The great complexity of the modern medical institution, the extreme development of specialization, the multiple details required by clinic and ward administration, all combine to create a certain inevitable amount of confusion, overlapping, and delay. Where there are several professions working together, there are unavoidable duplications, gaps, and conflicts. Division of labor in the hospital has been carried to a degree where many of the activities have assumed an impersonal character, until the patient as an individual is lost to sight. Mechanical procedures and rigidities may develop until the very concept of the hospital’s purpose itself becomes narrowed. This means that it is at the same time both more important and more difficult for social case work to find and hold its own purpose in such a setting.

The term hospital social service is unfortunately not a very specific term, as it has come to be used to include a great variety of extra-mural service to hospital and dispensary patients. It has been used to designate such a variety of functions as a simple follow-up system to keep track of patients’ attendance at clinics, friendly visiting in the wards, various phases of public health nursing, a variety of administrative functions at admission desks and in the clinics, and medical-social case work. The fact is that all these various types of service are coming to be recognized as necessary to the improvement of hospital and dispensary service. All of them recognize the necessity of individualizing the patients and taking into account some of the social elements in the patients’ situation. Before we can discuss hospital social work intelligently, we need more specific terminology and definition.

I shall not attempt that now but shall choose for discussion the contribution that was made to the efficiency of medical treatment by the introduction of the trained social worker into the staff of hospitals and dispensaries. Visiting nursing in the homes of dispensary patients antedated the present hospital social work movement by several years and still remains in many cities the long arm of the hospital extending skilled nursing service and hygiene teaching to the patients discharged from the hospital or under supervision of the dispensary. Such service has long been recognized as essential to baby welfare and tuberculosis clinics and has stimulated the development of public health nursing organization in most of our cities.