Approval of new ventures.-One of the most difficult duties assigned to the State Board of Charities is the approval of the incorporation of new charitable ventures. In passing upon such proposals originating from religious groups the board can be greatly helped by the advice of a central diocesan organization. In the field of Catholic charity no new activity can be started without the approval of the bishop. The wisdom of this policy has been evident where racial or fraternal groups desired to start new orphanages or other works which were either unnecessary or lacking in assurance of substantial support and capable management. For political or personal reasons a public body might have hesitated to refuse the required authorization. In other instances the work proposed may be necessary, but the plans and the location faulty. The state board is more or less limited to a simple approval or disapproval of the project. The diocesan organization is able to work with the proposers in the selection of a better location and in the formulation of better plans. After this valuable preliminary work has been done the state board can then give consideration to the project. Where objectives, plans, and financing are acceptable there may still remain in the mind of the board some doubt as to the ability, experience, and trustworthiness of the individuals making the proposal. It is helpful in such situations to be able to call upon a central agency which is in a position to furnish reliable information.

Assurance of sound financing.-The financing of charities is also a matter of great concern. Yet the state board is not in a position to deal effectively with this problem. An organization may incur indebtedness upon indebtedness until it is hopelessly insolvent, all without the knowledge or approval of the state board. This situation cannot happen in the Catholic field, where institutions are prohibited from contracting for a loan or mortgage without first securing the approval of the diocesan authorities. On the other hand, the central organization can secure increased borrowing power for any of its agencies and thus provide for the development of far-seeing undertakings. Bankers readily extend increased credit to charitable agencies which have the indorsement of the diocesan authorities. In addition, the diocesan organization, from its general resources, can provide finances to meet emergent situations. In the matter of appeals for funds, the Catholic agency has the benefit of the experience and counsel of the diocesan organization. Thus inopportune, simultaneous, and conflicting appeals can be avoided, and methods that have proved wasteful, and professional organizers who have been inefficient or unreliable, can be eliminated. In New York City, Catholic Charities requires that every solicitor for Catholic charitable work shall secure a card of authorization from the archbishop. This is a guaranty to the contributor of the worthiness of the appeal.

Cooperation in carrying out standards. For various reasons the supervision of the state board is often limited to an annual inspection of premises and procedure. Following this inspection a list of recommendations is submitted to the agency. Often the state board has no further contact with the institution until

the next annual inspection. With Catholic agencies the diocesan organization may be the instrument to carry out these recommendations. Equipped with trained specialists it is able to work with the officers of the institution and introduce the improvements suggested. These supervisors, for instance, may follow up a criticism of the dietary of an institution by formulating and putting into effect a standard dietary adjusted to its particular needs. Or again, the diocesan supervisors may instal a standard system of social and financial records adapted to the requirements of the institution and see that they are properly utilized. Supervision of agencies not subject to the state board. In New York the supervision of the diocesan organization frequently extends beyond state and city requirements. For example, the departments of health of the city and state are empowered to exact certain sanitary standards of day nurseries, summer camps, and other organizations. But the many other important activities of these agencies are unsupervised by any public authority. The Catholic Charities of the archdiocese of New York, however, with twenty-seven nurseries and twentytwo camps under its supervision, has not only met the regulations of the public authorities in matters of sanitation, but has formulated standards of medical care, nutrition, recreation, education, and policies of admission. The social values of this policy are obvious.

Organizing for new needs.—With its knowledge of state-wide conditions, the state board may often see a need for the establishment of new agencies or the discontinuance of old ones. To be able to present these problems to a central diocesan agency is often of great value and frequently results in an adequate adjustment of the situation. For example, the state board recently brought to the attention of the Catholic Charities of the Archdiocese of New York that the great influx of colored people into New York City had created an urgent demand for additional child caring facilities for children of this race. Serious consideration is being given to the marshaling of resources and the readjustment of present facilities so as to provide for this need.

State supervision should be constructive, not repressive.-Whatever program of state supervision and direction is formulated and put into effect, it should not have room in it for petty annoyance, unreasonable interference, or arbitrary repression. Private philanthropic effort at the present time is bearing a very large proportion of the burden of remedial effort and, indeed, some of the most effective social work is being carried on by the private social agencies. Moreover, private agencies have contributed constructively to social advancement by experimenting with, and demonstrating the value of, some of the most significant forms of social work which later were taken over by public authorities. We cannot afford to discourage their experiments in untrodden fields or minimize their pioneer attempts to improve methods and procedure. Private agencies tap financial resources and draw on the enthusiastic support of personalities seldom available to public agencies. Such forces must not be diverted from the magnificent work of social betterment through enervating supervision by state authori

ties. The supervisory policy of state boards in regard to private agencies should be educational and persuasive. In their work of inspection and in making their recommendtions they should be reasonable, sympathetic, and impartial. They should endeavor to work with agencies, and not against them. Their attitude should not be that of carping criticism or petty domination, but generous, broadvisioned, and constructive.

A suggested plan of social leadership.-A state board of charities composed of men and women of eminence, ability, and vision might safely be trusted to assume the social leadership of the state. Such a leadership would bring together in conference the executives in social work, heads of important institutions, and other public-spirited persons for the purpose of surveying the social work of the state. Investigation of divers problems might be delegated to the persons or agencies best equipped to conduct them. Intensive study might go far toward solving problems of duplication, cooperation, coordination, and would bring about an interchange of ideas and methods and the formulation of standard policies of administration. Leaders and workers throughout the state, inspired by a program such as this, might be prevailed upon to accept an improved standard of service and pledge themselves to its attainment. Supervision of private agencies carried on in such a spirit of helpfulness, with vision, with an understanding of difficulties, and with a consecration to the highest ideals of service to mankind and to God, will bring untold benefits, not only to the agencies and to their clients, but to all the people of the state.

SOCIAL RESEARCH IN AN INFIRMARY

Ransom H. Sartwell, M.D., Superintendent, Rhode Island
State Infirmary, Providence

What I shall have to say will necessarily relate to the type of infirmary with which I am most familiar. I refer to the Rhode Island State Infirmary, which is an institution for the care of those who, for one reason or another, are unable to take care of themselves or be taken care of in the community.

In the past the reasons for admissions to so-called almshouses, infirmaries, city, county, or town farms were numerous, but in recent years the conditions which formerly necessitated such admissions have been rapidly lessening. At present the principal cause is illness, usually a chronic illness, affecting for the most part the patients themselves, but occasionally some member, or members, of their families who otherwise would have been able to have supplied the necessary care at home.

Ten or fifteen years ago, in studying the population of the average almshouse, one would find a fairly good number of comparatively healthy, ablebodied men and women who were there on account of economic conditions alone.

It is very probable that if a mental and psychological examination had been made of those physically healthy inmates it would have been quite evident that the economic status of many was due to their low mental level, making it impossible for them to cope on equal footing with their fellow-men in the industrial world. A certain number, no doubt, would have been found to have been there because of a mild and chronic type of mental illness; others, as a result of chronic alcoholism.

It is not my object, however, to emphasize so much the cause of admissions in those days, as the fact that before the advent of social service and modern medicine in these institutions the occupants invariably became institutionalized and stayed there the remainder of their lives, which they do at the present time in institutions without some sort of social service. The problem then was considered to be, and is today in most of the smaller town and county farms, a custodial one, providing a place where their unfortunate inmates (I am tempted to say victims) live, or eke out a vegetative existence. Such was the situation a decade ago, not only as applied to the poor and those suffering from a chronic physical illness, but also to those suffering from a chronic mental illness as well.

Then social service came along, and through its efforts a great many of those chronic sick were placed in the community in positions—not necessarily of the same type and responsibility as those they held formerly, but positions the duties of which were consistent with the physical and mental status of the patient, disregarding his former qualifications and facing the situation as it existed. This resulted in a great saving to the state, a great benefit to the persons so placed, and a distinct service to the community, because there always has been and always will be work to be done which does not require the physical strength of a Samson or the mental ability of a Socrates.

Social service had been successfully carried on in municipalities and hospitals several years before any systematic effort was made to use it in institutions caring for the poor; in fact, so far as I am able to determine, only a very small percentage of such institutions at the present time have a full-time adequately functioning social service department.

This is probably accounted for by the fact that the majority of paupers are still cared for in small town or county farms, each of which cannot afford a social service department or do a great many other things which we have come to feel are quite essential to the care of those sent to us. The larger and more progressive institutions, however, have faced the situation squarely, and have prepared to assume the rôle, less of custodial places, and more and more of hospitals. Consequently as their medical staffs have been increased they have inaugurated social service.

The Social Service Department of the Rhode Island State Infirmary was established three and one-half years ago, and I propose to give you a brief résumé of its activities during this time, mentioning some of the difficulties encountered as well as results achieved.

First, in order that you may understand the scope of our work, it will be necessary to explain the type of patients we have. Rhode Island (unlike any other state in the Union, with the exception of Massachusetts, I am told) attempts, in part at least, to care for its poor in an institution maintained by the state and known as the state infirmary. The population of our infirmary is a little over 600, with an admission rate of about 400 per year. We have men, women, and children ranging in age from newborn babies to those a hundred years old, and occasionally we have some even older. It is also the custom in Rhode Island to send to us unmarried women and girls who are pregnant and cannot be taken care of in their homes or by outside agencies. It is not difficult to understand the crying need for social adjustment and the opportunities presenting themselves for social salvage in such a conglomerate group of unfortunate human beings.

Social service activities at the Infirmary begins the moment the patient enters the institution, and includes all work done by agencies within the institution to uplift and enhance the social status of the patients and help to prepare them better to adapt themselves to outside environment when the opportune time comes for them again to assume the burdens of extramural life. We believe that preparedness is the underlying factor that makes for success in any undertaking. Many of our people, because of injury, physical handicaps, or lack of training, are absolutely unprepared to face extramural life, its problems, and difficulties with any assurance of success, but instead, with all prospects of being shipwrecked on the sea of mental and physical maladjustment. We cannot harvest potatoes until we have first prepared the soil, planted the seed, and cultivated the plant; neither can we successfully practice social service without first preparing the soil; and it is my belief that this should be started the moment the patient enters the institution, with rehabilitation as the ultimate always in mind.

I do not mean to imply that we reclaim, or even hope to reclaim, all of the 400 patients who come to us each year, because a great many (probably 30 per cent) before admission have reached a stage, because of some chronic illness or extreme age, where even the most optimistic would not dare predict a return to the community except as a result of a change in the social or economic status of the relatives which would enable them to take their mother, father, brother, or sister out and supply them with the necessary nursing care and medical attention. As a matter of fact, a change in the economic status of the family very often takes place or, with a little assistance, can be made to take place and I feel that we should always be on the alert for opportunities to lend a helping hand in assisting the relatives of our patients over a family crisis due to illness or financial reverses. In other words, I do not believe that social service should be limited exclusively to the patient, but also should include the relatives, friends, employers, social and domestic associates, with the end in view of bringing about some change that may be of benefit to the patient. In this connection