organization and putting to work of a health council, structurally expressed in some such diagrammatic way as the following:

Public and PRIVATE health agencies, hospitals, etc., Constituting Council ᄆᄃ

*NOTE.-Hospital Committee subsections: Dispensaries, Medical Social Service, Convalescent Care, Care of Chronically Sick.

Unless there is a committee including persons of critical and analytical minds, as well as capable of understanding the significance of trends, averages, percentages, and rates while still keeping their sense of proportion and their

social imagination, the study and report of facts, whether by local personnel alone or with the aid of visiting specialists, will be merely a mass of undigested material, and of little value.

Better service for prevention and care of sickness will depend upon the continuing activities of some body of men and women which may act as a deliberative forum where policies and plans of work are discussed, where inquiries as to fact and results are started, and to which the public will turn for advice in seeking improved public and private work in the field of health and hospitals. Such councils have been developed in Cleveland, Cincinnati, San Francisco, and Louisville, where they are recognized as indispensable.

The origin of so much dependency and delinquency is in preventable disease, and so large a part of the cost of charitable and relief agencies is due to the failure to develop and protect health, and so heavy an annual levy has to be raised to care for established and quite avoidable disease, that it would seem as if professional and financial interests in our organized communities must find it profitable and enlightening to apply social diagnosis to this field before committing themselves to policies of action or programs of construction.

HOW BOSTON MEETS AND SUPPORTS ITS
FAMILY SERVICE PROGRAM

William H. Pear, General Agent, Provident Association, Boston

If there is any special warrant for the presentation here of the story of organized family helping service in Boston, it is perhaps to be found in the example it may offer of, first, effective interaction between private agencies in the conduct of case work; second, interaction between private agencies and public tax-supported departments making their work supplementary; and third, the development of the case work laboratory with its second objective, service to community along with the old service to beneficiary.

I shall try, by the use of actual case stories, to illustrate the first two points, and then will give instances of the use of case material for preventive and constructive purposes. (And before proceeding let me explain that while this paper deals with the work of the agencies called family helping, I am not unmindful of the fact that some of the best family helping case work in our community is done by agencies specializing in child helping. A general recognition of this fact is due, if not overdue.) In order to present the picture in a proper light it seems necessary to set it over against a background of local conditions and facts. As to this background:

According to the latest census (1920), Boston proper is a city of 748,060 persons set down in the midst of a group of residential suburbs, making a metropolitan district of forty municipalities. Thus it happens that the effective community concern of many of its most influential citizens is diverted to the

suburban towns where they reside, or at best their interest is divided. One-third of our people are foreign-born, while a second third are of foreign parentage. Of the foreign-born there are 57,000 Irish, 59,000 English and Canadian, 38,000 Italian, 38,000 Russian, and of smaller groups of various nationalities, 46,000. Of native-born whites there are 181,000; of Negroes there are 16,350; the number of persons over sixty-five years of age is 33,100.

Census returns show that of 164,785 families in the city 80 per cent live in rented homes. In Old Boston, with land values forced up by encroaching business, there is more congestion, and many of the early dwellings have remained in various stages of decay, to become features of Boston's outstanding tenement house problem. These, with the newer tenement houses of cheap construction in crowded sections of the old city, house colonies of the newer comers from foreign lands. In such quarters they are near their fellow-countrymen, and often within easy reach of the factories or shops where they work. Indeed, such is the attraction of these little communities that there are all too many instances of Italian farm laborers working in the market gardens eight or ten miles out of town, but preferring to live in the crowded city. Our agencies well understand the problems that grow out of these poor housing conditions and from time to time have lent support to legislative measures for their improvement.

Boston's industries are well diversified, wages are usually fair, and, generally speaking, workers have the protection afforded by well-advanced state legislation. There is a workmen's compensation law, a minimum wage law, and a law limiting the hours of work for women and children.

Health conditions in Boston will compare favorably with those of other large cities. There are substantial provisions for hospital treatment and for home nursing of the sick, and both public and private agencies for the prevention of tuberculosis are active. But, notwithstanding all this, illness is probably the factor which appears oftenest in our case work, year in and year out.

Having thus seen the relation of the part to the whole, the next step is to study the make-up of the family service group, and at once it will be noted that the private agencies do not work alone. Two public departments, tax-supported, are added, for Boston has a system of outdoor relief and a "mothers' aid" law administered by the Overseers of the Public Welfare; while public aid is given to soldiers and their families through a second department, the Soldiers' Relief.

This is a feature of much importance, for with this disbursement of over a million and a half of public outdoor relief, the group of private agencies faces a more limited but no less interesting task. They turn their attention more to service and to the service of special groups; to filling the gaps, supplementing and rendering the work as a whole more elastic than it could be otherwise.

Of course it is hardly necessary to point out that no such result would be possible without the closest contact and cooperation between public and private agencies. The question of the division of the task is always an open one and is subject to routine periodical discussion between the executives of the various

departments. Furthermore, we depend upon the Social Service Exchange as a first essential. This "Exchange" of ours, which is still operated and underwritten by the Family Welfare Society-15 per cent of the cost being contributed by some of the agencies using it—is housed in the city's Public Welfare Building. Here also the Family Welfare Society, the St. Vincent de Paul Society, and the Provident Association with its allied agencies, the Industrial Aid Society and the Cooperative Workrooms. These two latter supply a free placement service to handicapped men and women respectively, and the Cooperative Workrooms gives workshop training to women and provides home work opportunities for "shut in's."

In viewing the work of this group of family helping agencies, two facts should be kept in mind. First: that any family is likely to have its natural sources of succor: relatives, friends, church, etc., helpers we are accustomed to turn to in our case work, but the value and extent of whose help we may nevertheless fail to realize. The spontaneity and kindliness and true generosity of it makes a chapter we are apt to leave out of the story of the city's charity. Any such summary of our assistance as is here given necessarily omits the very substantial aid from those sources which there is no way of estimating. We only begin where they reach their limits.

And then on the other side, there is the part taken by the agencies cooperating with us to bring in some specialized service. If there is one thing which may make worth while the telling of the Boston story it is the ready and effective cooperation of these services. For example, in one of the cases here cited, there entered at various points: the Psychopathic Hospital, for observation and diagnosis of mentality; the Legal Aid Society, for court action to protect a mother and children; the Children's Aid Society, for temporary care of the children; the Cooperative Workrooms, for training and placement in remunerative employment; the Boston Dispensary, for medical attention.

In all this varied service I think we may say that it is possible to proceed without any duplication, each agency taking its part according to a definite plan which, when necessary, is made a matter of case conference. Indeed, the biweekly "difficult case" conference is a matter of routine with the Family Welfare Society and the Provident Association; and representatives of the Jewish Federation and the Overseers of the Public Welfare commonly join in the discussions. Difficult cases involving industrial placement are considered by another such committee which is conducted by the Federation of Placement Work. With full understanding, therefore, of the importance of these interrelated services, I propose by the statement of a few case stories to describe how the family helping agencies themselves work.

Families in need of slight assistance may be supplied by their friends in the industrial or racial agencies of Group D or C. Those in Group B are able to do more. If Jewish, they or their friends will commonly apply to the Jewish district station where thoroughgoing aid and service may be had. If Roman Catholic,