Social Work At Massachusetts General Hospital

By Dr. Ida M. Cannon

A Presentation at the National Conference Of Charities And Correction During the Thirty-Fifth Annual Session Held in Richmond, Va., May 6th 1908

At Massachusetts General Hospital we have between four hundred and six hundred patients every day. They are seen by a very small group of men, and each patient has a very few moments with the physician in charge. Dr. Cabot felt very keenly that that examination, even if it were reasonably thorough, amounted to very little unless the patient and his treatment were followed up. Three years ago he established the system of nurses to visit the patients in the homes, and to follow up to see that the treatment was effective. The policy we have worked out has been to know our community and its agencies, to be a connecting link between the needs of the patient in the hospital and the agencies in the community ready to meet those needs.

Our work is entirely supported by volunteer contributions. Our patients come to us from the different physicians in the dispensaries. We make out a little record of the color, age and former address of the patient, and whether single or a widow or divorced, and the nationality, occupation and name of husband or wife, and children, and from what department that patient was sent, and the diagnosis. In Boston we have a central directory at the Associated Charities, where from fifty to seventy-five of our agencies register the cases they have handled. This avoids duplication, and each agency knows what the others are doing with the same problem.

Forty-five per cent of our cases come from outside of Boston, and we have a card index of suburbs, with the different associations and private individuals interested-the Board of Health, and all those organizations-that we can make use of. In connection with that we try to throw back to every community its own problem and thereby relieve the tuberculosis work. Whenever we have a patient whose problem we feel is a family problem, where it is a question of relief for any length of time, that is referred to the Associated Charities with a recommendation from the physical side. If it is a problem for a children’s aid society, we refer it to that.

The Bureau of Information has been very interesting. We often find patients from Boston referred to us for special needs when some other organization is just at the crucial point in dealing with the case. We use our Visiting Nurses’ Association a great deal. When we first began our work at the Massachusetts General Hospital, we were swamped with the tuberculosis problem. We feel that that is the entering wedge to the medical social work. The social aspect of the tuberculosis problem has enabled us to work out this whole question of connecting the medical and the social work, and I look for big developments.

We have been able through the women’s clubs and through the physicians, to arouse the suburbs to the tuberculosis problem. We have two tuberculosis classes of patients who live at home and meet once a week with the physician. They keep a record of what they eat and how much they sleep, and their symptoms, and the doctor gives them such instructions as they need. We have a children’s class. We feel that this is a good way to deal with many of our tuberculosis cases because we haven’t enough sanatoria to take care of them. Sometimes in cases that can be taken care of at home, that home can be reorganized hygienically, and much done to strengthen the family.’ We also examine the children of tuberculosis patients and arrange to have many of them sent to the country, as well as other children who have a predisposition to tuberculosis.

The psychiatric work is a specialty with Dr. Cabot. No group of people suffer more than nervous patients. Many of their families are not intelligent enough to realize that this is a diseased condition. We have now two paid workers who are giving all their time to cases of psychoneurosis, people who have no organic trouble but who suffer, and need treatment. Nurses visit the patients in their homes and have long talks with them. Often they have fixed ideas or hobbies. These workers are particularly trained in psychology and psychotherapy. We have an occupation class for these people, and it has aroused their interest and spirit. Nothing is said by the teacher about symptoms. Everything is done to stimulate them to a more wholesome point of view.

Defectives and feeble-minded are sent to an institution where they can be properly taught. You need a permanent body to follow up these cases. We thought we would do wonders with the stammering children; we had three or four. We visited the children in their homes, but before we had gone very far in arranging our classes, we discovered in one case that it was not a case of speech defect, it was largely a question of bad hygiene and child labor. This child has never had a chance. We have co-operated with one of the district agencies, and the child has been sent to the country where he works at a congenial task and gets enough to eat. We haven’t grasped the hygiene situation sufficiently

We had an insomnia patient. We found she was sleeping five in a bed. Talking it over with the family we arranged things so that the patient was allowed to have a room by herself.

On the social side also we see the problem of making adequate arrangements in the convalescent homes. Two or three weeks very often is not long enough to be effectual. It ought to be extended to six or eight weeks. In industrial hygiene we report our cases to the Board of Health and the district inspector of health.

We are trying to organize a group of health visitors like the friendly visitors in the Associated Charities. We have had in the children’s clinic a worker who has done interesting work. She is a kindergartner. She instructs the mothers and follows the patients into their homes and does a great deal in establishing friendly relations and personal hygiene.

We have one worker who is giving all her time to the problem of unmarried, pregnant girls. We feel that an institution is not the place for such girls, because many are not the kind that ought to be thrown with a lot of other girls in the same situation. Our woman is peculiarly fitted for her work. She follows up the patients and makes close friendships with them, and tries to adjust the family to the situation, and the patient to the situation. She has been with us only eight months, but it has been very much worth while.

In connection with that same problem we have had brought to our notice the need of a place for veneral diseases because we have no place but the almshouse for that. In connection with that we come in contact with the great problem of ignorance on the part of our young people, and the necessity of such work as the societies for moral prophylaxis.

We are also doing a little work on the question of occupation in tuberculosis. We feel in tuberculosis that it is not so much the question of occupation as of home conditions. Cooperation with other agencies is the part of the work that should be developed. Often the agencies, such as Dr. Minnick represents, feel the lack of an opportunity to know the mental and physical side of the patient whose problem they are dealing with on the social side. We have a system of thorough cooperation and exchange of information with the Associated Charities, the Children’s Aid Society and other similar organizations. In this and other ways we are trying to make the hospital a large social factor, as it cannot be, when the physicians and nurses simply attend to the medical and surgical work in an independent way.

Source: Proceedings Of The National Conference Of Charities and Correction at the Thirty-fifth Annual Session held in Richmond, Va., May 6th 1908 pp. 153-157.

http://www.hti.umich.edu/n/ncosw/