are deserving of a place in every medical and social worker's philosophy and practice. He commented that he had in a corner of his nature a little plant called Reverence, which he found needed watering about once a week. We gathered that he did not consider his need at all exceptional. We recalled having seen him in a particular pew in the balcony of King's Chapel, and remembered having been told of his regularity in attendance in that particular pew. He spoke of some of the points of view that divided people religiously. Cant and formula that did not square with knowledge and reason had hard shift with Dr. Holmes. He had keen tools for intolerance and bigotry, and for frozen minds. Looking out over the Charles that reached away to the north and west, its icy expanse just then glistening in the splendor of a rare sunset, he said, “Just as this beautiful estuary which we are looking out upon is ever widening as it approaches the sea, so civilization is gradually taking the barbarism out of our interpretation of religion and out of our narrownesses and intolerance and our religious bigotry." He was on his feet as he said it, as if subconsciously wishing that added emphasis might hasten the process. This seemed to me then, and seems even more now, vital and interesting, and perhaps the only true background for social or any other kind of work. However, my concern was with social processes and organization, and about what was beginning to be called social work.

The doctor made frequent reference to medical terms and physiological facts. He grounded his deductions and generalizations on a scientific knowledge of the human body, its functions and attributes, the marvel of its intricate and subtle processes as they harmoniously articulate to accomplish and maintain soundness and fullness of life—an end befitting this master-product of creation, this temple, the human body. His respect for the profession of medicine and his belief in its future was profound.

It was in this connection that the doctor used the particular formula or statement which with his elucidations burned the phrase and the idea into my mind, interstitial renovation. It was my first acquaintance with these words, at least in that combination. He developed with clearness and fascination this idea of constant renovation and renewal of tissue, the subtle and persistent activity which works to such a definite purpose that it gives to each and every individual, at the end of every seven years, a new body.

He discoursed with rare skill and charm on the microscopic mobilization of these subtle agents, busy not only with upkeep and renewal, but with a complement of forces, ready for any emergency within this body republic, and for constant warfare against all insidious foes. If injury came, these atomic bodyguards rushed to the place of trouble, staunching the flow of blood, starting the work of cleansing, of removal, of fortifying and healing the bruise or wound. Another set of diminutive allies fought contagion and disease. Still others stood ready to digest, assimilate, and appropriate, or to eliminate, if not too sorely

taxed, whatever the possessor of the body imposed, no matter how chemically irreconcilable the bill of fare may be.

Here then was a completeness of physiological personnel: sanitarians, doctors, lilliputian cooperators ready for every need, invisible, but nervetheless meeting the law of interdependence and oneness within the human body even more wonderfully, if possible, than that which the apostle Paul in his matchless Corinthian letter has said, so well as to serve for all time, concerning the outward and visible members of the human body.

This wonderfully complex human organism is then a tiny epitome of mankind. The body politic is merely a multiplication of this individual, having also its body politic, individuality, and need. Here is a vision to which one can apply his thinking and energy, especially in the field of welfare service and social endeavor. Taking a beginning from an understanding of one human being, his equipment, purpose, the destiny evidently ordained for him by his Creator, and by keeping one's course corrected to this fundamental guide, as the mariner trusts the star, a key is found for approach to the effective functioning of agencies for amelioration, for health, education, character, for the government of cities, states, and nations.

The growing number and complexity of organizations, in our American communities especially, has made it increasingly imperative that these organic entities of the body politic, or by whatever name we call our collective agency selves, should orchestrate in better accord and effectiveness for the achievement of their several purposes.

I believe that it is becoming more and more true that there is a conscious effort toward collective effort, collective understandings, and group action. The development of our social service agencies has been very generally on an individualistic basis. Quite likely the fundamental principles on which our government was founded have had something to do with this, at least in the United States. The fight for individual rights has been an age-long fight. Freedom of worship, of expression for the individual and for groups of individuals, having been thus won and embodied in the basic structure of our government, we have been very busy ever since in the fruitage of these ideas. One result, according to the interchurch movement, is some 315 denominations and sects in one religious group. In the social field every city, according to its size, has tens or hundreds or thousands of social service agencies. Until comparatively recently their activities have been characterized by a rather intense individualism. There has been more or less of aloofness, of isolation, rivalry, and to an uncomplimentary degree suspicion, unfriendliness, and even hostility.

Not so long ago hospitals received their patients and discharged them well or dead with what would now seem a surprising disregard of the implications of this service to other members of the family, and to other agencies that were interested in the family. It is possible that even yet a case working agency may have difficulty in getting a diagnosis or prognosis on the bread-winner patient

or other member of the family that would help them to plan wisely for the rest of the members concerned.

Dispensaries gave their quick once-overs and issued prescriptions without any regard for home relationships, occupational influences, and other considerations that had a direct bearing on the patient's chance of recovery. Health agencies had slogans-"A Sanatorium for Every County," or some other specialized millenium-good in itself but quite regardless of other elements in a wellordered program for the health of the community. Children's agencies built institutions, had well-defined rules of admission, meticulous specifications as to the kind of youngsters they would serve, and then they would take a child out of the family with about the same tribute to good social sense and practice as the stork theory of providing babies affords to the science of biology. Relief agencies would give tons of coal, pairs of shoes, or yards of red flannel again and again with no more appreciation of its significance or thought of rehabilitation than goes with pennies into a beggar's basket.

This procedure seemed to leave out the idea and the philosophy which Dr. Holmes stressed in his dissertation on this association of cooperators within the human body. Perhaps it required this individualistic performance to get a start, as it were, chancing to invent all the necessary parts of an automobile without having the idea of a completed machine in mind.

Anyway, we went step by step, chased by the results of belated logic. More and more, however, a sense of need for the completed mosaic or picture has asserted itself in the minds of progressive health agents and social workers. Here is a fine definition of the objects of public health with an indicated program by C. E. A. Winslow:

Public health is the science and the art of preventing disease, prolonging life, and promoting physical health and efficiency, through organized community efforts, for the sanitation of the environment, the control of community infections, the education of the individual in principles of personal hygiene, the organization of medical and nursing service for the early diagnosis and preventive treatment of disease, and the development of the social machinery which will insure to every individual in the community a standard of living adequate for the maintenance of health.

In the above statement we have a fine conception of something definite to do. Great things have been achieved already, resulting in handing to every baby born in the United States a life gift of some ten years more than he had twenty or thirty years ago. It also holds the possibility of handing some eight or ten years additional within the next twenty or forty years, if we can get fine team work into all our health and social forces. This can be done, it is said, without any more new discoveries or new inventions, which, however, we know are sure to come. Dr. Winslow says again: "Ignoring all minor specialties, there must be at least the following seven types of highly qualified persons in this field: the physician, the nurse, the bacteriologist, the epidemiologist, the engineer, the statistician, the social worker."

It is probably fair to say that the health agent has had a leading part in

initiating and developing this coordinating activity. He has proceeded from the vantage point of the medical profession, and the medical profession for a long time has been better understood and more appreciated than perhaps any other field of what might be called social endeavor. And be it remembered that a very large percentage of our social work is called for on account of a sickness or infirmity basis. This definiteness has had something of the same idea that an erecting crew has to the plant which fabricates steel and puts raw material in form for bridges, tunnels, and buildings. The health agent has been building something or planning something that had to do with getting people well, giving them convalescent opportunities, or, next of kin to this, something of a preventive or constructive nature.

However, there have been correspondingly great advances in the programs and services rendered by social case workers and those who are dealing more definitely with adjusting people to their environment and helping them out of their multitudinous bewilderments and difficulties.

Now that we are understanding that the mind and the spirit are very definite things in themselves, we are on the way to the creation of even more subtle, discriminating, and fundamental services.

After all, we have to keep in mind the purpose of this body politic in social work. If we conceive of it as an entity and undertake to discharge our relationships to it with the same faithfulness and vitality that these bodily agents perform, as described by Doctor Holmes, we shall function so as to realize in a large way on the possibilities in our field.

A remark once made at a commencement exercise comes to my mind in this connection. It was at a function of this kind, held in one of the largest corngrowing states in the Union, that a good farmer and his wife journeyed to the college to celebrate their son's graduation. There was the usual, if not unusual, galaxy of magnificence in oration subjects; indeed, they were of a nature that once led an essayist to say as he left that he came away with the sense that whereas the country had been in grave danger, the worst was over.

The farmer and his wife, together with a large assemblage, listened to these discourses on weighty subjects ranging all the way from manifest destiny to individual character, each in turn receiving the plaudits of the audience.

When the young man whom they had particularly traveled to hear had finished and retired with an unusually fervent demonstration, the farmer turned to his wife and said—and remember, this was in a corn-growing state, a region whose soil is so rich and whose loam is so black that it furnishes an eternal promise of bread to the world; where on warm says you can hear the corn grow, and this farmer had one of the best farms-nevertheless, turning to his wife, with a husky voice and with mist in his eyes, said, “Amanda, that's the best crop we ever raised!"

Social workers and health agents have for their job a share in just that task, namely, helping to produce to its fullest realization America's best crop, folks.

IS AN INDEPENDENT ADMINISTRATION OF HEALTH AND

SOCIAL WORK DESIRABLE?

Edith Foster, Director, Health Service Training School,
Milwaukee

In an age of combination and consolidation one hardly dares to predict either the possibilities or the limitations of social trusts. The question in the title of this conference paper implies doubt in things as they are and suggests a gigantic merger. There cannot be attempted within the limits of this paper more than a few of the considerations which should help to answer this inquiry.

In the field of big business, when mergers are contemplated, appraisal companies make elaborate studies of the bookkeeping of all the corporations involved. The bookkeeping of health and social work is not in such satisfactory columns as those of big business. No satisfactory unit for measuring efficiency of administration in either health or social agencies has yet been devised. In public health work vital statistics furnish partial measurements through mortality and morbidity figures. Extension of the life-span, for instance, measures real accomplishment. Reductions in death-rates from a number of diseases can well be looked upon as interest on the investment in public health. The fact of death rarely escapes notice, and therefore furnishes our best, but still a rather unsatisfactory, measure of efficiency in health work. Unfortunately social work lacks even the crude measurements possessed by public health. Nothing so final as death occurs in the field of social work. Even a life sentence to a penal institution does not carry so great finality in disposing of a delinquency case while the pardoning power exists and is used so generously. Figures on illegitimacy, desertion, delinquency, dependency, unemployment, neglect of children, and other social problems are far from complete. Studies of these problems in selected communities at various times seem to point to a rather constant rate in which these conditions occur. The accomplishment of social agencies in dealing with such problems can be measured with but a little more than pretense of accuracy.

Social work as now conducted by case working agencies concerns itself principally with these problems, all of which have health aspects, unemployment not excepted. The Milwaukee Family Welfare Association reports that in 2,728 families treated last year there were 1,590 cases of illness. This figure carries conviction that agencies dealing with dependency need to be interested in public health. The teaching of modern case work methods lays good emphasis upon the responsibility as well as the wisdom of referring health problems to medical agencies. The point at which problems are recognized by the social worker is, however, more important than the acceptance of the principle. There are almost unlimited possibilities of developing understanding of the nature of more or less prevalent chronic diseases, the ability to recognize the earliest symptoms, and the conviction that the best, and perhaps we shall come to