work 231-2, 319ff. 338 Index PAGE Church district plan in Buffalo 319 Churches, Institutional 230, 231-2, 321 Churches, Social creed of the a 291 Churches and social work 63, 204, 231-2, 319ff. Use of volunteers 93 Homes for the aged supported by churches 104 Homes for children 119 As general relief agencies 319ff. Cincinnati, Financial federation in 293 Cincinnati Council of Social Agencies 258 Cities, Re-planning of 212, 237, 245 Classifications of Social Work Chapter V, 311-2 Cleveland, Financial federation in 292, 293 Cleveland Foundation 232 Clientage 97 Clinics and dispensaries 15, 74, 146, 147 Clothing, in the American standard of living 55 Clubs 78, 204 College and university training for social work 299ff. Colony, for unimprovable offenders 187 Columbia University VI, 48, 50 Columbus Council of Social Agencies 258 Commissions and legislative committees 202 Commitments to children's institutions 123, 282-3 Committees and associations for improving living and work- ing conditions 16, Chapters XIII-XIV Community chests and community funds, see Financial federations Community conscience and civic memory 254 Community foundations and community trusts 232, 265 Community Organization, by Joseph K. Hart 255f.n. Community Organization 56, 245 "Community service" 78 Community Service (Incorporated) 259 Compensation : for occupational injuries 153, 241-2 to disabled soldiers 163 Conferences of social workers, National, state, and local 261-2 Confusion and duplication among social agencies 258-261 Congestion of population 77, 234, 244 Consumers' leagues 16, 240, 327 Contributions for social work 265, 286-296 Control, Boards of 263 Cooperation in social movements 248 see Coordination Coordination and Supervision Chapter XV Correctional institutions 74, 196-203 Index 339 PAGE Councils of social agencies ^57-8 Country life, Movement for improving 245 County officials, Lack of public interest in 102, 199-201 Courses in social work 301fF., 304 Courts 74 and child welfare 113 Crime and the Courts Chapter XI Criminal 175 Respect for 175 Special position in America - 180 Tendencies in court decisions 181 Specialization of 181 Practice of the courts in fixing fines 194 Crime V, 8, 19, 20, 42, 69, 75, 230, 233, 312, Chapters XI-XII and mental defect 166-7 Crime and the Courts Chapter XI Definition of 171, 174 Influences tending to increase 172 at the close of the war 173 "Crime wave" 173 Crimes, Classification of 185 Criminal courts 175 Criminality, Nature of 172 Criminals 3, 8, Treatment of 70, 74, Chapters XI-XII, 311 An ideal plan - 186-7 Female 183 Cripples 3, 155 Needs of 155, 157 Provision for 157ff. Cruelty to children, Societies for the prevention of 115 Dance halls 235 Day nurseries 127-8 Deaf, The 154 Needs of 154 Provision for 156 Deafness, Prevention of ~ 154 Death penalty 187-8 Death-rates 228 Defectives, IMental 3, 73, 165-7 Needs of 165 Inadequate provision for 166 Delinquency, sec Crime, Criminals, Juvenile Delinquency Denver, Financial federation in 292 340 Index PAGE Departments of public welfare, or social welfare, see Public Welfare Departments Dependence and mental defect ., 166-7 Dependent Adults Chapter VII, 311 Dependent children, see Children Detention laboratory for observation of convicted offenders 186, 203 Detroit, Financial federation in 293 Directors of social agencies 286-7 Disarmament 245, 270 Discrimination in giving 287-8 Disease V, 8, 19, 20, 42, 69, 7Z, 75, 204, 230, 233 Prevention of 216-229, 311-2 Disorderly conduct » 185 District committee 252 Diet in the American standard of living 59 Disabled soldiers. Provision for 155, 159, 162-4 Disasters, Relief in 95 Dispensaries and clinics 15, 74, 146, 147 Division of responsibility between voluntary social agencies and the state , 322-327, 330 Domestic relations, or family, court 181, 191 Drives for funds 289-292 Earnings of social agencies 265, 281-5 Economic dependence the primary social problem.. ..70ff., 85ff., 98 Economic ideals in the United States 32 Education in childhood as a preventive of crime / 188-9 Education of the public 66, 67, 216, 217, 296 Educational social movements Chapters XIII-XIV, 311-2 Common features of 245-8 Eight-hour day in the American standard of living 59 Elberfeld system 251 Elmira Reformatory 201 Endowments and bequests 232, 265, 275-280 Expert service undervalued 272 Extravagance in building 297 Families Chapter VI Family, The: Normal function of 78 Destructive influences ' • 81 Responsibility for physical and moral welfare of children 112 Family budgets 47ff., 92 Family, or domestic relations, court 181, 191 Family social work 7Z, 81-95, 253-6, 311, 317ff. "Family societies" 72 Family welfare, see Family social work Index 341 PAGE Federal Council of Churches 291 Federal department of public welfare, Proposal for 233 Federations of social agencies 248, 257-8, 260-1, 292-6 Feeble-minded, The, sec Defectives, Mental Felonies 185 Female offender. The 183-4 Filiation court 181 Finances Chapters XVI-XVII Financial federations of social agencies 248, 257, 260-1, 292-6 Financial methods and policies of social agencies 296-7 Financial secretary in social agencies 289 Fines 193-5 Fiscal supervisor 264 Folks, Homer 48, 49 Foster homes for children 116ff. Foundations, Philanthropic 230, 232, 246 Foundlings, see Children Freedom of the individual in modern times 6 Freedom of voluntary initiative in social work 315-6 Fresh-air agencies 129-130 Fry, Elizabeth 28 Function of social work 10-12, 22 Fundamentals of social work 301ff. Funds for the support of social work, see Finances Future of Social Work, The, 98, Chapter XIX Gary system 328 Giddings, Franklin H 302f.n. Gonorrhea 223 Government : Common services not social work 24 Purpose of • 170 Governmental and voluntary activities in social work.. ..267-8, 322ff. Governmental social work 63, 266-8, 322fF. Graduate professional training for social work 309ff. Grand Rapids, Financial federation in 293 Guilds 4 HANDicArpED, The Chapter X Handicaps, Physical ISO Mental 164 Hart, Joseph K., 255 Hartley, Robert M., 251 Headquarters and staff, essential in any social movement 247-8 Health : in dependent families 89 Extension of care more desirable than restriction 148 Promotion of „., 77, 227flf. 342 Index PAGE Health centers 146, 227ff. Health departments 219, 228 and child welfare 113 Visiting nurses maintained by 147 Health ideal 133 Health insurance 149 Heart disease, Prevention of 225-6 Hill, Octavia 210 Historical backgrounds of modern social work 306-9 "Home and aid" societies 116 Home care of the sick 146 Home service 72, 206, 316 as an alternative to institutional care 82, 120 Agencies for 84-5 Extension of 96, 317ff. Medical 146 Psychiatric 169 Main purpose preventive 205 Homeless, Provision for 108ff. Homes for children 119-123 Homes for the aged 15, 72 Public 99-104 Private 104-5 for old soldiers 105 Hospitals 15, 74, 135-146 Description of a modern hospital 13Sff. Maintenance 138 Public and private 139 Support 138, 139ff., 273-5 Value 143-6 for the insane 169 Household industry 4 Housing : Improvement of 77, 209-212 in the American standard of living 57 Housing movement 209-312 How Much Shall I Give, by Lilian Brandt 286f.n. Illegitimacy - 118, 167 Immigrants 78 Immigration ....^ 245 Impatience with poverty in America 41 Imprisonment as a punishment for crime....... 196-203 Improvement of living and working conditions 2, 3, 21, 22, 70, 75, Chapters XIII-XIV, 311-2 Index 343 PAGE Income, Insufficient 85ff., 220 Income requirements of the American standard of living 60 Indians 78, 236 Individual freedom and responsibility 4, 6 Individualism in America 7, 32 Individuals, Care of 2, 3, 20, 22, Chapters VI-XII, 204-6, 249, 250, 311-2 Inductive Sociology, by Franklin H. Giddings 302f.n. Industrial relations, Court of 181, 182 Industrial revolution 5 Industry, Household 4 Industry : Reorganization of 237-8 and social work 242-4 Constitutional government in 245 Infant mortality, Reduction of 76, 219-222 Insane, The 3, 165 Provision for 15, 168-9, 203 Insanity 167-9 Distinguished from mental defect 165 Influences tending to increase 167 Progress in treatment 167 Inspection by official boards 263, 264 Institution or home service 82-4 Institutional care : Advantages and disadvantages / 82ff. for the aged 106ff. for children ,...119ff. Alternatives to 119 for the sick ...135-146 Institutional churches 230, 231-2 Institutions 66, 67 Productive occupations in 283-5 Earnings of 281-5 Tendency to less extravagant construction 296-7 see also Institutional care Instruction in social work 301, 303fF. Insurance, Social 85-6, 106, 126-7, 149 Interchurch World Movement 291 International Labor Bureau of the League of Nations -4Sf.n. International Labor Conference 241 Introduction to Economics, by Henry R. Seager 302f.n. Investigation of social problems 245-7 Investment, Public-spirited 2\2ff., 216 "Iowa plan" 255-6 344 Index PAGE Jails 74, 186, 197-201 Joint budgeting by social agencies 293-5 Joint Legislative Committee of the State of New York Investigating Seditious Activities 179 Justice to the Poor i. 244 Juvenile court 181, 182-3, 191 Juvenile delinquency 172, 236 see also Juvenile court Keller, Helen 158 Landis, Judge K. M., 194 Lawr-abiding spirit 170 Conditions essential to 176, 179, 189 Cultivation of, in childhood 188-9 Law-breaking spirit 171 Laws, Character and administration of 189-190 Legal aid movement 244 Legislation for control of exploitation 216 Legislative committee 202 Le Play, F. 47 Literature of social work 246-7, 262 Living conditions, see Improvement of living and working conditions "Loan sharks" 212, 214 Loans on furniture, salaries, etc j 212-6 Lock-up, see Jail Lockwood Committee 194 Lodging houses 108-110 Louisville, Financial federation in 293 Lusk, C. R 179 McConnell, Bishop F. J 291 Martial, quoted 98 Massachusetts Bureau of Labor Statistics 48f.n. Massachusetts State Board of Charities 261 Material relief 93-5 Maternity aid 222, 267, 268 Meeker, Royal S -. 48f.n. Membership in social agencies 286 ^Mental defect, distinguished from insanity ^ 165 ]^,[ental defectives 3, 73, 165-7 Mental disability 164 Mental examinations, in social work for families 89 Mental hygiene movement 244 Merchant Alarine Hospital Service 138 Index 345 PACE Methodist Federation for Social Service 291 Minimum wage laws 240 Minneapolis Council of Social Agencies 258 Misdemeanors 1S5 Missions 15, 108 Mitchell, John 53 Modern Health Crusade 259 Monfs dc Piete 213 "Mothers' pensions" 123-7 Motion picture censorship 235-6 Motives for supporting social work 266, 267, 287 Mountain whites 236 Municipal research. Bureau of 254 Mutual benefit associations, not social work 26 National Catholic Welfare Council 292 National Child Labor Committee 238, 239, 259, 260 National Child Welfare Association 259 National Conference of Social Work (formerly Charities and Correction) 16, 42, 261-2, 263 National Consumers League 240 National Federation of Remedial Loan Associations 215 National financial federation, Proposal for 260-1 National Housing Association 211 National Information Bureau 259 National Public Health Council 260 National social agencies, Confusion and over-lapping 259-261 National Tuberculosis Association 259, 292 Natural advantages of the United States 31 Natural dependents 71, 1 1 1 Neglected children, see Children Negroes 78, 236, 237 New York Orphan Asylum 124 New York School of Philanthropy VI, 16f.n. New York State Conference of Charities and Correction, Committee on the Standard of Living 48, 49, 50ff. Night court 181, 182 Night work by women ;77, 240 Nomenclature in social work. Present tendencies 258-9 "Non-sectarian" charity, conspicuous in America 40, 64 Normal Life,_ The - .61f.n. Nursing services i 74, 147 Offenders, Treatment of 311 by warning 190-1 by probation 191-3 by fine 193-5 346 Index PAGE Offenders, (Cont.) by denial of privileges 195 by imprisonment 196-202 An ideal plan 186, 202-3 Official boards 263-4 Old age...... J 5, 9, 99-108 Pensions 106, 268 Old soldiers, Homes for 105 One-day-rest-in-seven 59 Organized charity 93 Organizing charity. Societies for 251-4 Orphans and orphan asylums, see Children Out-door relief 63, 72, 123-7 and careless commitments to institutions 123 Over-work and injurious work 77, 240 Palmer, A. Mitchell 177, 179 Parental authority and the state 114 Parks and playgrounds 78 Parole 74 Pawnbroking 212ff. Payment of prisoners 196 Penalties for crime 185ff. Penitentiary, see Prisons Pennsylvania State Charities Association 327 Pensions : for the aged 106ff., 268 for mothers 123ff., 268 for disabled soldiers I59ff. for the blind I59ff. Periodicals in the field of social work 262 Philanthropy, Unorganized 249 "Philanthropy and five per cent" 216 Physical disability 132 Physical examinations : in social work for families 89 in public lodging houses 109 Provision for free periodical 149 Physical handicaps 150 Pittsburgh Survey, The 48, 54 Placing out 72, 116ff. Play, see Recreation Playground Association of America 235 Playground movement 234 Police force 75, 190 Police stations as lodging houses 109 Index 347 PAGE Political ideals in the United States 37 Politics, Defects of American local 272 Population, General registration advocated 198 Poverty V, 8, 9, 19, 20 Relief of 69, Chapters VI-VITI, 311 Prevention of 75, 77, Chapters XIII-XIV Poverty, disease, and crime, the fundamental social prob- lems V, 19, 20, 42, 69, 75, 204, 230, 233, 31? Preparation for Social Work Chapter XVIII Prevention of poverty, disease, and crime 75ff., 186, Chapters XIII-XIV, 311-2 Preventive case-work 205-6 Preventive social work Chapters XIII-XIV, 311-2 Principles of Relief 48, 53f.n. Principles of Sociology, by Franklin H. Giddings 302f.n. Prison associations 202 Prison labor 283-5 Prisoners, Payment of 196 Prisoners' aid societies 202 Prisons and penitentiaries 15, 74, 186, 196fT., 201ff. Supervision of 263-4 Private homes for the aged 104-5 Private hospitals 140-1 Private philanthropy : Relative predominance in America 40, 64-5 Financial support of 265-6, 273-280, 281 ff., 286-296 Probation 74, 182, 183, 191-3 Processes in social work 66, 309 Professional training for social work 309fF. Progress and Social Work Chapter I Prohibition, National 207-8 Prosperity in America 8, 31 Prostitution 183-4 Protection, of the poor 88 of children 113, 115 Provident Loan Society of New York 213-4 Psychiatric clinics 147, 169 Psychiatric home service 169 Psvchologx, by James R. Angell 303f.n. Public and private enterprise in the tuberculosis movement.... 219 Public and private relief 267-8, 322fT. Public authorities, Social work by 63 Support 265-273 Handicaps 272 Public health code ^27 Public health movement 219, 227-9 348 Index PAGE Public Health Service 138, 223 Public hospitals 139-143 Public lodging houses 109 Public officials, handicapped by lack of public interest 102, 199-201, 272 Public revenues for social work 269-272 Public support of private institutions ....141-3, 329 Public Welfare Departments 93, 228, 230, 232-3 Publication, an essential feature of any social movement 246-7 Publicity methods 288-292 Punishment of crime 185ff. Qualifications for social work 298ff., 313-4 Racial and social groups, Social work for 236-7 Reactionary tendencies in treatment of criminals 187 Recreation 77, 233-6 Red Cross, see American Red Cross Red Cross Roll Call 292 Re-education and rehabilitation of disabled soldiers 162 and of disabled civilians 163 Reformation of offenders 186 Reformatories 15, 74, 186, 187, 201 Registration of births 222 Registration of population, advocated 198 Relief Administration, The 96 Relief agencies 72, 75, 205 Relief in disasters 95 Relief, "Material" 93-5 Relief funds 14, 252 Relief of poverty and dependence.. ..69, 70ff., Chapters VI-VIII, 311 Responsibility of the state for 325ff. Agencies for • '^ their interest in prevention of poverty 75, 205 Religion, Relation to social work 231-2 Unique function 319 Religious ideals in the United States 33 Religious origin of much social work 63 Religious problem in public relief 327fF. Remedial loans 212-6, 248 Re-planning of cities 212, 237 Report of work done by social agencies, expected by con- tributors 287-8 Research, Social I' Resources available for purposes of the social welfare 269-272 Right to life. New meaning 4>, Index 349 PAGE Rights of childhood 114 Riis, Jacob A 28 Rockefeller Commission 218 Rockefeller Foundation , 232 Roman idea of the family 113 institution of clientage 97 Rural social centers ^ 78 Russell Sage Foundation 48, 54f.n., 214-5, 232, 317 "Safety-first" movement 153 Saint Louis Council of Social Agencies 258 Saint Vincent de Paul societies 72 Salaries in social work 297 Saloon 208-9 San Francisco fire 48 Sanborn, F. B., 261 School, The, and child welfare 112 School attendance laws 239 School hygiene 147 Scope of Social Work, The, Chapter II Seager, Henry R., 302f.n. Secular or non-sectarian charity 64 Serfage 4 Settlernents 15, 16, 78, 93, 204, 230-1 Sex discrimination in treatment of prostitution 183-4 Sex hygiene 224-5 Sick, The, Chapter IX Sick, disabled, and defective 3, 5, 69, 73, Chapters IX-X, 311 Home care 146-7 Slavery 4 Small claims court 181 Social agencies. Councils and federations of 257-8, 292-6 Social centers 78 Social creed of the churches 291 Social economics : Definition 1 relation to social work 1, 3, Social ideals in the United States 35 Social needs, institutions, problems, forces 1 Social problems : the unifying element in social work 19 definition 20 as a basis for the classification of social work 69, 311-2 Investigation of 245-7 Social research 245-7 Social service exchange 250, 261 350 Index PAGE Social settlements, see Settlements Social work: Description and definition V, 1, 2-4, 15-30, esp. 21ff. Object of 3, 92, 271, 298, 301 Function 10-12 Character_ 27-30, Chapter HI, 204-S', 298, 302 Its place in the American social economy 330-4 consult^ also analysis given in the Table of Contents Specialization of courts 181 Advantages 182 Standard of Life, The, Chapter IV Standard of Living in Nezv York City, The, by Robert Coit Chapin 54 Standard of living 7, Chapter IV the background of modern social work in America.. ..45ff., 55, 61 definition 54-6 The American standard 57-61 Influence of 55, 71 Standard Oil Company ^ 194 Standard minimum wage law 240 Standards : of child welfare, see Child Welfare Standards for women in industry 240-1 for compensation laws 241 State, The, and social work 322ff. Responsibility of 322, 325ff. State activity for social welfare, Expansion of 324 State boards of charities 233, 263-4 State Charities Aid Associations, of New York and of New Jersey 327 State intervention in the family 114 Stevenson, Archibald E., 179 Story of Social Work in America » 308f.n. Subsidies to private institutions 141-3, 273-5, 239 Supervision of social agencies Chapter XV, passim Supervisory state boards 263-4 Support of social agencies, see Finances ; also the various types of agency Survey, The 262 Surveys 256-7 Swimming pools 78 Syphilis 223 Tagging 290 Taxation 265, 266-272 Tax-paying ability 268-272 Index 351 PAGE Teaching material for courses in social work 304ff. Technical preparation for social work 298, 309ff. Technique in social work 67, 205 Temperance movement, The, 206-9 Temporary shelter 108-110 Training for social work 299ff. Training schools 262 Travellers' aid 244 Treatment for all who need it. Importance of 147-9 Treatment of Criminals Chapter XII Tuberculosis, Prevention of 76, 216-9, 248 Tucker, Frank 49 Unemployment 9, 85-6 Uniform Small Loan Law 215 United charities 252 United States, sec America United States Department of Labor 240 United States Labor Bureau 48f.n. Unity in social work. Tendency toward 42 University and college training for social work 299ff. Variety in American social work 39 Venereal disease, Prevention of 76, 223-5 Village improvement societies 78 Violation of local ordinances 185 Visiting nurse associations 147 Vital statistics 228-9 Vocational guidance 153, 154, 157, 169, 226 Voluntary and governmental activities in social work.. ..267-8, 322ff. Volunteer service 92 Wald, Lillian D 231 War, Effect on treatment of criminals 187 on financial methods of social agencies 289ff. War chests 292 War psychology 177-9, 231 Wa'^ning, Treatment of offenders by 190-1 Waste, Prevention of 270 Wealth, Posthumous use of 279 Welfare Departments, Public 93, 228, 230, 232-3 Welfare Federation of Cleveland 260 Well Baby Clinic, Portland, Oregon 220 Whittier School 202 Widows' pensions 123-7, 268 Wills and will-making 275-280 352 Index PAGE Woman's Trade Union League 26 Women in industry, Protection of .'. 240-1 Women's clubs 211 Woodvard 109 Work-house 201 Working conditions 237-244, 311-2 see also Improvement of Living and Working Conditions Wright, Carroll D 48f.n. Young Men's Christian Association 248 V r I I"" — n >/- RY