SOCIAL SERVICE 
 
 AND THE 
 
 ART OF HEALING 
 RICHARD C CABOT. MX>, 
 
LfJ3 
 
 Cll 
 
 €amtU IBitiwsttj pikatg 
 
 BOUGHT WITH THE INCOME 
 FROM THE 
 
 SAGE ENDOWMENT FUND 
 
 THE GIFT OF 
 xSqx 
 
 HA^.5:.i.g..Ls , %.c>\iiir^ji 
 
 1357 
 
DATE DUE 
 
 Ja 2 8 '35 
 Ja 2 e '^5 
 
 JAN I 9 1943 
 
 ktr 
 
 
 M: 
 
 Cornell University Library 
 RA 413.C11 
 
 Social service and the art of healing, by 
 
 3 1924 012 460 535 
 
Cornell University 
 Library 
 
 The original of tliis bool< is in 
 tine Cornell University Library. 
 
 There are no known copyright restrictions in 
 the United States on the use of the text. 
 
 http://www.archive.org/details/cu31924012460535 
 
SOCIAL SERVICE AND 
 THE ART OF HEALING 
 
SOCIAL SERVICE 
 
 AND THE 
 
 ART OF HEALING 
 
 BY 
 
 RICHARD C. CABOT, M.D. 
 
 Atiiitant Profaior of Medlcint in, Ike Harvard Medical School 
 Aiiietant Visiting Physician at the Mauachuttttt Oeniral Hospital 
 
 NEW YORK 
 
 MOFFAT, YARD AND COMPANY 
 
 1909 
 

 Copyright, 1909, by 
 
 MOFFAT, YAED AND COMPANY 
 
 New Yoek 
 
 AU Bights Besened 
 
 Fublisbed, September, 1909 
 Beprinted, December, 1909 
 
 THE giTINH ft BODEN CO. PRESS 
 RAHWAV, N. J. 
 
To the Social Workers of the 
 Massachusetts General Hospital, 
 whose fruitfill labors this book 
 lamely but most gratefully describes. 
 
The author's thanks are due to the editors of 
 The Survey and of American Medicine for per- 
 mission to reprint portions of Chapters II and IV. 
 
INTRODUCTION 
 
 This book is written to exemplify three 
 forms of team-'work which are now tend- 
 ing to ennoble medicine. 
 
 1. Social service — the modern type of 
 what used to be called philanthropy — ^is 
 drawing nearer and nearer to medicine. 
 PubKc health and the extermination of 
 disease, — that most fruitful cause of pov- 
 erty, of misery, and of crime, — are the 
 ideals for which doctors and social workers 
 are joining hands to-day. When the doc- 
 tor looks for the root-cause of most of the 
 sickness that he is called upon to help, 
 he finds social conditions, such as vice, ig- 
 norance, overcrowding, sweatshops, and 
 poverty. When the social worker ana- 
 lyzes the reason why a family is in need, 
 why a bread-winner is slack or shiftless, 
 
 vii 
 
viii INTRODUCTION 
 
 why girls go wrong, and boys are caught 
 stealing, he finds physical conditions, 
 medical conditions — poor nutrition, bad 
 air, alcoholism, tuberculosis, injuries in 
 factories — staring him in the face. 
 
 Therefore team-work of doctor and 
 social worker is called for, and the two 
 professions are beginning to hear this call, 
 to feel this kinship, and somewhat bash- 
 fully to work together. 
 
 2. But. moral and spiritual problems 
 also branch out of medical problems. Be- 
 hind much physical suffering is the mental 
 torment, the doubt, fear, worry, or re- 
 morse that the stress of life has created 
 in most of the sick and in many who call 
 themselves well. Without recognizing 
 and treating these ills of the mind it is 
 impossible to control the bodily sufferings 
 for which people consult the doctor. 
 
 The doctor must be a psychologist, an 
 educator, a physician to the whole man — 
 body and soul alike. But can he? 
 
INTRODUCTION ix 
 
 Again team-work is the need. The 
 doctor must work with the educator, the 
 psychologist, and the minister as well as 
 with the philanthropist. Only in this 
 way can he become himself an educator, 
 a teacher, putting the truth into his pa- 
 tients' minds and letting it do its own 
 work there. 
 
 3. The problem of truth spealdng vs. 
 deception and concealment in medical 
 practice springs naturally out of the 
 newer educational and preventive work 
 which is being recognized to-day as the 
 core of medical helpfulness to the public 
 as a whole. To fool a patient is tyranny, 
 not guidance. He must understand what 
 is being done for him if he is to do his 
 part properly. This means team-work of 
 doctor and patient. 
 
 To describe the changes just suggested 
 whereby medical, social, and educational 
 work are now being drawn together for 
 the public good is the object of this book. 
 
CONTENTS 
 
 PAQG 
 
 I. Backgrounds and Foregrounds in 
 
 Medical Work .... 3 
 
 II. The Nature of Social Work, Espe- 
 cially IN Its Relation to Medi- 
 cine S2 
 
 III. Team-work op Doctor, Educator, 
 and Social Worker, and the Re- 
 sulting Changes in the Three 
 Professions — ^A Review and a 
 Programme 91 
 
 IV. Team-work op Doctor and Patient 
 Through the Annihilation op 
 Lying 116 
 
 V. Social Work in Hospitals; the 
 
 Palliation op Absent-mindedness 171 
 
SOCIAL SERVICE 
 
 AND THE 
 
 ART OF HEALING 
 
SOCIAL SERVICE AND THE 
 ART OF HEALING 
 
 CHAPTER I 
 
 BACKGROUNDS AND FOREGROUNDS IN 
 MEDICAL WORK 
 
 There are two kinds of blindness from 
 which I have suffered in my medical work. 
 As I am now beginning to be convalescent, 
 I note, with the sensibility of the recent 
 sufferer, similar misfortunes in those 
 around me. Blindness to what is before 
 you just this minute and never before, or 
 blindness to foregrounds, is a very com- 
 mon disease, due to the habit of looking 
 off into the distance over the head (as it 
 were) of the fact before you. 
 
 But there is another type of blindness 
 in which the sufferer can see nothing ex- 
 
4 SOCIAL SERVICE AND 
 
 cept the facts directly in front of his nose ; 
 this I call blindness to backgrounds. I 
 will mention a group of examples of each 
 type. 
 
 I 
 In my medical work at the Massachu- 
 setts General Hospital I used to see about 
 30 patients a day, or 3,000 in my four 
 months' service. As I sit in my chair be- 
 hind the desk, Abraham Cohen, of Salem 
 Street, approaches, and sits down to tell 
 me the tale of his sufferings ;, the chances 
 are ten to one that I shall look out of my 
 eyes and see, not Abraham Cohen, but a 
 Jew; not the sharp, clear outhnes of this 
 unique sufferer, but the vague, misty com- 
 posite photograph of all the hundreds of 
 Jews who in the past ten years have shuf- 
 fled up to me with bent back and deprecat- 
 ing eyes, and taken their seats upon this 
 same stool to tell their story. I see a 
 Jew, — a nervous, complaining, whimper- 
 ing Jew, — with his beard upon his chest 
 
THE ART OF HEALING 6 
 
 and the inevitable dirty black frock-coat 
 flapping about his knees. I do not see this 
 man at all. I merge him in the hazy back- 
 ground of the average Jew. 
 
 I look behind, beyond, through this 
 actual flesh-and-blood man, to my own 
 habitual mental image of what I expect to 
 see. Perhaps, if I am a little less blind than 
 usual to-day, I may hear what he says in- 
 stead of what I expect him to say. I may 
 notice something in the way his hand lies 
 on his knee, something that is queer, un- 
 expected. That hand, — that hand, why, 
 it's a muscular hand, it's a prehensile hand; 
 and whoever saw a Salem Street Jew with 
 a muscular hand before? That shocks me 
 awake, at last. This is not merely "a 
 Jew ": this is a new kind of Jew. Why, 
 his eyes are farther apart than I ever saw 
 before in a Hebrew, and they don't avoid 
 mine, but look straight at me with a long, 
 deep look that somehow reminds me of the 
 child in Raphael's Sistine Madonna. 
 
6 SOCIAL SERVICE AND 
 
 They are blue eyes, thunder-cloud blue 
 and very steady. 
 
 All this time he has been talking to 
 me, not about himself, but about his fi- 
 ancee whom I have examined and found 
 consumptive yesterday. " Is she cur- 
 able?" he asks, and "Would Colorado 
 give her the best chance? How soon must 
 she go, — ^before cold weather? Well, I 
 think I can arrange it before that. I have 
 a little business just established in Provi- 
 dence, but I think within a month I can 
 sell it out, and take her to Denver or 
 wherever is best." 
 
 " And what will you do out there? " I 
 asked him. " Have you any friends to 
 help you start in business? " 
 
 " Oh, I guess I'm strong enough to sup- 
 port two," he said. " I can work in the 
 mines if there is nothing else." He saw 
 nothing out of the way in giving up the 
 retail dry-goods business which he had just 
 got well under way in Providence, and 
 
THE ART OF HEALING 7 
 
 going to work underground in the dark- 
 ness of a mine, if there was any chance of 
 saving his fiancee, the dried-up, mincing 
 little milliner whom I had seen, or thought 
 I'd seen, the day before. There was no 
 certainty that he could save her. I told 
 him that; but as soon as he understood 
 that there was a chance, he was off to make 
 his arrangements. He has gone now out 
 into that unknown country, made, I hope, 
 a little less forlorn and friendless to him 
 by some letters I was able to give him 
 to friends in Denver and Colorado 
 Springs. 
 
 You could never forget that man if you 
 had seen him, — ^his eyes, his quiet, slow 
 voice, his muscular hands. I saw him. 
 Yet he was no more real than the thou- 
 sands of others whom I have seen and for- 
 gotten, — forgotten because I never saw 
 therrij but only their ghostly outline, their 
 generic type, the racial background out of 
 which they emerged. 
 
8 SOCIAL SERVICE AND 
 
 The pity of it is that we see only what 
 we have seen before. But the man, him- 
 self, is just precisely that which I have 
 never seen before. So he is for me in- 
 visible: to him, as he sees himself, I am 
 usually blind, I see a case of phthisis in 
 a sad-eyed Irishman, but I cannot see, as 
 he does, his children at home, the coldness 
 of his employer when he asks if his job 
 can be kept for him, the dreariness of this 
 great hospital with its suggestion of name- 
 less horrors behind doors which open for a 
 moment and are swiftly closed again. 
 The self that is pushing painfully through 
 these experiences I fail to see, though it 
 is all written in the stoop of his shoulders, 
 the fear in his eyes, and the swift snatches 
 of hesitating speech as he questions me 
 about his lungs. 
 
 My students cannot even hear the new 
 sound which I hear over one spot in his 
 lungs, — a sound I never heard before. 
 The students hear only the old common 
 
THE ART OF HEALING 9 
 
 sounds which every case of advanced 
 phthisis shows. These f amihar old sounds 
 they promptly hear and record, but to 
 this new and startling sound, which might 
 be the prelude to a better understanding 
 of phthisis, they are deaf, though it is loud 
 and clear, even to them, after it is pointed 
 out to them. 
 
 It is very humiliating, this blindness to 
 the new facts, but it is a disease that we 
 all have in greater or less degree. 
 
 II 
 Let me tell you another of our humilia- 
 tions. This case of typhoid, — a " walking 
 typhoid " who has just turned up late, 
 near lunch time, at the Out-Patient De- 
 partment, is obviously too sick to go home. 
 We must keep him in the hospital. 
 " Well, make out his recommendation slip, 
 and count his white corpuscles; ring for 
 John and the wheel-chair, and get his 
 clothes on, and don't forget to record the 
 
10 SOCIAL SERVICE AND 
 
 dimensions of his spleen before you put 
 his record slip away." 
 
 While these orders were being given, 
 and while half a dozen assistants were ex- 
 ecuting them, a visitor to the hospital, not 
 yet blinded and deafened by routine, heard 
 the sick man ask three times for a drink of 
 water. The visitor heard it: the others 
 stood just as near, but none of them heard 
 it. The sounds of his voice struck the 
 tympanum of each man's ear, but to three 
 of them it was an unusual request, and so 
 was simply unheard; by two others it was 
 heard, but disregarded, not because they 
 were cruel-hearted, — ^not at all, — ^but be- 
 cause they were none of them assigned to 
 that duty. It was no one's business in 
 particular, and they all had other jobs — 
 though, to be sure, jobs which could wait. 
 One other assistant who heard the request 
 said to himself, " Oh, he'll be in the ward 
 in half an hour, and get plenty of cooler 
 water; and what possible difference can 
 
THE ART OF HEALING 11 
 
 it make in his recovery anyhow? He'll 
 want water again in a few hours." So no 
 one stirred to get him the water until the 
 visitor could hear it no longer, and so 
 hunted up the timihler and faucet, and 
 brought it himself. Goodness! to see the 
 sick man down that glass and look up 
 with the gleam of momentary relief was 
 something that visitor will never forget, 
 and wouldn't have missed for a year's life. 
 It was the foreground, — ^immediate, 
 pressing, wholly transient relief, direct 
 personal service of the simplest kind, — all 
 hidden from the minds of the regular as- 
 sistants because they were looking off into 
 the distance, shaping the sufferer's future 
 course to the ward and towards recovery, 
 each pointing like a dog at his task, each 
 put in blinders, like a horse, by his con- 
 centration on the future and the distant. 
 All concentration is perilously near to 
 blindness outside the circle which is lit up 
 by the lamp of attention. The concen- 
 
12 SOCIAL SERVICE AND 
 
 trated beam of the searchlight on a battle- 
 ship is typical of the mind of a busy, well- 
 trained, unimaginative man. Any well- 
 trained physician, as he looks with one eye 
 through a microscope, keeps the other eye 
 open, not closed, as the beginner does, but 
 wide open and perfectly blindj absolutely 
 unaware of the images that fall upon it. 
 
 So foregrounds always tend to be in- 
 visible to the man whose mind is else- 
 where, intent upon its duties and its plans. 
 
 Sometimes an immediate crying need, 
 like that of the thirsty fever patient, is 
 disregarded, because, as we say, it is so 
 transient^ — so momentary is the relief we 
 give. " He'll be thirsty again in half an 
 hour, and water won't cure him, anyway." 
 Yes. It is now and here. It does not 
 stretch into the distant future. In other 
 words, it is just what I have called it, a 
 foreground, and we are dreadfully prone 
 to forget that all eternity is made up of 
 half -hours as transient as this, as simple. 
 
THE ART OF HEALING 13 
 
 unimpressive, and insignificant as this. 
 Nothing divine, nothing heroic, about this 
 mean, commonplace present. If the occa- 
 sion were imposing and resounding, we 
 should rise to it nobly, but we notice noth- 
 ing very important just here in this dingy 
 laboratory or on that dreary corridor. 
 We are almost indignant, if anyone tries 
 to open our eyes. How can this piece of 
 cheap, transient drudgery be linked to 
 anything noble or significant? 
 
 " Lord, when saw we thee an hungered, 
 or athirst, or a stranger, or naked, or sick, 
 or in prison, and did not minister unto 
 thee? " 
 
 Whatever we think, whatever our creeds 
 say, our acts prove that we count it mere 
 poetic exaggeration or literary figure 
 when Christ said, " Inasmuch as ye did it 
 not unto one of these least, ye did it not 
 unto me." Christ said that every person, 
 every moment, is a representative of the 
 best in life, — a fair specimen opportunity. 
 
14 SOCIAL SERVICE AND 
 
 " One of the great illusions is that the 
 present hour is not the critical, decisive 
 hour. God give me insight into to-day! 
 The meal in the firkin, the milk in the pan, 
 the ballad in the street, the glance of the 
 eye, the form and gait of the body; show 
 me the sublime presence lurking, as it 
 always does lurk, in these suburbs and ex- 
 tremities of nature." 
 
 " Inasmuch as ye did it unto the least 
 of these my brethren, ye did it unto me." 
 
 " What are you doing? " 
 
 " Oh, nothing. I have been doing that, 
 I shall be doing so and so, but just now 
 I am only " — " Inasmuch as ye did it not 
 unto the least of these my brethren, ye did 
 it not unto me." 
 
 Ill 
 
 From another point of view the duty 
 
 of seeing the foreground becomes what 
 
 Stevenson calls the duty of happiness. 
 
 Not merely in some far-off divine event 
 
THE ART OF HEALING 15 
 
 which shall gloriously consummate and 
 fulfill the hopes of to-day, hut all along 
 the road, in the details of meeting, serving, 
 directing our patients, in the very process 
 itself, and not only in its results, we must 
 find our happiness. Why must we? Be- 
 cause the man that doesn't enjoy his job 
 never does it well, and because, if you do 
 enjoy it, you will make others happy. If 
 it is only the fully achieved result that you 
 enjoy, you will be glum or grim most of 
 the time, for results are rare and uncer- 
 tain things, and the " best-laid plans of 
 mice and men gang aft agley." One ought 
 to enjoy the motion of walking down a 
 corridor, the actual questions and answers 
 by which we get at our patients' needs, the 
 simple technique of accurately reading a 
 thermometer and neatly recording the re- 
 sult on a chart. One ought to get pleasure 
 out of the eyes and faces, the gestures and 
 tones, of our patients and our fellow- 
 workers, the rich roll of the Scotchman's 
 
16 SOCIAL SERVICE AND 
 
 brogue, the musical undulations of the 
 Englishman's voice, and the quick, sym- 
 pathetic flash of the Italian's eye. How 
 stupid, how purblind, to front all these 
 guests with the same stereotyped kindness, 
 the same military precision, or, worst of 
 all, the same dull inattention! Let us be 
 in it! Let us catch the vital impulse of 
 happiness that there is in sight, sound, 
 and touch, in the infinite novelty and un- 
 expectedness of the foreground. 
 
 This unique unforeseen opportunity, 
 this direct personal service, this momen- 
 tary joy springing from the sight and 
 sound before us, make up a part of that 
 foreground of our work to which I wish 
 with all my heart I could never again be 
 blind. 
 
 There is much else in that foreground 
 of which I should like to speak. To be 
 blind to the humor of the moment or to 
 the pathos and the tragedy of the moment, 
 to meet them all with the same engaging 
 
THE ART OF HEALING IT 
 
 smile or the same businesslike finnness, — 
 oh, it is a performance fit only for lay- 
 figures on wheels ! God grant we may act 
 to-morrow a little less like stuffed images! 
 No wise thought of the future, no deep 
 scientific ardor for the truth to be learned 
 from these sufferers, no preoccupation 
 with the wider interests of the community, 
 can justify our blindness to the here and 
 now. 
 
 IV 
 
 But I should wholly miss my mark if I 
 left you with the impression that I hate 
 blindness to foregrounds a whit less than 
 I hate the shortsightedness that can see 
 only the foreground. 
 
 We physicians are prone to scoff at the 
 habit of taking a drug for a symptom Uke 
 headache, without looking deeper to find 
 the underlying disorder of which this 
 headache is a symptom. We point out 
 very truly that only by finding and remov- 
 ing the cause of this headache — an eye- 
 
18 SOCIAL SERVICE AND 
 
 strain, perhaps, or a stomach trouhle — 
 can its recurrence be prevented and other 
 disorders nipped in the bud. This is as 
 it should be, but we need to carry the same 
 habit further. Why should we not push 
 on, and find out why this patient has the 
 stomach trouble? The headache is only a 
 symptom of stomach trouble, we say. 
 Yes, but the stomach trouble itself may 
 be only a symptom of chronic worry, and 
 the worry a symptom of deficient income. 
 The patient's expenses turn out to be a 
 trifle larger than his wages, and one of the 
 many bad results of this fact is the worry 
 that causes the stomach trouble, which in 
 turn causes the headache. 
 
 If we are really to treat that patient, 
 and not merely smother one of his symp- 
 toms under a dose of medicine, we must 
 push on into the background of his case, 
 and see what disease in the body politic — 
 perhaps in the organization of industry — 
 is behind his individual suffering. Not that 
 
THE ART OF HEALING 19 
 
 we should lose sight of him. On the con- 
 trary, we can do much better for him if, 
 instead of stopping at the first stage, head- 
 ache; or at the second stage, the stomach 
 trouble ; or even at the third, worry, we go 
 into the matter of his income and outgo, 
 and see if the two ends can't be made to 
 meet. I have heard physicians giving ad- 
 vice to patients not to worry, advice that 
 would be laughable if it were not so pa- 
 thetic: " Just stop worrying " (you might 
 just as well say stop breathing) , " and 
 take a long rest. Avoid all mental and 
 physical strain." What his wife and chil- 
 dren are to do meantime never occurs to 
 this type of physician. The wife and chil- 
 dren are in the background, out of range 
 of his vision, and so for him they play no 
 part in the case. 
 
 The shortsightedness of our hospitals 
 in this respect is really marvelous. They 
 will take in the wards a baby whose diges- 
 tion is upset, give it free treatment, which 
 
20 SOCIAL SERVICE AND 
 
 costs the hospital twenty dollars, send it 
 out again without any inquiry into the way 
 the mother feeds it or the air it breathes 
 or the clothes it wears. A month later the 
 baby is back again, as sick as before, and 
 from just the same causes. The hospital 
 takes it again, spends another twenty dol- 
 lars in getting it well, and so on. I fol- 
 lowed up a case like this recently, and 
 found that the mother was grossly igno- 
 rant of the first principles of feeding and 
 caring for a baby, though perfectly ca- 
 pable of being taught. Even in terms of 
 dollars and cents the hospital is losing by 
 its blindness to backgrounds. The same 
 ailments in the same patients are treated 
 again and again, with a wisdom equal to 
 that of the sage who dipped up water with 
 a sieve. 
 
 Our patients shoot by us like comets, 
 crossing for a moment our field of vision, 
 then passing out into oblivion. At the end 
 of hundreds of hospital records one can 
 
THE ART OF HEALING 21 
 
 read the words " Discharged well," and 
 the eminent surgeon figuring up his " suc- 
 cesses," often counts as such all who have 
 left the hospital well, and never been heard 
 from again. But peer into the back- 
 ground a little, follow up these cases for a 
 few months or years, and you will often 
 find that " the last state of that man was 
 worse than the first." The past and the 
 future of our cases is one aspect of that 
 background of their lives to which we are 
 so blind. 
 
 v 
 Another background of our experience 
 with the sick, and one to which we are 
 almost as blind as we are to their home 
 conditions, is the moral and spiritual set- 
 ting from which their physical symptoms 
 project into our foreground. This is the 
 field in which our friends the Mental Heal- 
 ers and Christian Scientists have worked 
 with so much success. Mind Cure and 
 Christian Science have a strong hold upon 
 
22 SOCIAL SERVICE AND 
 
 thousands in this community to-day be- 
 cause they have not been blind to the 
 spiritual background of physical suffer- 
 ing. Doctors and nurses used to be un- 
 willing to admit that fear causes disease 
 because the Mind Curists have so long 
 said that it did, but now there is scarcely 
 a week in which you will fail to find upon 
 several of the record shps in our Out- 
 Patient Department the diagnosis, "Ap- 
 prehension." 
 
 A man comes to us complaining of a tri- 
 fling pain in his chest, but also sleepless, 
 without appetite, losing weight, too weak 
 to work, — all because the trifling pain 
 happens to be in the spot where he has been 
 told his heart is. I examine his heart, find 
 it wholly normal, tell him so with all the 
 emphasis I can express, and add that he 
 couldn't die if he tried, will probably live 
 to be a hundred, and that meantime he 
 must go to work and put the idea of heart 
 trouble out of his head once for all. In 
 
THE ART OF HEALING 23 
 
 three days that man will be a changed 
 being. You will hardly recognize him as 
 the same. He believed me because he 
 heard me tell the patient just ahead of 
 him that he had heart trouble, and could 
 never hope to work again. Believing me, 
 he began to sleep and eat, to work, to love 
 life, and to throw from his shoulders the 
 millstone of fear that had been weighing 
 him down. 
 
 Every candid physician knows that fear 
 causes some disorders, that self -absorption 
 causes others, that sin and half -smothered 
 remorse cause still others. But he is 
 afraid to admit the full consequences of 
 these truths. Because he knows that can- 
 cer, typhoid, meningitis, are not caused by 
 fear or by sin, because he fears to admit 
 that the Mind Curists have a piece of real 
 truth in their possession, he blinds himself 
 to this whole realm of fact. He calls it 
 rubbish or sentimentality or superstition 
 or simple ignorance, but he has to recog- 
 
24 SOCIAL SERVICE AND 
 
 nize it more or less in his practice, though 
 grudgingly. 
 
 The enormous influence of spiritual en- 
 vironment, of friendship, of happiness, of 
 beauty, of success, of religion, is griev- 
 ously, ludicrously underestimated by most 
 physicians, nurses, and hospital superin- 
 tendents. There are diseases that cannot 
 be cured without friendship, patients that 
 never ynll get well unless you can get 
 them to make a success of something or 
 to conquer their own self-absorption 
 by a self-devotion, losing their hfe to 
 find it. 
 
 Our blindness to backgrounds of this 
 type is well illustrated by the recent re- 
 mark of a hospital superintendent: " I 
 want you to understand," he said, — to 
 someone who was laboring to correct some 
 of the results of our habitual blindness to 
 backgrounds — " I want you to under- 
 stand that we want sense, and not senti- 
 ment, in this work." Think of the short- 
 
THE ART OF HEALING 26 
 
 sightedness of one who has lived for years 
 in the midst of these problems, — ^your 
 problems and mine, — ^yet doesn't know 
 that both sense and sentiment are abso- 
 lutely essential in any competent medical 
 work. It is as if one should say, " We 
 want eyes, but no ears, in this work." 
 
 VI 
 
 Another type of blindness to back- 
 grounds, and one less appealing perhaps 
 to most of us, is the blindness to the scien- 
 tific truth which can and ought to be won 
 out of every case of poverty, ignorance, 
 or disease. Now, I hope you will not 
 suspect me of lack of respect for the hu- 
 manitarian side of medicine, the direct 
 immediate helpfulness of man to man, — 
 in short the foreground. But I wonder 
 if we all realize that Pasteur, who had 
 scarcely any direct dealings with patients, 
 scarcely entered what I call the fore- 
 ground of medical work, won truth that 
 
S6 SOCIAL SERVICE AND 
 
 has been the means of saving more lives, 
 more suffering, more rack and ruin in hu- 
 man flesh, than all the doctors and nurses 
 and social workers now living. It is the 
 man of science who works out the preven- 
 tion of typhoid epidemics, banishes yellow 
 fever from Cuba and the terrible parasitic 
 anemia from Porto Rico. You and I can 
 only alleviate a little suifering here and 
 there. We are pygmies of human help- 
 fulness compared to those giants who look 
 beyond and behind the sick patient in the 
 foreground, to the tiny glimpse of truth 
 in the far distance, and work towards that 
 distant gleam by faith. I want to make 
 you feel as I do the spiritual nobility of 
 scientific work. It deals almost exclu- 
 sively with the unseen. You and I deal 
 with the seen, with the ills and griefs of 
 the foreground, and we are quite right in 
 doing so, but we ought to give all honor to 
 the spiritual imagination by means of 
 which the man of science grasps those un- 
 
THE ART OF HEALING 27 
 
 seen truths which are eternal, and, using 
 them as a lever, Ufts us all out of our diffi- 
 culties. Let me illustrate. 
 
 It was a mere idea, a mere theory, for 
 which Lazear laid down his life five years 
 ago in Cuba, — the theory that mosquitoes 
 transmitted yellow fever from man to 
 man. Nothing visible, nothing reliable 
 and certain in it. To test it, men must be 
 found who would allow themselves to be 
 bitten by mosquitoes which had previously 
 bitten a yellow-fever patient. Lazear and 
 three other physicians were bitten, and by 
 their example induced several others (sol- 
 diers in the American army) to do the 
 same. All were infected, all took yellow 
 fever. The theory was proved, and La- 
 zear died. To-day, and as a direct result 
 of the scientific work that culminated in 
 the sacrifice of Lazear's life, Cuba is free 
 from yellow fever after one hundred and 
 fifty years of the scourge. 
 
 Those doctors did not directly serve 
 
28 SOCIAL SERVICE AND 
 
 any patient. They nursed no one, they car- 
 ried no cup of cold water. In books and 
 laboratories they imagined, thought out, 
 worked out, and proved that theory. As 
 we look back now from the solid ground 
 of assured fact, with New Orleans saved 
 three years ago from decimation owing to 
 the appUcation of this theory, it is hard 
 to realize the imagination, the faith, the 
 hold upon the unseen, which went to the 
 elaboration of that theory. " Faith," says 
 Saint Paul, " is the substance of tilings 
 hoped for, the evidence of things not 
 seen." 
 
 You would realize the high spiritual 
 quality of this wbrk if you were associated 
 with the men who do it. Do you remem- 
 ber Scott's description of the Round- 
 heads in "Old Mortality,"— the lean, 
 bare-headed group upon the hill, utterly 
 wanting in the graces and trappings of the 
 Cavaliers, poor and mean, silent, un- 
 worldly, shining only by the inner light of 
 
THE ART OF HEALING 29 
 
 their determined purpose and of their 
 abounding faith in the unseen? 
 
 That is the type evolved by scientific 
 discipline, a discipline the full rigor of 
 which must be experienced to be appreci- 
 ated. If ever you feel inclined to belittle 
 the work of scientific men, or to believe 
 the legends of their brutality and material- 
 ism, go and look into the faces of any gath- 
 ering of them, and listen to their work. 
 I think you will be convinced, as I am, that 
 no small part of the seed of the God-fear- 
 ing Puritans has taken root and is flour- 
 ishing in the rigorous asceticism of the 
 modern scientific investigator. We accept 
 the fruits of his labors, and live on them 
 like parasites, but we do not often stop to 
 acknowledge our indebtedness, still less to 
 realize that the work has been done by 
 minds disciplined by a degree of self- 
 denial, a degree of renunciation of the 
 world and its rewards, before which you 
 and I should quail. 
 
80 SOCIAL SERVICE AND 
 
 VII 
 
 I have set foreground and background 
 apart, and described them separately, as 
 if it were true that the more one sees of the 
 one, the less the other is visible. But, of 
 course, that is not so. The man who has 
 a clear sense of the individuahty and 
 sacredness of each person and each mo- 
 ment of time will yet run into confusion 
 and distortion unless he backs his fore- 
 ground view with the vista of the distant, 
 the past and the future, the background of 
 the community life out of which this 
 individual has emerged and to which 
 he belongs. The only justice to one in- 
 dividual is justice to all. The only true 
 consideration of one is consideration 
 of all. 
 
 The humanitarian and the scientific 
 sides of our work need each other as man 
 and woman do. Science without humanity 
 becomes arid and, finally, discouraged. 
 
THE ART OP HEALING 31 
 
 Humanity without science becomes 
 scrappy and shallow. 
 
 No one ought to be satisfied to test his 
 work by any easier standards than these: 
 
 First. Am I seeing all the actual facts, 
 the ever-new and unique facts, the crying 
 and immediate needs as they come before 
 me? 
 
 Second. Am I tracing out as far and 
 as deep as I can the full bearing, the true 
 lesson, the unseen spirit of this moment, 
 this situation, this calamity, this illness? 
 
 Am I using my eyes and ears, my sym- 
 pathies and my imagination, as hard as I 
 can? Am I searching for the deepest 
 meaning, the widest bearing, the furthest 
 connection of these facts? Am I seeing 
 and helping as truly as I can the fore- 
 ground and the background of my work? 
 
CHAPTER II 
 
 THE NATURE OF SOCIAL WORK, ESPECIALLY 
 IN ITS RELATION TO MEDICINE 
 
 As soon as we open our eyes to the back- 
 grounds of medical work such as I exem- 
 plified in the last chapter, social, educa- 
 tional, and preventive activities begin to 
 loom up round us in deep vistas which we 
 cannot reasonably refuse to explore. A 
 man is not flat like a card. We cannot 
 get the whole of him spread out upon our 
 retina at once. The bit of him which is 
 recorded in the history of his aches, his 
 jumps, and his weaknesses is built into the 
 rest of his life and character like a stone 
 in an arch. To change any part of him 
 appreciably we must change the whole. 
 As well might one try to pick up a man's 
 shadow and carry it away as to treat his 
 
 33 
 
THE ART OF HEALING 33 
 
 physical ills by themselves without knowl- 
 edge of the habits that so often help to 
 make him sick and the character of which 
 these habits are the fruit. 
 
 Yet physicians and hospital managers 
 have only just begun to realize this 
 because the inquiry into the ultimate 
 causes and results of disease has not yet 
 gathered much momentum. The question : 
 " Why does this disease occur at all? " is 
 still thought of as one which a few paid 
 officials or virtuous amateurs may well be- 
 stir themselves to answer, provided they 
 have the time and provided they do it with- 
 out disturbing the practical work of the 
 busy physician. The average practitioner 
 is used to seeing his patients flash by him 
 like shooting stars — out of darkness into 
 darkness. He has been trained to focus 
 upon a single suspected organ till he thinks 
 of his patients almost like disembodied 
 diseases. 
 
 " What is there in the waiting-room? " 
 
34 SOCIAL SERVICE AND 
 
 I asked my assistant as I arrived one 
 morning at the hospital. 
 
 " A pretty good lot of material," said he 
 briskly. " There's a couple of good hearts, 
 a big liver with jaundice, a floating kid- 
 ney, three pernicious ansemias, and a flat- 
 foot." 
 
 Among such flying fragments as these 
 the physician has to pass his days. He 
 couldn't earn a living if he did not attend 
 first and chiefly to the part that is thrust 
 before him. He must clip very close the 
 wings of his curiosity as to the " txihence " 
 and the " whither " of these apparitions. 
 
 When a bloody finger is presented to 
 him for relief he looks far enough to see 
 that it is attached to an arm and the arm 
 to a body of average shape and carriage. 
 Beyond that he cannot afford to look. 
 The finger waits for attention. His work 
 calls. He cannot be looking off into space 
 for causes and results. He must get busy, 
 and as he does so a mist settles down along 
 
THE ART OF HEALING 35 
 
 these puzzling vistas. Those who have 
 time can ask " how it happened." That 
 is not his business, for the accident must 
 be attended to however it happened. The 
 finger must be dressed whoever owns it; 
 and as soon as it is bandaged and splinted, 
 there's a boil to be opened, a sprain to be 
 examined, some ether to be given, and so 
 on through a day, a week, a year. Brief, 
 isolated arcs in the span of a human life, 
 accidents, fragments, each crowding out the 
 last — never a whole, a finished day, or a 
 story completed — that's the doctor's life, as 
 it tends to be — tends with all the strength 
 of the pressure brought to bear on him by a 
 public hungry for immediate relief, — any 
 relief, " but be quick about it," and by the 
 need to earn a living and support a family 
 in decent comfort. 
 
 If disease were mostly " accident " and 
 " hard luck " or " too bad " as we are 
 prone consolingly to assure one another 
 that it is, my plea would be nonsense and 
 
36 SOCIAL SERVICE AND 
 
 tliis book would never have been written. 
 If sickness usually fell from the clouds 
 and floored man like the hghtning stroke 
 there would be no use in hunting for ulti- 
 mate causes in the victim's character, in- 
 heritance or environment, no sense in prat- 
 ing of social or educational work in con- 
 nection with the healing art. It is because 
 the sphere of accident is becoming more 
 and more contracted that the importance 
 of social, psychical, and educational causes 
 looms up larger and larger every year. 
 Disease is not often " hard luck " nor " too 
 bad." For the most part it is as bad as we 
 — the tax-payers — allow it to be and as we 
 — ^the unconquerable soul of us — recognize 
 it to be. Preventable disease stares us in 
 the face. Yet still the rank and file of the 
 medical profession are too busy with cases 
 of disease {a" case " means an accident) 
 to have time for causes. It is only when 
 the social workers stir us into action 
 that the Anti-Tuberculosis crusade and 
 
THE ART OF HEALING 37 
 
 the Clean Milk crusade, the Pure Food 
 law, the Playground Association, and the 
 School Hygiene agitation come into being. 
 
 Why, then, does not the social worker 
 get the credit that he deserves from all of 
 us, physicians, parents, and citizens, who 
 have reason to thank him for the most and 
 the best of public health work and pre- 
 ventive medicine? 
 
 Why is it that lawyers, business men, 
 " hard-headed " people generally look 
 upon the social worker as belonging " mid- 
 way between the dancing master and the 
 theologian " — among the luxuries and the 
 trifles, the dreams and impracticahties? 
 
 I believe the answer is found in the fact 
 that social work as a profession is new. It 
 has evolved out of more or less haphazard 
 alms-giving and spasmodic benevolence, 
 out of Utopian philanthropy and priestly 
 " good works." The motives, the efforts, 
 and (here and there) the superbly ef- 
 fective practice of social work, — all this 
 
38 SOCIAL SERVICE AND 
 
 is ancient and tolerably familiar; but the 
 organization of these efforts into a definite 
 profession, trained, paid, and recognized 
 like engineering, medicine, or law, is a 
 matter of hardly more than a decade. 
 
 Even now I think the value of the social 
 worker and his proper recognition are con- 
 siderably limited by the fact that he can- 
 not often recognize himself or tell you 
 what the value of his profession is. He is 
 an expert. But in what is he an expert? 
 What is his special field of knowledge and 
 of skill? 
 
 I want in this chapter to attempt an an- 
 swer to this question because I think that 
 the public will not get the best service 
 either out of doctors, or out of social 
 workers, until the close relationship 
 of these two professions is generally 
 recognized. 
 
 In my opinion, medical and social work- 
 ers must act together as a team, if they 
 are to serve the public efficiently. But this 
 
THE ART OF HEALING 39 
 
 they cannot do till they recognize and the 
 public recognizes their affinity. 
 
 I 
 
 What is Social Work? 
 
 " Philanthropy " and " charity " are its 
 poor but honest parents. From their 
 point of view we may naturally approach 
 its definition — beginning with negatives, 
 (a) We may assume in the first place 
 that, in the evolution of the conception of 
 philanthropy, we have left behind the stage 
 at which a fair sample of the morning's 
 work was the round of visits made by the 
 rich and kindly lady, with her basket of 
 choice victuals, virtuously dispensed to 
 her beneficiaries, " the poor." We no 
 longer need to expose and refute the twin 
 delusions : 
 
 That philanthropy is especially merito- 
 rious work. 
 
 That philanthropy is easy, provided our 
 motives are good. 
 
40 SOCIAL SERVICE AND 
 
 To-day we all abhor the patronizing atti- 
 tude in theory, if not always in practice, 
 and we have had it effectually brought 
 home to us that it is hard to do good and 
 easy to do harm in social work. 
 
 It is never safe to suppose that a stage 
 of growth which we have left behind us 
 is, therefore, to be dropped bodily out 
 of our theory and our practice. There 
 is a good in that old " I am better than 
 thou " attitude ; truth in the de haut en has 
 treatment of the social sufferer; — what 
 good, what truth, I shall try to indicate 
 later in my .address. 
 
 (b) But the error and harm of these 
 methods are more obvious than the truth of 
 them. Stung by this fact, philanthropists 
 have striven in the next stage of evolution 
 to democratize social work. " Not alms, 
 but a friend," becomes our motto, as we 
 come to recognize that by the giving of 
 money, food, and clothes we can easily do 
 harm, while much more often, by the giv- 
 
THE ART OF HEALING 41 
 
 ing of friendly advice, sympathy, and en- 
 couragement, or simply by " lending a 
 hand," we may be of use. Realizing that 
 anyone who is being treated coldly, as an 
 inferior, an outcast, and an opportunity 
 for the " acquisition of merit," is not likely 
 to get any good out of the transaction, we 
 try to make our common humanity a meet- 
 ing ground on which we may do some serv- 
 ice. " Not alms, but a friend." 
 
 But this second conception of charity 
 as simple friendliness is also becoming out- 
 grown. It is good as far as it goes, but 
 there are two obvious flaws in it: 
 
 First, wise friends, skillful, experienced, 
 and f oresighted friends, are rare, and any 
 other kind of friends may be useless or 
 worse in the difficult tasks of social work. 
 Mere friendliness will not do. " Friendly 
 visiting " is a term as applicable to the 
 physician's work as to the philanthropist's. 
 Both make friendly visits: each also does 
 his own more specific service. 
 
42 SOCIAL SERVICE AND 
 
 Second, friends are not made in a day 
 or a month. The skilled social worker 
 may, in the end, succeed in becoming the 
 friend of those who need his help, but in 
 the long intervening time which miist 
 elapse before genuine friendship emerges, 
 we must have some spiritual modus Vi- 
 vendi;, some reason other than friendship, 
 other than friendliness, for meeting at all. 
 The attitude in which one person regularly 
 gives and seldom receives help, the one- 
 sided relation, is not friendship and tends 
 only very slowly to the growth of friend- 
 ship. I take it that all of us are glad to 
 to see that the word " friendship " is com- 
 ing to be less lightly used, that we are 
 more conscious of the rarity and sacred- 
 ness of the relation, and of the time, pa- 
 tience, and rare good fortune necessary for 
 its creation. Letters to perfect strangers 
 beginning, " My dear friend," are, I hope, 
 less common than they used to be. The 
 following extract from the Boston Di- 
 
THE ART OF HEALING 43 
 
 rectory of Charities was written in 1899 
 and remained unchanged until 1906, 
 though it has been expunged in the edition 
 now current: 
 
 " Personal friendship furnished to both 
 sexes and all ages " [by a certain chari- 
 table society!] 
 
 The wholesale acquisition of " friends " 
 by the dozen a week is going out of 
 fashion. 
 
 Where, then, shall we look for that 
 spiritual standing-ground on which the so- 
 cial worker may meet those who need his 
 help, without a patronizing air, but also 
 without blaspheming the sacred name of 
 friend? Is such a standing-ground al- 
 ready anywhere in use? Where shall we 
 look to find pleasant, healthy, manly, 
 democratic relationships maintained be- 
 tween persons diflPering sharply in inherit- 
 ance, education, habits, and environments, 
 between rich and poor, wise and ignorant, 
 cultivated and uncultivated? 
 
44. SOCIAL SERVICE AND 
 
 ( c) We may answer with Mr. Brackett, 
 head of the School for Social Workers in 
 Boston, that we find the ideal standing- 
 ground in the neighborly relationship. 
 When neighbors meet in country villages, 
 at church suppers, town meetings, and 
 cattle shows, we have friendly, comfort- 
 able, democratic relations between many 
 sorts and conditions of men, without great 
 intimacy, but equally without any snob- 
 bishness. 
 
 Can we extend tliis neighborliness to 
 cover the relationship between a profes- 
 sional social worker and those in need of 
 his advice? I think not; the two are not 
 neighbors in any ordinary sense. They 
 have not the common property-interests, 
 conunon acquaintances, common dealings 
 in town, church, and club affairs, that 
 make the stable basis of true neighborli- 
 ness and furnish topics of conversation. 
 The settlement worker may persuade him- 
 self not only that he really has these com- 
 
THE ART OF HEALING 45 
 
 mon interests with his neighbors, but that 
 this fact makes the basis of his relation- 
 ship to them more natural and more effect- 
 ive than that of any other social workers. 
 But I think that it is more and more 
 agreed that valuable as settlement work 
 surely is, the relationship is not essentially 
 that of neighbor to neighbor, but of 
 teacher to pupil or pupil to teacher. The 
 settlement worker rarely brings up his 
 family at the settlement, and in his rela- 
 tions to those who are literally his neigh- 
 bors he is more hke the explorer, or the 
 lighthouse keeper. He is not there for 
 the same reason that any of the people in 
 the adjoining houses are there, any more 
 than the explorer is in the jungle for the 
 same reason as the bushranger and the 
 antelope. 
 
 The most valuable work which the set- 
 tlement worker does is not, I think, as 
 neighbor but as investigator, teacher, ex- 
 pert interpreter, and referee. Still more 
 
46 SOCIAL SERVICE AND 
 
 obviously, but no more genuinely, is this 
 true of other social workers. 
 
 To fall back on the scriptural usage of 
 the words " my neighbor " is to confuse 
 the issue, for that phrase, Kke " friendU- 
 ness," defines everybody's business in gen- 
 eral and not the social worker's in particu- 
 lar. Everyone is, in the scriptural sense, 
 the neighbor of all with whom he is 
 brought into contact. But everyone is 
 not a social worker either in fact or in 
 ideal. Neither my neighbor in space nor 
 my neighbor in scripture, nor any attempt 
 to fuse the two meanings, furnishes the 
 central idea of social work. It is some- 
 thing much more definite than this. Yet 
 we see in the attempts to think of the social 
 worker first as a friend and later as a 
 neighbor the natural and proper reaction 
 against the aristocratic and patronizing 
 idea of charity alluded to at the begin- 
 ning. 
 
 The " Lady Bountiful " conception of 
 
THE ART OF HEALING 47 
 
 charity accented unduly and perversely 
 the perfectly true fact that the giver is in 
 some respect the superior of the recipient. 
 The conception of social work as a rela- 
 tionship between friends and neighbors 
 errs equally on the other side, for it sup- 
 presses the difference and proclaims that 
 the luiity is all in all. Both conceptions 
 are true, both one-sided. What can unite 
 them? Modern social work answers : 
 
 The conception of expert service. 
 
 (d) Here, I think, is the solution of the 
 problem of distinctions within a democ- 
 racy. This is the immortal soul of the 
 patronizing conception of charity, surviv- 
 ing the death of its body. Superiority 
 there is and ought to be, but superiority 
 in one respect — ^the obvious superiority of 
 the expert. We can look up to the expert 
 with ready acknowledgment of his superi- 
 ority. We are not his equal here, but there 
 is not a particle of sense of shame on the 
 one side or of condescension on the other. 
 
48 SOCIAL SERVICE AND 
 
 As we sit by the stage driver, or travel 
 with the Adirondack guide, the motorman, 
 or the navigator, our relationship is per- 
 fectly democratic because each tacitly ac- 
 knowledges the other as an expert in his 
 own line, giving and receiving respect, 
 and, if there is opportunity, exchanging 
 information such as to strengthen each 
 other's weak points. 
 
 This is the nearest approach to ideal 
 democracy outside the neighborhood rela- 
 tionship. Whenever the neighborhood re- 
 lationship does not genuinely exist, this 
 relationship of mutually acknowledged ex- 
 perts is the best alternative. 
 
 A third, slightly different but equally 
 democratic relationship is exemplified in 
 the relationship of a public school teacher 
 to a child in her class, or of a physician 
 to some of the more ignorant of his pa- 
 tients. Here there is expert knowledge on 
 one side and none on the other. The com- 
 mon ground of meeting is the common in- 
 
THE ART OF HEALING 49 
 
 terest in the subject studied or in the 
 health sought. This makes something ap- 
 proaching a neighborhood relationship, the 
 essence of which is a common interest in 
 property, in business, in town, church, or 
 club affairs. It differs from the neighbor- 
 hood relation in that the meeting ground 
 is in thought and in hope instead of in 
 the neighborhood interests. Teacher and 
 pupil are both interested in the subjects 
 studied; doctor and patient are united in 
 the pursuit of health. On these grounds 
 they meet. 
 
 There are, as far as I know, no satis- 
 fying human ties except: 
 
 (a) Family relationships and friend- 
 ship; 
 
 ( b ) Neighborhood relationships ; 
 
 (c) Relationships based on common in- 
 terests (financial, scientific, art^tic, ath- 
 letic, etc.) ; T*' 
 
 (d) Relationships betweei{x, experts, 
 and '* 
 
50 SOCIAL SERVICE AND 
 
 (e) Relationships of the teacher and 
 pupil type. 
 
 Now the social worker cannot often be 
 a professional friend, a professional 
 " uncle " or " aunty," a professional 
 neighbor, or a professional " good man."- 
 Nor can he often share in the financial, 
 artistic, political, or scientific interests of 
 his chent. Hence the social worker must 
 take one of the parts that are left. He 
 must hold his position and command re- 
 spect as an expert, as a teacher, or as a 
 pupil. 
 
 He needs all the virtues no more and no 
 less than the railroad man, the farmer, or 
 the shopkeeper. But his first and chief 
 duty to all men is to give, with such ripen- 
 ing sympathy and friendliness as is pos- 
 sible under the circumstances, the benefit 
 of his expfert skill, and so fulfill his special 
 functionH^ the community. 
 
 In a glaeral way, I think, this view is 
 coming tP prevail. The social worker has 
 
THE ART OF HEALING 61 
 
 more and more, in the last decade, come to 
 command respect and salary as an expert. 
 People are beginning to take this view of 
 him, and with the change come the new 
 schools for social workers, which plan not 
 only to inspire their members with social 
 ardor, but to give them the professional 
 knowledge and the rigorous training nec- 
 essary for the difficult and delicate task 
 which they have undertaken. 
 
 But this attitude is new and not yet very 
 stable. The social worker has not yet won 
 the position or the salary that he deserves, 
 because the public rightly demands that 
 a genuine expert shall be expert in some- 
 thing in particular; if we are to acknowl- 
 edge his preeminence we must have some 
 clear idea of what it consists in. 
 
 We are told by Mr. Edward T. Devine 
 that many topics, many sciences, group 
 themselves about the study of philan- 
 thropy. Political economy, housekeeping, 
 law, medicine, public hygiene, architecture. 
 
63 SOCIAL SERVICE AND 
 
 statistics, the humanities, all form, he says, 
 more or less important auxiliaries. But 
 what is their center? Can we say that the 
 general purpose to do good, the general 
 aim of social amelioration^ is definite 
 enough to constitute such a center? I 
 think not. For that should be everyone's 
 business and no one profession should 
 have a monopoly of it. It is too all- 
 inclusive. 
 
 On the other hand, the proper adminis- 
 tration or withholding of financial relief is 
 too narrow, for social workers deal with 
 many persons who are not dependent and 
 ask for no relief. We need as the center 
 and focus of social work something more 
 comprehensive than relief but less vague 
 than charity or neighborliness or the at- 
 tempt to serve the pubhc good; we need 
 a center around which we can group the 
 auxiliary topics and sciences. What is 
 that center? 
 
 A comparison with medical work may 
 
THE ART OF HEALING 63 
 
 help us here. The physician, Uke the social 
 worker, finds it necessary to master the 
 rudiments of many sciences in which he 
 cannot hope to become an expert. He 
 dips into chemistry, optics, physiology, bi- 
 ology, and ethics, but he does not merely 
 organize these sciences for the physical 
 good of man. He arranges them about 
 a central core of knowledge, a central 
 science, which occupies more than half of 
 all his training, — the diagnosis and treat- 
 ment of disease. It is only in this field 
 that he is an expert. 
 
 Do social workers possess already any 
 such central body of knowledge to which 
 all the rest of their studies contribute? In 
 point of fact I think the most valuable 
 social workers do use such a science in 
 practice, though rarely in clear conscious- 
 ness. But it seems as if the schools of 
 philanthropy had lagged behind the work- 
 ers, because these schools conceive their 
 functions to be fulfilled by teaching a little 
 
54 SOCIAL SERVICE AND 
 
 of the auxiKary sciences, such as house- 
 keeping, hygiene, and political economy, 
 while spending most of their time on a 
 bird's-eye view of the existing agencies and 
 institutions which have been created as 
 remedies for the difficulties which confront 
 us. 
 
 But the successful social worker often 
 knows very little of political economy, 
 medicine, and the rest. He differs from 
 the rest of us in quite other respects. An- 
 other man may know more of all these sci- 
 ences than the social worker and yet be a 
 bungler in the actual craftsmanship of 
 social work. He may have a good work- 
 ing knowledge of all the items in the di- 
 rectory of charities, of all the existing 
 agencies for the cure of social ills, and yet 
 make an utter mess of it when he tries to 
 do a bit of probation work or to pull up a 
 shiftless family. 
 
 This (some will say) is because he has 
 not inherited or acquired the unteachable 
 
THE ART OF HEALING 56 
 
 tact, the actual deftness in handling cases 
 which the successful worker possesses. 
 He must first be bom to it, we say, and 
 then half -instinctively find out the rest as 
 he gets his experience in the work itself. 
 But this is equally true of the diagnosis 
 and treatment of disease, or the apprecia- 
 tion and interpretation of music. The doc- 
 tor and the musician, as well as the social 
 worker, must be born for his profession, 
 else he cannot be trained for it. But we 
 do train him despite the old false antith- 
 esis, " born, not made." 
 
 The central knack and talent of the so- 
 cial worker, then, is not economics, or 
 neighborliness, or a general desire for social 
 amelioration, nor is it something unteach- 
 able. The essence and center of social 
 work, that which corresponds to diagnosis 
 and treatment as the center of the group 
 of medical sciences, I may venture to 
 phrase as: 
 
 The study of character under adversity 
 
66 SOCIAL SERVICE AND 
 
 and of the influences that mold it for good 
 or ill. 
 
 This is the genuinely new science which 
 it is the business of our best social students 
 to build up in theory, where it already ex- 
 ists more or less concisely and satisfac- 
 torily in practice. In social work the art 
 has preceded the science, as it did in medi- 
 cine and music; but neither science nor 
 art can live well without the other. 
 The science must back and direct the 
 art. 
 
 In support of this, which is the central 
 thesis of this chapter, I shall adduce two 
 groups of arguments: 
 
 First, illustrations of the fact that suc- 
 cessful social workers are now engaged, 
 for the most part, in the practice of this 
 art, the diagnosis and treatment of char- 
 acter under adversity, which I am urging 
 should be systematically taught in schools 
 of philanthropy. 
 
 Second, reasons for believing that it is 
 
THE ART OF HEALING 67 
 
 not impossible to teach this science, nor 
 inconceivable to make a text-book about it. 
 
 II 
 
 Taking up the first of the above theses, 
 I will remind you, first of all, of the wide, 
 and interesting field of probation work. 
 When I first became a director of the 
 Boston Children's Aid Society and began 
 to spend time with the paid agents of the 
 Society, I watched them in their advisory 
 and supervisory work with children and 
 their parents. I soon became aware that 
 I was witnessing the expert practice of 
 the art of character-study and character- 
 molding. Mr. C. W. Birtwell, Mr. W. H. 
 Pear, and Mr. S. C. Lawrence, with whom 
 I was chiefly associated, went at their cases 
 with a definite diagnostic method, studied 
 their antecedents, their environment, their 
 present characteristics, their strong points, 
 their weak points, and their possibilities 
 with as scientific and sure-footed a course 
 
58 SOCIAL SERVICE AND 
 
 of procedure in their mental diagnosis as 
 the physician uses in his much simpler 
 physical diagnosis. 
 
 First diagnosis, then treatment. Know- 
 ing the child's environment, his diet, his 
 play, his school, his parents, his compan- 
 ions, his amusements, where he is weak and 
 where he is strong, how his strength and 
 his weakness are linked, and where these 
 links can he unfastened, these experts in 
 the psychology of erring children pro- 
 ceeded to choose a remedy among the re- 
 sources of the community. They used 
 cluhs, churches, country families for plac- 
 ing out, personal supervision at home, the 
 help of a properly assisted and directed 
 parent, studying and judging these agen- 
 cies of the environment as molders of 
 character, i.e., as spiritual influences. 
 
 Questions of financial relief and depend- 
 ence are here quite subordinate. If we 
 define the vocation of the social worker 
 as the diagnosis and treatment of financial 
 
THE ART OF HEALING 59 
 
 distress (as has been suggested to me) we 
 should have to say that such probation 
 work was not social work at all, because 
 it is in most cases a labor of education 
 pure and simple. What is the weakness in 
 this child's character; how can it be helped? 
 Environment is, of course, most carefully- 
 studied, but not only the physical environ- 
 ment. The influences about the child and 
 their bearing on his character are the chief 
 subjects of the social worker's study when 
 he has made his diagnosis and turns to 
 treatment. 
 
 Take as a second example the care of 
 the girls placed out from a large reform 
 school like that at Lancaster, Mass. Even a 
 slight acquaintance with the young women 
 who are in charge of these girls makes 
 one at once aware of the same trained man- 
 agement of character based on the skillful 
 study of character in its environment. 
 Which girl is in trouble because of excess 
 of vitality, and which because of moral 
 
60 SOCIAL SERVICE AND 
 
 flabbiness, deficient vitality? Which one 
 is really below par mentally, which is in 
 need chiefly of encouragement and a 
 healthy spiritual environment? Char- 
 acter is always the central problem, the 
 true basis both of classification and of the 
 choice of remedies. To classify these girls 
 according to their " crimes " has only a 
 very Umited value and cannot be used as 
 a sufficient basis for intelligent treatment. 
 
 Here, again, there is often no question 
 of charity or of financial rehef. In many 
 if not most of these cases there is no finan- 
 cial or economic question at issue. The 
 problems are mental, moral, and physical. 
 
 Is it so different in the work of charity 
 organizations and in the treatment of per- 
 sons who are financially dependent? As 
 I watch the work of experts in this field 
 I feel, as in other instances, that the task 
 is chiefly one of delicate and difficult 
 psychical diagnosis and psychical treat- 
 ment. To the expert social worker an 
 
THE ART OF HEALING 61 
 
 application for relief comes as a complaint 
 of pain does to the physician. It is a 
 symptom of deeper defects. Poverty is to 
 social work as pain is to medical work. 
 It may or may not need treatment, but 
 thorough diagnosis is the first necessity. 
 To find out whether it is discourage- 
 ment, overwork, unforeseeable misfortune, 
 arrogance, conceit, forgetfulness, un- 
 imaginativeness, congenital degeneracy, 
 alcohohsm, ignorance, or some other cause 
 that is back of the financial breakdown, — 
 this is what I see these experts busy about. 
 IS'ext they ask: What sound hfe, what 
 untainted character, is left, and what is 
 the best that can be made of it? What in- 
 fluences can be brought to bear on the 
 paralyzed will, the spasmodic and ungov- 
 emed energies, the darkened and narrowed 
 mental horizon? Physical and financial 
 diagnosis, physical and financial remedies 
 are always useful, but always subordinate 
 to the central problem, which is more like 
 
62 SOCIAL SERVICE AND 
 
 a problem in horticulture than one in 
 economics. 
 
 Even in the almshouse, where we should 
 be dealing, I take it, chiefly with the 
 wrecks and relics of character, our prob- 
 lem is still how to make the most and best 
 of what life and character is left; how to 
 prevent it from degenerating into a merely 
 brutal or vegetable existence ; how to make 
 the outlook less gloomy and desperate. 
 
 Another evidence that character study 
 is behind most if not all of the common re- 
 lief problems appears when we ask: Why 
 do we allow many widows and children, 
 and most that are sick or aged, to be de- 
 pendent? Why do we not urge them all 
 on into the ranks of the self-supporting? 
 Some children, many women, and a certain 
 number of sick or aged men are doubtless 
 the better for earning their salt ; others are 
 not. The principle of decision, which 
 seems to be recognized by expert social 
 workers, is this: What is best for the in- 
 
THE ART OF HEALING 63 
 
 dividual's development and for the com- 
 munity? It is not good for the mental 
 and moral life of most healthy adults to 
 be dependent financially or in any other 
 way. Whenever we find exceptions to this 
 rule they must be made because we believe 
 it best for the character of the individuals 
 and of the community in which they hve 
 that they should be financially dependent 
 in order that they may put forth their full 
 powers in ways not now remunerative ; for 
 example, in getting educated or getting 
 well. But some children, some sick, and 
 some old people ought nevertheless to 
 work for a living. Why? Because they 
 need it to keep their souls alive, and be- 
 cause nothing else will do this as far as we 
 know. Our campaign is not against all 
 poverty and distress but against such pov- 
 erty and distress as cramp the normal de- 
 velopment of character. 
 
 The fact that dependence and relief are 
 usually, but not always, undesirable in the 
 
64 SOCIAL SERVICE AND 
 
 healthy adult, that they are more often 
 desirable in children under sixteen and in 
 the sick, while in adolescence dependence 
 is sometimes good and sometimes bad, 
 shows that even in that portion of social 
 work that deals with relief problems, the 
 underljang question, in many if not in 
 most cases, must be still: What is the 
 structure and need, the strength and weak- 
 ness, of these persons before us, and what 
 is the effect on them and on the community 
 of the dependence which we propose to 
 create or to abolish? 
 
 I have now considered the psychical 
 factor in social work as exemplified in the 
 case of misbehaving children, adolescents, 
 and adult dependents. In the charities 
 aiding unmarried mothers, the blind, the 
 feeble-minded, in the training of social 
 secretaries, welfare workers, settlement 
 workers, prison ofiicials, home and school 
 visitors, school nurses, factory nurses, 
 tuberculosis nurses, and workers in church 
 
THE ART OF HEALING 65 
 
 clubs, it is even more obvious that not relief 
 but the analysis and understanding of 
 character under adversity, and of the 
 means of developing it, are the main things 
 to be learned. 
 
 I will rest at this point my case for the 
 thesis that the true business of the social 
 worker is psychical diagnosis and treat- 
 ment, a labor parallel to that of the physi- 
 cal diagnosis and treatment of the physi- 
 cian. 
 
 Ill 
 
 But now, granting that this is the sort 
 of wisdom to be desired and striven for, 
 is it possible to teach it? What has been 
 done thus far towards reducing it to teach- 
 able, that is, to scientific form? 
 
 Character and the influences molding 
 it, — this is the subject of our inquiry. 
 The studies relating to it can be arranged 
 in two groups : 
 
 1. The researches of Jacob Riis, Helen 
 
66 SOCIAL SERVICE AND 
 
 Bosanquet, Jane Addams, Robert Woods, 
 and others, into the psychology of the 
 hard-pressed. Put a newly-arrived inuni- 
 grant into a crowded tenement house dis- 
 trict amon^ races and customs foreign to 
 him — what results? The outcome of this 
 huge laboratory experiment is reported 
 in such books as Jane Addams's " Newer 
 Ideals of Peace," Riis's " How the Other 
 Half Lives," Woods's " The City Wilder- 
 ness " and " Americans in Progress." 
 
 Put a relatively homogeneous race into 
 the crowded capital of a small and crowded 
 island, squeeze it between the upper and 
 nether millstones of poverty and drink: 
 what type of character results? Mrs. 
 Bosanquet has answered the question in a 
 series of searching and skillful studies/ 
 
 Charles Booth's monimiental survey of 
 London conditions (" Life and Labor in 
 London"; 8 volumes) and especially the 
 
 »"The Family," "Rich and Poor," "The Standard 
 of Life," "The Strength of the People." 
 
THE ART OF HEALING 67i 
 
 recent " Pittsburg Survey " are concerned 
 throughout with the bearing of physical 
 and economic conditions on character, 
 though the connection is not always thor- 
 oughly worked out. 
 
 2. The second group of studies is less 
 generally known to social workers them- 
 selves and has been carried on for the 
 most part by their cousins the educators. 
 I refer to the child-study researches. Like 
 the last group, these investigations deal 
 with character in its environment, but here 
 the emphasis is on character — there, on en- 
 vironment. These character-studies are 
 supposedly concerned with normal chil- 
 dren, but as all. children are more or less 
 faulty, the distinction from those who come 
 into the field of the social worker is not a 
 sharp one. Indeed, the distinction be- 
 tween the vocation of the educator and 
 that of the social worker should be merely 
 one of convenience. 
 
 Without trying to sum up in any way 
 
68 SOCIAL SERVICE AND 
 
 the work of the child-study researches, I 
 have selected two interesting items in illus- 
 tration of the sort of study which I hope 
 to see much furthered in schools for social 
 workers. 
 
 Joseph Lee ^ has made a striking effort 
 to found a character-study of children, by 
 dividing them into three ages, with special 
 reference to play: 
 
 (a) The " dramatic " age, when the 
 child is fond of plays of make-believe; 
 
 (b) The " Big-Injun " period, when 
 he is prone to individualistic, realistic oc- 
 cupations ; 
 
 (c) The " age of loyalty," when team- 
 work becomes possible. 
 
 Professor Josiah Royce, of Harvard 
 University, gave some years ago a course 
 of lectures on the character of children, lec- 
 tures containing a few references to chil- 
 dren's faults and their management. 
 After each lecture he was bombarded with 
 
 ' Joseph Lee: Educational Bevieio. December, 1900. 
 
THE ART OF HEALING 69 
 
 interesting questions from anxious moth- 
 ers and teachers, who were hungry for 
 such crumbs of a science of the diagnosis 
 and treatment of children's faults as were 
 dropped in a course of lectures not con- 
 cerned primarily with these questions. 
 
 The attempted classification at the Lan- 
 caster Reform School for girls by the, char- 
 acteristics supposed to lead to the crime 
 rather than by the crime itself is another 
 straw floating on the same current. I will 
 merely mention also Mrs. Bosanquet's^ 
 studies in the mental characteristics of the 
 shiftless, and President Hadley's ^ division 
 of the college students into men of action, 
 men of literary interests (artistic), and 
 men of science. 
 
 These disjointed scraps and sugges- 
 tions are, of course, no proof that a science 
 of character-study and character-molding 
 
 'Helen Bosanquet: "Aspects of the Social Problem," 
 page 83. 
 "A. T. Hadley: Harper' a Magazine, June, 1905. 
 
70 SOCIAI. SERVICE AND 
 
 exists. The art exists, but the science has 
 not yet gotten very far. I have often 
 longed to have the opportunity to tran- 
 scribe, like some sort of a Boswell, the wis- 
 dom, the science, which I know is stored in 
 the minds and active in the habits of our 
 most skillful social workers but is nowhere 
 in print. When these experts die much 
 wisdom will die with them. There is, 
 however, especially in France, some scien- 
 tific work on this matter, work with which 
 I think social workers should be more fa- 
 miliar. 
 
 Social workers have already begun to get 
 in touch with psychotherapeutic literature 
 on the one hand and with psychodiagnostic 
 literature on the other. But the acquaint- 
 ance should ripen into intimacy. Social 
 workers are constantly confronted with the 
 problem of training the will, but how many 
 of them have ever seen J. Payot's book 
 on the " Education of the Will," or Levy's 
 monograph on the same subject, or even 
 
THE ART OF HEALING 71 
 
 Dubois's " Psychic Treatment of Nerv- 
 ous Disease "? These books are not ex- 
 hortations or theoretical analyses. They 
 are the works of men who have been train- 
 ing wills, — ^more or less diseased and 
 broken wills, — and report their niethods 
 and the degree of success that can be rea- 
 sonably expected. 
 
 We all agree that the treatment of cases 
 as they come to us must not be mechanical 
 or routine. If we are to avoid this we 
 must distinguish the types of character 
 with which we are concerned and adapt 
 our methods accordingly. But do social 
 workers ever read Fouillee's " Tempera- 
 ment and Character, — Their Variations 
 According to Race, Sex, and Individual- 
 ity," ^ or Levy's " Psychology of Char- 
 acter," or Paulhan's works on the same 
 subject? As a matter of fact, I think so- 
 cial workers can write books far better 
 than these. They are more closely in touch 
 
 'Paris (Alcan), 108 Boulevard St. Germain, 1895. 
 
72 SOCIAL SERVICE AND 
 
 with the facts. They treat more cases than 
 these writers do. Yet these books will 
 be found stimulating, unless I am very 
 much mistaken. The social worker can 
 verify what is true, reject the rest, and 
 work out to their fulfillment the good in- 
 tentions of these scholars. 
 
 Meantime, in order to afford a basis for 
 criticism, and to make a little more con- 
 crete the rather vague suggestions so far 
 presented, I shall try to imagine the chap- 
 ter headings or table of contents of the 
 epoch-making book on character-study 
 which an expert social worker will some 
 day write out of the abundance of his 
 knowledge. 
 
 AN OUTLINE STUDY OF CHARACTER 
 I. The Physiology of Character 
 
 (1) The more or less swbcon- f^l^At' *'"■' . 'j^^*,* 
 scious seeMnff of the primal \ (^oftes. shelter). 
 f»)ces,Uiei " ' '^ ] food, water, procre- 
 
 (. ation. 
 
(d) Nurturing 
 
 THE ART OF HEALING 73 
 
 (3) The Fundamental Their 
 
 Conscious Tendencies and Outlets 
 
 , . T i- !.• < Scientific Interests. 
 
 (a) Investigation ^ Philosophy. 
 
 t Exploration, subjuga- 
 of Nature . -J tion, hunting, ex- 
 ( ploitation. 
 
 (b) Conquest^ 
 
 C War, politics, diplo- 
 of other men ) macy, business, 
 ( athletics. 
 
 (c) Creation, construction, ( Art, literature, games, 
 play I government, accumu- 
 lation. 
 
 ' Family and friendly 
 relations, nursing, 
 social work, part of 
 medicine, education, 
 care of plants and 
 animals. 
 
 (3) The differentiations and admixtures of these 
 tendencies according to: 
 ... ( Childhood, adolescence, ma- 
 
 W -*Ke \ turity, old age. 
 
 (b) Sex 
 
 , , _, (In this country especially 
 
 ^'^> "^''^ \ Irish, Jew, and Italian. 
 
 (d) Climate and Resi- j City, suburbs, open country, 
 
 dence \ seashore, mountains. 
 
 (e) Occupation 
 
 ( Rich 
 
 (f) Economic Status -J Poor 
 
 ( Comfortable. 
 
 (g) Social environment { IS;f,Teac^A. 
 
 i.e., the portion left after 
 (h) Education excluding the above in- 
 
 fluences. 
 
74 SOCIAL SERVICE AND 
 
 II. Pathology of Chabacter 
 (1) Exaggerations, deficiencies, and perversions ot the 
 
 tendencies above described (congenital, acquired). 
 (3) Paroxysmal and impulsive outbreaks; temper, 
 
 tramping, drinking, sexuality. 
 
 (3) Dissociations, i.e., forgetfulness, tangent-taking, 
 
 panic-states, cowardice, dissipation. 
 
 (4) Degenerations, atrophies, formation of fixed, stereo- 
 
 typed habits. 
 
 III. Causes of Special Faults 
 IV. Froqxosis 
 
 The outlook for rarious faults, as judged by statistics 
 of cases under standard treatment. 
 
 v. TREATMElfT 
 
 Methods, agencies, laws, institutions, for the preven- 
 tion, modification, alleviation, or cure of the faults above 
 described. 
 
 At present only No. 3e and No. V of 
 this outline are taught to any extent in 
 schools for social workers. Until text- 
 books are gradually built up through sys- 
 tematic research and the statistical study 
 of records, the principle of character-study 
 and character-molding will have to be 
 learned as it has been so far, without books 
 or lectures, but largely: — 
 
 (a) By watching the work of experts. 
 
 (b) By studying under supervision 
 carefully recorded reports of illustrative 
 
THE ART OF HEALING 76 
 
 cases. (The effort to select these would 
 make of itself a tentative classification or 
 grouping, which is the beginning of a 
 science.) 
 
 (c) By practicing under careful super- 
 vision the actual diagnosis (investigation) 
 and treatment (disposal) of cases. 
 
 I see no reason to doubt that, in the 
 science and art of character-study and 
 character-molding, books will ultimately 
 come to occupy the same useful position 
 as in medicine, though as educative influ- 
 ences they will alwajj's be subordinate (as 
 they are in medicine) to the watching of 
 experts at work, the subsequent or pre- 
 liminary analysis and discussion of printed 
 cases, and the later apprenticeship in the 
 work itself. 
 
 IV 
 
 The need for a clearer recognition of 
 the new science and center of social work 
 may be brought out in some other ways. 
 
76 SOCIAL SERVICE AND 
 
 The organizers of conferences and of 
 schools for social workers find it hard to 
 decide what to include and what to ex- 
 clude. Programmes contain each year more 
 and more. What shall determine their 
 limits? I should answer. Whatever brings 
 new grist to the mill of character-study 
 and character-molding. Play, for exam- 
 ple, is surely an essential element in the 
 expression and formation of children's 
 character. Social workers should study 
 play, playgrounds, and play-apparatus, 
 especially with reference to their value in 
 the development of normal and the pre- 
 vention of faulty character. Their 
 physical aspect, their economic and 
 municipal aspect is a matter primarily 
 for others. 
 
 In a striking and important paper 
 printed about three years ago in Charities ^ 
 Lee K. Frankel analyzed the cases of one 
 hundred persons applying to a New York 
 
 ■ Charities, November 17, 1906. 
 
THE ART OF HEALING 77 
 
 charitable organization for relief, and stu- 
 died the causes leading to the application. 
 He found practically no moral or mental 
 deficiency, no fault or warping of char- 
 acter. The trouble he concludes is due to 
 the conditions, the environment in which 
 these people were forced to live. Ap- 
 parently then there is nothing here for the 
 social worker, if I am right in describing 
 him as a student and physician of charac- 
 ter. Do not his figures wholly refute my 
 thesis? 
 
 Let us look again at his figures. In 
 sixty-two, or practically two-thirds of all 
 his cases, the destitution was due to illness. 
 But it was the business of the physician to 
 have prevented that illness through the 
 public health authorities, or to have treated 
 it when it occurred. It is true that physi- 
 cians do not now prevent or properly treat 
 such cases; but that does not mean that 
 the social workers should, except tempo- 
 rarily, take charge of them. Social work- 
 
78 SOCIAL SERVICE AND 
 
 ers must study the effects of diseases (e.g., 
 malnutrition) upon character, and then do 
 all they can to make the public aware of 
 the harm that is being done, the waste 
 which should be stopped. Social workers 
 must force upon physicians and Health 
 Boards the full weight of their responsi- 
 bility for the public health. 
 
 In the remaining one-third of Mr. 
 Frankel's cases the trouble seemed to be 
 due chiefly to insufficient wages. But 
 social workers cannot do much to raise 
 wages. That is the business of the capi- 
 talist and of labor, organized or unorgan- 
 ized. Sickness and low wages it is rarely 
 the social worker's business to cure. With 
 environment in its effects on character he 
 must constantly deal, but rarely with the 
 great physical or economic forces that 
 produce the troubles such as Mr. Frankel 
 brings to our notice. I wish especially to 
 emphasize my appreciation of the fact that 
 because the social worker's chief business 
 
THE ART OF HEALING 79 
 
 is with character, and because his training 
 should be so shaped as to help him deal 
 skillfully and appreciatively with charac- 
 ter, — for these reasons he must be con- 
 stantly studying environment. Anyone 
 who studies character knows how deeply 
 it is made, molded, or marred by con- 
 ditions. 
 
 But he will study conditions not pri- 
 marily in their bearing on health, as the 
 physician should; not on earning power, 
 which is the business of the captains of 
 labor, who bend their energies to see how 
 this environment can be made more pro- 
 ductive. The social Worker should study 
 the eflFect of city life, of hfe on the plains, 
 of noise, dirt, vice, child-labor, long hours, 
 not only in their effect on health or in- 
 come, but especially in their effect on 
 character. Hygienically it is often imma- 
 terial whether a room or a person is 
 clean, but morally it may make a crucial 
 difference. 
 
80 SOCIAL SERVICE AND 
 
 Tuberculosis is a matter of great im- 
 portance both in relation to public health 
 and in relation to the exhaustion of savings 
 with the production of dependency ; but it 
 is also and chiefly important to the social 
 worker by reason of the effect which tuber- 
 culosis and its treatment may have on the 
 character of the sufferer and of his family. 
 Just here I think the social workers have 
 been somewhat misled by the enthusiasm 
 and vigor of the present public interest in 
 the crusade against tuberculosis. The 
 suppression of tuberculosis is the business 
 of doctors and public health officials. The 
 doctors have been remiss in this matter. 
 It needed the pressure of the general pub- 
 lic and of the social workers, spokesmen 
 for the public, to stir the doctors to the 
 proper realization of their duty, but here 
 I think the duty of the social worker 
 should cease. He should not give upon 
 the programmes of his conferences so 
 much space to those aspects of the mat- 
 
THE ART OF HEALING 81 
 
 ter which are primarily the physicians' 
 business. 
 
 On the other hand, I hope to see social 
 workers devote more research and energy 
 to the study of how to prevent the doctors 
 from hurting the souls of their tuberculous 
 patients while busy in the attempt to have 
 them live by bread (with milk and eggs) 
 alone. The importance of properly chosen 
 work for the tuberculous patient in differ- 
 ent stages of the disease has, I think, been 
 greatly underestimated. The doctor's at- 
 tention is directed elsewhere. It should 
 be the special business of the social worker 
 to point out that, not for economic but for 
 spiritual reasons, it is a dangerous experi- 
 ment to take a man away from his work 
 and put him on his back in a steamer-chair 
 for months at a time. 
 
 Had the social worker thought of his 
 business not as primarily either physical 
 or financial, nor as that of a worker for 
 the public good in general, but specifically 
 
82 SOCIAL SERVICE AND 
 
 as that of guarding, building, and develop- 
 ing character, this mistake might have been 
 more generally recognized and avoided. 
 
 Social workers must not labor prima- 
 rily over the physical aspects of tubercu- 
 losis, playgrounds, tenement houses, pris- 
 ons, garment- workers ! Who will watch 
 over the psychical aspects of every such 
 bit of social machinery tmless the social 
 worker is awake to this responsibility? 
 The doctor, the legislator, the economist, 
 the school teacher, each faces a slightly 
 different problem. No one but the social 
 worker is set to watch the spiritual effect 
 of these agencies. There is danger that 
 he may not be duly watchful at the post. 
 
 The social worker, like the teacher, 
 should be chiefly an educator, nurturer, 
 stimulator, developer, and director of hu- 
 man souls, particularly in that group of 
 persons whose character, temperament, or 
 environment has brought them into some 
 sort of trouble. 
 
THE ART OF HEALING 83 
 
 He is an educator; a school of philan- 
 thropy is a normal school; but we must 
 avoid thinking of the subject-matter in 
 this sort of normal school as the survey 
 of the resources, such as almshouses, pris- 
 ons, playgrounds, probation, etc., which 
 have already been found useful in his spe- 
 cial branch of education. The educator 
 knows that his subject-matter is never, at 
 bottom, a subject like geography or his- 
 tory, but always the child's soul, and such 
 product of other people's souls as may 
 serve to develop it. For fear of seeming 
 to lack a sense of humor, the educator can 
 hardly yet say this to the public, but he 
 knows that it is true and in " family 
 gatherings " he admits it. So must the 
 social worker. There is no more arro- 
 gance in the admission for him than for 
 the teacher. For is it not really true that 
 the science of social work is not any rem- 
 edy like relief, or placing out, or alms- 
 houses, but primarily the nature and type 
 
84 SOCIAL SERVICE AND 
 
 of warped, pinched or faulty human souls, 
 and secondarily, the psychical effects of 
 the social remedies which have been 
 worked out experimentally in the past? 
 
 The medical student does not begin with 
 the study of drugs, but with anatomy and 
 physiology as aids to diagnosis. He is 
 not primarily concerned with theories of 
 cure. No more should the student of 
 social work be concerned primarily with 
 a bird's-eye view of the existing charitable 
 and reformatory resources of the conmiu- 
 nity, nor with the reforms proposed and 
 laws enacted for the cure of social ills. 
 For this is to learn treatment before 
 diagnosis. 
 
 It is true enough that you cannot de- 
 velop a man's character successfully nor 
 appeal effectively to the best that is in him 
 if all the while someone else is sitting on 
 his head. You can't train and strengthen 
 
THE ART OF HEALING 85 
 
 moral fiber if the physical tissues are half 
 starved and the brain deadened by over- 
 work, alcohol, or loss of sleep. Unless the 
 social worker can get someone else to 
 remedy these conditions his work is useless. 
 It is not his business to treat alcoholism 
 or to shut up breweries, to do police work 
 or nurse's work, nor to feed school chil- 
 dren. He may be forced in emergencies 
 to pitch into any of these occupations as 
 any citizen will jump into the fire brigade 
 when forest fires threaten a town. But 
 this is not his regular job. He may — nay, 
 he must do all in his power to rouse 
 the properly constituted authorities when 
 child-labor, disease, or lack of employment 
 balks his work. ,But he cannot be a busy- 
 body, a jack of all trades or a " supporter 
 of all good causes " if he is to command 
 respect as an expert in his own field. 
 
 If the social worker occupies himself 
 with improving the public schools, the 
 conditions of employment, the law courts, 
 
86 SOCIAL SERVICE AND 
 
 the hospitals, the condition of the streets 
 and tenement houses (as he has recently 
 been advised to do by the editor of Chari- 
 ties and the Commons), will he not de- 
 serve to be asked whether he has no busi- 
 ness of his own to attend to? No man 
 can understand so many subjects. 
 
 But he can understand a single (for him 
 an all-important) aspect of these intricate 
 subjects; viz., their bearing on character. 
 The doctor cannot know much about elec- 
 tricity; — its effect on human health is the 
 one thing he has time to understand. So 
 the social worker cannot pass judgment 
 on hospital management. But he must 
 be keen to understand (and if possible to 
 neutralize) the harm done to a family 
 when a wife goes to a hospital for some 
 weeks, and thereby deprives her husband 
 and her daughters of the moral support 
 which has hitherto kept them in the 
 straight path. 
 
 Shall the social worker effect no radical 
 
THE ART OF HEALING 81 
 
 reform, no removal of those conditions 
 (poverty, drink, ignorance, disease, over- 
 work, overcrowding) which undermine 
 and vitiate character? Must he confine 
 himself to case work, to palliation, to 
 patching up the broken characters? The 
 answer seems to me this: 
 
 If he is wise enough materially to dimin- 
 ish poverty and overwork he is the wisest 
 statesman living and his work should be 
 in statecraft, legislation, and economic re- 
 construction. There cannot be many such 
 prophets in any century — far too few to 
 constitute a profession. The diminution 
 of ignorance and disease is the work of 
 the educator and the physician through 
 centuries of endeavor, — not a reform to 
 be won at a stroke by anyone. 
 
 Every profession must work primarily 
 with individuals — the social worker as well 
 as the rest. Every profession will also 
 try to effect through education, through 
 public opinion, through legislation the re- 
 
88 SOCIAL SERVICE AND 
 
 moval of the obstacles in the way of its 
 work. Each will call the rest to account 
 when their failures block his path. But 
 none wants to earn the title of walking 
 delegate or professional reformer. 
 
 Does not the social worker deal con- 
 stantly in his work with characters far 
 finer than his own, victims of misfortune 
 and not of their own fault? Surely he 
 does; and he is then the pupil, not the 
 teacher. Social work is still going on, but 
 the positions are reversed. 
 
 In other cases there need be no more 
 sense of superiority than the butcher feels 
 when he sells us meat. He has more than 
 we, but he too needs it and eats it himself. 
 So the social worker, like the school 
 teacher, shares with others the knowledge 
 or the enthusiasm by which he himself is 
 guided, — on which he depends. He gives 
 advice, he shares experience, he helps to 
 make plans simply because he has been 
 in such scrapes before, not because 
 
THE ART OF HEALING 89 
 
 he arrogates any especial merit to 
 himself. 
 
 VI 
 
 Once thoroughly equipped and recog- 
 nized as an expert in the understanding 
 and management of the weaknesses and 
 perversions of character, the social worker 
 should command expert fees. He should 
 have his office hours and his private prac- 
 tice as well as his public work among the 
 poor. He should be consulted as Mark 
 Pagan used to be consulted, as Professor 
 Royce is often consulted, by rich and poor, 
 in all sorts of moral and domestic diffi- 
 culties, by the parents of difficult children, 
 by the children of difficult parents, and 
 also by many neurasthenics seen in con- 
 sultation with physicians. The average 
 social worker is, in my opinion, far better 
 equipped to treat neurasthenia than the 
 average physician is. The mental and 
 moral aspects of such cases altogether 
 
90 SOCIAL SERVICE 
 
 overshadow their physical aspects, and the 
 problems of occupation, of encourage- 
 ment, of foresight, hindsight, and of re- 
 sponsible hving are just what the social 
 worker is constantly encountering. 
 
 I see no reason why social work should 
 be done chiefly among the poor. My most 
 intimate and thorough knowledge of the 
 topic has been gained through the social 
 work done by my wife on me. Social 
 work (the understanding and molding of 
 faulty character) is possible, I know, be- 
 cause I have experienced it in the hands 
 of an expert. 
 
CHAPTER III 
 
 TEAM-WOEK OF DOCTOR, EDUCATOR, AND 
 SOCIAL WORKER^ AND THE RESULTING 
 CHANGES IN THE THREE PROFESSIONS — 
 A REVIEW AND A PROGRAMME 
 
 Despite the distinctions emphasized in 
 the last chapter, history shows that medi- 
 cal work and social work are branches 
 split off from a common trunk : — the care 
 of people in trouble. In earlier centuries 
 the priest healed the sick, cared for the 
 poor, taught the ignorant, and often led 
 his people in industrial, governmental, and 
 even in martial activities. He was the law- 
 giver and magistrate, the doctor, the 
 school-teacher, the dispenser of charity, 
 the temporal ruler, and sometimes the 
 leader in war. Such all-inclusive useful- 
 ness in the priesthood still lingers here and 
 
 91 
 
92 SOCIAL SERVICE AND 
 
 there among us. Father Niseo in the little 
 town of Roseto, Penn. (see McClure's 
 Magazine, January, 1908) , is doing some- 
 thing very like this now. He is the leader 
 of his town in industrial, municipal, and 
 political life as well as in educational and 
 spiritual affairs. 
 
 In a similar way, the country doctor, 
 the old-fashioned family physician, has 
 sometimes extended his profession as 
 widely and deeply as the priest was once 
 allowed to do. Barrie and Watson have 
 described such doctors and many of us 
 have known them, leaders in all civic work. 
 
 But specialization of work and division 
 of labor have come into the field once occu- 
 pied alone by the minister or the doctor. 
 The doctor is now supposed to care for the 
 diseased body, the teacher for the unde- 
 veloped mind, the minister for the needy 
 soul, the social worker for the poor, while 
 justice and governmental work are like- 
 wise intrusted to specialists. On the 
 
THE ART OF HEALING 93 
 
 whole, doubtless, this division of labor is 
 good for every resulting profession except 
 that of the minister, but what I wish here 
 to point out is that in this field, as in many 
 others, division of labor is never an un- 
 mixed blessing and may easily become a 
 curse unless energy and intelligence are 
 devoted to the ways and means of attain- 
 ing a close co-operation and interchange 
 of ideas, methods, and plans among the 
 divided laborers. 
 
 There is a distinction and an important 
 one between the troubles of mind, of body, 
 and of estate; but there is also a unity 
 among them. Hence no one can give the 
 most efficient aid to a diseased body, a dis- 
 tracted or undeveloped mind, or a needy 
 family without crossing the dividing lines 
 and laboring in fields assigned primarily 
 to others. A doctor needs to know some- 
 thing of social work and of the spiritual 
 and mental life of his patients. A social 
 worker must know something of physi- 
 
94 SOCIAL SERVICE AND 
 
 ology and hygiene, and all educators, 
 whether lay or clerical, must know some- 
 thing both of medicine and of social work. 
 I recently saw a priest create a strong, 
 but most unfavorable, impression at the 
 graduation exercises of a training school 
 for nurses when he said, addressing the 
 ■doctors and nurses present : " You deal 
 with the body, I with the soul." Our prac- 
 tice has gone far beyond this academic 
 theory. Despite Professor Miinsterberg's 
 plea for armed neutrality ^ no such sharp 
 boundaries can be maintained. The an- 
 cient controversy between materialism and 
 spiritualism is ended. There are no crass 
 materialists or rampant spiritualists 
 among the working professions. Matter 
 and spirit belong together; neither of them 
 independent, neither slavishly subordinate. 
 Each interpenetrates everywhere and who- 
 soever neglects either in his field of work 
 comes to grief. 
 
 '"Psychotherapy": New York, 1909. 
 
THE ART OF HEALING 95 
 
 Among my friends I am proud to num- 
 ber two cousins who are members of the 
 famous Worcester family, Elwood Wor- 
 cester of Boston and Alfred Worcester of 
 Waltham. Both are doctors, the first a 
 doctor of divinity, the second a doctor of 
 medicine, but Elwood Worcester, the min- 
 ister of rehgion, is now known and blessed 
 all over the country as a healer of souls 
 (and incidentally of bodies) through his 
 psychotherapeutic work at Emmanuel 
 Church ; whUe Alfred Worcester, the doc- 
 tor, is even more famous as a trainer of 
 souls than as a healer of bodies. Each 
 is distinguished within his own narrower 
 field; each is still more distinguished for 
 his success in work that overlaps and goes 
 far to erase the faint lines of division be- 
 tween his own profession and that of his 
 cousin. 
 
 Why is this so? 
 
 Simply because wherever troubles are 
 heaped up and gathered together as they 
 
96 SOCIAL SERVICE AND 
 
 are in a hospital, in a mission church, in 
 the offices of a relief society, we find that 
 those troubles are assorted. They are not 
 neatly separated, each in its own corner. 
 They do not heed our academic distinc- 
 tions or our divisions of labor. Poverty, 
 disease, moral shiftlessness, and spiritual 
 torment are inextricably intermingled in 
 the face and fortunes of a single sufferer. 
 Not even the sufferer himself can tell what 
 is root and what is branch among his 
 troubles. He will wander into a hospital 
 in search of a tonic (" something to give 
 me strength, doctor ") , although his weak- 
 ness may be due to lack of food and that 
 lack to the loss of his job. He will run 
 to a clergyman distracted with religious 
 doubts when the root of his troubles is in- 
 somnia. In all such cases he goes to the 
 •wrong shop and the shopman (doctor, 
 minister, social worker) is apt to take him 
 at his own valuation, to treat him for his 
 stomach if he complains of that or for his 
 
THE ART OF HEALING 97 
 
 atheism if that is the burden of his re- 
 marks. Disaster often results. 
 
 Let me exemplify more in detail the ex- 
 traordinary intermingling of the afflictions 
 of mind, body, and estate as we meet them 
 in all sorts and conditions of men. 
 
 Mental or spiritual turmoil for physical 
 reasons 
 (a) Religious ecstasies, moral doubts, 
 and self-condemnations are often manifes- 
 tations of insanity, of hysteria, of neu- 
 rasthenia, or of the stresses of adolescence 
 with its torrential flood of developing en- 
 ergies. Suffering of this kind often leads 
 people to seek help from a clergyman. 
 But unless the clergyman is on his guard 
 he will make a bad matter worse. The in- 
 tense " conviction of sin," which such a 
 sufferer often experiences, may be as mor- 
 bid as the dreams of an opium eater, some- 
 thing that vanishes and ought to vanish 
 
98 SOCIAL SERVICE AND 
 
 with the return of health. The religious 
 ecstasies and visions which the evangelist 
 might welcome and encourage in his young 
 pupil may yet possess no more spiritual 
 significance than the black cats and snakes 
 at. which the alcoholic snatches in his de- 
 lirium. I am far from asserting that all 
 religious visions are morbid. I am merely 
 recalling the well-known fact that some 
 religious visions are morbid, and that un- 
 less clergymen work in close touch with 
 medical men and medical ideas they may 
 do unnecessary harm by encouraging the 
 wrong vision. 
 
 (b) Excessive worry, timidity, scrupu- 
 losity is often an early symptom (though 
 mistaken for the cause) of arteriosclerosis, 
 of Bright's disease, anaemia, or tubercu- 
 losis. "Poor man!"^ (people say.) 
 " Business worry, too heavy responsibil- 
 ities, too long hours of work broke him 
 down." Doubtless this is sometimes a 
 true bill, but irregular meals, frequent nips 
 
THE ART OF HEALING 99 
 
 of whiskey, and advancing arterial degen- 
 eration are often more potent than the 
 psychical causes. A child's fear of the 
 dark may vanish after a summer in the 
 open air and return again after a winter's 
 " education " in stuffy schoolrooms and 
 cramped positions. In this sense it is 
 " physical " in origin. 
 
 ( c ) Laziness, shiftlessnessj carelessness , 
 may be only the mental manifestations of 
 the debility of adolescence, of chorea, of 
 cerebral disease, of malnutrition, or of any 
 of the other diseases mentioned above. I 
 once heard a social worker illustrating out 
 of her own bitter experience the need of 
 more medical knowledge or medical co- 
 operation for the members of her profes- 
 sion : " He seemed to be getting lazier and 
 lazier, every motion slower and slower. It 
 took him an interminable while to get 
 dressed and out at work in the morning. 
 He lost place after place. We tried first 
 to appeal to his ambition, then to his af- 
 
100 SOCIAL SERVICE AND 
 
 fection for his wife and children. We 
 tried encouragement and reproof. We 
 got the priest to use his influence. There 
 was some improvement. The man evi- 
 dently tried hard for a time, but he seemed 
 to get no satisfaction out of his dawning 
 prosperity. His spirits sank lower and 
 lower, till he was so depressed that an 
 alienist was consulted. Insanity was the 
 expert's verdict; and all that I had inter- 
 preted as moral slackness was undoubt- 
 edly, he said, the ' psycho-motor retarda- 
 tion ' characteristic of an early stage of 
 depressive-manic insanity. He is in an 
 asylum still. I wish I hadn't plagued him 
 so for what wasn't his fault." 
 
 But though I am keenly aware of the 
 dangers of mistakes due to overlooking the 
 physical conditions just alluded to, I think 
 that we all of us, doctors, teachers, minis- 
 ters, social workers, need to be just as alert 
 to avoid the opposite error. 
 
THE ART OF HEALING 101 
 
 II 
 
 Physical complaints and even diseases may 
 be due to mental and spiritual causes, to 
 ignorance, mental disease, and sin 
 
 (a) The fear-neuroses, the habit-pains, 
 the hysterical paralyses, spasms, and an- 
 assthesias are among the more common 
 and obvious examples, often wrongly 
 treated by drugs and physical means alone. 
 
 (b) Many people are sick because of 
 remorse more or less stifled, because of an- 
 imosities or shghts brooded over, because 
 of loss or disappointment to which they do 
 not become reconciled. 
 
 (c) Ignorance of the laws of health, of 
 the workings of the organs of nutrition 
 and reproduction, of the influence of mind 
 on body and of body on mind is certainly 
 a prolific cause of disease. 
 
102 SOCIAL SERVICE AND 
 
 III 
 
 Financial dependence and want is more 
 and more often seen to he the result of 
 physical and mental causes. People are 
 poor because they are sick and ignorant 
 
 In illustration of this I need only re- 
 mind you of the great prevalence of tuher- 
 culosis, typhoid, and. other infectious dis- 
 eases among the poor, and of the facts 
 cited hy Lee K. Frankel, in the article to 
 which I have already referred (see page 
 76). In 62 out of 100 successive cases 
 applying to a relief agency the destitution 
 of the applicant was due to illness. 
 
 Old age, accident, alcoholism, acute and 
 chronic disease, the death of the bread win- 
 ner, are among the commonest causes of 
 financial distress in America. Hence the 
 social worker must be in the closest touch 
 with physicians and must, in my opinion, 
 know a good deal of medicine, as, in fact, 
 he often does. 
 
THE ART OF HEALING 103 
 
 In the last chapter I tried to show how 
 far character-defects are responsible for 
 many of the problems with which social 
 workers are concerned. Here I will not 
 repeat what was then said. That the diag- 
 nosis and treatment of character in difficul- 
 ties is the business of social workers who 
 deal with children, with delinquents and 
 the whole field of probation work is, I 
 think, obvious. It is not quite so obvious 
 that behind the effort to remove any of 
 the causes of financial troubles or poverty 
 is an educational problem. We ought to 
 educate somebody every time we receive 
 an application for financial relief. It may 
 be the applicant himself whose ignorance, 
 forgetfulness, lack of imagination or of 
 concentration are responsible for his fail- 
 ure. More often it is the duty of the so- 
 cial worker to begin an educational cru- 
 sade against the ignorance of those who 
 are responsible for the bad conditions 
 which produced the bankruptcy. Some- 
 
104 SOCIAL SERVICE AND 
 
 one in the community surely needs educa- 
 tion. It may be the employer who permits 
 unsanitary work-conditions, though they 
 may hurt his own pocket as well as the 
 health of his employees. It may be the 
 legislators whose error of omission or of 
 commission are responsible for health- 
 kilhng conditions in factories, schools, 
 tenements, and railroads. It may be the 
 bargain hunters and the fashion slaves, 
 whose shortsightedness makes starvation 
 wages and irregular employment so com- 
 mon. 
 
 But however difficult it may be to catch 
 the man who needs education, we may be 
 sure that he is there and we must make an 
 intelligent effort to find and to " reach " 
 him, so fatally dependent are mind, body, 
 and estate ; the mind of one and the body 
 and estate of others, in this field. 
 
 So far I have spoken of: 
 
 1. The dependence of mental on bodily 
 trouble. 
 
THE ART OF HEALING 105 
 
 2. The dependence of bodily on mental 
 trouble. 
 
 3. The dependence of financial on bod- 
 ily and mental trouble. 
 
 Naturally enough the interdependen- 
 cies which I have been pointing out are 
 tending to bring together again the doctor 
 and the social worker, whose now divided 
 functions were once united, and to empha- 
 size for them both the importance of edu- 
 cation in the remedy of all mental, physi- 
 cal, and financial troubles. What I have 
 said may be thus summed up : 
 
 Doctor and social worker must each 
 look to the other for the causes of the 
 trouble he seeks to cure. At bottom 
 medical ills are largely social, and social 
 ills largely medical. But both doctor and 
 social worker^ when they have learned 
 {each from the other) the deeper causes of 
 their patients' ills, must go hand in hand 
 to the educator, or at any rate must betake 
 themselves to educational methods, when 
 
106 SOCIAL SERVICE AND 
 
 they get through with diagnosis and begin 
 treatment. 
 
 The dependence of doctor and social 
 worker on education and on the educator 
 has been made so clear by the success of 
 educational campaigns against tubercu- 
 losis, alcoholism, child labor, dark tene- 
 ments, and unprotected machinery that I 
 do not care to dwell on it here. I wish 
 rather to point out the reverse, namely : 
 
 The dependence of the educator on the 
 doctor and on the social worker. 
 
 The educator and those in charge of 
 education are becoming increasingly aware 
 of the fact that since a compulsory school 
 law forces the children to undergo many 
 dangers (as well as to receive many bene- 
 fits), justice and common sense say: 
 " Neutralize so far as possible the peculiar 
 dangers of schoolUfe." Such dangers 
 are: — 
 
 1. Those resulting from keeping your 
 
THE ART OF HEALING lOT 
 
 children indoors and making them sit still 
 and use small muscles (eye and hand) . 
 
 2. Those resulting from eyestrain. 
 
 3. Those resulting from acute infectious 
 diseases and from tuherculosis. 
 
 4. Those resulting from discourage- 
 ment, ostracism, and handicapping of 
 the child by adenoids or speech defect, ac- 
 centuated by school work and school dis- 
 ciphne. 
 
 To neutrahze, prevent, or minimize 
 these evils, the school authorities are be- 
 ginning to institute : 
 
 (a) Physical as well as mental exam- 
 inations (especially in New York and Bos- 
 ton). 
 
 (b) Psycho-physical tests (especially 
 in Chicago and Philadelphia) . 
 
 (c) School nurses. 
 
 (d) Physical training, school-gardens, 
 and proper playgrounds. 
 
 Since the causes of many of the ills 
 which doctors, educators, and social work- 
 
108 SOCIAL SERVICE AND 
 
 ers are combating lie across the boundaries 
 that separate these professions from each 
 other, the reaUzation of this fact plus the 
 desire to be thorough, to leave no stone un- 
 turned in searching out causes, is chang- 
 ing all three professions. 
 
 Changes in the Medical Profession 
 
 Doctors are realizing that they must 
 know more than they do of 
 
 (a) Diagnostic psychology: i.e., the 
 scientific study of character in health and 
 in disease. 
 
 (b) Therapeutic psychology, the sys- 
 tematic application of mental methods to 
 the cure of disease. 
 
 (c) Educational psychology: the sci- 
 ence and art of pedagogy as applied to the 
 training of sick minds, sick wills, and un- 
 governed emotions. 
 
 (d) Social work: the bearing of indus- 
 
THE ART OF HEALING 109 
 
 trial, domestic, and economic conditions on 
 health. 
 
 (e) The possibilities of moral, and 
 thereby of physical, harm resulting from 
 some current methods of treating patients ; 
 i.e., the undermining of character and the 
 disintegration of families through the idle- 
 ness and isolation forced on phthisical pa- 
 tients; the drug-habits and doctor-habits 
 produced by the giving of placebos and the 
 telling of soothing lies. 
 
 (f) Preventive medicine: (see below). 
 
 II 
 
 Changes in the Profession of Social Work 
 
 (a) Social workers are learning and ap- 
 plying more of the doctor's stock-in-trade, 
 physiology, hygiene, and mental healing. 
 
 (b) They are at present taking the lead 
 in preventive medicine, i.e., in the improve- 
 ment of milk supplies, tenements and 
 parks, in the crusade against tuberculosis 
 and alcoholism, in the organization of pub- 
 
110 SOCIAL SERVICE AND 
 
 lie sentiment leading to legislation for the 
 introduction of school nurses, the medical 
 examination of school children, the pass- 
 age of child labor laws, pure food and drug 
 laws, the medical inspection of f9,ctorieSj 
 dairies, bakeries, and packing houses. 
 
 (c) Social workers are finding their 
 place in hospitals, factories, and churches 
 where the social problems may over- 
 shadow the industrial, surgical, or techni- 
 cally religious work. 
 
 ( d ) Such problems as that of blindness, 
 formerly attacked merely from the medical 
 side, are now being treated from the edu- 
 cational and industrial standpoint by so- 
 cial workers. 
 
 Ill 
 Changes in the profession of teaching 
 both clerical and secular 
 '(a) Clergymen and other teachers are 
 resuming their ancient functions of min- 
 istering to sick souls, i.e., the neurasthenics, 
 
THE ART OF HEALING 111 
 
 hysterics, and those burdened by unreason- 
 ing fears, vicious habits, and distracting 
 thoughts. 
 
 (b) Lay teachers are beginning to ap- 
 ply to their teaching some rudimentary 
 knowledge of physiology, of hygiene, of 
 psychology, and of social work. 
 
 (c) Hygiene and social ethics are be- 
 ginning to be taught in school. 
 
 (d) Schools are beginning to be used as 
 social centers, for evening recreation 
 classes, clubs, and lectures. 
 
 (e) Colleges are providing free pubUc 
 lectures on medical topics and are begin- 
 ning to take more responsibility for the 
 student's whole character and not merely 
 for his intellectual development.^ 
 
 One Result of These Changes 
 
 No one can have followed the history of 
 the last ten years in medicine, education, 
 
 'Woodrow Wilson: Address to the Phi Beta Kappa 
 Society at Harvard, July 1st, 1909, and A. Lawrence 
 
113 SOCIAL SERVICE AND 
 
 and social work and noted the increasing 
 evidence of their interpenetration and 
 closer co-operation without discerning: 
 
 (a) The rapid growth of public med- 
 icine, whose method is educational, pre- 
 ventive, and sociological; 
 
 (b) The consequent restriction of the 
 sphere of the " private doctor." 
 
 With the increasing power and respect 
 commanded by municipal, state, and na- 
 tional health boards it becomes possible for 
 such boards to open and manage a munici- 
 pal milk-depot with teacher nurses, as in 
 Rochester, N. Y. ; to enforce the anti-spit- 
 ting laws as in parts of New York City; 
 to investigate and control bakeries, dairies, 
 packing houses, and water supphes. Even 
 Philadelphia has finally (1909) ceased to 
 endure public murder (through typhoid 
 germs) at the hands of its city govern- 
 ment. 
 
 Lowell: Competition in College, Atlantic Monthly, June, 
 1909. 
 
THE ART OF HEALING 113 
 
 National medicine made a start in 1900 
 when it unmasked the lies and trickery by 
 which the San Francisco city government 
 concealed the existence of bubonic plague 
 in that city. It advanced a long step in 
 1904 when Colonel Gorgas was promoted 
 from a subordinate medical officer to a full 
 member of the Panama Canal Commission 
 and given power to stamp out yellow fever 
 and to curb malaria on the Isthmus. It 
 advanced two long steps in 1907 when the 
 Meat Inspection bill brought the packers 
 to their senses, and the Pure Food and 
 Drug bill broke the power of the Patent 
 Medicines. 
 
 School hygiene has now become the most 
 important branch of public medicine, for 
 in the school population the state can in- 
 fluence the health of all its future citizens, 
 putting its guiding hand upon them at the 
 most critical period in their lives. School 
 nurses, medical inspection, and systematic 
 treatment of school children, school play- 
 
114 SOCIAL SERVICE AND 
 
 grounds under the control and manage- 
 ment of the school itself (as by the Massa- 
 chusetts law of 1907) ; the teaching of hy- 
 giene, mental and physical, in schools and 
 colleges, all mark a long step in the ad- 
 vance of public, preventive, educational 
 medicine. 
 
 This, together with the development of 
 factory inspection, protection of machin- 
 ery, tenement house legislation, public 
 parks, baths and playgrounds, the grow- 
 ing efficiency of public diagnosis-labora- 
 tories and free drugs (quinine, diphtheria 
 anti-toxin, and in Porto Rico thymol), is 
 driving the private doctor more and more 
 to the wall. The " good, old-fashioned " 
 epidemics of typhoid, diphtheria, and ma- 
 laria are getting rarer and the doctors are 
 feeling the loss of income. Yellow fever 
 and smallpox are gone. The number of 
 chronic invalids requiring long and ex- 
 pensive medical attendance is being dimin- 
 ished by the growth of successful surgery, 
 
THE ART OF HEALING 115 
 
 of efficient psychotherapeutics, of outdoor 
 life, and by the sanatorium treatment of 
 tuberculosis. 
 
 Partly as a result of this, the number of 
 doctors and of medical students has begun 
 within the past five years to diminish not 
 only in America but in all parts of Eu- 
 rope. We doctors are actually beginning 
 to abohsh ourselves by merging ourselves 
 in the wider profession of public, prevent- 
 ive medicine, whose activities are inextri- 
 cably interwoven, as this chapter aims to 
 show, with social and educational work. I 
 am thankful that it is so. 
 
 Here are the cheerful facts : ' 
 
 
 1905 
 
 1908 
 
 Medical students 
 
 25,835 
 
 22,787 
 
 Population of U. S. 
 (estimated) 
 
 83,143,000 
 
 87,170,000 
 
 Ratio of students to 
 population 
 
 1 : 3,218 
 
 1 : 3,825 
 
 'See Report of U. S. 
 Vol. II, p. 777, 1908. 
 
 Commissioner of Education. 
 
CHAPTER IV 
 
 TEAM-WORK OF DOCTOR AND PATIENT 
 
 THROUGH THE ANNIHILATION 
 
 OF LYING 
 
 Team-work, genuine co-operation, has 
 been my guiding interest throughout this 
 book. It is largely because people can't 
 or won't pull together that the world 
 moves on no faster than it does. We are 
 held apart by professional narrowness and 
 professional case-hardening (as when a 
 nurse refuses to help a gasping, broken- 
 winded teamster up the hospital stairs, 
 " because it is the ward tender's busi- 
 ness"), or by mutual suspicion (as be- 
 tween ministers and doctors), or simply 
 by ignorance of each other's existence. 
 But still more I think we hold each other 
 at arm's length by our persistent habits 
 
 116 
 
THE ART OF HEALING 117 
 
 of lying and prevarication. A doctor lies 
 to his patient about the medicine which he 
 is asked to take. The patient pours the 
 medicine down the sink and hes to the 
 doctor about it. Poor team-work, that! 
 Friends cool down to mere acquaintance- 
 ship because their cordial faces and effu- 
 sive manners don't prevent their reading 
 behind the mask (with the marvelous in- 
 sight of aroused suspicion) what each has 
 said of each in other company. 
 
 I believe that the art of healing is going 
 to spring ahead with astonishing swiftness 
 in the next decade because the community 
 is coming to reahze that doctor and patient 
 can work together to exterminate or Umit 
 disease. Preventive medicine, first fos- 
 tered by the social workers and by the 
 national government, now tardily taken 
 up by the medical profession in great cities, 
 makes for frankness, for education of the 
 whole public, for the general diffusion of 
 medical knowledge, and for the abolition 
 
118 SOCIAL SERVICE AND 
 
 of professional secrecy and unprofessional 
 buncombe. 
 
 But the battle is stiU not won. Far 
 from it ! The great bulk of medical work, 
 public and private, is still done by men — 
 high-minded men — ^who believe that it is 
 impossible to deal frankly and openly with 
 patients. The social workers are not al- 
 ways as truthful as they might be. The 
 head of a great humanitarian enterprise 
 recently asked me to co-operate with her in 
 a complicated deception of one of her tem- 
 porary employees. When I remonstrated 
 with her, she quoted to me Lecky's saying 
 that in such matters we must be guided by 
 " a combination of good sense and good 
 feeling. " Her good sense and good feeling 
 taught her to lie in the same kindly pater- 
 nal way used by many doctors when they 
 fool their patients, strictly for the latter's 
 good, but still to the destruction of all 
 team-work and enhghtenment. 
 
 I have thought it worth while, therefore. 
 
THE ART OF HEALING 119 
 
 to report as objectively as I can my own 
 experience with lying and with veracity in 
 medicine. 
 
 I approach the subject of truth in med- 
 icine, not from the point of view of scien- 
 tific method, nor of metaphysical analysis, 
 but of professional ethics. I do not ask 
 " how can we find truth," nor " what is 
 truth," but " how far should we speak the 
 truth in deahng with our patients, our col- 
 leagues, or anyone else? " " Are lies ever 
 in place? If so, under what conditions? " 
 
 My method is experimental, the only 
 one in which reasonable men place confi- 
 dence, the only sound, scientific method. 
 I shall not discuss the general principles, 
 the authorities, or traditions which might 
 guide our course in this matter. As in- 
 dicated in the title of this chapter I have 
 made an experimental study of two dif- 
 ferent hypotheses on the subject, submit- 
 ting them to the test of experience, as any 
 candid person must, if he wishes to make 
 
120 SOCIAL SERVICE AND 
 
 the fairest judgment in his power on any 
 question. I have been working on this 
 subject during a considerable part of the 
 last eighteen years, and my conclusions, 
 however faulty they may be, must be 
 criticised like any other piece of scientific 
 work only by those who have repeated the 
 experiments on which they are based. 
 
 I began, as was natural, with the hy- 
 pothesis on which I had been brought up. 
 My medical training included some few 
 lectures on medical ethics, but in such mat- 
 ters example far more than precept was 
 the guide of the Harvard medical student 
 of my day. Only once during my course 
 was the question of veracity in medical 
 matters directly treated. 
 
 "When you are thinking of telling a 
 lie," said the teacher, " ask yourself 
 whether it is simply and solely for the pa- 
 tient's benefit that you are going to tell 
 it. If you are sure that you are acting 
 for his good and not for your own 
 
THE ART OF HEALING 121 
 
 profit, you can go ahead with a clear 
 conscience." 
 
 The lies which the medical profession 
 agree in condemning are those told for per- 
 sonal and private gain. The magazine 
 article representing work never performed 
 and written solely for advertising pur- 
 poses, is a lie that no one approves. The 
 diagnosis of diphtheria when the physician 
 knows the case is merely one of tonsilitis, is 
 not justified hy the increased fees which his 
 frequent visits entail. There is no dis- 
 agreement of opinion among physicians 
 about such lies as these. 
 
 But the lies which are usually defended 
 among physicians are of a different type 
 and may be illustrated by the following 
 quotations : 
 
 " The young physician in our day has 
 some advantages in competition with older 
 men. People sometimes consider a young 
 man more up-to-date than his elders. Still 
 there are some alleviations in growing old. 
 
122 SOCIAL SERVICE AND 
 
 When you don't know what's the matter 
 with a patient you can then enjoy the 
 luxury of saying so. When you're young 
 you have to know everything, for if you 
 say you don't know, the patient is likely 
 to chuck you out and send for someone 
 else, who does." 
 
 That veracity in diagnosis is possible for 
 the older physician, but not always for the 
 younger, seems to be the moral of this 
 quotation. 
 
 Veracity in prognosis is even harder. 
 In the course of a lecture on the prognosis 
 of heart disease, I once heard the follow- 
 ing story: 
 
 A business man past middle life was 
 found to be suffering from some form of 
 heart disease. His wife inquired about the 
 diagnosis and hearing it was heart disease, 
 she asked: " Isn't it true that he may drop 
 dead suddenly? " The doctor had to con- 
 fess that this was a possibility, " The con- 
 sequence was," went on the story-teller. 
 
THE ART OF HEALING 123 
 
 " that day after day she sat at her window 
 about the time that her husband should be 
 returning from business, watching to see 
 whether he would come home on his feet 
 or in an ambulance," 
 
 " Now," said the narrator, " when you 
 get into practice, gentlemen, whatever 
 you do, don't do that. Don't make a 
 woman's life miserable because you can't 
 keep a fact to yourself." 
 
 Surely it seems as if this is the place 
 for a good straight lie. I thought so when 
 I heard the story and made up my mind 
 that, whatever blunders I made in dealing 
 with any patients I might have, this one 
 I would avoid. But I found it more diffi- 
 cult than I had anticipated. It was not 
 very many years before I saw in consulta- 
 tion a case the duplicate of that just de- 
 scribed. Mr, B, had angina pectoris, with 
 serious disease of his heart and kidneys. 
 He needed rest. He had refused to take 
 it, and the chances were that he would 
 
124 SOCIAL SERVICE AND 
 
 continue to force himself along until he 
 dropped in his tracks. After I had talked 
 over the case with the attending physician 
 and was ahout to return and say a word to 
 the family, my colleague said : " There's 
 one thing I must warn you about. This 
 man's wife is an excessively nervous, excit- 
 able woman of no stamina at all. She gets 
 hysterical on the slightest pretext, and 
 when that happens she makes everyone 
 else in the house sick. If she hears what's 
 the matter with her husband, she'll go all to 
 pieces. So you'll be very guarded in what 
 you say, won't you?" To this I readily 
 agreed. Remembering my lesson, we went 
 downstairs where Mrs. B. was waiting to 
 hear the result of our deliberations. She 
 placed a chair for me and then planted her- 
 self in another, squarely facing me and 
 very near. " Now, first of all," said she, 
 " I want to know whether you are going to 
 give me a straight and true answer to 
 everything I ask you?" Having just 
 
THE ART OF HEALING 126 
 
 promised the family physician that I 
 would do nothing of the kind, I was so 
 taken aback that I hesitated a moment. 
 " That's enough," said Mrs. ,B., getting 
 up. " I don't care to hear anything more 
 from you." 
 
 I did not blame her. She had fairly 
 caught us in our attempt to trick her. But 
 the anecdote shows that the path of 
 the medical man who conscientiously 
 tries to shield people from pain and 
 trouble is sometimes a difficult and 
 thorny one. 
 
 By means of these examples I hope I 
 have succeeded in making clear the prob- 
 lems that I wish next to discuss more in 
 detail. 
 
 I propose now to consider: (1) Veracity 
 in diagnosis; (2) Veracity in prognosis; 
 (3) Veracity in treatment. 
 
 By veracity I mean doing one's best to 
 convey to another person the impression 
 that one has about the matter in hand. 
 
126 SOCIAL SERVICE AND 
 
 One may do one's best and yet fail; but 
 that is not lying. I once spent half an 
 hour trying to convey to my parlor girl 
 my impression about how to build a wood 
 fire, but when she next tried to build one 
 it appeared that the only idea she had re- 
 ceived was that of packing kindling wood 
 into the fireplace as tightly as she could 
 and piling logs on top, without leaving 
 a chink or cranny anywhere for a draft. 
 Clearly I did not succeed in conveying my 
 impression to her, yet I suppose no one 
 will accuse me of lying to her. 
 
 A true impression, »ot certain words 
 literally true, is what we must try to con- 
 vey. When a patient who has the earhest 
 recognizable signs of phthisis in one lung, 
 and tubercle bacilli in his sputum, asks, 
 " Have I got consmnption? " it would be 
 conveying a false impression to say, " Yes, 
 you have," and stop there. Ten to one his 
 impression is that by consumption I mean 
 a disease invariably and rapidly fatal. 
 
THE ART OF HEALING 127 
 
 But this is not at all my impression of his 
 case. To be true to that patient one must 
 explain that what lie means by consump- 
 tion is the later stages of a neglected or 
 unrecognized disease; that some people 
 have as much trouble as he now has and 
 get over it without finding it out ; that with 
 climatic and hygienic treatment he has a 
 good chance of recovery, etc. To tell him 
 simply that he has consumption without 
 adding any further explanation would 
 convey an impression which in one sense is 
 true, in the sense, namely, that to another 
 physician it might sound approximately 
 correct. What is sometimes called the 
 simple truth, the "bald truth," or the 
 " naked truth," is often practically false — 
 as unrecognizable as Lear naked upon the 
 moor. It needs to be explained, supple- 
 mented, modified. 
 
 Bearing in mind, then, that by veracity 
 I mean the faithful attempt to convey a 
 true impression, and by lying an inten- 
 
128 SOCIAL SERVICE AND 
 
 tional deception, however brought about; 
 let us take up the question of 
 
 Truth and Falsehood in Diagnosis 
 
 The common conception of a doctor's 
 duty in this matter, and one according to 
 which I practiced medicine for the first 
 five or six years after my graduation, is 
 something as follows: 
 
 " Tell the truth so far as possible. But 
 if you are young and not yet firmly estab- 
 lished in practice, it won't do to let the pa- 
 tient or his family know when you are in 
 doubt about a diagnosis. If you do, they 
 will lose confidence in you and perhaps 
 turn you out." 
 
 That is what is implied in the frank and 
 refreshing confession of a middle-aged 
 and successful physician whose words I 
 have already quoted : " The great ad- 
 vantage of getting old is that when you 
 
THE ART OF HEALING 129 
 
 don't know, you can enjoy the luxury of 
 saying so." 
 
 The first experience that made me doubt 
 whether it was necessary for a young prac- 
 titioner to pretend omniscience in order to 
 retain his patients' confidence was the fol- 
 lowing: I had the opportunity of driving 
 about a large town some twenty-five miles 
 from Boston with a young physician only 
 a year or two my senior. He took me on 
 his regular rounds; we saw farmers and 
 the grocer's wife, the hotel-keeper's daugh- 
 ter, and the blacksmith's baby, as well as 
 one or two well-to-do people. The great 
 majority of the cases were in families of 
 very limited education, the kind of folks 
 that we think of as subsisting mostly on 
 pies and patent medicine. But what made 
 each case an eye-opener to me was the 
 utter frankness of the doctor with the 
 families. Diagnosis, prognosis, and treat- 
 ment were given with an absence of subter- 
 fuge and of prevarication that astounded 
 
130 SOCIAL SERVICE AND 
 
 me, and what surprised me even more was 
 to see the way the patients liked his frank- 
 ness. I never have seen manifested more 
 implicit confidence in a physician than 
 during that drive. He never forced his 
 doubts or his suspicions upon his patients, 
 but when they asked a straight question 
 they got a straight answer. A baby had a 
 fever. " What's the baby got? " asked its 
 mother. " Can't tell yet," said the doctor; 
 " may be going to break out with some- 
 thing to-morrow, or it may be all right in 
 a day or two. We shall have to wait and 
 see." There was no talk of " febricula " 
 or " gastric fever." Not once did I hear 
 him say that a patient was " threatened " 
 with any disease. He knew that Nature 
 makes no threats and that no honest doctor 
 ever foists his ignorance upon " Nature " 
 by charging her with making a " threat." 
 I asked him the obvious question: 
 " How can you be so frank with your 
 patients and yet keep their confidence? " 
 
THE ART OF HEALING 131 
 
 " Because they know," said he, " that 
 whenever anything unusual comes up that 
 I can't handle or that puzzles me I have 
 a consultant. So when I say that I do 
 know, they believe me, and when I say I 
 don't know and yet don't call in a con- 
 sultant they understand that nothing of 
 any seriousness is the matter, and that they 
 don't need to worry. Lots of men are 
 afraid to call a consultant because they 
 are afraid the family will think the less 
 of their ability. But it makes the family 
 feel a great deal safer to know that I don't 
 pretend to know everything and stand 
 ready any moment to call in someone who 
 knows more than I do. I've seen a man 
 lose a family because he didn't have 
 a consultant, but never because he 
 did." 
 
 " Don't the families ever object to the 
 expense of a consultant? " I asked. 
 
 " No," said he, " it's perfectly easy to 
 get good consultants at low prices if you 
 
132 SOCIAL SERVICE AND 
 
 explain the family's circumstances to 
 them." 
 
 As a result of that conversation I began 
 cautiously to try the experiment of telling 
 the truth, whether I understood the case 
 thoroughly or not. I never had reason to 
 regret it, and I am every year more firmly 
 convinced that the young doctor, even 
 when practicing chiefly among uneducated 
 people, does not need to pretend omni- 
 science merely because he is young and his 
 patients ignorant. The truth works just 
 as well for the pocket, and a great deal 
 better for the community and for our own 
 self-respect. 
 
 " A certain profession of dogmatism," 
 said Sir Frederick Treves in an address ^ 
 to medical students, "is essential in the 
 treatment of the sick. The sick man will 
 allow of no hesitancy in the recognition of 
 disease. He bUndly demands that the ap- 
 pearance of knowledge shall be absolute, 
 
 ' British Medical Journal, October 18, 1902. 
 
THE ART OF HEALING 133 
 
 however shadowy and unsubstantial may 
 be the bases of it." 
 
 This declaration has the great merit of 
 frankness. But how would a doctor like 
 to have his patients hear those words? 
 How would he like to be caught by his 
 patients in the act of passing on to medical 
 students such little tricks of the trade as 
 this ? It is true that his address may never 
 come to his patients'' ears ; he may never 
 be found out. But is it good for us as 
 professional men to have our reputations 
 rest on the expectation of not being found 
 out? 
 
 I doubt beside whether (as Dr. Gould ^ 
 once pointed out in an admirable editorial) 
 we " succeed in humbugging the patient's 
 relations and friends by the devices which 
 apparently suit the patient. Among intelli- 
 gent laymen, far more frequently than is 
 supposed, one finds that such sham cer- 
 tainty without the reality of knowledge 
 
 'American Medicine, November 1, 1903, p. 681. 
 
134 SOCIAL SERVICE AND 
 
 and conviction is at once detected. Doc- 
 tors make a great mistake when they think 
 their deceits really deceive. 
 
 Then there is the patient who recovers. 
 When he is well, the false diagnoses, the 
 changes of dogmatic opinions and of medi- 
 cines, the blind alley of proved errors, 
 these are thought over." 
 
 It is getting steadily harder to deceive 
 the public. Some years ago I heard a 
 prominent and representative citizen of 
 Boston commenting upon the medical bul- 
 letins on ex-President Roosevelt's leg. 
 " Of course," he said, " no one ever believes 
 these bulletins. The doctors give out only 
 so much as they think fit, in order not to 
 alarm the public unnecessarily. The re- 
 sult is that the public never beUeves the 
 bulletins and is always more or less 
 
 anxious." 
 
 Now, I do not believe that the truth was 
 in any way tampered with in the bulletins 
 either of President Roosevelt's or of 
 
THE ART OF HEALING 135 
 
 President McKinley's illness. I believe 
 these bulletins gave the strict and accurate 
 truth. But I think it is generally admitted 
 that such bulletins do not command the 
 respect which they usually deserve. Busi- 
 ness men and others to whom it may be of 
 vital importance to get reliable informa- 
 tion about the illness, are especially apt to 
 " discount " the bulletins of the group of 
 physicians in attendance on a man whose 
 life is of great importance financially. We 
 all remember how persistently the general 
 public beUeved that King Edward's illness 
 of 1902 was due to malignant disease, and 
 not to the " perityphlitis " mentioned in 
 the bulletins. How can we blame the pub- 
 Kc for not believing the doctors in attend- 
 ance on the King when one of them. Sir 
 Frederick Treves, is willing publicly to 
 advocate the systematic deception of pa- 
 tients? His words I have quoted. It is 
 true that he does not advise deception 
 under conditions like those of King Ed- 
 
136 SOCIAL SERVICE AND 
 
 ward's illness, but how is the public to 
 know just when and how far the doctor 
 will think it best to deceive? Such dis- 
 crimination is especially difficult in a coun- 
 try like England, where the public can- 
 not help knowing that what is " given out " 
 concerning foreign affairs, especially in 
 matters of diplomacy and war, represents 
 only so much of the truth as the officials 
 think it best for the public to know. 
 
 I have been speaking of the disadvan- 
 tages of trying to deceive a patient or 
 those interested in him with regard to the 
 diagnosis. I have argued so far that it is 
 not necessary to assume absolute knowl- 
 edge in order to impress the patient's 
 mind and hold his confidence, and that 
 owing to the increasing scepticism of the 
 public, it is becoming more and more diffi- 
 cult to fool the patient at all. 
 
 Very few Americans like to lie. They 
 would rather tell the truth if they could, 
 but there are cases in which the voice of 
 
THE ART OF HEALING 137 
 
 duty itself seems to tell us that we must 
 lie. To prevent the breaking up of a 
 family, to save a life, are we not to lie? 
 A husband confesses to you the sin that 
 has resulted in disease for him. The wife, 
 suspecting something, catches you on your 
 way out and asks you point-blank what 
 ails her husband. Can you tell her the 
 truth? Well, suppose you tell her a good, 
 round, well-constructed lie. What are the 
 chances of her believing you? If she has 
 got to the point of suspecting her husband, 
 are her suspicions likely to be quieted per- 
 manently by your reassurances? Is there 
 not a fair chance that she knows enough of 
 the usual customs of physicians when 
 placed in this position, to discount what 
 you say? 
 
 The truth in such matters very often 
 comes to light sooner or later, and if it 
 does, the wife is apt to let a nimiber of per- 
 sons know what kind of a trick you have 
 played her. Of course, there are many 
 
138 SOCIAL SERVICE AND 
 
 such cases in which the truth is never found 
 out, but I ask again, is it a good thing for 
 us as professional men to be Uving in the 
 hope of not being found out? 
 
 II 
 
 Truth and Falsehood in Prognosis 
 
 That it is a bad thing to lie about a 
 prognosis we all admit, as a general rule, 
 but there are cases when it is not easy to 
 see what harm it does when the good that 
 it does is very evident indeed. 
 
 A patient has gastric cancer. He is 
 told that he has neuralgia of the stomach, 
 and feels greatly relieved by the reassur- 
 ance, for the effect of psychic influences is 
 nowhere more striking than in gastric 
 cancer (as the cases quoted in Osier's text- 
 book show) . Meantime the truth is told to 
 the patient's wife, and she makes whatever 
 preparations are necessary for the inevi- 
 table end. Now what harm can be done 
 
THE ART OF HEALING 139 
 
 by such a lie as this? The sufferer is pro- 
 tected from anticipations and forebodings 
 which are often the worst portion of his 
 misery, while his wife, knowing the truth 
 and thoroughly approving of the decep- 
 tion, is able to see that her husband's fi- 
 nancial affairs are straightened out and 
 to prepare, as well as may be, for his 
 death. Surely this seems a humane and 
 sensible way to ease the patient's hard 
 path, and who can be the worse off 
 for it? 
 
 I answer, " Many may be worse off for 
 it, and some must be." The patient himself 
 is very possibly saved some suffering. 
 But consider a minute. His wife has now 
 acquired, if she did not have it already, a 
 knowledge of the circumstances under 
 which doctors think it merciful and useful 
 to lie. She will be sick herself some day, 
 and when the doctors tell her that she is 
 not seriously ill, is she likely to believe 
 them? 
 
140 SOCIAL SERVICE AND 
 
 I was talking on this subject not long 
 ago with a girl of twenty-two. " Oh, of 
 course, I never believe what doctors say," 
 was her comment, " for I've helped 'em lie 
 too often and helped fix up the letters that 
 were written so that no one should suspect 
 the truth." 
 
 In other words such lies simply transfer 
 to the future account of one person, the 
 sufferings which we spare another. We 
 rob Peter to pay Paul. 
 
 But it is not likely that the mischief will 
 be so closely limited. There are almost al- 
 ways other members of the family who are 
 let into the secret; servants, nurses, and 
 intimate friends, either before or after the 
 patient's death, find out what is going 
 on. All told, I doubt if there are less than 
 a dozen souls on the average who are en- 
 lightened by such a case in regard to the 
 standards of the physician in charge and 
 so of the profession he represents. I have 
 heard such things talked over among " the 
 
THE ART OF HEALING 141 
 
 laity," and, as a rule, not one, but several 
 cases are adduced to exemplify the pre- 
 vailing customs of medical men in such 
 circimistances. 
 
 We think we can isolate a lie as we do a 
 case of smallpox, and let its effect die 
 with the occasion that brought it about. 
 But is it not common experience that such 
 customs are infectious and spread far be- 
 yond our intention and our control? They 
 beget, as a rule, not any acute indignation 
 among those who get wind of them (for 
 " how," they say, " could the doctor do 
 otherwise"), but rather a quiet, chronic 
 incredulity which is stubborn just in pro- 
 portion as it is vitally important in a given 
 case to get at the truth, as in the case of 
 King Edward before mentioned. 
 
 You will notice that I am not now argu- 
 ing that a lie is, in itself and apart from its 
 consequences, a bad thing. I am not say- 
 ing that we ought to tell the truth in order 
 to save our own souls or keep ourselves 
 
142 SOCIAL SERVICE AND 
 
 untainted. I am saying that many a lie 
 saves present pain at the expense of 
 greater future pain, and that if we saw 
 as clearly the future harm as we see the 
 present good, we could not help seeing 
 that the balance is on the side of harm. 
 Only intellectual short-sightedness bhnds 
 us to this. 
 
 I have told fully my share of lies, under 
 the impression, shared, I think, by many 
 of the profession, that it is necessary in ex- 
 ceptional cases to do it for the good of the 
 patient and his friends; but since I have 
 been experimenting with the policy of 
 telling the truth (at first cautiously, but 
 lately with more confidence), I have be- 
 come convinced that the necessity is a 
 specious one, that the truth works better 
 for all concerned, not only in the long run, 
 but in relatively short spurts, and that its 
 good results are not postponed to eternityi 
 but are usually discernible within a short 
 time. 
 
THE ART OF HEALING 143 
 
 In vindication of my belief let me relate 
 the sequel to one of the stories already 
 told. The reader will recall that I pre- 
 pared "to be very guarded in what I 
 said " (as the technical phrase is) to a 
 lady whose husband had angina pectoris. 
 The attending physician, who had known 
 the lady for years, and who represented 
 entirely the views of her family, assured 
 me that she was too delicate and too un- 
 strung by neurasthenia to be capable of 
 bearing the truth about her husband. If 
 she knew that he might at any time die 
 suddenly, she would brood and fret over 
 the knowledge until she became so queru- 
 lous and unhinged that all the family, the 
 sick husband included, would be made mis- 
 erable. It will be remembered that I made 
 up my mind to conceal the truth from her 
 if I could, and how she upset all my cal- 
 culations by asking me suddenly whether 
 or not I would tell her the whole truth so 
 far as I knew it. 
 
144. SOCIAL SERVICE AND 
 
 Now consider a moment the difficulties 
 of that situation. 
 
 " Will you give me a true answer to 
 every question I ask you? " I could 
 scarcely be expected to pop out a prompt 
 " yes " when I had just promised the 
 family physician not to do anything of the 
 sort. Of course I coidd not say " no," and 
 if I hesitated an instant, I had betrayed ' 
 my intention of deceiving her. What 
 would you have done? 
 
 As a matter of fact I hesitated a bit, 
 as I think anyone but a most practiced 
 liar or a hide-bound truth-teller would 
 have done. "That's enough," said she; 
 " that's all I want to hear." But of course 
 I couldn't leave it there, so I pulled my- 
 self together and made a clean breast of 
 the whole thing. I told her just what I 
 thought and what I expected, including 
 all that I had promised the doctor not to 
 tell. Now you will remember that the at- 
 tending physician, who had known her 
 
THE ART OF HEALING 146 
 
 intimately for years, had warned me that 
 she could not bear this sort of news — 
 that she would brood and worry over it, 
 until she had made herself and everyone 
 else in the house miserable. So when she 
 cornered me and got the truth out of me, 
 I made haste to get out of the house, and 
 thanked my stars that I did not have to 
 stay behind and pick up the pieces of the 
 nervous wreck to which my plain, unvar- 
 nished tale must needs reduce the poor 
 lady. 
 
 Several weeks after, I met the family 
 physician and learned that for some mys- 
 terious reason the expected collapse on the 
 part of the neurotic wife had never ar- 
 rived. Everyone was still expecting her 
 to go to pieces, but as yet she had got 
 along about as usual. In point of fact she 
 has never met their expectation. It is 
 now nearly fourteen years since the dread- 
 ful truth was told her and no breakdown 
 has occurred. 
 
146 SOCIAL SERVICE AND 
 
 After that most astonishing experience 
 I began cautiously to tell the truth in 
 similar cases, even though intimate friends 
 or relations of the patient declared that 
 the truth could not be borne, and even 
 when I had no knowledge of the patient's 
 character to set against that of his closest 
 friends. It has been, on the whole, the 
 most interesting and surprising experi- 
 ment that I have ever tried. The astound- 
 ing innocuousness of the truth when all 
 reason and aU experience would lead one 
 to believe it must do harm, has never 
 ceased to surprise me. It seems as if when 
 the pinch comes and the individual has to 
 face stern realities, some species of anti- 
 toxin is spontaneously and rapidly de- 
 veloped whereby the individual is rendered 
 immune to the toxic and deleterious effects 
 of the nervous shock ! 
 
 May we not conceive that under the 
 stimulus of the first sting and nettle of 
 hard truth, the nervous system of the pa- 
 
THE ART OF HEALING 147 
 
 tient produces rapidly an overplus of 
 fighting courage — rises to the emergency j 
 as we ordinarily say, and so is rendered 
 immune against the otherwise depressing 
 effects of full knowledge? 
 
 But whatever the theory, the fact has 
 been brought home to me as it can only be 
 brought home by actually trying the ex- 
 periment; the fact, namely, that patients 
 and patients' friends exhibit an astonish- 
 ing power to stand the full truth, an amaz- 
 ing immunity against its depressing de- 
 fects. No one ought to believe this who 
 has not tried it. All that my say-so ought 
 to accomplish is to make someone ready to 
 try the experiment ; to take the risks which 
 we must always face if we are to get ahead, 
 and see whether he can verify my findings. 
 
 One precaution, however, must be borne 
 in mind. Anyone who is familiar with ex- 
 perimental work knows that the difficulty 
 of verifying another's experiment is often 
 due to failure to repeat just that experi- 
 
148 SOCIAL SERVICE AND 
 
 ment and no other. A certain blood-stain 
 is highly lauded. Others try it and can- 
 not get the results which its inventor claims 
 for it. But very often they fail because 
 they have not followed exactly the details 
 of the inventor's technic. 
 
 So, if anyone tries to repeat my experi- 
 ments I trust that he will notice just what 
 it is that I recommend him to try. I am 
 not saying that a doctor should explain to 
 every mother in f uU detail the cause, symp- 
 toms, course, and prognosis of her baby's 
 illness. I have never tried that experi- 
 ment, and I should suppose it would be 
 a very stupid, useless, and probably harm- 
 ful thing to do. I do not believe in cram- 
 ming information down people's throats 
 or trying to tell them what they cannot 
 understand properly, any more than I be- 
 lieve in button-holing every acquaintance 
 in the street, and giving him a detailed 
 account of what I consider his faults and 
 failings. 
 
THE ART OF HEALING 149 
 
 But if my friend asks me for an opinion 
 of his first literary productions, and if I 
 think that they are dreadful rubbish, I do 
 not consider it friendship to say pleasant 
 things of his style and thereby encourage 
 him to pursue literature as a calling. I 
 do not give my opinion unless it is really 
 asked for. But if it is, I do not beUeve in 
 lying to save anyone's feelings. It does 
 more harm and bruises more feelings in the 
 end. 
 
 So in medicine, if a patient asks me a 
 straight question I believe it works best to 
 give him a straight answer, not a rough 
 answer, but yet not a lie or a prevarica- 
 tion. I do not believe it pays to give an 
 answer that would justify a patient in 
 saying (in case he happened to find out the 
 truth) — " That doctor tried to trick me." 
 I have heard a patient say that, apropos of 
 a lie told by one of the most high-minded 
 and honorable physicians I know, and I 
 do not believe it advisable for any of us 
 
150 SOCIAL SERVICE AND 
 
 to expose ourselves to the chance of rous- 
 ing that sort of indignation in a patient. 
 
 A straight answer to a straight question 
 is what I am recommending, not an un- 
 asked presentation of any of the facts of 
 the patient's case. He may not care to 
 know those facts any more than I care to 
 know the interesting details of dental 
 pathology in which my dentist might wish 
 to instruct me; I prefer to leave all that 
 to him. Just so my patient may very 
 properly prefer to he told nothing about 
 his disease, trusting that I shall do my 
 best and let him know when there is any- 
 thing for him to do in the matter. 
 
 But a straight answer does not mean 
 what is often called the " blunt truth," the 
 " naked truth," the dry, cold facts. Verac- 
 ity means (as I have said) the attempt to 
 convey a true impression, a fully drawn 
 and properly shaded account such as is, 
 as I well know, very difficult to give. I 
 know one physician (and a splendid type 
 
THE ART OF HEALING 161 
 
 of man he is, too) who, when he sees a 
 case of rheumatic heart trouble, and is 
 asked for a prognosis, is apt to say some- 
 thing hke this : " Well, I'm mighty sorry 
 for you, but your trouble is incurable. 
 Your heart is damaged past repair and 
 there is not much of anything to be done 
 except to take sodium sahcylate during the 
 acute attacks and hope that the process 
 will become arrested spontaneously before 
 long." " Is it likely to get worse? " asks 
 the patient. " Yes, I'm afraid that 
 
 it IS. 
 
 Now in one sense that is all true, but 
 the impression that it will convey to the 
 patient is not true, not at all what I mean 
 by veracity. I would rather a physician 
 would tell this sort of truncated, imper- 
 fect, and very distressing truth, than give 
 the patient a smooth and pleasant assur- 
 ance that he can be cured and that all will 
 go right provided he does so and so. 
 
 But better than either a misleading half- 
 
152 SOCIAL SERVICE AND 
 
 truth or a pleasing lie, is an attempt so to 
 answer the patient's question that he shall 
 see not only what he can't do and can't 
 hope for, but what he can do and what 
 there is to work for hopefully. That his 
 heart-valve is leaky and perhaps useless 
 is true, and in that sense, to that extent, 
 he is incurable; the damaged heart-valve 
 is damaged once for all. Yet by ac- 
 commodating himself to his diminished 
 heart power, the patient can gradually 
 educate to a considerable extent both his 
 heart and the rest of himself. His heart 
 can be made to adjust itself to its maimed 
 state and to put forth, in spite of it, a good 
 deal more power than it would have done 
 without the educational process; and the 
 individual, by learning to take the best 
 advantage of all the power he has, can 
 accomplish, not all that he could in health, 
 but yet perhaps as much as he actually 
 would have done, allowing for the amount 
 of wasted time and wasted opportunity 
 
THE ART OF HEALING 153 
 
 that has often to be deducted from the 
 effective power of a healthy man. 
 
 Because this kind of explanation is so 
 difficult and takes so much time, doctors 
 are apt to shirk it and give the patient 
 either a rough half-truth or a smooth lie. 
 In our free dispensaries one can witness 
 any day a rich and varied assortment of 
 these two methods of shirking a difficult 
 and tedious explanation; the rough half- 
 truth and the smooth lie are dealt out by 
 the shovelful and students watch and make 
 their choice between these two pitiful 
 makeshifts according to their tempera- 
 ments, often in entire ignorance of any 
 tertium quid. For it is particularly in 
 dealing Avith uneducated people, such as 
 frequent dispensaries, that we distrust the 
 power of truth and the possibility of con- 
 veying it. In this field I have made many 
 experiments both with lies and with the 
 truth. I know very well that the truth 
 is sometimes next to impossible to convey. 
 
164 SOCIAL SERVICE AND 
 
 owing to differences between the patient's 
 vocabulary (or his habits of mind) and the 
 physician's, but on the other hand the lie 
 may do more harm, for there is more 
 chance of its being implicitly believed. 
 
 To refuse to answer questions is now 
 and then a necessity and need not involve 
 any falsehood. For example, to balk med- 
 dling inquiries by an outsider is often our 
 business. Then there is the patient about 
 to undergo an operation, who sometimes 
 catechizes us about the details of the opera- 
 tion, though he had better remain ignorant 
 about it until after it is over. On the other 
 hand, if the patient's mind is already oc- 
 cupying itself with a definite, but exag- 
 gerated picture of the horrors of the 
 operation, a prosaic explanation of the 
 real facts may act as a sedative. 
 
 Not infrequently we need to choose our 
 time well, if a piece of painful truth has 
 to be communicated, and it may be neces- 
 sary lo avoid giving the patient a chance 
 
THE ART OF HEALING 155 
 
 to cross-question us at a time when we 
 consider him temporarily below par. I 
 have heard a patient say: "The doctor 
 didn't mean to let me get that out of him 
 to-day," but it was said without any bit- 
 terness or sense of being tricked by his 
 physician, for the fact that the doctor 
 avoided being questioned presaged that, if 
 cornered, he would not tell a lie. 
 
 I have said that in my experience pa- 
 tients and their families often develop a 
 most astonishing power to rise to the 
 emergency and to bear the hard truth 
 when it has to be told. But I cannot say 
 that this is always so. There may be cases, 
 I suppose there are such, when the patient 
 does not react from the shock of a cruel 
 truth, but is made worse by it. It is said 
 that such a shock sometimes turns the 
 scales and brings death. I have never seen 
 this happen, but I cannot deny the possi- 
 bility. 
 
 Ought we to persist in telling the truth 
 
166 SOCIAL SERVICE AND 
 
 even when we know that it may Idll the pa- 
 tient? Could any effect produced by a lie 
 be as bad as the loss of a human hfe? 
 
 Before answering this question directly, 
 let me ask you to consider a somewhat 
 fanciful hypothesis. Suppose it lay in 
 our power to let loose into the atmosphere 
 a poisonous gas, which would vitiate the 
 air of a whole town so that the whole com- 
 munity would gradually suffer in effi- 
 ciency, in physical and moral fiber. Would 
 it not be worth sacrificing a human life 
 to save a whole community from such 
 deterioration? 
 
 Now a lie seems to me to do something 
 like that. By undermining the confidence 
 of man in man it does its part in making 
 not one but every human activity impos- 
 sible. If we cannot trust one another, we 
 cannot take a step in any direction. Busi- 
 ness, social relations, science, everything 
 worth doing depends on mutual con- 
 fidence. It is the very air we breathe. To 
 
THE ART OF HEALING 167 
 
 poison it is to do a thing far worse for so- 
 ciety than the loss of a single life. Hence 
 though I believe that it is extraordinarily 
 rare to be able to save a life by a lie, it 
 seems to me that the remedy, the lie, is 
 worse than death. 
 
 Ill 
 Truth and Falsehood in Treatment 
 
 In discussing truth and falsehood in 
 diagnosis and in prognosis, I have dealt 
 chiefly with spoken truth or spoken lies. 
 In the domain of treatment the true or 
 false impression is often conveyed without 
 words. 
 
 I do not know who it was that defined a 
 quack as " one who pretends to possess or 
 to be able to use powers (either of diag- 
 nosis, prognosis, or treatment) which in 
 fact he knows he is without." If we think 
 over the various forms of quacks familiar 
 to us — Dr. Munyon, with his hfted hand 
 swearing to the value of all those specific 
 
168 SOCIAL SERVICE AND 
 
 cures which he knows he does not possess ; 
 the cancer eurers, those who advertise to 
 cure " weak men," Francis Truth, who 
 cheats his dupes with all-healing handker- 
 chiefs sent through the mails at $5 apiece 
 — we see that they aU pretend to use 
 knowledge ahout valuable medicines or 
 other remedies which they know are 
 frauds. 
 
 Now, I was brought up, as I suppose 
 every physician is, to use what are called 
 placebos, that is bread pills, subcutaneous 
 injections of a few drops of water (sup- 
 posed by the patient to be morphine), and 
 other devices for acting upon a patient's 
 symptoms through his mind. How fre- 
 quently such methods are used varies a 
 great deal I suppose with individual prac- 
 titioners, but I doubt if there is a physician 
 in this country who has not used them and 
 used them pretty often. It never occurred 
 to me until I had given a great many 
 " placebos " that, if they are to be really 
 
THE ART OF HEALING 159 
 
 effective, they must deceive the patient. I 
 had thought of them simply as a means of 
 getting rid of a symptom and no more a 
 lie than hypnotism or any other form of 
 frankly mental therapeutics. 
 
 But one day a patient caught me in the 
 attempt to put her to sleep by means of a 
 subcutaneous injection of water. " I saw 
 you get that ready," said she, " and there 
 is no morphin in it; you were just trying 
 to deceive me." I was fairly caught and 
 there was no use in trying to bluff it out, 
 so I merely protested that my deception 
 was well meant, that it profited me noth- 
 ing, that it was simply intended to give 
 her a night's rest without the depressing 
 effects of morphia, etc. 
 
 " Of course I see that," she said, " but 
 how am I to know in future what other 
 tricks you will think it best to play me for 
 my good? How am I to believe anything 
 you say from now on? " 
 
 I did not know what answer to make at 
 
160 SOCIAL SERVICE AND 
 
 the time, and I have never heen able to 
 think of any since. 
 
 But water subcutaneously does not dif- 
 fer in principle from any other placebo. 
 If the patient knows what we are up to 
 when we give him a bread pill it will have 
 no effect on him. If he is dyspeptic he 
 must believe that we consider the medicine 
 we give likely to act upon his stomach and 
 not merely upon his stomach through his 
 mind. Otherwise it will do him no good. 
 Suppose we said to him: " I give you this 
 pill for its mental effect. It has no action 
 on the stomach " ; would he be likely to get 
 benefit from it? No, it is only when 
 through the placebo one deceives the pa- 
 tient that any effect is produced. It is 
 only when we act like quacks that our 
 placebos work. 
 
 But what harm, one may ask, does a 
 placebo do? Admitting that it is a form 
 of deception and that if a doctor is de- 
 tected in it the patient and his friends are 
 
THE ART OF HEALING 161 
 
 likely to lose confidence in him, what harm 
 does it do, so long as you are not found 
 out? 
 
 Well, as previously said, I do not think 
 it is a good thing for any man to succeed 
 only so long as he is not found out, but 
 there are other objections to the use of 
 placebos which I will next try to explain. 
 
 The majority of placebos are given be- 
 cause we believe the patient will not be 
 satisfied without them. He has learned to 
 expect medicine for every symptom, and 
 without it he simply won't get well. True, 
 but who taught him to expect a medicine 
 for every symptom? He was not born 
 with that expectation. He learned it 
 from an ignorant doctor who really be- 
 lieved it, just as he learned many old 
 legends, as, for example, that pimples are a 
 disease of the blood, that " shingles " kills 
 the patient whenever it extends clear round 
 the body, and that in the spring the blood 
 should be "purified" by this or that 
 
162 SOCIAL SERVICE AND 
 
 remedy. It is we physicians who are re- 
 sponsible for perpetuating false ideas 
 about disease and its cure. The legends 
 are handed along through nurses and fond 
 mothers, but they originate with us, and 
 with every placebo that we give we do our 
 part in perpetuating error, and harmful 
 error at that. If the patient did not ex- 
 pect a medicine for his attack (say of 
 mumps) we should not give it, yet we do 
 all we can to bolster up his expectation for 
 another time, to deepen the error we de- 
 plore. 
 
 Some years ago an unfortunate patient 
 was floating around from one clinic to 
 another, as happens now and then when 
 diagnosis and treatment are unsuccessful. 
 This poor woman complained that she had 
 a lizard in her stomach, that she felt his 
 movements distinctly, and that they ren- 
 dered her life imbearable. Doctor after 
 doctor had assured her that the thing was 
 impossible, that no such animal could sub- 
 
THE ART OF HEALING 163 
 
 sist inside a human being, that the trouble 
 was wholly a fanciful one, and that she 
 must do her best to think of it no more. 
 But all such explanations and reassur- 
 ances were of no avail. 
 
 One evening a group of physicians at a 
 small medical club were discussing the 
 nervous affections of the stomach, with 
 this case as a text. Then up spoke one 
 of the elder of the number had said, " I'll 
 fix that woman ; you send her to me ! " So 
 said, so done. The unfortunate female 
 appeared at his clinic within a few days. 
 Our friend the doctor listened with great 
 attention to all her symptoms, nodding his 
 head gravely from time to time. He en- 
 tered a lengthy account of the case upon 
 his records, and meditated sagely for a 
 time when she had finished. " Yes," he 
 said, with a sigh, " there is no doubt about 
 it ; it's a clear case of lizard in the stomach. 
 It is no use concealing the truth from you 
 any longer; you have every symptom of 
 
164 SOCIAL SERVICE AND 
 
 the disease. But we have made a good 
 deal of progress within the last few 
 months, Madam, in the treatment of that 
 trouble, and while I cannot make any 
 promises (for no honorable doctor can do 
 anything of that kind) , I think I can give 
 you good hope that you may be relieved. 
 A medicine has recently been discovered 
 which, in the majority of cases, — not all 
 cases, mind you — will dissolve hzards in 
 the stomach and allow the resulting sub- 
 stance to be excreted by the kidney. As 
 I say. Madam, I cannot promise a cure, 
 but this I can promise: — ^within a few 
 days after you have taken my medicine 
 you will be absolutely sure whether or not 
 it has proved effective. In case it should 
 prove effective, you will notice within 
 forty-eight hours from the time you take 
 it an extraordinary change in the color of 
 your urine, which will be tinged some 
 shade of blue, or bright green. In case 
 the medicine fails, as is quite possible that 
 
THE ART OF HEALING 165 
 
 it may, there will be no change whatever 
 in the color of the urine. The medicine 
 will be contained in three capsules, for 
 which I have just written a prescription; 
 they can be obtained only at one apothe- 
 cary's in the city, as the medicine is diffi- 
 cult to procure and known to but few. I 
 have written his address on the prescrip- 
 tion." 
 
 The doctor then handed her a prescrip- 
 tion for three-grain capsules of Methylene 
 Blue, a substance which, when taken 
 into the stomach, invariably produces a 
 deep blue color in the urine. The woman 
 took the medicine, perceived to her amaze- 
 ment and delight that a blue color was im- 
 parted to her urine, recognized that the 
 lizard must have been dissolved, and was 
 at once freed from all her symptoms. 
 
 Now, this is the end of the story as it is 
 usually told ; but there is a sequel. Within 
 the course of three months another lizard 
 grew. This time the poor lady had no 
 
166 SOCIAL SERVICE AND 
 
 more faith in Methylene Blue as a per- 
 manent cure, and turned up at still an- 
 other Out-Patient cUnic under the charge 
 of a very honest physician, to whom she 
 told her story. He said of course that 
 it was ridiculous and impossible, because 
 lizards couldn't grow in people's stomachs. 
 " Oh," she said, " you know Doctor Blank, 
 don't you? He is a good doctor, isn't 
 he?" "Yes." " Well, he told me I had 
 all the symptoms of Uzard in the stomach. 
 He wouldn't tell me a he, would he? " 
 
 " Well, anyway, you haven't got a liz- 
 ard in your stomach now." From this the 
 doctor went one step further than anyone 
 had gone before ; he investigated not only 
 what was not the matter with her, but 
 what the trouble actually was. He found 
 that she had an excess of gastric juice in 
 her stomach, the irritation of which gave 
 the gnawing and scratcliing feeling which 
 she attributed to the presence of a lizard. 
 Having discovered this fact he proceeded 
 
THE ART OF HEALING 167 
 
 to treat her for this trouble, which he suc- 
 ceeded in curing, and after that time the 
 lizard never grew again. All of which 
 shows that lies do not always work, and 
 that the truth sometimes does. 
 
 Placebos with or without lies are un- 
 necessary. I have for the past few years 
 been trying the experiment of explaining 
 to the patient why he does not need a 
 drug, when there is no drug known for his 
 trouble. It takes a little more time at 
 first, but one thorough explanation serves 
 for many subsequent occasions. One has 
 only to remind the patient of what we have 
 gone over with him before. When the oc- 
 casion for a drug really comes, the patient 
 has far more confidence in its workings. 
 
 We doctors feel these things acutely 
 when a patient comes to us who has been 
 previously under the care of another 
 physician who educates his patients. How 
 refreshing to hear the mother of a child 
 sick with measles say, " Well, I don't sup- 
 
168 SOCIAL SERVICE AND 
 
 pose he needs any medicine, does he? The 
 disease has to run its course, I suppose, 
 and nursing is the main thing." That 
 mother has been given the truth by her 
 physician instead of placebos, and has 
 become accustomed to realities as easily as 
 most people learn to believe outworn 
 errors. On the other hand, we see now and 
 then a patient into whose mind it has been 
 carefully instilled by some physician that 
 every draught of fresh air must be avoided 
 Uke a plague, that every symptom needs 
 a drug, and that a visit from the doctor 
 every few days is a necessity to salvation. 
 But the habit of giving placebos has an- 
 other evil result. It gives the patient in- 
 directly a wrong idea, a harmful idea of 
 the way disease is produced and avoided. 
 If symptoms can be cured by drugs, it is 
 impossible to bring to bear upon the pa- 
 tient the full force of that most funda- 
 mental principle of therapeutics : " To re- 
 move a symptom remove its cause." That 
 
THE ART OF HEALING 169 
 
 a man can be made well " in spite of him- 
 self " as the patent-medicine advertise- 
 ments say (that is, in spite of violating the 
 laws of health) is a belief produced as one 
 of the by-products of the way we hand 
 out placebos, especially in our hospitals 
 and -dispensaries. Thus we foster the 
 patent-medicine habit. 
 
 No patient whose language we can 
 speak, whose mind we can approach, needs 
 a placebo. I give placebos now and then 
 (I used to give them by the bushel) to 
 Armenians, Greeks, and others with whom 
 I cannot communicate, because to refuse 
 to give them would then create more mis- 
 understanding, a falser impression, than 
 to give them. If I give nothing at all the 
 patient will think I am refusing to treat 
 liim at all; but if I can get hold of an in- 
 terpreter and explain the matter, I tell 
 him no lies in the shape of placebos. 
 
 Before I close this chapter I want to 
 speak of one further point which my ex- 
 
170 SOCIAL SERVICE 
 
 periments with truth and falsehood have 
 brought home to me. When I have 
 plucked up courage and ventured to tell 
 the truth in hard cases, I have been sur- 
 prised again and again to find how all the 
 chances and accidents of nature have 
 backed me up. Everything seems to con- 
 spire to help you out when you are trying 
 to tell the truth, but when you are lying 
 there are snares and pitfalls turning up 
 everywhere and making your path a more 
 and more difficult one. 
 
 I will sum up the results of my experi- 
 ments with truth and falsehood, by saying 
 that I have not yet found any case in 
 which a lie does not do more harm than 
 'good, and by expressing my belief that 
 if everyone will carefully repeat the ex- 
 periments he will reach similar results. 
 
 The technic of truth-teUing is sometimes 
 difficult, perhaps more difficult than the 
 technic of lying, but its results make it 
 worth acquiring. 
 
CHAPTER V 
 
 sociAii woEK IN hospitals; the pallia- 
 tion OF absent-mindedness 
 
 Suppose a person sharing the ideas ex- 
 pressed in the foregoing chapters were 
 suddenly and for the first time in his 
 hfe deposited in a busy hospital clinic. 
 Suppose also that he is a genius and can 
 see through his own eyes, as the rest of 
 us rarely do. What will most of all sur- 
 prise him? Not the rush and roar of it 
 all. That he is used to wherever Ameri- 
 cans are at work. Not the foul air and 
 bad smells. He has learned long since 
 that the practice of hygiene is for other, 
 people, not for ourselves who preach it. 
 Not the amazing and unnecessary ugliness 
 of every room and hall. Rather he will 
 be arrested by the astonishing absent- 
 mindedness of the doctors. 
 
 171 
 
172 SOCIAL SERVICE AND 
 
 The philosopher, intent upon his prob- 
 lem, may abstractedly walk over a preci- 
 pice, but I never heard of one so absent- 
 minded as to push a young girl over a 
 precipice as we are doing every month in 
 our gynaecological cUnics. Not an atom 
 of cruelty or hard-heartedness about it ; — 
 purely the habit of abstraction, the habit 
 of saying, " My job ends here." 
 
 " She came in to find out if she was 
 pregnant. I told her ' Yes,' and she went 
 off. Is that pushing her over a preci- 
 pice? " 
 
 Yes, in many cases it is just that. The 
 doctor is so absent-minded that he doesn't 
 notice the push towards hell which his 
 word all innocently gives her. " Yes, 
 you are now cut off from your family, 
 who will be indignant at the shame you 
 put upon them; from your friends, who 
 will no longer want their names coupled 
 with yours. You will be branded as 
 ' fallen ' and kindly looked down on by 
 
THE ART OF HEALING 173 
 
 those who have fallen perhaps far oftener 
 than you, though in less obvious ways. 
 Everyone in the community will be 
 against you except the keepers of the 
 brothels. You cannot longer go on earn- 
 ing an honest living, for if you try to do so, 
 your condition will soon be observed. If 
 you try to get square with the world-again 
 by kilhng your child before its birth, you 
 will run a considerable danger of death 
 by blood-poisoning, and the law will re- 
 gard you as a criminal if you are found 
 out. That is all to-day; — step into the 
 next room, please, and the nurse will help 
 you to dress." 
 
 I say — a man who in effect gives that 
 message to a girl and doesn't notice that 
 he has done so is wonderfully absent- 
 minded. Methodically his mind has 
 passed on to the next case, to the steriliza- 
 tion of his rubber gloves, to the record 
 sheet on which he is writing his diagnosis 
 and his account of the physical examina- 
 
174 SOCIAL SERVICE AND 
 
 tion. He is absent-minded precisely as the 
 mathematical professor or the philosopher 
 is absent-minded, because his mind is so 
 actively present somewhere else. The 
 mathematician is not vague or dreamy. 
 He is abnormally clear, but he is so con- 
 centrated and specialized upon one set 
 of problems that he doesn't notice the 
 rest of the world. So the doctor's mind is 
 absent from certain human aspects of his 
 patients' lives merely because his atten- 
 tention is so strongly concentrated upon 
 disease. 
 
 Now it is always dangerous to be absent- 
 minded. It is risky to have one's head so 
 full of mathematics as to ignore physics 
 and fall into a ditch, to become so absorbed 
 in profit and finance as to allow unpro- 
 tected machinery to maim workmen, to be 
 so wrapped up in Eddyism as to catch and 
 spread smallpox, to be so bent on good- 
 fellowship as (absent-mindedly) to get 
 drunk. But if ever there was a place 
 
THE ART OF HEALING 176 
 
 where absent-mindedness is dangerous to 
 life and limb, to soul and body, — that place 
 is a hospital. 
 
 Why? Because its contents are so curi- 
 ously assorted. People wander in there, 
 — ^the first because he has lost his money, 
 and the next because he has lost his mind. 
 The third needs a ham splint, the fourth 
 needs a husband (who has deserted her) . 
 One wants a fortnight's outing, another 
 wants false teeth and something to put 
 between them. New caution with the cat 
 (which gives ring- worm), new care with 
 the cooking (which spoils digestion), new 
 plaster jackets and new plans of action, — 
 absolutely we can see no end to the variety 
 of need that pours in through the hospital 
 gates at nine and pours out again at 
 noon with some sort of patch or plaster 
 
 « 
 
 on it. 
 
 Presence of mind, presence of the whole 
 resources of the best-trained intellect, we 
 obviously need if we are to do anything for 
 
176 SOCIAL SERVICE AND 
 
 this miscellany when once it is sorted out. 
 But the task is made ten times harder, 
 ten times more of a Waterloo for the 
 absent-minded, by the fact that each need 
 comes to us obscured under a blinding 
 dust-storm of understatement, overstate- 
 ment, misstatement, and omission. The 
 poor folks have no idea what they need. 
 They know that they are off the track, — 
 that's all. 
 
 The need, then, is for all-round human 
 beings who can supplement the necessary 
 and valuable narrowness of the physician. 
 The physician is there because he has 
 learned a great deal about one small but 
 vital aspect of human hfe, — ^learned it at 
 the expense of a habit of violent absent- 
 mindedness towards other aspects. His 
 value, his skill, rest on this concentration 
 of his. But with the painful acquisition 
 of this necessary habit of abstraction he 
 becomes a dangerous man, just as the law- 
 yer, the orator, and the financier are dan- 
 
THE ART OF HEALING 177 
 
 gerous, — unless supplemented and bal- 
 anced. Abstractedly he will give an ap- 
 petizing, bitter tonic to a starving man, or 
 break up a family some crowded Satur- 
 day morning, unless there is help at hand. 
 
 11 
 
 There is a vast deal of work in a hospital 
 that the doctor can't do and doesn't want 
 to do. For example, — ^he has neither the 
 time nor the talent to teach hygiene, to fit 
 new sets of habits to the idiosyncrasies of 
 each sufferer's build. Yet without hygiene 
 most of medicine is useless, and without 
 skillful fitting to the individual's needs, 
 hygienic rules are simply old junk. 
 
 Better health means more money usu- 
 ally; — ^in consumption, heart disease, 
 neurasthenia, somebody has got to hustle 
 for some money if the doctor's orders are 
 to be carried out. He doesn't want to go 
 out and hustle for the money, but neither 
 does he care to whistle to the wind, or give 
 
178 SOCIAL SERVICE AND 
 
 orders that can't be carried out. To order 
 for one patient a diet which he cannot buy, 
 for the next a vacation which he is too poor 
 to take, to forbid a third to worry when 
 we know that the necessary cause of worry 
 remains unchanged, to give the fourth di- 
 rections for an outdoor life which we are 
 morally certain he won't carry out, to try 
 teaching the fifth (a Jewish mother) how 
 to modify milk for her baby, when she 
 understands perhaps half of what you say 
 and forgets most of that, — such a morn- 
 ing's work is not satisfactory in the retro- 
 spect. 
 
 Therefore to make the doctor's work 
 worth while to himself and to the patient, 
 it must be done (in hospitals) in co-opera- 
 tion with someone who has time and ability 
 to teach hygiene and to see that it is car- 
 ried out (for instance, in tuberculosis), to 
 study the home conditions and report upon 
 their part in causing or prolonging dis- 
 ease, and to help modify those conditions, 
 
THE ART OF HEALING 179 
 
 financial, mental, moral, which stand be- 
 tween the patient and recovery. 
 
 This " someone " is the social worker, — 
 a man or woman trained to think of a 
 hmnan being as a whole just as naturally 
 as the physician concentrates attention 
 upon a part. 
 
 " Whafs missing here of the essentials 
 of a human life? " asks the social worker. 
 No matter whether her job is in a factory 
 (as welfare worker or factory nurse), in 
 an immigration station, in a court-room, in 
 an almshouse, a schoolhouse, or a hospital, 
 — ^her job is to supplement the efforts of 
 the specialist in the interests of healthy, 
 Uving character. 
 
 In a hospital-patient the missing neces- 
 sities may be food and clothes, rest, work, 
 decency, hope, self-respect, a bath, a 
 crutch, or a confidant; — to make him 
 wholesome the social worker looks stead- 
 fastly to the man's whole needs and tries 
 to fill in wherever the need is greatest. He 
 
180 SOCIAL SERVICE AND 
 
 is the synthesizer, and he must stand be- 
 side the analyzing specialist always, if hos- 
 pital work is to be worth the enormous 
 sum it costs. The physician trained to 
 special analytic keenness can give us diag- 
 nosis, but hospitals were not founded for 
 diagnosis but for diagnosis-issuing-in-efR- 
 cient-treatment. 
 
 Ill 
 
 As I look over the varieties of social 
 service work which within the past four 
 years have been established in a dozen 
 or more hospitals in Boston, New York, 
 Chicago, Philadelphia, Baltimore, and 
 Cleveland, the degree of success seems to 
 me to depend once more on the amount of 
 team-work, that is, on the intelligent co- 
 operation between the social workers and 
 some physician or physicians in the hos- 
 pital itself. Unless there is at least one 
 doctor who really knows what the social 
 
THE ART OF HEALING 181 
 
 worker is trying to do, the scheme fails. 
 If he thinks of her merely as a nurse and 
 asks of her only such help as a nurse can 
 render, she will either fall short of his ex- 
 pectations (in case she has no adegus^te 
 nurse's training) or will narrow herself to 
 fulfill the purely physical needs (in which 
 case she is not doing social work) , or finally 
 she will exceed his expectations and his 
 horizon — which will make him think her 
 " uppish " or interfering or visionary. 
 
 Unless a doctor has already acquired 
 the " social point of view " to the extent 
 of seeing that his treatment of dispensary 
 patients is slovenly, without some knowl- 
 edge of their homes, their finances, their 
 thoughts and worries, — he will think that 
 the social worker is trying to teach him 
 how to do his work whenever she does 
 what he didn't and couldn't do before. 
 Naturally he will resent this indignantly. 
 A doctor is treating a young girl— quite 
 unsuccessfully — for insomnia. A sopial 
 
182 SOCIAL SERVICE AND 
 
 worker discovers through a home visit that 
 she is sleeping (or trying to sleep) in the 
 same bed with two other girls, — a fact she 
 never would have mentioned to the doctor. 
 Now, if the doctor is quite unaware of 
 the social, financial, and psychical back- 
 ground out of which individual " cases " of 
 disease emerge momentarily (and quite 
 misleadingly) at the hospital, he will not 
 care to be advised by any " woman charity 
 worker." That she can throw light upon 
 " his case " implies that his vision of it was 
 not previously clear. The more useful she 
 is the more it will irritate him, if he has not 
 previously been led to discover that he is 
 attempting a task impossible without some 
 such aid as hers. I have seen a good deal 
 of such irritation implied or expressed in 
 the comments of physicians on social work 
 in hospitals, g-nd in the long run it is sure 
 to checkmate the effort of the social worker 
 no matter how tactful she is. 
 
 It is not worth while then, in my 
 
THE ART OF HEALING 183 
 
 opinion, for any outsider or outside body 
 to establish social work in a hospital unless 
 some physician in that hospital has al- 
 ready become aware of his need of such 
 help. The doctor must first have felt 
 the difficulty of finishing the work which 
 his diagnostic studies begin or of carry- 
 ing into effect his desire to go to the bot- 
 tom of his cases, to find their cause (physi- 
 cal, chemical, hygienic, financial, domestic, 
 emotional, or whatever it may turn out to 
 be) and to root it out. 
 
 The truth is, that before proper and 
 helpful co-operation of doctor and social 
 worker can be established each of the two 
 must educate the other considerably — per- 
 haps painfully. The social worker must be 
 led to understand, for example, how often 
 " laziness " is a sign of disease rather than 
 of sin and how devious and unexpected are 
 the paths by which sex-tension connects 
 itself with cruelty, with " nervousness," 
 and with slipshod habits. The doctor 
 
184 SOCIAI. SERVICE AND 
 
 must be helped to see how a patient's 
 physical good may have to be sacrificed 
 temporarily in order that a job may not be 
 lost or a family broken up. 
 
 Sut this co-operation of doptpr and speial 
 worker is only one of the forms of team- 
 work which grows up in a hctspital as soon 
 as social work is established there. My 
 interest in its establishment springs from 
 the perception that it involves and com- 
 bines all the types of team-work which this 
 book describes. It brings medical back- 
 grounds and medical foregrounds into 
 their proper organic unity. It helps medi- 
 cal and sociological minds to pool and ex- 
 change their earnings. It allows the teach- 
 ing art to take its all-important part in 
 the prevention and suppression of disease. 
 Finally social workers can bring doctor 
 and patient still closer by acting as inter- 
 
THE ART OF HEALING 185 
 
 preters, and helping on a free, full, truth- 
 ful explanation on both sides. 
 
 If I can show how these various teams 
 are actually hitched up when social work 
 is established in a hospital, it will serve to 
 focus and summarize the meaning of this 
 book. 
 
 (a) I have pictured in Chapter I that 
 insane separation of foregrounds and 
 backgrounds which hospital hurry, medi- 
 cal routine, and scientific absent-minded- 
 ness tend to bring about. Now the social 
 worker is not permeated by the hospital 
 traditions of hurry; moreover she is to a 
 certain extent defended from catching the 
 deadly miasm of routine, by the necessary 
 miscellaneousness of her work, while the 
 very mainspring of her activity is anti- 
 specialism. A foreground gone astray 
 from its background shocks a social worker 
 like a runaway horse. It must be caught 
 arid takin home. But the case-histories 
 piled on the desks in our dispensary cUiiics 
 
186 SOCIAL SERVICE AND 
 
 are just such foregrounds torn away from 
 their backgrounds. No. 3861 describes 
 the shriveled and clammy fingers of a 
 " splendid case of Raynaud's disease " and 
 how " the case " was engaged to return on 
 a certain day for the professor's teaching 
 hour, and how the patient spontaneously 
 improved each summer when warm 
 weather limbered her useless fingers till 
 the return of winter renewed her suffer- 
 ings. All these facts stare one in the face. 
 iThey are in the foreground. 
 
 But the background, — ^her life away 
 from the hospital — ^her past — ^her future? 
 Where is it? A social worker went in 
 search of it, ascertained that the girl had 
 been a good worker whenever her hands 
 were sound enough to be of any use, 
 found a place for her as a domestic in 
 Florida, arranged for her journey thither, 
 and thus gave her a winter of comfort 
 and self-support — ^her first in many 
 years. 
 
THE ART OF HEALING 187 
 
 (b) Teaching, — training has usually 
 gone hand in hand with medical work in 
 our hospitals, — ^teaching, that is, for every- 
 one but the patients. Doctors, students, 
 nurses, ward tenders, all are getting their 
 training in most of the hospitals of this 
 country. But the patients? How many 
 of them are being efficiently and skillfully 
 taught those fundamental and far-reach- 
 ing lessons on which their permanent re- 
 covery often depends? We know that the 
 cure of most cases of incipient phthisis, of 
 neurasthenia, and dyspepsia is made pos- 
 sible only by a long course of training. 
 Such patients must learn to give up life- 
 long habits, to acquire new ways of think- 
 ing, new self-control. But they cannot 
 and will not make these radical changes 
 in their lives merely because they are 
 handed a printed list of rules prescribing 
 how they shall eat, drink, sleep, and act. 
 This problem the social worker attacks 
 as an educator — all the more effectively. 
 
188 SOCIAL SERVICE AND 
 
 because she is not merely an educator but 
 a person endowed by the patient with some 
 of the authority of the hospital in which she 
 works, and of the physicians with whom 
 she is associated. To train a neurasthenic 
 or a tuberculous patient we need the team- 
 work of doctor, educator, and social 
 worker as described in Chapter III. So- 
 cial workers in hospitals must be or become 
 teachers and thus make possible the triple 
 team-work which we need. This is very 
 little realized by those who think that an 
 ordinary nurse or an ordinary associated 
 charity agent, untrained for teaching and 
 unfitted for it by sympathy and interest, 
 can do social work in hospitals. 
 
 (c) All good team-work arouses my 
 enthusiasm. Football, part singing, ma- 
 chine politics, even house-breaking are 
 admirable so far as team-play is manifest 
 in them. But of all the forms of medical 
 team-play to which the spirit of our time 
 is leading us, none seems to me so fruitful, 
 
THE ART OF HEALING 189 
 
 so full of efficiency and of promise, as 
 that in which doctor and patient get to- 
 gether against their common enemy- 
 disease. 
 
 This union the social worker can do 
 much to promote and to develop. A pa- 
 tient needs (for example) to be persuaded 
 to undergo a surgical operation. The doc- 
 tor has no time to explain in detail the 
 reason why he advises this perilous ven- 
 ture. It is impossible for him to blow his 
 own trumpet and expound his own fitness 
 to advise, his own cautious weighing of the 
 pros and cons. But if the social worker 
 genuinely believes in the physician with 
 whom she works, she can speak for him and 
 help to build up in the patient that well- 
 deserved confidence which is half the battle 
 in medical work. 
 
 Social workers may thus help the patient 
 to have faith in the expert. Th^y also 
 help the expert to have faith in the patient. 
 The expert natufally hesitates to explain 
 
190 SOCIAL SERVICE AND 
 
 his plans of treatment to the patient be- 
 cause he fears that the explanation — ^made 
 hastily in a noisy room to a bewildered Jew 
 or Italian — will convey only that scrap of 
 knowledge which is a dangerous thing. 
 So doctors have gone on giving bread pills 
 (encouraging thereby the habit of depend- 
 ing on drugs rather than on hygiene) be- 
 cause there was no time or opportunity ad- 
 equately to explain to patients why drugs 
 are sometimes unnecessary, how diet, fresh 
 air, regular habits, and clean minds may 
 work both the cure and the prevention of 
 disease. 
 
 But with the social worker acting now 
 as teacher and interpreter, passing on to 
 the patient the doctor's ideas in words of 
 one syllable, reiterating and illustrating 
 them, following up and correcting errors 
 of misunderstanding, it becomes possible 
 for the doctor to deal frankly and truth- 
 fully with his patient, sharing knowledge 
 rather than issuing arbitrary commands. 
 
THE ART OF HEALING 191 
 
 Possessing at last the principle of treat- 
 ment, the patient can learn to apply it to 
 himself and finally to teach others. 
 
 Can anything be more inspiring than 
 the thought of the endless chain of help- 
 fulness thus linked up ? All over the coun- 
 try cured consumptives are acting as mis- 
 sionaries to teach other consumptives what 
 they must do to be saved. But at the 
 Massachusetts General Hospital this is 
 only one of the endless chains which our 
 team of doctor and social worker con- 
 structs. Girls who have been helped 
 through their time of bitter trial, have 
 borne and cared for their illegitimate chil- 
 dren and finally married, are now helping 
 to care for other girls in trouble like their 
 own. They in turn will some day want to 
 help others. 
 
 Neurasthenics who with the help and 
 teaching of our social workers have learned 
 to understand the doctor's ideas, to master 
 their vagrant impulses, to " side-track " 
 
192 SOCIAL SERVICE 
 
 their nagging pains, to forget their fears, 
 and to get some happiness out of life — 
 already some of these " converted " suf^ 
 ferers are passing on the gospel to others. 
 This is team-play extended to infinity. 
 Without exaggeration we may say that 
 such a linkage and brotherhood of help- 
 fulness has no end, and that as far and as 
 fast as we can really achieve it we spread 
 the kingdom of heaven upon earth. 
 
 FINIS 
 

 *> 
 
 X 
 
 I'-yjofjIjj