Social Diagnosis PDF

THE LIBRARY
OF
THE UNIVERSITY
OF CALIFORNIA
LOS ANGELES
SOCIAL DIAGNOSIS
BY
MARY E. RICHMOND
DIRECTOR CHARITY ORGANIZATION DEPARTMENT
RUSSELL SAGE FOUNDATION
AUTHOR OF
" THE GOOD NEIGHBOR," ETC.
NEW YORK
RUSSELL SAGE FOUNDATION
1917
COPYRIGHT, 1917,
BY RUSSELL SAGE FOUNDATION
COPYRIGHT, RENEWED 1944,
BY RUSSELL SAGE FOUNDATION
Printed May, 1917
Reprinted June, 1917
Reprinted October, 1917
Reprinted April, 1918
Reprinted July, 1921
Reprinted December, 1925
Reprinted July, 1928
Reprinted August, 1930
Reprinted February, 1935
Reprinted November, 1940
Reprinted November, 1945
Reprinted January, 1964
WM. F.FELL CO PRINTERS

PHILADELPHIA
JUbrary
TO
ZILPHA DREW SMITH

WHOSE STEADY FAITH IN THE POSSIBILITIES
OF SOCIAL CASE WORK HAS BEEN THE INSPIRA-
TION OF THIS BOOK AND OF ITS AUTHOR
One of tbe most striking facts with regard to the conscious life of
any human being is that it is interwoven with the lives of others.
It is in each man's social relations that bis mental history is
mainly written, and it is in bis social relations likewise that tbe

causes of tbe disorders that threaten bis happiness and his effec-
tiveness and tbe means for securing bis recovery are to be mainly
sought.
DR. JAMES JACKSON PUTNAM
No matter bow mean or hideous a man's life is, tbe first thing is
tounderstand him; to make out just bow it is that our common
human nature has come to work out in this way. This method
calls for insight, firmness, and confidence in men,
patience,
leaving room for tbe denunciatory egotism of a certain kind
little
of reformers. It is more and more coming to be used in dealing

with intemperance, crime, greed, and in fact all those matters
in which we try to make ourselves and our neighbors better.
CHARLES HORTON COOLEY
Only the sham knows everything; tbe trained man understands

bow little tbe mind of any individual may grasp, and bow many
must co-operate in order to explain the very simplest things.
HANS CROSS
PREFACE
years ago, I began to take notes, gather illustra-
tions, and even draft a few chapters for a book on Social
FIFTEENWork in Families. In it I hoped to pass on to the younger
people coming into the charity organization field an explanation
of the methods that their seniors had found useful. It soon be-
came apparent, however, that no methods or aims were peculiarly

and solely adapted to the treatment of the families that found
their way to a charity organization society; that, in essentials,
the methods and aims of social case work were or should be the
same in every type of service, whether the subject was a homeless
paralytic, the neglected boy of drunken parents, or the widowed
mother of small children. Some procedures, of course, were
peculiar to one group of cases and some to another, according to
the special social disability under treatment. But the things
that most needed to be said about case work were the things
that were common to all. The division of social work into de-
partments and specialties was both a convenience and a neces-
sity; fundamental resemblances remained, however.
With other practitioners with physicians and lawyers, for ex-
ample there was always a basis of knowledge held in common.
Ifa neurologist had occasion to confer with a surgeon, each could
assume in the other a mastery of the elements of a whole group
of basic sciencesand of the formulated and transmitted experience
of his own But what common knowledge could
guild besides.
social workers assume in like case? This was my query of fifteen
years ago. It seemed to me then, and it is still my opinion, that
the elements of social diagnosis, if formulated, should constitute

a part of the ground which all social case workers could occupy
in common, and that it should become possible in time to take for
granted, in every social practitioner, a knowledge and mastery

of those elements,and of the modifications in them which each
decade of practice would surely bring.
5
PREFACE
This narrowed my proposed topic to the beginning processes of

case work, but at the same time widened it enormously in demand-
ing for treatment an experience of all the various types of such

its
work. As the executive head, in those days, of a large family

agency, I had little time for study, so the task was set aside for
nearly nine years.
More than six years ago, however, after I had become a member
of the staff of the Russell Sage Foundation, itwas again taken up.
Meanwhile, the wider usefulness of social evidence, social diag-
nosis,and social treatment, both in their own special field and in
the other professions, even when these latter dealt with people
who were neither dependent nor delinquent, had begun to dawn
upon me. It was evident that social case work could supplement
the work of justice, of healing, and of teaching. Groups of workers
in some of our American cities, moreover, were doing notable
things in the regular social agencies; they were developing quietly

a diagnostic skill in dealing with the difficulties of human beings
which should be given ample opportunity, especially in its forma-
tive period, to grow to the full stature of social technique, un-
trammeled by long established professional traditions, whether of
courts, hospitals, or schools.
I turned to this task in the winter of
1910-11 for the second
time, therefore, with a quite different outlook from that of earlier
days and with the determination to push my inquiries as far be-
yond the limits of my own personal experience as possible. Mr.
Francis H. McLean, who was my colleague in the Foundation at
the time of this second beginning and who has rendered invaluable
assistance throughout the undertaking, had already invited a
group of social case workers (most of them but not all connected
with charity organization societies) to prepare short papers de-
scribing informally their methods and experiences in taking the
steps which, in their work, preceded the development of a plan of
treatment. This group was added to later, and some of their
papers on such subjects, for instance, as present neighborhood
sources of information, relations with employers in the study of a
work record, methods of conducting a first interview, etc. were
privately printed and given a limited circulation among their
fellow workers in charity organization- This was done partly for
6
PREFACE
the purpose of getting the benefit of criticisms. The papers were

too experimental for publication. They contained passages of
great value, however, of which free use has been made, with credit
given, in Part 1 1 of this book.
The next step was to engage two case workers of experience
one in family and one in medical-social work to study original
case records for a year. Their case reading was done in five dif-
ferent cities. No attempt was made to arrive at an average of
the case work in these cities. On the contrary, our aim was to
bring to light the best social work practice that could be found,
provided it was actually in use and not altogether exceptional
in character. In addition these case readers held many inter-
views with case workers, of which were carefully reported.
all
As my own experience had been so largely in the charity organiza-

tion field, especial pains was taken to center most of this case
reading and interviewing in the child-helping and the medical-
social agencies. A large part of the illustrative material used so
freely in Part 1 1 is drawn from the much larger stock of case notes
and of reports of interviews prepared by these two case readers,
though use has also been made of notes from own case reading
my
and of the field memoranda of my colleagues in the Charity Organ-
ization Department of the Foundation.
As this Department had been interested from the time of its
organization in the teaching of case work in the various schools
for social workers, it began to edit a group of original records, most
of them current cases, to be used in the class room. These were
printed in full with all their sins upon their heads (bad work is
almost as instructive as good) and were used in class conferences
by a small, accredited group of teachers of case work. Criticisms
and comments based upon certain of these records were also
gathered from a number of specialists. As noted elsewhere, the
experiment of printing the records of cases could not be a public
one, because their subjects were real people whose confidences had
to be respected. Even when all names had been changed, there
were few things more identifiable, we found, than a full social case
record. The experiment, limited though it had to be, has brought
to light many valuable suggestions which are used in these pages.

For the most part the subject of social diagnosis defies statistical
7
PREFACE
treatment, though as a means of getting started and to arrive at

a rough quantitative measure of the relative frequency with which
the various outside sources of information and co-operation were
consulted, a brief statistical study was made. Fifty-six social
agencies engaged in a number of different forms of social case work
in three cities were persuaded to let us list the outside sources con-
sulted by each in fifty cases. The results of this study are given
in Part and in one of the Appendices.
1 1
One of the minor methods of study adopted was to correspond

with or interview social case workers who had changed from one
type of case work to another from work with families to child
protection, from settlement work to probation or medical-social
service in order to learn the changes of method and the shiftings
of emphasis made
necessary by their change of task.
The foregoing methods supplied the data for Part 1 1 and the
;
sifting of these data and the interpretation of what was significant

in them have been the work of such portions of several years as
could be spared for the task. The errors that were found have
been frankly commented upon in this book. Since methods in
case work are rapidly improving, these may now belong to the
past in the particular places in which we found them. Never-
theless there is always a chance that they are surviving somewhere
else.
For the variations in the processes leading to diagnosis, still

another method of gathering data was tried. How could these
variations, many of them made necessary by the different types of
social disability, be indicated comprehensively enough and com-
pactly enough to be of daily service for reference? The plan was

hit upon of gathering in from many
specialists suggestions for a
series of type questionnaires not to consist of questions to be
asked the case worker's client, not schedules to be filled out, but
lists of suggestive queries which, at some time in his inquiry, the
case worker might find it worth while to ask of himself. Such a

battery of interrogations as is presented in Part I II is sure to be
misunderstood by somebody; it is confessedly a clumsy device,
but no other way has occurred to me or my colleagues of giving
the case worker, in small compass, a bird's-eye view of the possible
implications of a given disability. It will be seen that some
8
PREFACE
questionnaires were prepared by one hand, some by another; while

still others have been made by members of our departmental staff
in consultation with case workers. These latter in particular must

be understood to be experimental in their present form; they will
have to be revised from time to time as it is possible to get
further light from specialists who understand not only their own
specialty but the needs of social workers.
The most difficult of all my problems has been tomake a pre-
sentation of the subject of evidence in Part I which would be of
practical value to the case worker. He is handling evidence all
the time. How
can he learn to handle it in such a way as to aid
him in achieving a truly social result? When Professor Hans
Gross was preparing his large handbook for the investigating
officers of European law courts, 1 he planned at first to have each
part written by a specialist by a physician, an armorer, a photog-

rapher, etc. But these specialists could not, he finally decided,
meet the needs of the investigating officers by sufficiently keeping
in view their aims and the conditions of their work. Therefore,
though Gross reflected that the various chapters of his book
"would have been set out in a more scientific manner" by such a
plan, he was constrained for his purpose to adopt a less ambitious
one. With far less equipment than Gross, who had an encyclo-
pedic mind, this is what I have had to do, and I could not have
done it without very generous help in criticism and revision from
those who knew law and history, psychology and logic, as I did not.
Both Professor J. H. Wigmore, Dean of Northwestern Uni-
versity Law School, and Professor Lucy Salmon, head of the de-
partment of history at Vassar, have been kind enough to make
suggestions regarding individual chapters. Special acknowledg-
ment too should be made of the invaluable service rendered by
Mrs. Ada Eliot Sheffield of Cambridge, Massachusetts, who has
not only read and criticised the larger part of my manuscript,
but in connection with Part I has gathered some of the illustrative
material and has given the whole part a thorough revision, amount-
ing in at least two of its chapters to collaboration. Mrs. Sheffield's
1
Criminal Investigation. A practical handbook for magistrates, police officers,
and lawyers. Translated by J. Adam and J. C. Adam. Madras, A. Krishna ma-
chari, 1906.
PREFACE
thorough knowledge of social case work under both state and pri-
vate auspices has made her assistance doubly valuable.
Acknowledgment cannot be made individually to the several
hundred case workers who have answered letters, examined ques-
and helped me in a dozen other ways.
tionnaires, lent case records,
They lead lives with demands and are accustomed to spend
filled
themselves unsparingly, so that each and all met this one more de-
mand with prompt cheerfulness. Mention can be made, however,
of those who have been associated with me in the Russell Sage
Foundation in gathering data for this book or in correcting its
first draft. Mr. Francis H. McLean should head this list, and the
two case Day and Mrs. H. S. Amsden.
readers, Mrs. Hilbert F.
I am also indebted to Miss
Margaret F. Byington, Miss Caroline
L. Bedford, and to my present associate, Miss Mary B. Sayles.
Valued help was rendered at one stage of gathering material by the
departments of social investigation of the Chicago School of Civics
and Philanthropy and of the Boston School for Social Workers.
In 1914, as Kennedy lecturer of the New York School of Philan-
thropy, 1 had then gathered in a
used portions of these data that I
course of six lectures. I had to disclaim at that time and do now
any idea that one who "crams" technical discussions of method

becomes thereby an efficient practitioner. Not only is practice
under leadership needed in addition to book knowledge, but an
attractive and forceful personality is an indispensable factor.
The method that ignores or hampers the individuality of the
worker stands condemned not only in social work but in teach-
ing, in the ministry, in art, and in every form of creative en-
deavor. Yet in none of these disciplines have practitioners refused
to profit by process studies in their own field, in none have they
found ordered knowledge the enemy of inspiration. Phillips
Brooks once said of a certain type of minister, "The more the
empty head glows and burns, the more hollow and thin and dry it
becomes." Any social worker who has had to gather up the
pieces after a supposed original genius who had dispensed with
precedent and technique would be at a loss to say which leaves
behind him the more completely burnt out territory the purely
inspirational worker or the one who leans too heavily upon rules
and formulae.
10
PREFACE
For the benefit of those who find certain of the bibliographical

references in the footnotes too scant, it should be explained that
these have been deliberately cut to the briefest possible form

wherever the books or articles referred to, because they bore di-
rectly upon my theme, have been included in the Bibliography at
the end of the volume. Fuller details will always be found there.
It should be added that, in the illustrations taken from actual cases
which are given throughout the volume, names have in all in-
stances been changed.
Finally, no one will accuse me of disloyalty to the group with
which I have been identified so long because I have not hesitated
to point out its present weaknesses on the diagnostic side. My
task was undertaken because there were weaknesses, but it could
not have been pushed forward if many social case workers had not
been doing effective and original work, though often under great
difficulties. If, after examining these pages, the harassed and over-
burdened practitioner is tempted to think their counsels im-

practicable under the conditions which necessarily limit his daily
task, let him ask himself whether "necessarily" does not beg the
question, and whether some of those conditions should not and
cannot be changed. Then, if he is still sure that I am at fault,
or if he finds other errors, whether of omission or of commission,
let him write and tell me so. I have good reason for inviting
criticism. No one knows better than I how tentative this discus-
sion is. In the remote chance of there being another edition of
this book, however, I should like to make it more useful than,
with my utmost endeavors, I am now able to.
MARY E. RICHMOND.
New York, April, 1917
II
TABLE OF CONTENTS
PART I
SOCIAL EVIDENCE
CHAPTER I PAGE
BEGINNINGS 25
I. The Economic and the More Comprehensive Approach 28
I. The Forerunners, 28. 2. Charity Organization Beginnings, 29.
3. First Attempts to Establish Standards, 30.
II. The Approach by Way of Child Study 33

III. The Medical Approach 34
CHAPTER II
THE NATURE AND USES OF SOCIAL EVIDENCE 38
I. Social Evidence Differentiated 38
II. The Wider Use of Social Evidence 43
Summary 50
CHAPTER III
DEFINITIONS BEARING UPON EVIDENCE 51
I. Certain Terms Frequently Used 51
I. Diagnosis, 51. 2. Witnesses, 52. 3. Fact, 53. 4. Evidence, 55.
II. Types of Evidence 56

I. Real Evidence, 56. 2. Testimonial Evidence, 57. 3. Circum-
stantial Evidence, 59.
Summary 62
CHAPTER IV
TESTIMONIAL EVIDENCE 64
I. The Competence of the Witness 65
I. Attention, 66. 2. Memory, 68. 3. Suggestibility, 69. 4. Lead-
ing Questions, 71.
II. The Bias of the Witness 73
i. Racial or National, 73. 2. Environmental, 75. 3. The Bias of
Self-interest, 76.
Summary 79
13
TABLE OF CONTENTS
CHAPTER V PAGE
INFERENCES 81
I. How Inference Is Made 81
II. How Inference Is Corroborated 85
III. The Risks Involved in Thinking 87
i. Mistaken General Rule, 88. 2. Mistaken Particular Case, 90.
3. Mistaken Analogy, 91. 4. Mistaken Causal Relation, 92.
IV. The Risks Arising from the Thinker's State of Mind 94
i. Predispositions, 94.2. Assumptions, 95. 3. Some Other Habits
of Thought, 96.
Summary 99
PART II
CHAPTER VI
THE FIRST INTERVIEW 103
I. Modifying Circumstances 104
I. The Nature of the Task, 104. 2. The Origin of the Application,
106. 3. The Place of the Interview, 106. 4. The Recorded Expe-
rience Available as a Starting Point, 1 10.
II. Scope in
III. Method 115
i. The Approach, 115. Clues and Questions, 120. 3. Taking
2.
Notes, 126. 4. Premature Advice and Promises, 129. 5. Bringing
the Interview to a Close, 130. 6. Emergency Interviews, 131.
Summary 1
32
CHAPTER VII
THE FAMILY GROUP 134
I . The Family as a Whole 1
37
i. The Main Drift of the Family Life, 138. 2. The United and the
Unstable Family, 139.
II. The Husband and Father 143

i.The Man Should Be Seen, 143. 2. Place of Interview, 143. 3.
The Unmarried Father, 144. 4. The Young Couple, 145. 5. De-
sertion and Inebriety, 146.
III. The Wife and Mother 147

i. Physical Aspects of Homemaking, 148. 2. The Family Housing,
151.
IV. The Children 152

i. The Matter of Ages, 154. 2. The Older Children, 155.
V. Other Members 1
56
Summary 1
58
14
TABLE OF CONTENTS
CHAPTER VIII PAGE

OUTSIDE SOURCES IN GENERAL 160
I. Statistics of Outside Sources 161
i. A Study of the Sources Most in Use, 161. 2. Nature of Sources,
164.
II. Principles Governing the Choice of Sources 169
i. First Principle of Choice, 170. 2. Second Principle of Choice, 170.
3. Third Principle of Choice, 172. 4. Fourth Principle of Choice, 1 74.
5. Fifth, Sixth, and Seventh Principles of Choice, 175.
III. Method 176

Summary 179
CHAPTER IX
RELATIVES AS SOURCES 180
I. The Case against Relatives 181
i. Relatives Are Partisan and Prejudiced, 181. 2. Relatives Do Not
Know, 183. 3. Relatives Do Not Understand, 183.
II. The Case for Relatives 186

i.Individual and Family History, 186. 2. Insight, 188. 3. Backing
and Active Co-operation, 189. 4. Further Considerations, 194.
III. Questions of Support from Relatives 195
IV. Methods of Approach 200
Summary 202
CHAPTER X
MEDICAL SOURCES 204
I. Where Medical Evidence Sometimes Fails 205
i. Non-social Attitude, 205. 2. Conflicting Diagnoses and Prog-
noses, 206. 3. Faulty Medical Records, 207.
II. Complementary Nature of Medical and of Social Data 207

III. Social Responsibility for Early Medical Diagnosis 211
IV. Method 213
i. Ask for Prognosis, 213. 2. Economize Resources, 213. 3. Seek
First-hand Information, 215. 4. A Medical Diagnosis Should Have
a Date, 216. 5. Beware the Medical Opinions of the Non-medical,
216. 6. Doctor to Doctor Is More Frank, 216. 7. Careful Reporting
Wears Away Prejudice, 218. 8. Miscellaneous Suggestions, 218.
Summary 219
CHAPTER XI
SCHOOLS AS SOURCES 22 1
I. The Social Evidence of Teachers 223

i. Grade, 223. 2. Scholarship, 224. 3. Attendance, 225. 4. Be-
havior, 226. 5. Physical Condition, 227. 6. Mental Condition, 227.
7. Home Care, 229. 8. Results of Social Treatment, 230.
II. Method 232

Summary 234
15
TABLE OF CONTENTS
CHAPTER XII PAGK

EMPLOYERS AND OTHER WORK SOURCES 235
I . Uses and Scope of a Work Record 236
i. Uses, 236. 2. Scope, 239.
1 1 . Certain Failures of Employer Testimony 240

III. The Co-operation of Employers 242
i. Former Employers, 242. 2. Present Employers, 244. 3. Prospec-
tive Employers, 245.
IV. Method 246

I. The Approach, 246. 2. Accident Cases, 247. 3. Foreign Work-
men, 248.
V. Miscellaneous Work Sources 250
Summary 252
CHAPTER XIII
DOCUMENTARY SOURCES 253
I. Present Use of Documents 255
I. Birth and Death Records, 256. 2. Marriage and Divorce Records,
258. 3. Records Indicating Whereabouts, 260. 4. Property Records,
262. 5. Immigration Records, 264. 6. Records of Conduct, 265.
II. Use of Directories and Newspaper Files 265

III. Method 269
Summary 271
CHAPTER XIV
NEIGHBORHOOD SOURCES 273
I. Present Neighbors 274
1 1 . Former Neighbors 278
III. Landlords 280
IV. Other Neighborhood Sources 282
Summary 283
CHAPTER XV
MISCELLANEOUS SOURCES 284
I. Public Officials 285
i. Police, 285. 2. Other Officials, 287.
II. Certain Business Sources 288

III. Fraternal Orders 290
Summary 291
16
TABLE OF CONTENTS
CHAPTER XVI PAGB

SOCIAL AGENCIES AS SOURCES 292
I. Two Distinct Functions of Social Agency Testimony 296
I. To Supply Data from Their Own Experience, 297. 2. To Supply
the Results of Their Inquiries, 301.
II. The Confidential Exchange 303

III. The Use of Exchange Data 308
IV. Some Further Details of Co-operation 310
i. Duplicate Investigations, 311. 2. The Transfer to Another
Agency for Treatment, 313. 3. Additional Suggestions, 315.
Summary 315
CHAPTER XVII
LETTERS, TELEPHONE MESSAGES, ETC. 317
I. Blank Forms 318
II. Letters of Inquiry 319
i.Should the Letter Be Written at All? 320. 2. Should the Letter
Be Written Now? 321. 3. What Relation Does This Particular In-
quiry Bear to the Whole Process? 322. 4. Has the Best Correspond-
ent Been Chosen for the End in View? 323. 5. What Will Interest
the Correspondent Selected? 326. 6. What Presentation Will Save
the Correspondent Unnecessary Trouble? 327. 7. What Facts re-
lating to the Correspondent's Occupation, Education, etc., Should
Modify the Approach by Letter? 331.
III. Letters of Reply to Inquiries 333
IV. Some Technical Details 335
V. Communication by Telegraph 336
VI. Communication by Telephone 337
Summary 341
CHAPTER XVIII
COMPARISON AND INTERPRETATION 342
I. Certain Aspects of Earlier Processes Restated 342
i. Methods Common to All Interviews, 342. 2. Changes of Empha-
sis inInterviewing, 343. 3. Discrimination in the Choice of Outside
Sources, 344. 4. Types of Evidence, 346. 5. Characteristics of
Witnesses, 346.
II. The Comparison of Material 347

I. Suggestions for Self-supervision, 349. 2. Suggestions for Com-
parisons Made by a Supervisor, 351. 3. The Ames Case, 352.
III. The Interpretation of Material 355
i.Diagnosis Redefined, 357. 2. Diagnostic Content, 358. 3. The
Time Element, 361. 4. Full Diagnosis Not Always Possible, 363.
Summary 363
2
17
TABLE OF CONTENTS
CHAPTER XIX PACK

THE UNDERLYING PHILOSOPHY 365
I. Individual Differences 367
II. The Wider Self 368
PART HI
VARIATIONS IN THE PROCESSES
CHAPTER XX
SOCIAL DISABILITIES AND THE QUESTIONNAIRE PLAN OF
PRESENTATION 373
I. Objects of the Questionnaires 373
I. Their Dangers, 373. 2. Their Use Illustrated, 374.
II. What Is True of Everybody? 375

III. What Is Possibly True of Any Family? 377
Questionnaire regarding Any Family 378
CHAPTER XXI
THE IMMIGRANT FAMILY 382
I. Study of the Group 383
II. Study of the Individual 386
Immigrant Family Questionnaire 387
CHAPTER XXII
DESERTION AND WIDOWHOOD 395
Deserted Family Questionnaire 395
Questionnaire regarding a Widow with Children 400
CHAPTER XXIII
THE NEGLECTED CHILD 405
Questionnaire regarding a Neglected Child 405
CHAPTER XXIV
THE UNMARRIED MOTHER 413
Questionnaire regarding an Unmarried Mother 414
CHAPTER XXV
THE BLIND 420
Questionnaire regarding a Blind Person 42 1
18
TABLE OF CONTENTS
CHAPTER XXVI FACB

THE HOMELESS MAN THE INEBRIATE 425
I. The Homeless Man
425
Homeless Man Questionnaire 425
II. The Inebriate 429
Inebriety Questionnaire 430
CHAPTER XXVII
THE INSANE THE FEEBLE-MINDED 434
Questionnaire regarding a Patient Possibly Insane 436
Questionnaire regarding a Child Possibly Feeble-minded 44 1
CHAPTER XXVIII
SUPERVISION AND REVIEW 449
Supervision and Review Questionnaire 449
APPENDICES
I. First Interviews 457
1 1 . Statistics of Outside Sources 466
III. Specimen Variable Spellings 472
BIBLIOGRAPHY 483
INDEX 489
LIST OF TABLES
1. Twenty Sources Most Used in Three Cities, in Order of
Frequency of Use 165

2. Order of Frequency of Consultation in the Separate Cities
of the 20 Sources Most Often Used in the Three Cities
Taken Together 166
3. Twenty Sources Most Used by Agencies Doing Work with

Children, Family Work, and Medical-social Work in First
City, in Order of Frequency of Use 168
4. Use of the 20 Sources Most Used in the First City, by

Agencies Doing Work with Children, Family Work, and
Medical-social Work in That City 169
5. Social Agencies (Exclusive of Health and School Agencies)
Used as Sources by 56 Agencies in 2,800 Cases 298
APPENDIX II
A. Sources of Information Consulted in Three Cities, as

Shown by the Records Examined 467
B. Sources of Information Consulted in the First City by
Agencies Engaged in Specified Types of Work 470
21
PART I
SOCIAL EVIDENCE
CHAPTER I
BEGINNINGS
the social worker has won a degree of recognition
as being engaged in an occupation useful to the community,
THOUGH he is handicapped by the fact that his public is not alive to
the difference between going through the motions of doing things
" "
and actually getting them done. Doing good was the old phrase
for social service. It begged the question, as do also the newer
terms, "social service" and "social work" unless society is really

served. We should welcome,
therefore, the evident desire of social
workers to abandon claims to respect based upon good intentions
alone; we should meet halfway their earnest endeavors to subject
the processes of their task to critical analysis; and should encourage
them to measure their work by the best standards supplied by
experience standards which, imperfect now, are being advanced
to a point where they can be called professional.
The social workers of the United States form a large occupational
group. A majority of them are engaged in case work in work, 1
that is, which has for its immediate aim the betterment of indi-
viduals or families, one by one, as distinguished from their better-

ment in the mass. Mass betterment and individual betterment are
interdependent, however, social reform and social case work of
necessity progressing together. This fundamental truth will appear
repeatedly as the present discussion of social diagnosis advances.
1
Thus, a study made of the social workers in New York City, which does not
include those in public departments or public institutions, shows that the private
agencies of New York were employing in salaried positions 3,968 social workers in
1915. Of this number, 501 were engaged in "community movements research and
propaganda." The city is headquarters for a large majority of the national social
reform movements, which fact accounts for the size of this second figure; in any
other city it would be a smaller proportion of the total. All the other social workers
counted were dealing with individuals, but some of these in settlements and recrea-
tional activities, for example were giving an unknown proportion of their time to
dealing with individuals in groups. Deducting these also, therefore, approximately
2,200, the number remaining, were in social agencies doing case work. See Devine,
Edward T., and Van Kleeck, Mary: Positions in Social Work. Pamphlet of the
New York School of Philanthropy, 1916.
25
SOCIAL DIAGNOSIS
Since social case work too large a subject to be covered in one

is
volume, its initial process alone will be the subject of this book.
When a human being, whatever his economic status, develops
some marked form of social difficulty and social need, what do
we have to know about him and about his difficulty (or more often
difficulties) before we can arrive at a way of meeting his need? 1
The problem may be one of childhood or old age, of sickness, of
exploitation, or of wasted opportunity, but in so far as it concerns

some one individual in his social relationships it is not alien to
social work as here understood. The effort to get the essential
facts bearing upon a man's social difficulties has commonly been
"
called an investigation," but the term here adopted as a substi-
tute has the advantage that from the first step
social diagnosis
it the mind of the case worker upon the end in view. 2 The
fixes
primary purpose of the writer, in attempting an examination of

the initial process of social case work, is to make some advance
toward a professional standard. The volume, then, is addressed
first to social workers.
But another audience has been kept in view in its preparation.

Much of the process herein described is undoubtedly applicable,
with modification, to human situations which do not come within
the purview of social work as now organized. The special field of
social diagnosis lies in social case work. It is destined in addition
to become an adjunct in the fields of medicine, education, juris-

1
The word social has Its use throughout this book assumes that
many meanings.
wherever there are two individuals instead of one, human association or society
begins. As relations among human beings become groupal, they continue to be
social even in groups too large for personal contact, provided the groupal relation
continues to influence the minds of the units which compose the group. The more
or less arbitrary groupings of human beings in which no such influence is apparent
(into dependents or delinquents, for example) are often described as social too, but
they do not here concern us. When Dr. " James J.
Putnam said, in the passage which
is one of the mottoes of this volume, It is in each man's social relations that his
mental history is mainly written, and it is in his social relations likewise that the
causes of the disorders that threaten his happiness and his effectiveness and the
means for securing his recovery are to be mainly sought," he was writing of the
patients of a neurologist; but we may safely assume that he was thinking not only
of the intimate personal relationships of these patients, but of their occupa-
tions, recreations, and total of social contacts. For there is a very real sense in
which the mind of man is the sum of these contacts. Consideration of the bearing
of this concept upon our subject is reserved for the end of Part II. (See Chapter
XIX, The Underlying Philosophy.)
*
See the definitions of Chapter III, and the much fuller discussion of Chapter
XVIII, Comparison and Interpretation.
26
BEGINNINGS
prudence, and industry. While knowledge from these fields is being

applied to social case work, the latter has developed methods that
will be useful in return.
In this new discipline, as in each of the others, discoveries that
were made with pain and difficulty by the pioneers of one genera-
tion have become commonplaces of our thinking in the next. There
is a half century of hard social endeavor between Edward Denison's
despairing exclamation "Every shilling I give away does four-

pence worth of good by helping to keep their [his beneficiaries']
miserable bodies alive, and eightpence worth of harm by helping
to destroy their miserable souls" 1 and the request made by a
physician in an American city a few years ago. This physician,
who had seen in his hospital practice the excellent service given
by the trained social workers of the hospital in unravelling the
social complications of its patients, asked their leader to let him
engage one of them to render like service to a private patient of
his a patient abundantly able to pay, and unlikely to be bene-
fited medically without social treatment. The social service de-
partment of the hospital was unable to spare a worker from its
staff, but recommended one with the requisite qualifications from
the staff of a relief society.
The point to be noted is that the skilful methods which made
this undertaking possible had been built up laboriously by those
who had shared Denison's questionings and later by several case
work groups which struggled forward independently. Important
contributions have been made to social diagnosis by at least three
of these groups those identified with the charity organization, the
children's court, and the medical-social movements. In the first
of these movements interest in diagnosis shows two divergent im-
pulses one toward emphasis upon economic status to the exclu-
sion of other equally important aspects of human affairs; the other
toward a broader conception, which led its advocates from the
very beginning though without training and with few resources
to take the whole man into consideration. In the children's court
movement some of the methods of experimental psychology have
1
Quoted by Mrs. Josephine Shaw Lowell in "The Evils of Investigation and
Relief," Charities, July, 1898, p. 9. Denison was a volunteer almoner in 1860 for
the London Society for the Relief of Distress.
27
SOCIAL DIAGNOSIS
been adapted to the needs of social inquiry. The medical-social

movement is modifying in a striking way both medical and social
practice.
I. THE ECONOMIC AND THE MORE COMPREHENSIVE APPROACH

1. The Forerunners. In some ways it was unfortunate that
the first attempts to introduce investigation into the charitable
treatment of dependency (for it was in this field that social diag-

nosis hadbeginnings) were made by social reformers who were
its
primarily economists, or who took their cue from the economists.

This came about from the fact that the beginnings of social diag-
nosis were in England, where, after the riot of sentimentality in-
terrupted by spasms of severity which had passed for statesman-

ship in the treatment of distress from the time of Elizabeth, chari-
table reforms attempted in the first quarter of the nineteenth cen-
tury gave rise to the phrase "a thorough investigation." Thomas
Chalmers used it in Glasgow as early as 1823 in connection with
his parish work, and later it was used by the systematizers of Ger-
man poor relief at Elberfeld. 1 On the other hand, the Poor Law
reformers of 1834 turned their backs upon the idea, counting upon
1
See Charles R. Henderson's edition of The Christian and Civic Economy of
Large Towns by Thomas Chalmers, p. 261, for a passage on individual inquiry.
The reformers of poor relief in Elberfeld, Germany, in 1852, quoted Chalmers, but
neither then nor later does his fine spirit seem to have been made manifest to them.
At least, in an undated pamphlet which bears internal evidence of belonging to the
early 'jo's, Andrew Doyle, an English Poor Law inspector, could introduce a de-
scription of the methods of inquiry in use in Elberfeld methods which he admired
in these terms:
"
It was assumed by the framers of the English Poor Law, and is still assumed by
those who continue to take any interest in administering it upon the principle upon
which it was founded, that no real test of destitution can be devised except the test
of the workhouse. As the application of that test is as yet no part of the Elberfeld
system, it will be asked what is the substitute for it?
"
In the first place the applicant for relief is subjected to an examination so close
and searching, so absolutely inquisitorial, that no man who could possibly escape
from it would submit to it. He is not one of several hundreds who can tell his own
story to an overworked relieving officer, but one of a very few, never exceeding four
frequently the single applicant who is bound by law to answer every one of that
long string of questions that his interrogator is bound by law to put to him. One
of the peculiar merits claimed, and I believe rightly claimed, for this system is that
before a man can obtain relief it must be shown that he cannot exist without it."
The Poor Law System of Elberfeld, p. xv.
Doyle gives a long list of minute questions which each applicant must "
answer.
All of these have a direct relation to economic status with the exception of religious
profession," "the state of health of each member of his family," and "whether or
not the children are sent to school."
28
BEGINNINGS
willingness to enter the workhouse as a test of destitution and upon

the workhouse itself as a deterrent that would render individualized
inquiry unnecessary. Often the advocates of inquiry in those
earlierdays had nothing but the economic aspects of a given human
situation in mind, and, when called upon to explain their phrase,
"a thorough investigation," emphasized no resources save those of
income, no obligations save those that were liabilities of relatives
for support or repayment. The treatment they contemplated,
therefore, looked to the repression of unnecessary demands upon
public bounty rather than to the release of energy, the regenerating
of character, or the multiplication of health opportunities, oppor-
tunities for training, and the like.
No general statement such as this can be entirely fair. Chalmers
himself was a man of genius and vision who saw the need of liberat-
ing the powers of self-help and mutual help within the people
themselves, and who realized the part that personal service might
play in this task. But he had not then at hand most of the materials
out of which modern social diagnosis and social treatment are now
in process of being built. For every one thing that could then be
done about a man's attitude toward his life and his social relations,
about his health, housing, work, and recreation, there are now a
dozen things to do. The power to analyze a human situation
closely, as distinguished from the old method of falling back upon
a few general classifications, grows with the consciousness of power
to get things done.
2. Charity Organization Beginnings. The London Charity
Organization Society, heir to Chalmers' ideas and student of the
Elberfeld system, included in its membership from the beginning
a small group of social reformers who, while impressed with the
necessity for regulating relief-giving, especially concerned them-
selves with efforts to place distressed people above the need of
relief and, in doing this, to study and release their latent possi-
bilities. As early as 1869, the year in which the London society

was founded, Miss Octavia Hill had given, before the Social Science
Association, the first description that we have been able to find

of inquiry with social reinstatement as its motive and aim. It is
the first passage in which the human being himself, in his social as
distinguished from his economic environment, seems to emerge:
29
SOCIAL DIAGNOSIS
By knowledge more is meant than whether a man is a drunkard or

of character
a woman is means knowledge of the passions, hopes, and history of
dishonest; it
people; where the temptation will touch them, what is the little scheme they have
made of their lives, or would make, if they had encouragement; what training long
past phases of their lives may have afforded; how to move, touch, teach them.
Our memories and our hopes are more truly factors of our lives than we often
remember. 1
From that day to this the struggle in the charity organization

movement between what may be termed the comprehensive method
of inquiry and of treatment and the exclusively economic one has
gone on. Conditions in this country made it possible for Miss

Hill's ideas to bear fruit here more promptly than in England. Her
essays made a profound impression. In New York, the State

Charities Aid Association reprinted Homes of the London Poor in
1875, while in Boston the system of "volunteer visiting" owed its
impulse in large part to her writings. So lasting is the impress of
beginnings that even today it is possible to recognize signs of Miss
Hill's influence and of the spirit of her 1 869 statement in the current
case records of certain of the American charity organization
societies.
In a number of the American societies, however, the economic
program of inquiry was for a long time the more usual one. Some
of the earlier documents actually describe investigation as repres-
sive. 2 In fact, no one can understand the diversity in the charity
organization societies of today who does not realize that in this
country the early movement had several independent beginnings,
and that, in one of these, Miss Hill's work in London and her occa-
sional essays were the shaping influence, while in some of the
others inquiry and treatment centered around questions of relief
or no relief.
3. First Attempts to Establish Standards. It is to the credit
of the societies identified with the broadest of these initial impulses
that they have been dissatisfied with their own work. Although
they have failed again and again to make their inquiries into indi-
vidual situations skilful and effective, they have been aware of
1
Life of Octavia Hill, C. E. Maurice, p. 258.
*
See especially S. Humphreys Gurteen's Handbook of Charity Organization,
published by the author in Buffalo in 1882. While in some passages another note
is struck, on p. 146 he expressly refers to investigation as repressive. Some Ameri-
can leaders of the movement were doing the same as late as 1904.
30
BEGINNINGS
such shortcomings and have applied themselves to achieving a

greater measure of success. Both in England and here they have
attempted to formulate experience.
1
The American leaders have
protested, moreover, in no uncertain terms against regarding in-
vestigation as an end in itself, without reference to the use to which
the information obtained may be put. This was notably true of
Mrs. Josephine Shaw Lowell, founder of the New York society,
who wrote:
We had in New York, in the hard times of 1893 and 1894, a most painful experi-
ence in this regard. The very word "investigation" seemed then to have been made
a sort of shibboleth by the newspapers, and in too many cases, by the ministers also.
To every remonstrance against methods of relief-giving which were injurious to the
character of those who were supposed to be helped by them, and cruel in their entire
disregard of their comfort, happiness, and moral and physical well-being, it seemed
to be considered a sufficient answer to say: "All the cases have been thoroughly
investigated," and it was evidently thought that this answer ought to be entirely
satisfactory to charity organizationists, even though the investigations were made,
not for the purpose of furnishing guidance and knowledge for a long course of "treat-
ment" by which weak wills might be strengthened, bad habits be cured, and in-
dependence developed, but in order that a ticket might be given by means of which,
after a long, weary waiting in the street in the midst of a crowd of miserable people,
whose poverty and beggary were published to every passerby, some old clothes or
8
some groceries might be got.
The year before this was written (1897), Edward T. Devine,

secretary of the New
York society, made a strong plea for improve-
ment in the personnel of the investigators, for their training, and
end which investigation has in view.
for a clearer definition of the
In the following year he organized3 the summer course of training
which was to develop later into the New York School of Philan-
thropy, the first of the training schools for social workers established
in this country. The opening of these schools gave a strong im-
petus to developments already under way in social agencies. It
became more apparent than ever, for example, that investigation

was not merely a notion of the charity organization societies, that
1
See, for example, the early English statement of C. J. Ribton-Turner:
Suggestions for Systematic Inquiry, 1872; and "How to Take Down a Case" in
the 1896 Occasional Papers of the London Charity Organization Society. The Bos-
"
ton Associated Charities has given us Miss M. L. Birtwell's all too brief Investi-
gation" (Charities Review, January, 1895, pp. 129-137).
*
See "The Evils of Investigation and Relief" in Charities, June, 1898.
1
Under the directorship of Philip W. Ayres.
SOCIAL DIAGNOSIS
this process was essential wherever the reinstatement of a human

being was to be attempted. On the other hand, practical instruc-
tion in social diagnosis and treatment was made possible for the
school students by the case work opportunities (analogous to the
"bedside opportunities" in medical instruction) offered to them
from the beginning by the charity organization societies and later
by other agencies. Case work cannot be mastered from books or
from class room instruction alone, though both have their place
in its mastery.
If social case work is indebted to the schools and the social
agencies jointly for their encouragement of a technique in common,
itmust look to social reform to make possible a technique that is
varied and flexible. New methods of social treatment have been
developed by the charity organization campaigns for better hous-

ing and for the prevention of tuberculosis; by the long struggle of
another group of social reformers to secure diagnosis and care of
the feeble-minded; by child labor reform, by industrial legislation,
by the recreation movement, the mental hygiene movement, and
a host of other social reforms. The significance of these reforms
here is that, after they had achieved a measure of success, case work
treatment had at its command more varied resources, adaptable
to individual situations, and that therefore the diagnosis of those
situations assumed fresh importance.
Summing up the main facts of the relation of charity organiza-

tion to social diagnosis, it may be said, First, that the movement
developed and fought for the beginnings of this process. Second,

that some of its earliest leaders had grasped the idea of the sym-
pathetic study of the individual in his social environment. Third,
that this conception, imperfectly realized, was often thrust aside
by belief in the commanding importance of economic data. Fourth,
that progress in diagnosis necessarily awaited the development of
varied methods of treatment, there being at first no accepted pro-
gram of treatment otherthan the giving or withholding of relief. 1
Fifth, that the promotion of preventive measures which made
varied treatment possible, notably of those looking to the better
1
Here and there individuals and agencies had broader conceptions of what could
be done, but in the earlier days these were carried out with difficulty against the
main current of charitable activity, which ran strongly toward dole-giving.
32
BEGINNINGS
housing and health of the people, became an important part of

charity organization work.
II. THE APPROACH BY WAY OF CHILD STUDY

Movements more or less independent in origin may act and
react upon one another in such a way as to make it difficult to
unravel their beginnings. The idea of juvenile probation, for ex-
ample, goes back to the '6o's. The Boston Children's Aid Society
and later (1869) a state visiting agency which was established in
Massachusetts interested themselves in probation. In addition,
the Boston Municipal Court began to hold separate hearings of
children's cases. It was not until 1899, however, when repre-
sentatives of the women's clubs, the children's agencies, and the

social settlements in Chicago were able to secure the passage of a
juvenile court law, combining the ideas of probation, separate hear-
ings, and the specialized judge, that the first juvenile court was
organized.
The contribution of the children's court movement to social
diagnosis deserves more than passing mention. It drew upon the
family agencies, and upon the children's agencies even more largely,
for its technique; but it developed a point of view of its own, as
isshown by the following passage in which Judge Harvey H. Baker
of the Boston Juvenile Court describes the duty of the judge:
In determining the disposition to be made of the case the procedure of the physi-
cian is very closely followed. The probation officer investigates the case and reports
to the judge all available information about the family and other features of the
environment of the boy, the boy's personal history at home, in school, at work, and
on the street, and the circumstances attending the particular outbreak which got
him into court. The boy himself is scrutinized for indications of feeble-mindedness
or physical defects, such as poor eyesight, deafness, adenoids. The judge and pro-
bation officer consider together, like a physician and his junior, whether the out-
break which resulted in the arrest of the child was largely accidental, or whether it
is habitual or likely to be so; whether it is due chiefly to some inherent physical or
moral defect of the child, or whether some feature of his environment is an impor-
tant factor; and then they address themselves to the question of how permanently
to prevent the recurrence. 1
Twoyears before this was written, the judge of the Chicago

Juvenile Court had begun to urge the importance of procuring, in
1
The Survey, February 5, 1910, p. 649.
3 33
SOCIAL DIAGNOSIS
addition to family histories, thorough physical and mental exami-

nations for all court children. 1 This court was the first social agency
to utilize to the full applied psychology a source of insight the
use of which had been developed in the psychological clinic only a
few years before the Chicago court was organized. 2 A Psychopathic
Institute was organized in connection with the court in 1909.
This institute has been from the first under the direction of Dr.
William Healy, whose three books The Individual Delinquent,
Pathological Lying, and Honesty embody the results of his
institute studies of juvenile court children. Social case workers
read these books with more interest than they do any others relat-
ing to child study. Although The Individual Delinquent is "a
text-book of diagnosis and prognosis for all concerned in under-
standing offenders," its discussion of method contained in the first
third of the book makes it a text-book for all engaged in the study
of humanbeings. In his simpler statement, Honesty, intended for
teachers and parents, Dr. Healy holds a similar point of view re-
garding the influences to be brought to bear upon character to that
developed nearly fifty years before from a different angle and with
a different equipment by Miss Octavia Hill. He believes that steal-
ing is usually a symptom, not a disease, and that the physical,
mental, and social facts behind that symptom must be grasped and
interpreted if we are to effect a cure.
III. THE MEDICAL APPROACH

In the earlier days of the charity organization movement in this
country, physicians used to appeal to the societies to advocate the
adoption of some form of inquiry by hospitals and dispensaries to
prevent the fraudulent use of free medical charities by those who
could afford to pay. This is another instance of that inadequate
conception, already mentioned, of a problem which presents aspects
1
See Judge Julian W. Mack's address in Proceedings of National Conference of
Charities and Correction for 1908 (Richmond, Va.). p. 374.
s
As early as 1896 Lightner Witmer of the University of Pennsylvania had opened
such a clinic and had begun to receive children for examination from schools and
children's agencies; later he did examining also for the juvenile court. The exami-
nations as now made at the University of Pennsylvania's clinic are physical and
social as well as mental. Ten years later (1906) Henry H. Goddard began his work
for the feeble-minded at Vineland, N. J., and developed the use of the Binet-Simon
measuring scale.
34
BEGINNINGS
of greater significance for social treatment than the exclusively

economic.
Doctors and charity organization workers co-operated to better
purpose when the New York Charity Organization Society began
in 1902, through a special committee on tuberculosis, its first cam-
paign for the prevention of disease. Other movements for improv-

ing public health soon followed, some initiated by the medical pro-
fession and some by social workers. Although each one of these
has influenced social diagnosis, the most direct influence exerted
upon this process by the medical profession comes from the medical-
social service movement.
Medical-social service owes its origin to Dr. Richard C. Cabot,
who in 1905 organized the first social service department in the
out-patient department of the Massachusetts General Hospital.

It was "conceived by a physician who, in seeking the improvement
of dispensary practice, found in the social worker a potent means

for more accurate diagnosis and more effective treatment." 1 What
Dr. Cabot had in mind in bringing trained social workers into the
dispensary and later into its separate clinics was not a mixture of
medical and social work but their chemical union. The fuller
development of this idea in recent years is best described in his

own words:
In our own case work in the social service department of the Massachusetts
General Hospital we are accustomed to sum up our cases in monthly reports from
the case records by asking about each case four questions: What is the physical
state of this patient? What is the mental state of this patient? What is his physi-
cal environment? What is his mental and spiritual environment? The doctor is
apt to know a good deal about the first of those four things, the physical state, and
a little about the second, the mental, but about the other two almost nothing. The
expert social worker comes with those four points in mind to every case. It is of
interest to notice that this fourfold knowledge is not the goal of the social worker
merely; it is the goal of every intelligent human being who wants to understand
another human being. Suppose a man was about to be married to a member of
your family and you wanted to know whether he deserved this great promotion.
You would want to know just those four things the social worker needs to know
. . . (a) his physical condition, (b) his character, (c) the physical condition
under which he has been brought up and lives, and (d) the mental and spiritual
influences under which he has grown up and now lives. It would be the same if you
were studying candidates for a paying teller's position, for a governor's position,
1
From Social Work in Hospitals, by Ida M. Cannon, p. 15 sq.
35
SOCIAL DIAGNOSIS
for the headship of a college, or for president of the United States. Social work, as
I see it, takes no special point of view; it human
point of view, and
takes the total
that is who by reason of their training are disposed
just what it has to teach doctors
to take a much narrower point of view. They can safely and profitably continue
that narrow outlook only in case they have a social worker at their elbow, as they
should have, to help them. Each of us has his proper field, but we should not work
separately, for the human beings who are our charges cannot be cut in two.
1
The half of the senior class of medical students at Harvard who

take their clinical work at the Massachusetts General Hospital
also take a course there in medical-social work under its chief of
and some of the medical colleges in other cities give
social service,
similar instruction. Even more directly related to our subject is
the systematic instruction in medical matters which this Boston
medical-social department now gives to non-medical social workers.
Indeed, the medical-social movement has had a marked influence
upon the daily work of other social agencies by giving them a
clearer notion of the bearing of health upon the social welfare of
the individual.
All of these streams of experience the judicial, the psycholog-
ical, and the medical are modifying social case work profoundly,
and as indicated earlier are being modified by it in turn. A ten-
dency to drift away from effective standards sometimes notice-
is
able, however, in the social work connected with court or clinic.

The explanation of this lies in the fact that long established pro-
fessions cast a long shadow. They have their traditions, their
routine of procedure, their terminology, their sense of professional
solidarity. Social work has few of these things. When, there-
fore, the doctor or judge receives social workers as an adjunct to
his clinic or court, he may have but a dim idea of the distinctive
contribution of authenticated and interpreted social fact which
they should bring to his professional work. In this case, he tends
to fit them into the traditions of his own calling, and to ignore the
characteristics of theirs. The judge has been known to use them
for detective work; the physician, accustomed to implicit obe-
dience from nurses, may use them for errands to patients or
for semi-clerical service. One unfortunate result, apart from
the waste of opportunity, is that if any social observations are
1
Proceedings of the National Conference of Charities and Correction for 1915
(Baltimore), p. 220 sq.
36
BEGINNINGS
possible and if any social statements are taken, they are accepted
at their face value by professional men who are accustomed in their
own field to apply rigid tests, but who fail to recognize the need
or the possibility of testing social evidence. The nature of social

evidence and the tests which social experience and the principles
of reasoning should enable us to apply to it will be the theme of the
next four chapters.
CHAPTER II
THE NATURE AND USES OF SOCIAL EVIDENCE

processes which lead up to social diagnosis and thence to
the shaping of a plan of social treatment may be divided into
THE the collection of evidence and the drawing of inferences there-
from. The collection of evidence comes through the social worker's
firstrelations (i) with his client, 1 (2) with his client's family, and
(3) with sources of insight outside the family group. These stages
will all be described in detail in Part II, as will also the further
stage (4) of comparing the evidence gathered from these various

sources (inference), and of interpreting its meaning (diagnosis).
I. SOCIAL EVIDENCE DIFFERENTIATED

From the beginning of his task the social case worker deals with
testimonial evidence in a way shaped by the end for which it was
obtained; namely, the social treatment of individuals. As he pro-
ceeds he often finds himself in need of more knowledge as to the
weight which should be attached to the social evidence he has
gathered. Are there rules of evidence, principles of choice, that can
guide him in selecting from a group of unassorted observations and
testimonies those which he can rely upon from those which must
be accepted "with a grain of salt"? If so, are these principles
peculiar to social work, so that its practitioners will be obliged to
dig them out from their own experience alone, or may they hope
to findthem already identified in law book or laboratory?
That there are such rules to guide the social worker is intimated
1 Those with whom social case workers are
dealing are called by many names
applicants, inmates, cases, children, families, probationers, patients are only a few
of them. One word will be used for all, usually, in this volume the word "client."
Its history is one of advancement from low estate to higher. First it meant "a
suitor, a dependent." Later it meant "one who listens to advice," and later still
"one who employs professional service of any kind." The more expert the service,
the more appropriate the word, which has the advantage, moreover, of democratic
implications. When a public defender in California serves defendants too poor to
employ him, he still thinks of them as his clients.
38
by a correspondent who had gone from a charity organization

society to a society to protect children from cruelty. He writes:
As a result of S. and with S. P. C. C. investigators,
my experience both with C. O.
there seems to me
a weakness in the training of the C. O. S. district secretary, who
from the nature of her duties is constantly required to weigh evidence but who has
not got clearly in mind the fundamental differences between different classes of
evidence and their different values. I do not now refer to the nice discriminations;
those I am content to leave to trained lawyers to squabble over. Not only would the
co-operation with an S. P. C. C. be at once improved but evidence as it stands in
a C. O. S. investigation would be increased in value and reduced in bulk. I confess
to considerable impatience at times when I find district secretaries of some and even
of great experience apparently valuing every statement equally and tben adding the
items together to find a total.
Many will share this correspondent's impatience with such

arithmetic. Nevertheless, no considerable group of social case
workers whether in a society to protect children or a charity
organization society or anywhere else seem to have grasped the
fact that the reliability of the evidence on which they base their
decisions should be no less rigidly scrutinized than is that of legal
evidence by opposing counsel. On the other hand, the question of
admissibility, the rules for which were framed mainly to meet the
average juryman's lack of skill in testing evidence, does not enter
into the weighing of facts as gathered by an agency all in whose
service are, or can be, trained to this special task. Skill in testing
evidence, as leading to such proof as social workers need, is in no
way dependent upon a knowledge of the legal rules of admissibility.
Social evidence, like that sought by the scientist or historian, in-
cludes items which, however trifling or apparently irrelevant
all
when regarded as isolated facts, may, when taken together, throw

light upon the question at issue; namely, as regards social work,
the question what course of procedure will place this client in his
right relation to society? Many an item, such as a child's delayed
speech, for instance, may have no significance in itself, whereas
when considered in connection with late dentition and walking and
with convulsions it may become a significant part of evidence as
to the child's mentality. Social evidence, then, has an advantage
over legal evidence in that it can include facts of slight probative
value. Without this advantage social case work would not be
possible, since the problem of the orientation of a family or indi-
39
SOCIAL DIAGNOSIS
vidual is far more complex than the single question as to whether

or not a litigant or a defendant to be penalized. Moreover, facts
is
having a subjective bearing, like that of delayed speech just in-

stanced, are especially characterized by their cumulative signifi-
"
cance. Variations between people in mental endowment, in per-
sonality," display themselves ordinarily not in a few conspicuous
acts, but in a trend of behavior evidenced by innumerable trifling
remarks or by a succession of decisions and impulses each unim-
portant in itself. Evidence of this cumulative sort, therefore, is
essential wherever, as in social work, decisions rest upon intimate
understanding of character.
In examining the reliability of evidence, social case work should
make its own application of universal tests; and, coming late to
the task, should be able to profit by the experiences not merely of

law, but of history and of natural science. The various professions
apply rules of evidence for arriving at truth, each according to its
own special conditions. The scientist uses controlled experimen-

tation because he works with material which may be brought under
complete control. He may, for instance, till half of an orchard

whose physical conditions, soil, grade, exposure, etc., are the same
throughout. If the tilled half bears much better than the untilled,
he concludes that tilling increases the product of fruit trees. When,
however, the farmer in the fable digs in his orchard for buried
treasure, and in place of gold finds his promised fortune in an
unprecedented yield of fruit, he probably draws no causal inferences
whatever.
Should a social worker have the task of showing whether the
farmer's labor had paid or not, he would get the testimony of the
farmer, of his family, and his neighbors as to the previous care of
the trees; their evidence as to any other measures of improvement
he might have taken, such as pruning, thinning out, etc.; their
recollection, corroborated by governmental reports, of weather
conditions, pests, etc., of preceding years. He would take account
of hearsay evidence, of persistent rumors, of the general appearance
of the man's farm and home. As a result, the social worker might
establish or discredit the value of tillage in this instance with a fair
degree of probability.
Suppose on the other hand some decision in a law court should
40
turn on the question whether or not it was his tilling of the soil
that had brought the farmer an increased yield of fruit. The court
would deal in the main with the same facts as the social worker,
namely, with the testimony of witnesses, with government reports,
or with an inspection of the premises; the difference would be that
a court would guard with scrupulous care the admission of hearsay
evidence and would exclude rumors; that it would, in short, hold
each witness to a responsibility for his statements, allowing him in
the main to say nothing of which his own knov/ledge was not first-
hand. This evidence might or might not satisfy the court beyond
a reasonable doubt that it was justified in concluding that tillage
had increased the farmer's yield. But these restrictions upon
evidence are necessary in law because of the obligation the judge is
under of sifting evidence for a jury who are liable to allow undue
weight to items which have small value as proof.
The common difference between the point of view of social
worker and court stands out in the following instance of alleged
parental neglect:
SOCIAL EVIDENCE WHICH LED REASONS WHY THE SOCIETY TO

A CASE WORK AGENCY TO ASK PROTECT CHILDREN BELIEVED
COURT ACTION THROUGH A SO- THAT THE COURT WOULD NOT
CIETY TO PROTECT CHILDREN ACT
I. Three rachitic children aged seven, i. "No doctor has yet made a definite
five,and three years; the oldest could statement as to the serious result of
not walk at all at four years; the second failureon the parents' part to follow di-
and third had bowed legs and walked rections in the treatment of these chil-
with difficulty at three years old. Al- dren." A court would not accept a lay-
though the oldest child has been three man's judgment even on so obvious a
and a half years in a hospital where it matter as extremely bowed legs, because
was sent by a social agency, the parents this might establish a precedent which
omitted to take the other children to in most instances would work badly. A
the dispensary for examination and ad- layman's opinion in such a case as this
vice. The social worker made seven is a less responsible one than a doctor's,
calls tourge them to do this. They as- since the latter's professional standing is
sented each time, but were increasingly involved in his statements. Even with
resentful at what they regarded as an a physician's statement "it is very dif-
and
intrusion into their private affairs, ficult to make such neglect the basis of a
did nothing. The social worker con- case in court." The father supports his
strued this as parental neglect. family, the mother gives good care as
she understands it. The court, fearing
that doctors may disagree, hesitates to
4'
SOCIAL DIAGNOSIS
force a debatable treatment upon well-
meaning, if ignorant parents. One

might venture to predict that courts will
more readily consider neglect of this sort
as they grow inclined to take common
sense risks instead of resting on the let-
ter of precedent.
2. This family has lived foryears in
six 2. The sunniness of the tenement and
two tiny rooms on the top floor. Al- the fact that the mother keeps it clean
though their tenement rooms are sunny would prevent a court from regarding
and clean, the children do not get suffi- these cramped quarters as evidence of
cient exercise or air. The parents refuse culpable neglect. Public opinion would
to move, as the rent is small. not uphold the court in making an issue
over home conditions that were not con-
siderably below the ideal held by social
workers. The social worker often for-
gets this.
3. A year and a half after having been 3. "While it looks as if the family had
urged to have the two younger children been neglected in years past either de-
examined, the mother took the youngest liberately or through ignorance, or both,
child to the hospital and promised to the situation today is not clear." The
bring the second child. Eight months oldest child is still in the hospital, the
later she had not done this. youngest has received hospital care, and
the mother has promised to take the
second child to the out-patient depart-
ment. With this evidence of good in-
tentions, a doctor's statement (see i)
would be necessary to satisfy a court of
present neglect.
Here was a deadlock. In asking court action on the ground of

parental neglect the social worker was in effect calling upon the
court to accept his interpretation of the evidence as establishing
the fact of neglect, and to order the children to be submitted to
physicians for treatment. The court, on the other hand, as inter-
preted by the society to protect children, would require the physi-
cian's testimony as a link in establishing the fact of neglect and
would be unlikely to act until the social worker himself had done
the thing he was asking the court to do; namely, confront the case
with a doctor. It would seem to a layman as if in such a case the
court might safely summon the parents and child into court, admit
the child's bowed legs and the social worker's efforts to persuade
the family as evidence, and put this father and mother on proba-
tion to consult any reputable doctor they chose.
It is clear, then, that whereas social evidence is distinguished
from that used in natural science by an actual difference in the
subject matter, it differs from legal evidence not in the sort of facts
offered,but in the greater degree of probative value required by
the law of each separate item. The additional testimony which
the court would have asked in the instance cited was not different
in kind from what the social worker already had.
In short, social evidence may be defined as consisting of any and
all facts as to personal or family history which, taken together, in-
dicate the nature of a given client's social difficulties and the means
to their solution. Such facts, when duly tested in ways that fit
the uses to which they are to be put, will influence, as suggested in

the preceding chapter, the diagnosis of physical and mental dis-
orders, will reveal unrecognized sources of disease, will change
court procedure with reference to certain groups of defendants, and
will modify methods in the school class room. To a certain extent
social evidence is already exerting this influence, but the demand
for such evidence is likely far to outstrip the supply during this
next decade.
II. THE WIDER USE OF SOCIAL EVIDENCE

Scattered and tentative as they still are, the signs of such coming
demand are nevertheless unmistakable; the uses of social evidence
in the older professions are beginning to multiply, as the following
illustrations will show:
A specialist in the diagnosis of feeble-mindedness committed two difficult girls to

custodial care, largely on the facts supplied him from first-hand observations by a
children's aid society as to the characteristics of these girls and of their families.
The "stream pictures" furnished in summaries of two case records, covering two
years in one instance and nine in the other, were his most conclusive evidence.
The nature of these stream pictures may be gathered from Dr.

W. E. Fernald's discussion of the evidence needed by the psychi-
atrist formaking a diagnosis of mental defect. Some of this evi-
dence, although obtainable by social workers, is of course medical in
character, that is, delayed dentition, late walking, delayed speech,
a history of convulsions in the first few years of life, the presence

43
SOCIAL DIAGNOSIS
of degenerative stigmata. Much of it, however, is precisely the

slight but cumulative evidence which social workers habitually
gather as bearing on disabilities; namely, facts of family and per-
sonal history with special reference to the period of infancy and
early childhood, a relatively long continuance of untidy habits
(of childhood), the public school grade in relation to age, inability
on the part of the patient to apply himself continuously either in
school or in any other occupation without constant supervision.
In some cases with only slight intellectual defect, the inability to
"make good" be a deciding factor in the diagnosis. 1
socially will
All of this information, including the medical, should be given
in the history of a client which the social worker is preparing to
submit to a psychiatrist.
The contributions of social work to medicine are not confined to
the diagnosis of feeble-mindedness. As we have seen in the first
chapter, medical diagnosis and treatment are beginning to show
the influence of the social evidence gathered in the medical-social
departments of hospitals and dispensaries.
We have also seen in the discussion of Beginnings that the chil-
dren's courts of the United States owe their existence to social
workers. These courts supplement legal evidence by social. Not
only have the courts come to recognize the value of a more liberal
inclusion of imperfectly relevant evidence in disposing of child
offenders; they are growing to feel that even the method of gather-
ing this evidence has an influence upon the welfare of the child.
They believe that such investigation should be inspired not by the
ambition to run down and convict a criminal but by a desire to
learn the bestway to overcome a boy's or girl's difficulties. The
need of modifying in these courts the usual legal procedure is thus
commented upon by Flexner and Baldwin :
The best interests of the child make it necessary for the court to consider hearsay
and other evidence of a more or less informal kind which would ordinarily under
strict rules of evidence be excluded. It is of the utmost importance that the court
should avail itself of just the kind of evidence that the investigator [the probation
1
Fernald, Walter E., M. D. (Superintendent of the Massachusetts School for
the Feeble-minded, Waverly, Mass.): The Imbecile with Criminal Instincts, p. 745.
American Journal of Insanity, Vol. LXV, No. 4, April, 1909, pp. 73 I-749-
See also questionnaire regarding a Child Possibly Feeble-minded in this volume.
Chapter XXVI I.
44
officer] presents. If it should finally be determined that the laws as drawn do not
permit the introduction of such evidence, express provision should be inserted in
the statutes allowing its use. 1
Another court having its origin in needs brought to light by

social work the court of domestic relations, which may in time
is
be merged with the children's court. It suffers at present from

inability to secure and use the necessary social evidence. This ex-
periment, like many others, will continue to fall short of full use-
fulness until social workers develop the diagnostic skill that will
enable them to offer to the court authenticated and pertinent in-
formation. The following is a case in point :
A court of domestic relations sentenced a man for desertion and non-support on

the testimony of his wife. The wife then applied to a charity organization society
for relief for herself and four children. The district secretary, assuming that on the
face of it this convicted man was
good-for-nothing, asked her committee to arrange
for assistance to the family. was with reluctance that the secretary at the sug-
It
gestion of her committee agreed to make what she regarded as a superfluous inves-
tigation of the man's side of the story. This inquiry, however, brought statements
from employers, former neighbors, relatives, etc., which showed that the trouble
lay not with the man, who was a decent enough fellow, but with the woman, who was
probably mentally unbalanced. Instead of voting relief, therefore, the district
committee asked the judge to release the man.
In short, the secretary in question would hardly have been quali-

fied topersuade a court of the helpfulness of social evidence, while
she herself was capable of treating an inference that as to the
man's character as if it were an evidential fact.
Many educators, even though not thinking in terms of social
work, are recognizing their need of obtaining social histories of
pupils and of giving differential treatment based upon them. The
social worker's method they sometimes take over with little under-
standing of its details. For instance, Madame Montessori in her
Pedagogical Anthropology makes a plea for differential treatment
of pupilsand gives a whole chapter to the question of securing the
2
biographical history of the pupil and of his antecedents; but she
apparently has little conception of the varying reliability of the
1
Flexner, Bernard, and Baldwin, Roger N.: Juvenile Courts and Probation,
p. 52. New York, Century Co., 1914.
*
Montessori, Marie: Pedagogical Anthropology (Translated from the Italian
by Frederic Taber Cooper), pp. 404-453. New York, Frederick A. Stokes Co., 1913.
45
SOCIAL DIAGNOSIS
different sources from which such social evidence must be had, or

of the tests that could be applied to assure reliability.
Stuart Courtis, of the New York Committee on School Inquiry,
who starts with an effort to test, by measurements based upon
arithmetic alone, the efficiency of school and children, arrives fin-
ally at two interesting conclusions: First, that life histories alone
can make plain the play of those hidden forces which are constantly
modifying the results of educational effort; and second, that where
marked differences in the social life of the different types of children
exist, those differences must be reflected in school methods. For
"
reasoning cannot be taught from a text alone. Reasoning is a
process of adjustment to a situation, and only as children have
experienced the fundamental characteristics of a situation can they
intelligently make
the necessary adjustments to it." 1
Thebeginnings of social case work in a field closely allied to
education, in vocational guidance, serve to illustrate how, in the
enthusiasm of promoting a new discovery, the need of social evi-
dence may be overlooked. In this line of endeavor (though not in
some others, where the illustration may still serve as a warning)
the oversight was only a temporary one. The first volume of advice
addressed to what were to be known as "vocational counselors"
gave specimen interviews for their instruction. One of these is
with a lad of nineteen in Boston who comes for vocational guidance
and says that he wants to be a physician. 2 The following is a part
of the counselor's printed report:
He was and expres-

sickly looking, small, thin, hollow-cheeked, with listless eye
sionless face. He
did not smile once during the interview of more than an hour.
He shook hands like a wet stick. His voice was husky and unpleasant, and his con-
versational power, aside from answering direct questions, seemed practically limited
to "ss-uh," an aspirate "yes, sir," consisting of a prolonged 5 followed by a non-
vocal ub, made by suddenly dropping the lower jaw and exploding the breath with-
out bringing the vocal cords into action. He used this aspirate "yes-sir" constantly,
to indicate assent, or that he heard what the counselor said. He had been through
the grammar school and the evening high; was not good in any of his studies, nor
especially interested in any. His memory was poor. He fell down on all the tests
1
Courtis, Stuart A.: The Courtis Tests in Arithmetic (Section D
of Subdivision
I of Part 1 1 of the Report on Educational Aspects of the Public School Systems of
the City of New York), pp. 150-155. City of New York, 1911-12.
1
Parsons, Frank, Ph. D.: Choosing a Vocation, p. 114 sq. Boston, Houghton
Mifflin and Co., 1909.
46
for mental power. He had read practically nothing outside of school except the
newspapers. He had no resources and very few friends. He was not tidy in his
appearance, nor in any way attractive. He knew nothing about a doctor's life;
not even that he might have to get up any time in the middle of the night, or that
he had to remember books full of symptoms and remedies.
The boy had no enthusiasms, interests, or ambitions except the one consuming
ambition to be something that people would respect, and he thought he could ac-
complish that purpose by becoming a physician more easily than in any other way.
When the study was complete, and the young man's record was before him, the
counselor said:
"Now we must be very frank with each other. That is the only way such talks
can be of any value. You want me to tell you the truth just as I see it, don't you?
That's why you came to me, isn't it, not for flattery, but for a frank talk to help
you understand yourself and your possibilities?"
"When the study was complete!" Psychologists realize now

that tests of memory, like most other mental tests, must be re-
peated to eliminate accidental factors; but assuming that the coun-
selor had made the psychological tests with care, he still has ignored
many factors,which though not measurable by tests would yet

modify the social diagnosis. He tells the boy that he cannot be a
doctor, that he might succeed in some mechanical or manufactur-
ing industry, that he must cultivate a cordial smile by speaking
before a glass, that he must read solid books, study to prepare for
citizenship,and so on. Such unconstructive vocational guidance
the counselor apparently supposed to be a form of social treatment.
Had he used his opportunity to acquire social evidence as well as
psychological, he might have instituted treatment that would have
struck at the root of the boy's difficulty. Here is a boy who has
been attending the evening high school for several years. Has he
been employed during the day; if so, at what? Is this work of a
kind that would account, in part at least, for his failure as a stu-
dent? Are there removable causes not only for his lack of success
but for his physical condition as well? In the case of such a boy,
should not a medical diagnosis precede vocational advice? What
are his home surroundings? Have his parents plans for him or
aptitudes of their own that would suggest possibilities in him? Are
any of his family already known to some of the hundreds of social
workers in Boston? 1 If so, a summary of this social work experi-
ence might be suggestive. The book containing this illustrative
1
For a description of the confidential exchange see p. 303 sq.
47
SOCIAL DIAGNOSIS
interview was written to aid vocational counselors, presumably

busy men. Nevertheless the question as to what a boy is to do
with his working days for years to come is too vital a one for such
summary disposal. The interview here quoted, ignoring the pos-
sible aid of other specialists, professes to be complete in itself,
whereas a few letters and telephone messages to employers,
teachers, confidential exchange of information, and the boy's
parents, together with a reference to a competent physician, would
have brought to light social and physical factors which contributed
to the boy's ill success, and would have indicated how to remove
them.
The counselor dealt with symptoms only. He assumed that an
examination of the boy as regarded his appearance, speech, and
mental reactions, during that brief cross-section of time, would give
all the data necessary for treatment. Only to one who was all-wise
and all-knowing could a single examination have been thus fruitful.

Variations of these same ideas crop up in unexpected places.
Scientific shop management has accepted the principle of studying
the personal traits of iloe individual workman and of basing his
advancement upon such study, but for lack of social technique its
present application of the principle is often too crude and some-

times too undemocratic to illustrate our theme.
It would seem that social evidence is beginning to receive recog-
nition. The endeavors
of social workers are bringing to light ways
of thinking and doing that prove useful in quite other fields. The
fact that law, medicine, history, and psychology, in their effort to
break new ground, have been opening the same vein of truth,
shows a growing demand for the kind of data that social practi-
tioners gather. The absence of any generally accepted tests of the
reliability of such evidence, however, still keeps this new demand

itself ill defined and unstandardized. Personal histories which
might appear sufficiently authenticated to a shop manager might
strike a neurologist as inadequate for conclusions, while they would
certainly be open to objections from a court. Progress on the social

side of these several fields of endeavor will be hastened as social
workers subject their own experiences to a more critical and
searching analysis.
It was not to be expected that industry, or education, or juris-
48
prudence, or medical science, or preventive social legislation should

wait, before they developed in harmony with the thought of today,
until the arts of social diagnosis and treatment had caught up.
All of these went forward in their several ways, but their very
advance has emphasized the need of skill in this newer art. Tech-
nique has not occupied the attention of the social workers them-
selves so much as has the rapid development of new social special-
ties, some of them

considered, perhaps, but all following inevit-
ill
ably upon that flowering of social ideals in this country which

belongs to the last fifteen years. The time has now arrived to take
fuller advantage of these new developments.
Attention to the details of social evidence is so new in case work

that, in addition to the comparing of case work experiences at-
tempted in Parts 1 1 and 1 1 of this book, it has seemed necessary
1
to seek light wherever it could be found. Social work has its own
approach to evidence, but wherever men of first-rate standing in

other professions have discussed, in a way not too technical to be
understood by the layman, this subject of evidence, it is worth our
while to give attention. As will be seen from the Bibliography, 1
free use will be made in these pages of the remarkable contributions
of Professor Hans Gross to criminal jurisprudence, of Professor
J. H. Wigmore's Principles of Judicial Proof, and of James B.

Thayer's Preliminary Treatise on Evidence at the Common Law.
Dr. S. Weir Mitchell, Dr. Paul Dubois, Dr. Richard C. Cabot, and
Dr. S. J. Meltzer have all written about medical diagnosis in a way
which is suggestive and stimulating even to those who have had
no medical training. The modern approach to the study of history
is clearly set forth in a book that case workers should all read, the
admirable Introduction to the Study of History by Langlois and

Seignobos. Alfred Sidgwick's books on logic have also been con-
sulted in the treatment of the subject of inferences.From applied
psychology, apart from the measuring scales now in use, we are
likely to receive in the future contributions which may, in many
important particulars, modify the methods described in this book.
Until case workers know more about psychology, however, than
they now do, they will not be able even to formulate their needs in
1
See page 483.
4 49
SOCIAL DIAGNOSIS
a way to command the psychologist's attention. There are, then,

tasks of absorbing interest awaiting the social case workers of this
and the next generation.
SUMMARY OF THIS CHAPTER

1. Social evidence be defined as consisting of all facts as to personal or
may
family history which, taken together, indicate the nature of a given client's social
difficulties and the means to their solution.
2. Depending as it does less upon conspicuous acts than upon a trend of behavior,
social evidence often consists of a series of facts any one of which would have slight
probative value, but which, added together, have a cumulative effect.
3. Social evidence differs from legal evidence in that it is more inclusive and that
the questions at issue are more complex. For these reasons, careful scrutiny of the
reliability of each item of such evidence is all the more necessary.
4. The usefulness of social evidence outside of what is usually described as social

work has been demonstrated in the diagnosis of physical and mental disorders, in
the procedure of courts with certain groups of defendants, in the differential treat-
ment of children in the schools and in their vocational guidance. As tests of its
reliability are better formulated and more generally accepted, it will be put to still
wider use.
5. Social work has its own approach to evidence, but as regards the testing of
its evidential material it hasmuch to learn from law. medicine, history, logic, and
psychology.
CHAPTER III
DEFINITIONS BEARING UPON EVIDENCE

first interview with one needing treatment, the early
contacts with his immediate family, the consultations with

THE those outside his family who may give insight or co-opera-
tion, the examination of any documents bearing upon his problem,
the later correlation of these separate items all these processes of
social case work are steps in what we hope will be a helpful course
of action. They lead up through social diagnosis to a plan of
treatment. The relation of diagnosis to this practical end cannot
be too much insisted upon. Before turning to the discussion of
this relation in present-day case work practice, however, it is
necessary, even at the risk of some repetition, to prepare the way

for the more concrete material which is to follow by giving at this
point a few formal definitions.
CERTAIN TERMS FREQUENTLY USED

I.
Diagnosis. The use of the word diagnosis is not restricted to

1.
medical case work; it means in zoology and botany, for example,

"a brief, precise, and exclusively pertinent definition." In social
diagnosis there is the attempt to arrive at as exact a definition as
possible of the social situation and personality of a given client.
1
Investigation, or the gathering of evidence, begins the process, the

critical examination and comparison of evidence follow, and last
come its interpretation and thedefinition of the social difficulty.
In common use, case workers often call all of this "an investiga-
tion," but, as their besetting sin is to slur over the processes of
comparison and interpretation and to overemphasize the gathering
of items of evidence, there is an educational advantage in using
for the whole process the word which describes more especially the
end of the process. Investigation enters into diagnosis, it enters
'See fuller discussion in Chapter XVIII, Comparison and Interpretation, p. 357.
51
SOCIAL DIAGNOSIS
into the laborious and learned seeking for truth which deserves to
be termed social research, and it forms an important part of the
many inquiries into social conditions which do not meet the exact-
ing requirements of research, but which may properly be described
as social investigations. While the word investigation is used in
all these forms of social inquiry, the place which the process itself
fills in social diagnosis, however necessary, is subordinate. An

added advantage in the word diagnosis is that its use in medicine
has given it the valuable connotation of a time limit. A diagnosis
may be and often must be revised, of course, but a relatively in-
elastic time limit, together with the beneficent action always in
view, constitute the controlling conditions of diagnosis in social

work.
2. Witnesses. In so far as personal statements rather than
documents are drawn upon by social diagnosis for its evidence,
case work deals directly with witnesses. These must not be confused
with trained observers. The latter word belongs to natural science;
the former is primarily a law term. The observer is trained to
accuracy, is on the lookout for facts tending to uphold or discredit
some hypothesis; the witness reports what he has seen or heard
incidentally in the course of his daily life. The observer uses con-
trolled experimentation as his method, approaching his subject
with impersonal detachment; whereas the witness has no method,
is liable to personal bias, and is accurate or not according to his
native powers of observation and memory. Rarely is the witness

whose testimony is recorded in the interviews of social records an
observer in the scientific sense. 1
Case records sometimes ask for and set forth the statements of
references.The word describes those who vouch for another.
The slackness of its meaning is reflected in the quality of evidence
"
secured, this frequently amounting to no more than the vouching"
of the early days of English law courts, when almost the only evi-
dence sought was that of witnesses who swore under oath to the
innocence or guilt of the defendant. Social case workers are some-
times content with equally bare testimony as to a man's sobriety
and industry even from references who are presumably in command
of factswhich would throw light upon the cause of his need and
1
See Chapter II, Nature and Uses of Social Evidence, p. 40.
52
upon methods of removing it. For example, a clergyman

possible
who a family for aid with the statement that he has known
refers
the man for some time and can vouch for him, must be in possession
of some definite facts about the man in question which would prove
helpful in planning treatment for the family. The initial difficulty

in case work is always that of getting at facts which are ample and
pertinent.
3. Fact. What do we mean by the word fact? It is not limited
to the tangible, as James Bradley Thayer has pointed out. 1
Thoughts and events are facts. The question whether a thing be
fact or not is the question whether or not it can be affirmed with
certainty. Social workers do not always bother to ask themselves
whether the statements they make can be affirmed with certainty.
It is no unusual thing, for example, to read in a social case record
the entry, "Gave the inquiring agency all the facts in this case,"
or "Asked the committee what they would advise in view of the
facts in our possession," when not a single fact or only a few irrel-
evant ones had been obtained. Records even show instances of
letters having been sent to other states or countries suggesting
"
action on some family situation and presenting the following
facts," when the alleged facts are no more than unverified state-
ments intermingled with the opinions and conjectures of the writer.
The following is a case in point:
A case work agency wrote this answer to an agency in another state: "The Aid
Society here in X has known the Y family since January, 1910, and we have con-
sulted their record and also have looked up two references given in your letter. A
year ago the Aid Society looked up Mr. Y's work references and his employers all
speak ill of him. They say he was a shifty fellow who drank heavily, did unsatis-
factory work, was untruthful, and has even been accused of stealing. have We
heard that Mr. Y has at different times gone under assumed names. believe We
that Mrs. Y is of a much better sort than her husband, though we have only her
friends' word for it."
The "facts" in this case were that the Aid Society, although its acquaintance
with the family began in 1910, had not kept track of them all that while, but had
only the intermittent knowledge accompanying two appeals for relief. The em-
ployers who "all speak ill of him" consisted of but one employer with whom the
man worked a year and whom he left of his own accord. This one employer, how-
ever, didspeak of the man as shifty. The testimony as to drink came from a land-
lady, not an employer, while the accusation of theft was made by the woman's
1
Preliminary Treatise on Evidence, p. 191.
53
SOCIAL DIAGNOSIS
brother, the theft being of clothes loaned by this brother which the man wore when
he house owing money for board. Mr. Y had used no alias but the
left his relative's
last name of his stepfather, and the alleged reason for his doing this had not been
verified. The last sentence is frankly a mere expression of opinion.
However near the truth may be the general impression conveyed

by this letter, since the statements taken one by one could not be
"affirmed with certainty," the agency to which this information
was sent could not, on such a basis, plan treatment that would
strike at the root of the trouble.
Every body of organized knowledge and skill advances in accord

with its command of facts relevant to its aims. To take an in-
stance far afield: An advertiser, writing in Printers' Ink, says that
"
Many an advertisement contains little arid spots, each of which
represents a fact which the copy writer didn't know, and the lack
of which had to be glossed over with language." This sentence
might have been written about many a social case record, though
it would have fitted the record of ten years ago still better.
The
gathering of facts in any field of interest is made difficult
first recollection or by inexpert or prejudiced observation
by faulty
on the part of persons giving testimony, and second by a confusion
between the facts themselves and inferences drawn from them on
the part either of witnesses or, in the special realm of our study,
of social workers.
The confusion between the fact itself, even when accurately
observed, and the inferences drawn by the observer is well illus-
trated by Dr. S. J. Meltzer:
A physician has given ... let us say, five grains of phenacetin to a pneu-
monia patient with a temperature of 105 F. on the seventh day of the disease.
The temperature dropped to normal and the patient got well. The non-critical
physician might record it as a fact that five grains of phenacetin reduced a tempera-
ture of 105 F. to normal and cured the patient. But this was not a fact; it was a
conclusion [an inference] and a wrong one . . . ; the cure was accomplished by
the crisis which accidentally set in after the giving of the phenacetin. Possibly the
reduction of the fever was essentially also due to the crisis. What the physician
actually observed were the three facts following one another, (i) the giving of the
phenacetin, (2) the reduction of the fever, and (3) the recovery of the patient. The
connecting of the three facts was ...
an act different and separate from the
facts he actually observed. 1
1
"Ideas and Ideals in Medicine," in Journal of the American Medical Associa-
tion, May 16, 1908, p. 1577 sq.
54
An American statesman who justified a public act by the asser-

tion that he "dealt with the facts," was criticised in a leading
article of the New York Evening Post as follows :
The assumption is that to ascertain facts and act upon them is the easiest thing
in the world. Principles may be cloudy and ideals escape us, but when you have a
big, brutal set of facts before you, how can you go wrong? Everybody who stops
to think, however, knows that dealing with one of the most delicate opera-
facts is
tions of the human mind. There is, enormous difficulty of

in the first place, the
making sure that the facts are as stated to us by others. Next comes the arduous
duty of avoiding that "instinctive theorizing," whence the fact looks to the eye as
the eye likes the look. And in the end there is the obligation to decide what is the
correct inference to be drawn from the facts, once granted that they are clearly
"
established. To say in defence of challenged conduct, I dealt with the facts,"
is no defence at all unless you are able to show that you first got your facts straight
and then dealt with them properly. 1
Thus at the threshold of our consideration of social evidence,

the duty confronts us of making sure what are facts in a client's
situation. Evidence which is reliable and which is sufficient in
amount and cogency is the for searching diagnosis;
first requisite
the second is clear reasoning to inferences that shall further our

purpose. The use of inference, then, the act of passing from some
fact, belief, or judgment about a matter bearing on the client's
difficulty to a further judgment, is an important part of diagnostic
skill. Its risks in case work, and its relation to assumptions and
2
hypotheses, are discussed at length in a later chapter.
4. Evidence. The words evidence and proof are often confused.
Evidence is the ultimate fact or facts offered as a basis for infer-
ence; inference, a part of the process of reasoning from this fact
or facts to another unknown fact; while proof is the result of
the reasoning. In social diagnosis, the kinds of evidence available,
being largely testimonial in character, can of course never show a
probative value equal to that of facts in the exact sciences. All
that is possible for us is to obtain proof that amounts to a reason-
able certainty. Social treatment is even more lacking in precision

than the treatment of disease, of which Dr. Meltzer says that every
treatment is an experiment. This is true partly because social
work has as yet amassed but a small body of experience, partly
because its treatment demands for success an understanding of
*New York Evening Post, August 19, 1911. *
See Chapter V, Inferences.
55
SOCIAL DIAGNOSIS
"characterology," for which no satisfactory body of data yet

but most of all because, for the social case worker, the facts
exists,
having a possible bearing upon diagnosis and treatment are so

numerous that he can never be sure that some fact which he has
would not alter the whole face of a situation. He can,
failed to get
however, partially offset these handicaps by being on the lookout

for the special liability to error characteristic of each type of evi-
dence used in his investigations.
TYPES OF EVIDENCE
II.
Distinctions have been made by the law that will be of some

service to us here, although it would be easy to exaggerate their
value. Evidence in the law is used to ascertain the existence of a
particular disputed fact; in social work, as already indicated, the
problem is much less simple. Nevertheless, since case work shares
with the law the risks and the advantages that come from a depen-
dence upon testimony for the bases of action, the legal classifica-
tions of evidence should be kept in mind. 1
The kinds of evidence presented to courts may be divided into
real, testimonial, and circumstantial. There are many other classi-
fications, but they are not of general application; they refer to
some special danger or weakness of evidence as offered in courts,
for the sake of which a rule of caution has been established. These
three kinds of evidence differ in the ways in which we make our
inferences from them; in real evidence no inference is needed;
in testimonial evidence the basis of our inference is a human asser-
tion; in circumstantial evidence the basis of an inference is any-
thing whatever except a direct human assertion. This may not seem
clear, but the explanations which follow should make it so, and the
distinctions made
are important enough to be studied closely.
1. Real Evidence. In real evidence the very fact at issue is
presented to our senses. The classic instance in the law is that of

the tailor and his customer who disagree as to
the fit of a coat.
The customer wears the coat during the trial, and
tailor sues, the
the jury sees for itself whether the coat fits or not. 2 Real evidence
1
For suggestions and criticism in this part of the chapter the author would make
grateful acknowledgment to Professor J. H. Wigmore, Dean of Northwestern
University Law School.
*
Thayer's Preliminary Treatise on Evidence, p. 363.
56
may become the basis of an inference and usually does. Thus, a

person seen
is to be of a certain size and complexion, and to have
a certain cast of features. These are real evidence as to his appear-
ance, from which we may infer that he is of a certain age.
1
In social case work, real evidence is any item of evidence had

by first-hand inspection. The appearance of a client's home is
real evidence as to the conditions under which he lives; the meal
on the table is real evidence that his family is not without food;
and so on. When, however, the case worker who makes these in-
spections reports them to others to case supervisors or commit-
tees, for example the evidence which was "real" to him is testi-
monial to them, as it comes to them on the assertion of the worker.
2. Testimonial Evidence. This is the assertions of human
beings. There is an important distinction here for the case worker
between the testimonial evidence of one who says he saw or heard
the supposed fact himself, and that of one who asserts it only from
what others have told him. The latter is called hearsay evidence.
As a statement is passed along from one to another it is very easy
for error to creep in. In court, therefore, the first question is,
Did you see or hear this affair yourself? And if the witness says,
No, Mrs. Jones told me, then the judge says, Send for Mrs. Jones,
and we will ask her to tell us whether she saw it; and so on, until
they find some first-hand observer.
The social worker and the historian cannot and need not reject
an item of hearsay evidence, as the court does; but (i) they should
be cautious in relying upon it, and (2) they should, if possible,
probe back until they find an original observer. Few things would
strengthen social diagnosis more effectively than the habit of dis-
covering, in interviews with witnesses, the extent to which their
assertions are founded on observations or on mere rumor. "An
event is attested three times by three chroniclers," says Langlois,
"but these three attestations, which agree so admirably, are really
only one, if it is ascertained that two of the three chroniclers copied
the third, or that the three parallel accounts have been drawn from
one and the same source." 2
1
See Wigmore, J. H.: A Treatise on the System of Evidence in Trials at Common
Law, Vol. 11, Sec. 1150. Boston, Little, Brown, and Co., 1904.
An Introduction to the Study of History, p. 94.
57
SOCIAL DIAGNOSIS
The following illustrations of the risks in hearsay evidence are

taken chiefly from our reading of social case records.
L. H. Levin of the Federated Jewish Charities of Baltimore tells of one case
treatment in which it was necessary to consult a merchant about a former employe.
The merchant answered by quoting the report of his manager that the man was list-
less,tardy, and inclined to shirk work. Fortunately the manager was seen for fur-
ther details, and was found to base his opinion solely upon the employe's tendency
to come late and leave his work early. He added by the work-
that the reason given
man was that he must take care of his home. The
worker found that the
social
home consisted of a sick wife and a number of helpless children, and that the hus-
band and father felt the imperative necessity of caring for them.
[Neither manager nor merchant intended to deceive. The manager's report,
however, because first-hand, showed more clearly than the merchant's what was
fact and what inference, and was therefore easier to reconcile with the other evidence
obtained by the social worker.]
Theparents of a baby under treatment in a dispensary were boarding with a
friend. A milk station nurse who was visiting this friend's family reported to the
dispensary that the friend's children had syphilis, whereupon the dispensary visitor
proceeded at once to advise the use of separate towels, dishes, etc. She then looked
up the medical record of the boarding house keeper's children and found that the
trouble was not syphilis but scabies. The milk station nurse had secured her in-
formation from the mother of these children. The original source for medical
information, in other words, is the doctor or his record, and not even a layman so
near to the situation as the patients' mother.
A girl was brought late at night to a hospital by a policeman. When her land-
lady was seen the next day by a visitor from the medical-social department of the
hospital she stated that the girl had been picked up on the street in an intoxicated
condition, and that the policeman who found her had said she was a "tough lot."
At the police station, however, the patrolman said that he had never seen the girl
until he discovered her in an unconscious condition, and that, so far as he knew,
she was not intoxicated. Two physicians reported that the girl had heart attacks.
The landlady was a hearsay source as to the girl's condition when picked up; the
policeman a first-hand source as regards his own experiences with the girl; the
doctors who had made a physical examination were the only first-hand sources as
regards her physical condition.
A case worker supplies the following example of hearsay evidence from recent
experience: A neighbor said of Mrs. B that she neglected her little girl and had been
ordered by the school to cut off the child's hair. The inference which the investi-
gator was intended to make and did make was vermin.

Inquiry at the school,
however, showed that the child's hair had been cut off because of a rash. On another
occasion the brother-in-law of this same client reported that the clinic nurse had
said in a way that made it sound detrimental that she was "through with Mrs.
B." Inquiry showed that this nurse, in attempting to get the little girl into a pre-
ventorium, had failed repeatedly to find Mrs. B at home (the woman was away at
58
her work of washing and ironing), and had remarked that she would give up trying
to find her.
The reporter of this case, who is a graduate of a law school, feels

that many social case records show a failure to recognize the burden
of proof as resting on the one who attacks a client's character, and
even a tendency on the part of some case workers to accept with-
out scrutiny any bit of unfavorable testimony that may help them
to classify clients more readily. The rule of law which requires that
the best evidence procurable shall be produced would, in her
opinion, be a safeguard. Moreover, the social records that had
come to her notice did not show that in weighing evidence allow-
ance had been made for prejudice where it undoubtedly existed.
Prejudice or bias in witnesses is one of the things for which to cul-
tivate a keen eye, as will appear in the discussion of Testimonial
Evidence in the next chapter.
3. Circumstantial Evidence. This is the catch-all; it includes
everything which is not the direct assertion of a human being. By
"direct assertion" is here meant one which if true would estab-
lish the point immediately at issue; whereas an indirect assertion
indirect evidence of any kind, in fact merely asserts some other
fact which, in turn, tends to establish the point at issue.
Suppose the point to be determined in a given case is whether

a husband feels affection for his family a question which is of
practical importance sometimes in case decisions. If the wife
states that her husband does not care for her and their children,
she giving direct testimonial evidence. She may be mistaken or
is
she may misrepresent, but the assertion bears directly upon the
issue,and the only risks involved in accepting her evidence as
proof are the risks involved in judging her competence and her
bias. When, however, she names certain cumulative circumstances
from which might be inferred the state of the man's affections;
when she says that he gives her $6.00 a week out of $22, that he
spends over half of his leisure time away from home, that he is
irritable when he does appear there, etc., these statements, which
would be direct testimony as to his habits, are only indirect testi-
mony as to his indifference. Now this indirect testimony is subject
to the same competence and bias as the wife's direct testi-
tests of
mony, both being the assertions of a human being. But to the

59
SOCIAL DIAGNOSIS
inferencesdrawn from the former additional tests must be applied;

if believed, become the bases of an infer-
these assertions of fact,
ence to another fact. We must ask: Do they, taken together,
fairly indicate the thing inferred? Do the meager allowance, the
frequent absences, and the irritability granting all to be true
really mean what the wife asserts that they mean? Are any other
explanations possible? If they are, it is the duty of the case worker
to seek for them.
Note in the foregoing the cumulative effect of adding item to
item of indirect evidence, each a comparatively weak basis of in-
ference in itself, but gaining in cogency with every circumstance
added. Circumstantial evidence, always indirect, is characteris-
tically cumulative. Moreover, any fact in the material universe
or in the mind of man may become the basis from which some other
fact is inferred. The trustworthiness of this indirect evidence,
apart from the bias and competence of the witness through
whom it may have come, depends upon a set of considerations
which vary with the nature of the subject matter for ex-
ample, electric wires, coal, medicine, cooking utensils, sewer gas;

whereas the trustworthiness of direct evidence depends upon cer-
tain human traits possessed in varying degrees by all witnesses,
such as honesty, bias, attention, suggestibility, etc.
memory,
The relation of these traits to evidence will be discussed in the next
chapter.
Despite the difficulty of drawing correct inferences from circum-
stantial evidence, it has the advantage over direct testimonial
evidence that the inference does not depend upon the elusive per-
sonal trustworthiness of a witness; for example, if a child's back
is wounded in a certain way, the shape of the wound may be such
as indicates infallibly that it was beaten with an instrument and
that the father's assertion about the child's falling down stairs must
be false. The case worker will have to use both kinds of testi-
monial evidence direct and indirect. In using indirect evidence,
moreover, he will have to adapt his tests to an infinitely varied
subject matter.
Besides these cardinal distinctions of evidence, there are certain

minor distinctions which may be of service to the social worker.
60
Oral testimony defines itself. It is the main reliance of the social

diagnostician.
Documentary evidence is of many kinds, from formal documents of
legal origin to the informal letters and writings of private per-
sons. This subject of the uses of documents in case work is im-
portant enough to receive separate treatment in Chapter XIII,
Documentary Sources. Suffice it to say here that it is a dangerous
thing to trust to anyone's memory of a document ; hence the rule
of law, Always look at the document itself. If a tenant says,
"The landlord sent me
a notice to get out," call for the document.
It may read: "// you do not pay your rent by next Monday, I
will put you out/' which is a different thing.
Expert evidence is one species of testimonial evidence. Its use

signifies that the subject under consideration is one which is
believed to need special skill in observing and judging. The ad-
vantage of expert testimony lies in the skill of the person giving it.
A physician can tell to what extent certain children are suffering
in health, whereas the social worker's opinion would be of little
value. Hence, call in an expert whenever the judgment to be made
is one that should not be based on ordinary experience. The dis-
advantage of expert testimony lies in the bias which specialists are
apt to develop. A policeman is a specialist in crime; looking for
the same thing always, his bias may become in time a marked ten-
dency to expect to find it on every hand.
Character evidence needs no defining. Since the social worker
seeks to discover the possibilities of bettering a client's situation,
he naturally must look for those traits in the client and his family
which may further or obstruct his purpose.
Years ago, when it often happened that the choice of treat-
ment hardly went further than between the giving or refusing of
coal and groceries, character evidence in social work was, as in the
law courts, a mere generalized estimate, favorable or unfavorable,
of an individual's characteristics. He was either worthy of relief
or unworthy. The social worker's preoccupation, like the lawyer's,

was with desert. Since on that basis the case worker's decision
against any became invidious, the pre-
client's application for aid
sumption, as a matter of justice, had to be in the client's favor.

The burden of proof rested with those who gave evidence as to
61
SOCIAL DIAGNOSIS
unworthiness. One still sometimes finds this point of view in

private agencies and public departments. As a rule, however, the
case worker's interest is approaching an impartial study of per-
sonality, such as concerns itself not with the meting out of punish-
ment or reward (the offering of almshouse or outdoor relief, for
example) but with the determining of all traits, whether in their
good or their bad aspects, as they affect the possibility and the
method of social reconstruction. The successful outcome of case
work is nowhere more dependent upon flexibility of method than
in the study of personal traits. The choice of method being wide,
and there being, generally speaking, no presumption in favor of
one diagnosis rather than another, the social case worker, like the
"
physician, has little call to consider the burden of proof." Never-
theless, since the worker in his effort to arrive at an understanding
must be free to take into account not only
of a client's personality
hearsay evidence but, with due precautions, even rumor, he may

find it sometimes necessary to guard against his own infirmities
ofjudgment by placing, as already suggested, the burden of proof
with regard to his client's less admirable traits upon those who give
this unfavorable testimony.
The relative importance of the distinctions made in this chapter
is many ways greater to the lawyer, historian, or scientist, than
in
to the social worker. The conspicuous thing which the social case
worker can learn from the lawyer is the risks involved in the various
types of evidence, while from the historian he can learn the im-
portance of a rigorous examination of sources of information as to
their trustworthiness. From physician and psychologist social
work has more to learn than from either lawyer or historian, inas-
much as science, unlike law or history, can throw direct light on
the social needs and possibilities of the case worker's clients.

I. Social diagnosis is the attempt to arrive at as exact a definition as possible of
the social situation and personality of a given client. The gathering of evidence,
or investigation, begins the process, the critical examination and comparison of
evidence follows, and last come its interpretation and the definition of the social
difficulty. Where one word must describe the whole process, diagnosis is a better
word than investigation, though in strict use the former belongs to the end of the
process.
62
2. A controlling condition in social diagnosis is its relatively inelastic time limit
as compared, that is, with other forms of social inquiry. This does not mean that
a social diagnosis cannot be revised; often it must be. Another controlling condi-
tion is the beneficent action always in view.
3. The word fact

not limited to the tangible. Thoughts and events are facts.
is
The question whether a thing be fact or not is the question whether or not it can
be affirmed with certainty. The gathering of facts is made difficult by faulty
observation, faulty recollection, and by a confusion between the facts themselves
and the inferences drawn from them.
4. Real evidence is the very fact at issue presented to our senses. Testimonial
evidence is the assertions of human beings. Circumstantial evidence is the catch-
all; includes everything which is not the direct assertion of a human being
it the
assertion, that is, which if true would establish the point at issue.
5. The three classes of evidence which are of general application may be distin-
guished by the way in which we make inferences from them. In real evidence no
inference is needed; in testimonial evidence the basis of our inference is a human
assertion; in circumstantial evidence the basis of our inferencemay be anything
at all.
6. There is an important distinction in testimonial evidence between the evidence

of one who says he saw or heard the supposed fact himself, and that of one who
asserts it only from what others have told him. The latter is hearsay evidence. It
should be relied on with caution, and a very necessary practice in interviewing
witnesses is to discover the extent to which their assertions are founded on observa-
tions or on mere rumor.
7. There is another important distinction in evidence between direct and in-
direct evidence. Circumstantial evidence is always indirect and characteristically
cumulative. In direct evidence, the only tests of trustworthiness needed are those
usually applied to human traits, such as honesty, bias, attention, memory, sugges-
tibility, etc.
CHAPTER IV
TESTIMONIAL EVIDENCE
an historian has established the genuineness and
authorship of a document, his next care is to discover the
ATER competence and bias of the man who made it to go back, ;
in short, to the testimonial evidence, the human assertions, on

which the document is based. The following passage summarizes
1
many of the queries suggested by Langlois and Seignobos in their
discussion of the tests of an author's good faith and accuracy.
Questions of legal competency aside, it will be seen that, with slight
variations, these tests would apply to the competence and bias of
any witness. They are most suggestive in the field of social work
and deserve the case worker's careful consideration.
Good Faith. Were there any practical advantages to be gained by the witness
who made the statement in its present form? Had he an interest in deceiving?
What interest did he think he had? (We must look for the answer in bis tastes
and ideals, not in our own.) If there was no individual interest to serve was
there a collective interest, such as that of a family, a religious denomination, a
political party, etc.? Was he so placed that he was compelled to tell an untruth?
Was some rule or custom, some sympathy or antipathy, dominating him? Was
personal or collective vanity involved? Did his ideas of etiquette, of what polite-
ness demanded, run counter to making a perfectly truthful statement? [We do not
know a man at all until we understand the conventions that form so large a part of
the moral atmosphere which he breathes.] Or again, has he been betrayed into
telling a good story, because it made an appeal to the artistic sense latent some-
where in all of us?
Accuracy. Was the statement an answer to a question or a series of questions?

(It is necessary to apply a special criticism to every statement obtained by in-
terrogation.) What was the question put, and what are the preoccupations to
which it may have given rise in the mind of the person interrogated? Was the
observer well situated for observing? Was he possessed of the special experience
or general intelligence necessary for understanding the facts? How long before
he recorded what he observed? Or did he record it, like some newspaper accounts
of meetings, before it happened? Finally, was the fact stated of such a nature that
it could not have been learned by observation alone?
1
Introduction to the Study of History, p. 165-176.
64
Like the historian, the case worker must have for the weighing
of the evidence with which he deals a clear understanding of the
two factors which condition the value of testimony; namely, (i)
the witness's opportunity to know the facts and the way in which
he has used this opportunity his competence, in short; and (2)
those ideas or emotions of the witness which may prejudice his
judgment his bias.
I. THE COMPETENCE OF THE WITNESS

Case workers heed the competence of a witness only in an
unavowed and hit-or-miss fashion. Their daily experience it is
true teaches them to take roughly into account the witness's op-
portunity to know the facts. For instance, they frequently find
that the person referring a client for care thinks he has had ample
opportunity to know the client's affairs when the reverse is the case.
A charitable woman relief for a capable widow whom she said she had
asked
known well for years. appeared, however, that she did not know how many
It
children were at home, whether the oldest son was working, what were the woman's
habits as to drink, what the family income was, or whether, in fact, they needed aid
at all. She had not been to the home of this family for several years, and had
taken the statement of need as the widow gave it to her one day in church. The
charitablewoman was quite surprised, as her conversation with the secretary of the
agency proceeded, to discover how superficial was her knowledge of any of the real
circumstances of the widow's family life.
The social worker has to be on guard against this same risk in
consulting the relatives of a client. Some relatives know a great

deal, and others, who think they know everything, really know very
little.
An agency tried to interest fairly well-to-do relatives in the needs of a delicate

man with a wife and several children. They were not responsive. They claimed
they had already helped more or less, that they had burdens of their own, and that
he was a loafer, a "poor shrimp," as one of the kin described him. It turned out
that the man had locomotor ataxia, the result of syphilis. With this medical diag-
nosis, which explained to a considerable extent the man's ill success, the worker
again appealed to the relatives, this time with good results.
This man's brothers and cousins had had no opportunity to learn

the crucial point in his situation, and were therefore not competent
witnesses as to his character for industry.
Ordinarily employers would not be competent witnesses as to a
5 65
SOCIAL DIAGNOSIS
man's home conditions; social acquaintances as to his industrial
capacity; nor a social agency that trusted to intuitions as to his

personal repute. These would be facts concerning which the
groups named could have had no knowledge.
The use which a witness has made of his opportunity to know the
facts is a subject which social workers have hardly begun to con-
sider;it therefore does not admit of adequate discussion at present.
Inasmuch as this use depends upon the witness's powers of atten-

tion and memory, upon his suggestibility, etc., any searching in-
quiry into the relation of these factors to a witness's competence

must come from the psychologists. To case workers, however, will
have to be entrusted the application of the elements of psychology
to testimonial evidence in their own field.
1. Attention. The on the part of any wit-

closeness of attention
ness to an incident in his own
or another's situation 1 depends upon
the importance which at the time he attaches to it, or, it may be,
upon the existence of a similarity between some part of that inci-
dent and something which he has experienced before upon his
"funded thought." 2 This "funded thought" is his material for
1
In one of the short, unpublished papers referred to in the Preface, Mr. Julian
"
Codman, writing on Evidence in its Relation to Social Service," gives the follow-
ing instance of inattention:
One day Mr. P, a lifelong resident of Nahant, a man of high cultivation and
exceptional ability, and an enthusiastic golfer, came to the chairman of the green
committee of the Golf Club and told him that he thought part of the course was
unsafe for passers-by. This was a place where the county road crossed the course.
He said that he thought a notice should be put up warning all players to look and
see that the road was clear of foot-passengers and carriages before playing a ball
from the teeing ground. The chairman suggested a notice as follows, and asked
if that would be sufficient:
"DANGER: All persons before driving from this tee are cautioned to see that
no one is passing in the road."
Mr. P said that he thought such a sign would be just the thing.
"Well," said the chairman, "a sign in exactly those words in letters three inches
long in black paint on a white ground has been in front of your eyes every time you
have driven off that tee during the last six years."
Have you any doubt that, if Mr. P had been called on the witness-stand to
testify as to the presence or absence of a sign in that particular tee, he would have
taken his oath that no such sign existed? And he would have so sworn with the
utmost confidence in his correctness. [The explanation for this gentleman's ap-
parent inattention may have been that for six years he had heeded the warning
given by the sign board automatically, and that therefore its importance for him-
selfhad long disappeared.]
*"
I remember vividly a case of jealous murder in which the most
important
witness was the victim's brother, an honest, simple woodsman, brought up in the
wilderness, and in every sense far-removed from idiocy. His testimony was brief,
66
thinking, the sum total of ideas which his traditions, education, and
experience have made an integral part of his mind. New experience
which is entirely strange, which he can relate to nothing in his past
thinking, he will not heed.

A woman whose husband showed signs of mental disturbance consented to his
being observed with a view to commitment for hospital care. She did this, how-
ever, merely because she was desperate at what she considered his incorrigible
laziness, and because she knew she would be better off without him. The social
worker interested could neither make her see that he was other than normal men-
nor give her a conception of what it meant to be insane without violent mania.
tally,
His occasional abuse of his wife, his desire to keep her in the house so that she
should not talk with neighbors, his ungrounded suspicions of her fidelity and of his
son's honesty, she apparently took for granted as "crankiness the way he was
made." His incompetence even in the least skilled work she of course accounted
for as wilful indolence.
This woman was familiar with the idea of the unreasonable and
lazy husband, and totally unfamiliar with the idea of an early
stage of insanity. This last idea therefore could not command her
attention and credence as an explanation of her troubles. case A
worker who wants to get evidence throwing light on mental abnor-
malities from uneducated people is likely to have better success by
leading them to talk not about "peculiarities" but about temper,
laziness, etc. familiar domestic phenomena. The social worker,
then, in weighing evidence, must take account of differences in the

funded thought of witnesses, in so far as this is likely to affect
the objects or incidents to which a particular witness will give
attention.
The influence of the social worker's own funded thought upon
his success in collecting evidence shows in the following instance,
supplied by one who was training young case workers:

decided, and intelligent. When the motive for the murder, in this case most
important, came under discussion, he shrugged his shoulders and answered my
'
question whether it was not committed on account of a girl with Yes, so they
say.' On further examination I reached the astonishing discovery that not only
the word 'jealousy' but the very notion and comprehension of it were totally foreign
to the man. The single girl he at one time had thought of had been won away
from him without making him quarrelsome, nobody had ever told him of the pangs
and passions of other people, he had had no occasions to consider the theoretic
possibility of such a thing, and so 'jealousy* remained utterly foreign to him. It
is clear that his hearing now took quite another turn. All 1 thought I heard from
him was essentially wrong; his 'funded thought' concerning a very important, in
this case a regulative, concept, had been too poor." Gross, Criminal Psychology,
p. 21-22.
67
SOCIAL DIAGNOSIS
A post-graduate student in sociology had been sent, after careful directions, to

visita family, but apparently there had been no hooks in his mind on which to
hang his instructions. He could not tell, when he returned to the office, whether
the wife and mother seemed in good health or bad, he had no idea of the woman's
approximate age, or of the number of her children (there were a lot, he thought),
of the number and size of the rooms, or of their condition. But he did learn that
the husband and father was working and that he was a member of a union. As
the young man was writing a thesis upon Trade Unionism, the inference is obvious.
He saw what he knew enough to notice.
"
2. Memory. Social case records area series of miniature biog-
"
raphies," says Professor J. M. Vincent, the materials for which are
gathered while the subject is still living. In part these are auto-
biographical and have both the strength and weaknesses of per-
sonal memoirs." 1 The weakness of personal memoirs is the mis-
leading impression that they give of being contemporary testimony
when they are not; in reality they are memory material; 2 the most
significant things that they narrate may have happened months

or years before.
It is characteristic ofthe uneducated narrator with whom the
social worker frequently has to deal that he must often arrive in-
directly at the time which has elapsed since any given event. He
remembers by associating this event with certain others, the dates
of which are wellknown, such as a public calamity (a war, earth-
quake, or fire) a national or civic landmark (a holiday, an election)
; ;
a family event which is on record (a birth, marriage, or death); a

8
natural phenomenon (the seasons, the tides, the weather).
What appears a defect in memory may sometimes be the inex-
pressiveness often met in ignorant people, an inability to find or
to arrange in cogent order the words needed to describe a past
4
experience. The silence of the peasant has probably a different
1
From one of the short, unpublished papers referred to in the Preface.
* See Langlois and Seignobos, An Introduction to the Study of History, p. 175.
*
The distance in time between two events both of which are in question is ar-
"
rived at in the same way. If anybody says that event A occurred four or five days
For when A occurred
'
before event B, we may believe him, if, e. g., he adds,
we began to cut corn, and when B occurred we harvested it. And between these
"
two events there were four or five days.' Gross, Criminal Psychology, p. 384.
4 "In other words, discrepancies or inadequacies may appear in reports, which
are due, not only to misdirected attention, malobservation, and errors of memory,
but also to lack of caution or of zeal for accurate statement, to scanty vocabulary,
to injudicious phraseology, or, of course, to deliberate intent to mislead." Guy
M. Whipple, reprinted by Wigmore in Principles of Judicial Proof, p. 576.
68
source. One worker of considerable experience with Lithuanian
peasants attributes it to their doubt as to what is going on in

the stranger's mind, and whether the latter thinks in the same
way as do their own people. As they find common intellectual
ground, they drop their reticence. It takes no small skill on the
part of an interviewer, however, to start the train of ideas which
will induce frank communication from such people.
Memory material is liable to two changes in repeated reporting.
Whipple calls attention to the fact that repetition "tends in part to establish in
mind the items reported, whether they be true or false, and .tends also to
. .
induce some departure in the later reports, because these are based more upon the
memory of the verbal statements of the earlier reports than upon the original
1
experience itself."
In social case work the first, unrehearsed statement of a client or

of those who know him is likely to be the fullest and most reliable.
Competent workers dread the client who has told his story to sev-
eral different social agencies. Becoming tired of repeating his ac-
count of his situation, he leaves out essential parts, or else, having
found that certain incidents had a desired influence upon his
hearers, he emphasizes them and perhaps slights others quite as
significant.
3. Suggestibility. A third factor which affects a person's com-
petence as a witness is his suggestibility. By that we mean an
over-readiness to yield assent to and to reproduce the assertions
of other people. A
witness may confuse observations made by
others with his own; he may give a facile acceptance to what he
reads 2 as well as to what he hears. Dr. Frankwood E. Williams, 8
when secretary of the Massachusetts Society for Mental Hygiene
and member of the Prison Board in that state, noted as one of the
most conspicuous factors in the misdoings of boys at the State
1
Whipple, reprinted by Wigmore in Principles of Judicial Proof, p. 580.
1
"A first and natural impulse leads us to accept as true every statement con-
tained in a document, which is equivalent to assuming that no author ever lied or
was deceived; and this spontaneous credulity seems to possess a high degree of
vitality, for it persists in spite of the innumerable instances of error and mendacity
which daily experience brings before us." Langlois and Seignobos, Introduction
to the Study of History, p. 155.
3
In 1917, Associate Medical Director, National Committee for Mental Hygiene.
69
SOCIAL DIAGNOSIS
Industrial School at Shirley their ready suggestibility for either

good or evil. 1
A had a discouraging struggle with an unusually bright girl

children's agency
in her early teens. She came under the influence of two older girls of low character
and did just what they proposed, which was to go on the street. On the other
hand, when under the influence of the agency's visitor, she conducted herself
properly and showed an ambition to make something of herself. In company with
respectable, intelligent people, she rose to their level, but would drop back again
the moment she chanced upon evil counsels. She would be as absorbed in a re-
vival meeting as in some sailor whom she happened upon afterwards. This girl,
although aware of her suggestibility and of just how it might affect her prospects,
apparently could not control it.
The following illustration, although of an adult, shows the same

weakness:
A man who was a good workman, married, with several children, lost two suc-
cessive positionson the ground of his dishonesty. The second time the charge
was that of receiving stolen goods, the theft itself having been committed by two
other employes. Between his arrest and trial he got work as a chauffeur, and used
his employer's car without permission until he ran into a telegraph pole and dam-
aged the machine. He was placed on probation for a year. After a few months
of temporary jobs, his probation officer got him steady work. From then on he
improved, receiving an advance in wage and then the promise of a foremanship.
To the delight of his wife, his interest in his children awakened. The man himself
said he owed all to the probation officer, who, as he observed, was wonderful in his
understanding of men. Unfortunately for this fellow, probation terms end. At
last accounts he had disappeared, leaving his children to be supported by charity.
While under the supervision of a man of good standards this man could keep
straight. Without that brace he went to pieces.
The case worker must bear in mind that

suggestibility may in-
fluence not only the client's conduct, but also his thinking and his
standards. The girl just cited, in the presence of a refined, earnest
woman worker, would rise above the coarse speech and free
demeanor which she finds an asset among low companions. A
kindly bias common to social workers leads them, in the case of
any client who interests them, especially a young one, to try to

get at those traits that give most promise of amended conduct.
Roused by this bias, the girl's suggestibility, taken together with
1 "The one
factor that more than any other is
responsible
for the poor reports
of children their excessive suggestibility, especially in the years before puberty."
is
(Whipple, reprinted by Wigmore in Principles of Judicial Proof, p. 580.) This

is strikingly illustrated in Whipple's report of a Belgian murder trial, reprinted by
Wigmore. (The Puyenbroeck Case, Principles of Judicial Proof, p. 521.)

70
her desire to please, may make her not only seem but be so different
a person while in the presence of the social worker that the latter
forms a mistaken estimate of her character as a whole. What is
true of such a girl as the one referred to, is true to a lesser extent
of the man who was influenced by the probation officer.
Suggestibility may even reach the extent of leading to mistaken

confessions:
A judge was about to sentence to prison a woman who had been arrested for
disorderly conduct and for attracting a crowd on the street. Although she made a
long and circumstantial confession of immorality, her apathetic manner awakened
doubt in the mind of a social worker present. This worker, having secured a sus-
pension of sentence, traced the woman's husband and relatives to another city and
found that her claim to have been long leading a prostitute's life was without
foundation. The prisoner's "disorderly conduct" was due to an epileptic seizure.
Her confession showed the need, not of a prison sentence, but of observation in a
psychopathic hospital.
This woman, arrested for disorderly conduct, was undoubtedly

assumed by the police to be of low character and probably put in
jail among women of this sort. May the layman venture to sur-
mise that the frank talk about unsavory experiences to which such
women are prone, and to which she would have been a listener, may
have suggested to her enfeebled mind the story she told the court?
4. Leading Questions. Closely related to the suggestibility of
"
witnesses is the response which they may make to leading ques-
tions." The social case worker must be on guard against getting
back as alleged fact some mere conjecture of his own which he has
implicitly expressed by his wording, or by the inflection of his voice.
"
A case worker with little faith may ask, You have no relatives
who would take in the baby while you go to the hospital, have
you?"; whereas the worker who gets results would put the ques-
tion, "Which of your sisters could best take the baby?"
Aworker in training reported to the district secretary under whom she was
visiting that one of her clients had misrepresented her daughter's wages. The
secretary asked, "Did Mrs. B actually say that Bertha was earning $5.00 a week?"
After thinking a moment, the worker replied, "Why no, but when I said, 'Bertha
is earning $5.00 a week, is she not?' she said 'Yes.'"
The permissibility of leading questions in social work is solely

1
1
In courts of law those leading questions are objectionable in direct examina-
tions (i) which embody a material fact and suggest a desired "yes" or "no" in
71
SOCIAL DIAGNOSIS
a matter of adapting the means in a given case to the end in view.

This end, the social readjustment of the client and of his affairs,
may be defeated by a detective manner or by a shrewd framing of
questions such as places the subject at a disadvantage. The stage
of social inquiry in which case investigators prided themselves upon
an ability to catch people tripping, to surprise an admission, has
given way to a diagnostic method which, shunning small subter-
fuges such as raise barriers between worker and client, establishes
the latter's confidence by a direct approach and by putting aside,
to be sought elsewhere, questions that can be answered equally well
from another source.
"In myearly experience," writes Miss Zilpha D. Smith, "I was apt, in inter-
views, to make, out loud, deductions from what had been told me, and then ask if
my conclusion was right. I learned to check myself in doing this, for it invited un-
true statements."
It is, however, not always possible to avoid leading questions.

Some minds are so sluggish, others so unwilling or unable to recol-
lecta series of events until a starting point has been supplied, that
the common rule against leading questions in case work, like the
similar rule in law, must be "understood in a reasonable sense." 1
Some forms of the leading question remove the temptation to
be untruthful, as in the following example:
A medical-social worker was talking with a patient about whom there was a per-
"
ceptible odor of strong drink. She began, What kind of liquor do you ordinarily
drink and how much?" Then, not waiting for an answer, continued, "With the
disease which you have and the kind of medicine you are taking, all liquor is bad,
and certain kinds are very dangerous." The man told her that he took gin and how
"
much. She feels that had she asked, Do you drink?" he would have denied it.
The question "Do you drink?" is often taken to mean "Do you
drink to excess?" "Are you a drunkard?" and is of course offensive.
The worker framed her question in a way dictated as much by
politeness as by investigating skill.
Itcannot be claimed that framing such questions as will elicit

the truth is always easy, nor will there be unanimity of opinion as
reply; (2) which contain assumptions that facts are known that are not known,
or that answers have been given that have not been given; (3) which constitute an
argumentative series. See Greenleaf on Evidence, p. 538 sq., for exceptions to
these rules.
1
Greenleaf on Evidence, p. 537.
72
to what is is not permissible on ethical grounds.

and what Take,
for illustration,a statement in Mrs. Solenberger's book on Home-
less Men. 1 To a homeless man of over thirty, applying for relief
and guidance, she was accustomed to say in her first interview not
"Are you married?" but "Where is your wife?"; not "Have you
" " "
a family? but How much of a family have you? Some students
of social work have objected to this as a form of deception, advo-
cating "Are you married?" as the more honest question. Experi-

ence has shown, however, that "Are you married?" usually leads
to the answer "No," while "Where is your wife?" usually reveals
the existence of a wife.
A doctor once gave an amusing example of how to avoid the
leading question. He found that when he asked his patients
"
whether they were better they said Yes," and when he asked them
whether they were worse, they also said "Yes," so that he had
learned to force from them an original opinion by framing his
inquiry: "Well, are you worse or better, or bow are you this morn-
ing?" Questions can often be avoided by the use of circumstantial
"
evidence. A probation officer need not say Do you smoke cigar-
ettes?" but "Let me look at your hands."
To sum up, leading questions may suggest to the client answers
which are not true, or they may prevent the establishment of con-
fidence between worker and client. When used at all, it should be
with an awareness of these dangers on the part of the social worker.
II. THE BIAS OF THE WITNESS

1. Racial or National. The risk of bias in testimony is so obvious
that social workers become alive to it in a general way. In the
industrial centers of the United States bias arising from race must
be constantly allowed for. One of the social worker's difficulties
with foreigners is that he does not understand their conventions
any more than they do his; a knowledge of their history and of
their old world environment is indispensable to the most helpful
relations with them. In a paper on a group of South Italians 2
known to her as a social worker, Miss Ida Hull names, among other
1
Solenberger, Alice Willard: One Thousand Homeless Men. A
Study of Origi-
nal Records, p. 22. Russell Sage Foundation Publication. New York, Charities
Publication Committee, 1911.
1
One of the short, unpublished papers referred to in the Preface.
73
SOCIAL DIAGNOSIS
things to be kept in mind, the fact that they have tilled the soil
of their primitive communities according to Virgilian methods, that
they have lived where parish jealousies were strong, where the
machinery of government of the courts, for instance was dis-
trusted; that they are intensely proud of their race and their lan-
guage, and resentful, therefore, of any assumption of superiority
in others; that they act from emotional rather than from reasoned
motives; and that they prefer the leisurely and indirect approach.
Letting fly the question direct means receiving in return evasions, prompted by
a repugnance for what seems intruding brusqueness. Hurry is absolutely fatal to
a successful interview. Social amenities must have their place, and the conversa-
tion must proceed important point seems to come
in such fashion that the in rather
incidentally, or to be suggested by the family itself.
The perplexing experience of a young worker bears this out. She

was an enthusiastic and capable college graduate who belonged to
the Society of Friends and had been trained to the habit of telling
the unflinching truth. Whenever she visited a family in "little
Italy" who were bred in the tradition that the courteous thing to
do was to say whatever a guest seemed to desire said, there was a
clash of standards which finally brought about her assignment to
a district less alien to her traditions.
Social workers will sometimes meet a class bias in peasants from
the old world. The is more likely to assume humility
case worker
in a peasant than to recognize his family pride and the grounds for
it. For example,
A young peasant girl expressed astonishment that an older woman, who had
been adopted from an institution in childhood, had been able to get a good hus-
band. She wondered that such a man would take a woman when he could not
know from what sort of people she came. She herself was expecting to marry a
man the character of whose forebears she knew as well as she knew her own.
Such a girl would be

likely to give biased evidence about one
who was without established family respectability. Miss Emily
G. Balch describes the peasant attitude as follows:
A peasant is thus something quite distinct from anything that we know in Amer-
ica. On the one hand, he is a link in a chain of family inheritance and tradition
that may run back for centuries, with a name, a reputation, and a posterity. On
the other hand, he is confessedly and consciously an inferior.
74
And of racial bias among the various Slavic nationalities, she

says,
In American communities they have different churches, societies, newspapers,

and a separate social life. Too often the lines of cleavage are marked by antipathies
and old animosities. The Pole wastes no love on the Russian, nor the Ruthenian
on the Pole, and a person who acts in ignorance of these facts . .
may find.
himself in the position of a host who should innocently invite a Fenian from County
Cork to hobnob with an Ulster Orangeman on the ground that both were Irish. 1
One in receipt of unfavorable evidence from a Pole about a Russian,

therefore, would have to allow not so much for personal as for
racial bias.
The use of interpreters also presents difficulties. When people
who do not speak English have to be interviewed through one, the
results are the reverse of satisfactory. As one worker put it, if an
interpreter can fulfill his part in an honest, unbiased, and intelligent
way, he had better be turned into a social worker and do the case
work needed himself. Such interpreters are almost non-existent.
A Polish interpreter, either through a misunderstanding or from self-interest,
told a deserted wife with three children that she was to be deported by the state.
She ran off, leaving the children to public care. It took two months to find her and
reunite her and the children, and three years for the state visitor to gain her con-
fidence. Her bias naturally inclined her to trust the statement of one of her own
race and language.*
2. Environmental. Bias also accompanies standards of conduct

springing from this or that kind of education or environment.
An ex-probation officer states that the police officers other than the one making
the arrest in the criminal courts where he served would never give him unfavorable
information about a prisoner before sentence. They would allow him to spend
several hours running down
previous arrests, etc., or would be silent while the
court gave him some old jailbird as a probationer for a first offense, rather than be
guilty of the meanness, as they thought it, of hitting a man who was down.
8
After
the case was settled they would tell what they knew, showing respect for the proba-
tion officer's acuteness if he had not been fooled and some good-natured contempt
for him if he had. It never occurred to them that to succeed in eluding justice
might have a bad effect upon the prisoner's character.
*Our Slavic Fellow Citizens, p. 42 and p. 8.

1
See also reference to interpreters in Chapter VI, The First Interview, p. 1 18 sq.
1
The need of better court records, which would have saved the probation officer
and his client from some of these mistakes, is discussed in Chapter XIII, Documen-
tary Sources.
75
SOCIAL DIAGNOSIS
One meets this personal as contrasted with a social standard of

ethics frequently in people of fine character and of otherwise good
intelligence. may sup-
Mayors, clergymen, teachers, employers
press the truth where they think this would help someone for whom
they are sorry. They want to give him "another chance," often
regardless of the chances he may have already wasted, and of the
treatment best calculated to make him a useful citizen.
A woman whose maid had caused her great annoyance by staying out till the
small hours night after night, and had later left because pregnant, told none of this
to another mistress who inquired about the girl some months later. She said she
did not want to be the one to do it.
This woman thought she was being kind. Again, as in the case
of the police, it never occurred to her that this might be a poor way
to get the girl started right. She did not know how to take active
steps to help her maid, and so did the one passively kind thing
that presented itself.
A medical-social worker had occasion to consult a former employer of one of her

patients about the patient's insurance. The employer denied any knowledge of it,
though the insurance records showed his signature to payments. Here was an
honorable man making a false statement. He explained later that he had promised
hisemploye not to tell about the insurance. The denial was due to what he re-
garded as the demands of loyalty.
Of course, the social worker cannot ask that witnesses violate their
own standards of ethics. These instances show a kindheartedness
that no one would wish less. In the last illustration, however, what
was presumably good nature led the employer to make a promise
which was obviously futile.
3. The Bias of Self-interest. This form of bias is of course
universal. When, therefore, a witness testifies reluctantly and
apparently against his interest, his testimony has special weight.
A charity organization secretary was interested in a family consisting of a wid-
ower and four children under These children came to the office one day,
fifteen.
saying that their father when drunk had turned them out of doors, and that they
had spent the night with a cousin. The secretary called at once on this cousin,
finding his wife at home and himself in bed in the next room. The wife said nothing
except that the children had been there as they said. The next day the secretary
called again and found the woman alone. This time she said she had not dared to
talk openly on the previous day, because her husband would not approve of her
saying things about his uncle. The uncle, the children's father, was drunk most
76
of the time. Although the children should be taken away, she could not go to
court about Her husband, too, drank and often beat her. She did not dare
it.
complain about this even to her own relatives, because her husband had said that
he would kill her father and brother if she did.
This evidence, given under circumstances that warrant one's be-

lieving that the woman had nothing to gain and possibly much to
lose by telling it, carries a strong presumption of truth.
The suppression of facts from a desire to escape work and receive
assistance instead is a fairly obvious form of self-interest. The
following is the only illustration of this particular fault that need
be given:
An Italian girl of thirteen was referred to a medical-social department for gen-
eral hygiene. There were two younger children, the mother was dead, the father
out of work, the home wretched. A young man living there was said by the pa-
tient to be her cousin. The relationship was so described by the public relief
officials, the school teacher, and the Italian society all of which seemed to be con-
firmatory evidence. But a priest who was seen thought that the young man was
a brother, and, as a matter of fact, he was. All of the other agencies had taken the
statement from the family a first-hand source but not a disinterested one. Rela-
tives not living with the family group told the truth, and proof of the brother's
responsibility for support was taken into court, with the result that both father
and son were induced to go to work.
A less evident form of self-interest,

or of what the witness thinks
is such, the is
impulse to gratify some strong emotion. For in-
stance, a young unmarried mother with an unfortunate past
wrongfully accused a former lover of being the father of her child,
because she wanted to pay him back for an old score. Again, an
exasperated mother applied to an agency to get them to make her
stubborn, lazy daughter work and be obedient. She said she could
do nothing with the girl. It turned out that the mother drank, had
always abused her daughter, and was herself immoral. The like-
lihood seemed to be that she made the complaint partly because
she wanted the girl to support her and thought to get this through
the society's supervision, and partly because she feared that, once
the daughter was no longer as amenable to authority as when a
child, her younger attractions might alienate the affection of a
man who had been living with the mother.
Self-interested bias also shows itself in another form, in indi-
vidual or collective self-esteem. An ex-probation officer states
77
SOCIAL DIAGNOSIS
that when she has asked girl shoplifters from respectable families
how they happened to do such a thing, again and again she has
met the reply, " don't know what got into me." Her acquaintance
I
with such girls satisfied her that they had not thought of shoplift-
ing as a serious offense against the law. It had seemed to them a
peccadillo, something rather smart to put through without detec-
tion, like stealing a car ride. When they found themselves behind
prison bars, they were shocked to see themselves without illusion
as thieves, under disgrace. They had never intended to be that;
they had thought of themselves as being far-removed from the
After release, their rallying self-esteem led them to
criminal class.
the half-expressed feeling that it was not their real self that had
committed a crime.
Collective self-esteem appears frequently as family pride.
The secretary of a charity organization society interviewed the brother and

sister-in-law of a deserted wife who was asking relief for herself and children.
The brother blamed his sister's husband for being "no good," and for not support-
ing his family, but could offer no suggestions as to future plans. His wife, how-
ever, advised boarding the children out on the ground that their mother could not
go out to work and at the same time care for them.

A former landlord also condemned the husband, saying that while the deserted
wife lived in his house she had taken excellent care of it and paid her rent regularly.
He did not consider it her fault that the man deserted. Although this landlord had
heard that she went to town with men, he did not regard her as vicious. She un-
doubtedly needed the money, since she never seemed strong enough for work.
With further inquiry, more evidence came to light of this mother's wrong-doing.
The secretary then went again to the sister-in-law who, finding the woman's char-
acter known, testified that the husband had been away many years, that the last
two children were not his, but were the offspring of two different men, the last of
whom was paying the woman an allowance and still living with her from time to
time. The court removed these three children from the mother.
The family pride which led the brother and sister-in-law in this case
to withhold the truth in the first place was of course a feeling one
must respect, however disastrous its possible results to the children
involved or however annoying it may be to a busy worker. They
had never seen the worker before and perhaps could not judge how
carefully he would guard confidences or how much power or in-
terest he might have in remedying a bad situation. The landlord's
bias was twofold. His standards of conduct were evidently easy,
78
inclining him to be beyond reason, and his interests as a

tolerant
landlord prejudiced him in favor of a
good tenant.
There is a bias of self-esteem to which social workers, especially
the clever or informed ones, may themselves become liable. A
desire to be thought penetrating may lead them to interpret facts
of conduct with over-subtlety, to see a certain motive where it does
not exist. To such over-subtlety the social worker is tempted in
dealing with a case of the following type: She learns that a man's
relatives have habitually characterized his marriage as a very good
match on his wife's part. Learning further that the husband has
never told his family of his wife's capability as a manager, she in-
mean that the man has not wanted to modify
terprets these facts to
his family's flattering partiality of judgment towards himself. This
inference on the worker's part might easily spring from vanity at
her astuteness, rather than from unbiased reasoning. As is true
of all prejudice, the cure of this bias lies in becoming aware of it.
Finally, this discussion of testimonial evidence should not close

without the further warning that there is always danger though
the danger here is greatest for the beginner in social work in the
attempt to substitute the results of formulated experience for our
own unguided impulses. We may easily become, for a time at
least, hypercritical. The new worker, while throwing himself with
enthusiasm into the task of mastering a new discipline, may lose
his perspective. "The extreme of distrust in these matters," says
"
Langlois, is almost as mischievous as the extreme of credulity."
The case worker's best safeguard against formalism and skepti-

cism is a concern for the interests of his client.

1. The two which condition the value of a witness's testimony are his
factors
competence and his bias. Competence includes both the witness's opportunity to
know the facts and the way in which he has used this opportunity. Bias includes
those ideas and emotions of the witness which may prejudice his judgment.
2. A witness frequently thinks he has had ample opportunity to know the facts
when the reverse is the case. The use which a witness has made of his opportunity
to know the facts is conditioned by his powers of attention and memory, and by
his suggestibility.
79
SOCIAL DIAGNOSIS
3. Closeness of attention to an incident depends in part upon the importance

attached to it at the time, and in part upon the stock of ideas or "funded thought"
of the observer.
4. The time at which an event took place is often recalled by associating it with
some other event the date of which is already known. It is characteristic of mem-
ory material that it deteriorates with repetition. The first, unrehearsed statement
of a witness is often the most trustworthy.
5. An over-readiness to yield assent to or reproduce the assertions of others

often impairs the value of a witness's testimony. Such suggestibility may even
lead to mistaken confessions.
6. Closely related to this characteristic of suggestibility is the danger involved

in asking "leading questions." not always possible to avoid them, but the
It is
case worker can at least cultivate a watchful eye for their use, so that he shall not
be betrayed into accepting back as fact what he has himself suggested by the form
of his query.
7. The commonest forms of bias encountered in social work are racial or

national and environmental bias, and the bias of self-interest. Collective self-
esteem, one form of which is family pride, may be classified under this last-named
head.
CHAPTER V
INFERENCES
treatment of the processes of reasoning is not
within the scope of this book. The application of those proc-
FORMAL
esses to social diagnosis, however, will appear in brief illus-
trations of ways in which a case worker's inferences (justifiable or
not), his conscious or unconscious assumptions, and his predis-
positions help or hinder his diagnosis of a client's situation. An
understanding of a client's difficulties, like any advance in knowl-
edge, comes from the interplay of two methods; namely, that of
direct testimony to facts in his life treated in the two preceding
chapters and that of inference from these facts to others that are
unknown.
I. HOW INFERENCE IS MADE
Inference, then, a passing from known to unknown facts, is the
reasoning process most familiar when it takes the form of draw-
ing a conclusion from the relation existing between a general truth
and a particular instance. It may, however, proceed from many
particular cases to a general rule, as well as from a rule to some new
fact about a particular case. Reasoning from particular cases to
the general rule is shown in the following brief passages taken from
The Charity Visitor: 1
A knowledge of the number of rooms occupied is necessary in order to determine
whether the family is living under dangerously overcrowded conditions, either from
a physical or from a moral standpoint.
The constantly shifting family is certainly in need of some kind of assistance.
. . . Also the fact of a change of residence suggests some reason for change,
which is often a salient factor, particularly when the change is from one section of
the city to another or from one city to another.
The membership of a man in a labor union is in itself an indication that he is a

workman and associates with workmen; if his "card is clear," that is, if he is in
good standing and his dues are paid up, there is further assurance of his reliability.
1
The Charity Visitor, Amelia Sears, pp. 23, 26-27, 35-
6 8l
SOCIAL DIAGNOSIS
Here are three general rules familiar to the case worker which
are inferences from a large number of instances (i) of the effect
of an insufficient number of rooms, (2) of the significance of a
family's constantly shifting, and (3) of a man's membership in a

union. The validity of each of these rules depends upon the accu-
racy with which the particular instances from which the rule was
inferred were noted,upon the number and essential similarity of
these instances, and upon the absence of exceptions.
Reasoning from a rule to some new fact about a particular case
is illustrated by this item taken from our case reading:
A man with a record of drink owed a bill to a hospital. Its social worker learned
from the cashier at the patient's place of business that he had recently received a
considerable sum of money for accident insurance. The inference drawn was that
he could pay his hospital bill.
The implied general truth of which this case appeared to be an

"
instance is that People who have money enough on hand can pay
their debts." It is obvious that without this general truth in the
background of one's mind the above inference could not be drawn
and the man's having or not having received money would bear
no meaning for us. On the other hand, how did we get our dictum
that people who have money can pay their debts? This rule is an
inference drawn from innumerable particular cases to this effect
that have occurred within everyone's experience.
It is evident, then, that in reasoning one must be prepared to
support the conclusion by reassuring a doubter at either or both

of two points. The doubter may challenge it by asking either,
(i) Is the rule appealed to strictly true? or (2) Is the given instance
really a particular case of that rule?
A critic of a case record writes, "I infer that there must be some resource not
discovered, as a family of seven could hardly have subsisted for three months on
those grocery orders from the city only, even if the milk mentioned May 7 con-
tinued. I conclude it did not, since there is a new application for it in August."
The general rule implied in the first inference in this case is stated
here, namely, that a family of seven cannot live on the usual
public relief order. The rule implied in the second inference is
that people do not apply for the same aid from the same source
while they are already receiving it. As was true in the preceding
case, both these rules are in turn inferences drawn from many
82
INFERENCES
particular instances in the past (i) of the minimum diet which can
sustain life, and (2) of the habits of rational beings.
A child had been returned to its home from a hospital, and it had become neces-
sary to learn whether malnutrition was due to unwise diet in the home or to the
straitened circumstances of the family. The record of the medical-social depart-
"
ment making the inquiry reads: Family have two extra rooms which they are not
trying to rent to lodgers. If in straitened circumstances this would not be the case."
Is the general rule sound on which the inference in this case is

based; namely, that families in straitened circumstances rent their
extra rooms? That depends, as before stated, upon how many
instances of this have been observed, and upon the accuracy of the
observation.
In the process of our investigation of a case, an inference may
pass through various stages of certainty. Its first stage is often
tentative. It is a hypothesis, a possibility to be proved or dis-
proved by further evidence. In a first interview, for instance, the

skilful worker forms many hypotheses, holding some for the con-
firmation of further evidence, accepting a few as proven by the
evidence before him, and discarding others as the interview pro-
ceeds.
To
illustrate this a case worker recommends trying the experi-
ment of removing the "face card" (sheet of information in tabular
form at the beginning of a case record) from the unread history
sheets and drawing from the card alone see the one for the Ames
family reproduced on the following page a series of inferences.
This worker regards such an exercise as good drill for a beginner,
since it approximates the mental processes he should go through
in making an investigation. From the fact given on the Ames
face card that this family of five lived in six rooms at a rental equal
to their highest weekly wage, the worker in question inferred that
they had a fairly high home standard. Had she made this infer-
ence in the course of her interview with the family, she would have
gone on to confirm it by inquiring whether they had had or ex-
pected to have lodgers or whether they had taken the house merely
through inertia because it was the first decent one they had lighted
on, etc. If the family's statement barred out these other explana-
tions and fell in with her inference, she would accept the latter
as a fact. Again, the worker learned from the face card that four
83
SOCIAL DIAGNOSIS
FACE CARD
Surname AMES Date 5-10-09
Date
5-10-09
INFERENCES
years elapsed between the births of Mrs. Ames* two children.

This may mean miscarriages or the death of infants, either of which
may have been the cause or the result of low vitality in the mother.
Putting such an inference together with the fact of the man's being
tuberculous (experience with the reluctance of workingmen to yield
to sickness warrants the hypothesis that this man's condition is
fairly advanced) and of physicians' having been consulted for both
the wife and the children, the investigator makes the hypothesis
that the family health is poor. If she were interviewing these
people she would at once try to get at a few simple medical facts,
such as an intelligent layman can ascertain and such as would
indicate whether she should ask medical advice. The use of the
hypothesis to the social worker in the case is to stimulate his col-
lection not only of the medical facts indicated but of relevant
social evidence as well; namely, the ventilation and heating of the
family's rooms, the warmth of their clothing, their exercise, their

diet, includingthe wife's ability as a cook. In this instance, it
would be the physician and not the social worker who would estab-
lishor disprove the hypothesis of delicate health in the family.
Many other inferences occur to one from this face card; namely,
that the man came to this country before marriage, that he was
probably married in 1901 or 1902, that his work was unskilled al-
though he must have been acceptable to his employer, and so on.
His coming to this country before marriage might perhaps be con-
sidered a safe enough inference without more evidence; the two
latter inferences call for confirmation.
II. HOW INFERENCE IS CORROBORATED

In the illustration on p. 83, the inference that the family is not
in straitened circumstances because no effort is being made to
rent extra rooms, resting as it does on a rule open to occasional
exception, should in justice to the family in question be subjected
to the test of further evidence. A
woman whose husband was sick
and away was found to have allowed a man lodger to give her a
black eye without any resentment on her part. The inference
or hypothesis drawn from this fact as to the undue intimacy of
their relations was confirmed by further evidence.
Confirming evidence may be gathered deliberately for the pur-

85
SOCIAL DIAGNOSIS
pose of confirmation or it may be evidence lying in our past experi-

ence. The
professional experience of social workers makes them
recognize a recurring relation between the number of rooms occu-
pied and the health and decency of the occupants; between a man's
trade union record and his record as a worker; between the size
of a family and the minimum amount of food they can live on;
or between a family's income and their having extra rooms un-
rented, etc. Although none of these relations are fixed for all time,
the richer the experience of the worker in supplying him with such
fairly constant rules, the greater is the variety of hypotheses to
which such experience can give and therefore the more
rise, likely
ishe to light upon the hypothesis which will prove correct.
What workers sometimes complacently term their intuitions are
often merely rapid inferences based on experience. A case in point
is the following:
A medical-social worker was explaining that she had learned to trust her intui-
tions. When asked for instances of what she meant by intuitions she replied, "A
man was referred to me not long ago whom I classified as a jailbird at once, and
sure enough I found that he had a long record at our county prison." Further
questioning revealed this process of reasoning: "The man was an Irishman and had
been in this country twenty-two years, but had never been naturalized, which struck
me as shiftless for a man of his nationality. That made me sure that he had some
reason for not wanting to vote or that he was prevented from doing so by a criminal
history."
The intuition was an inference, a hypothesis which the worker's

experience suggested and which served to lead her to a search for
confirming evidence in the public records. It is of course possible
that the man's appearance played an unrecognized part in the
forming of this hypothesis.
Occasionally, because of gaps in evidence, confirmation of a
hypothesis has to be sought through experiment. Such evidence
is,for the purposes of social case work, far from satisfactory, be-
cause in dealing with human material experiment is controlled
with difficulty. If we send to the charity woodyard an Italian
whose work references are inaccessible and he leaves the work after
a short stay, is he lazy, or is he incapable of adapting himself
quickly to the changed conditions of work with a foreman who does

not understand Italians, and with fellow workmen who do not
speak his language, etc.? "The one great difficulty," says Alfred
86
INFERENCES
making sure that when we introduce A

1
Sidgwick, "is that of
[laziness] into a given set of circumstances nothing else comes in
along with it, or directly after it, or is already there unknown to us.
For if another detail, Z, [the difficulty of getting on with an Ameri-
can foreman, among other things] has crept in thus insidiously,
the experiment fails to show that it is A rather than Z to which
the effect is due."
There a satisfaction beyond the establishing of a certain
is
number of required facts for those who have or acquire the insight
to make such tentative inference. These inferences are a means
of leading us from the comparatively few known facts about any
client to some of the many unknown ones which a personal social
problem always contains, as well as a means of guiding our inves-

tigation into fruitful channels. Evidence gathered to corroborate
or disprove a theory, to combine new facts with those previously
known, thus becomes a creative thing; whereas facts collected
mechanically item by item to fill out a schedule or meet a minimum
requirement of some sort lack the interrelation that would give
them significance. They give but a sketchy outline of a client's
needs. When evidence is meager, ingenuity in the making of one
working hypothesis and then another and patience in trying them
out by experiment may be the only way of arriving at the truth.
As we proceed with our inquiry and get, from the accumulating
facts and from the use of these in testing our successive hypotheses
and inferences, the evidential material for accurate diagnosis,
reasoned knowledge gradually takes the place of hypothesis.
In making an advance in knowledge, whether in law, science,
or social work, certain risks are involved. Those contained in
erroneous testimony have been discussed in the preceding chapter.
Assuming then that our testimony is reliable, there are still risks
that arise (i) from the process of thinking, or (2) from the thinker's
state of mind.
III. THE RISKS INVOLVED IN THINKING

The may occur in four ways; we
risks in the process of thinking
may have a mistaken general rule, a mistaken particular case, a

mistaken analogy, or a mistaken causal relation.
1
Application of Logic, p. 91.
87
SOCIAL DIAGNOSIS
1. Mistaken General Rule. Suppose that in the case cited on

p. 86 we infer that the Italian in question is lazy. We thereby
imply that as a general rule needy men who refuse to work at the
charity woodyard are lazy. There are, however, frequent excep-
tions to this rule, other explanations of a man's refusing such work.
Therefore the general rule is open to question, and the inference
in the particular case is, as a consequence, of doubtful validity.
Again take the case of James Smith, who withholds the name of
"
his present employer. May we say as a general rule, the man who
puts obstacles in the way of consulting his employer is a man with

a poor work record" and draw the inference that James Smith
wants to conceal his inefficiency? Hardly. Here too there are so
many possible reasons besides the one given for such an unwilling-
ness on the part of employes that we must apply this general rule
only with great caution.
Couples who are married have neither embarrassment nor hesitancy in giving
this information [t. e., date and place of marriage] unless they are purposely with-
holding facts of early life. 1
"It quite conceivable," writes a critic of this statement, "that the question
is
might have been asked as if it were an accusation that the couple interviewed were
not married, or that it might have been so taken by a hypersensitive person. Such
an apparent attitude of suspicion does not always bring, in return, the proof wanted
and producible; it sometimes brings instead a stubborn refusal, or else the informa-
tion is given with real embarrassment. Also (2) clients may honestly not remember
the date and the year, or (3) they may consider it unimportant and not germane
2
to their present situation."
Therefore this general rule is untrustworthy and reasoning which

depended upon it would be invalid. In the case of the Browns,
who hesitated when asked for the information, you could not in-
fer such concealment with any certainty.
*The Charity Visitor, p. 21. Some excellent examples of sound inference have
already been given from Miss Sears' pamphlet. In the attempt, however, to formu-
late generalized statements applicable to given combinations of case work circum-
stance, there is always the danger a danger which the present volume illustrates
too, probably of assuming that in no case can the outer fringe of circumstance not
specifically included in the combination make another conclusion necessary. The
inference quoted above and a few others that follow, taken from The Charity
Visitor, illustrate this risk.
*
For some of the comments quoted in this part of the chapter, the author is
indebted to a group of former students, especially to Miss Marion Bosworth and
Miss Ruth Cutler.
88
INFERENCES
A definite statement of the floor and the part of the house in which the family
lives . . . indicates . . . economic status, the probable sanitary condi-
tion of the home, and, taken in comparison with the part of the house at a previous
address, the advancement or deterioration of the family fortunes. 1
Has it been the common experience of social workers that knowl-

edge of the floor and the part of the house in which a family lives
indicates these three distinct conditions?
A case worker suggests the following exceptions: A family may have risen
economically above its rooms or neighborhood but be held there by some tie of
kinship, nationality, sentiment, or by accustomedness and inertia. Or a family's
idea of thrift may lead them to deprive themselves and their children of what we
consider necessities in order to keep a bank account intact. Or again, inconvenient
rooms may be in an exceptionally favorable location, near the work of some member
of the family, near a church, a settlement, a day nursery, etc. As regards the rela-
tion suggested between "floor" and "sanitary conditions" experience does not bear
itout. The comparison suggested with a "previous address" might mean nothing,
but on the other hand comparison with a series of such addresses would probably
have significance.
In short, this rule subject to so many exceptions or qualifications

is
that we can but it as mistaken.

regard When, then, we find a
family living in a third floor back on Y Street we cannot from that
infer their income and the sanitation of their home.
The following rule is evidently of doubtful validity, since it
holds good only with certain exceptions:

Information concerning the school opportunities of any illiterate person should
be most carefully gathered and, unless the history shows a gross exploitation of the
individual that more than accounts for his illiteracy, it is advisable to have the
2
mental ability of the illiterate person tested.
As regards those who come from states where there is or has been
no compulsory education law and as regards foreigners this rule
should be more tentatively stated. Lack of opportunity and lack
of compulsion have made illiteracy common among some of them
among the Galician farmers, for instance.

The mere statement of the age and the grade of the child
is of value in showing
whether or not he is below his grade, a special effort must

a retarded child. If he is
be made to ascertain whether he is backward merely as a result of bad environment,

neglect, physical condition, or irregularity of attendance, or whether he is a mental
defective. 1
l
The Charity Visitor, p. 23.
2 The Charity The Charity
Visitor, pp. 34-35. Visitor, p. 33.
89
SOCIAL DIAGNOSIS
Here the various possibilities are indicated, thus safeguarding the

statement adequately.
The social worker must bear in mind that the "general rules"
that enter into reasoning in the field of human conduct can never
be of universal application; that is, they will all be liable to many
exceptions. This, however, does not disqualify them from serving
to advance knowledge about particular cases. For instance, if 75
per cent of the couples who hesitate to give information about

their marriage do so with the motive of concealing discreditable
facts, the worker cannot, it is true, from such a rule deduce with
any assurance the conclusion that a given reticent couple has a
scandal to conceal. But he can make such an approximately gen-
eral rule the basis of a tentative inference, a hypothesis, which will
serve as a guide to his inquiry into the past life of a given couple.
The hypothesis may be disproved by further evidence, the couple
in question turning out to have an honorable reason for reticence.
Nevertheless, the worker's merely tentative inference, based
it is
on a rule of only partial application, which will have been the first
step in bringing the truth to light.
2. Mistaken Particular Case. Since an inference is drawn not
a
from general rule standing by itself, but from such a rule as it is
applied to a particular case, it follows that, however unimpeach-
able the rule, the particular case may not come under it. The rule
"
that the constantly shifting family is certainly in need of some
kind of assistance" 1 may be accepted by all social workers. If,
however, the breadwinner is an exhibitor of trained dogs who takes
his wife and children on business tours, this is not a shifting family
in the sense intended in the rule. The term shifting family at once
becomes ambiguous for this particular case.
Take again the case cited on p. 82 of the patient who was in-
ferred to have been able to pay his hospital bill because he had
recently received an accident insurance. The rule back of the in-
ference was that people who have money enough on hand can pay
their debts a sound enough dictum. The first assumption was
that this particular patient's case came under the rule. But how
did it turn out? The man on being questioned produced a receipt
for the board of his children which had just been paid. The sum
1
90
INFERENCES
amounted to almost the total of his insurance. The particular case,

then, was different from what it was first supposed to be. This man
was not a person with money on hand. The case did not fit the rule.
Again we may have the
rule "first offenders are hopeful subjects
for probation." In a given instance, however, the offender may
have been a boy who had been pilfering undetected for years or a
girl who had had sexual relations with boys and men since child-
hood, although only now brought to court. In the sense intended
by the general rule neither of these is a first offender.
3. Mistaken Analogy. Inference is often drawn by what ap-
pears to be an analogy between some one case under consideration
and another which, in those respects that are of importance for
the purpose in hand, closely resembles it. For instance, if a worker,
knowing of a number of cases of tuberculosis among hatters who
had worked same factory with Ames, 1 conceived the purpose
in the
of attempting to render more sanitary the processes of the hat
trade, he would look for a probable analogy between the facts of
these several cases and of men in other hat factories as to working
conditions, incidence of the disease, etc.; whereas if his purpose
were to get Ames himself well and self-supporting, he would look
for a different set of analogies in making his diagnosis and would
emphasize many things in which Ames and his family differed
from the other cases of tuberculosis in hat factories.
Again, suppose that Mrs. X's explanation, that the beer seen
going into her tenement was left there temporarily for a neighbor,
proved to be a falsehood. A worker hearing the same explanation
offeredunder apparently similar circumstances by Mrs. Y might
reason by analogy that this was the same old excuse and that
Mrs. Y like Mrs. X was a drinking woman. Whereas, if he inquired
further he might find that Mrs. Y's neighbor, who was not a tee-
totaler, had been so kind to Mrs. Y during her children's sickness
that Mrs. Y could not refuse her the small favor of taking in her
kettle of beer. The
analogy, therefore, would prove a mistaken
one. The two would have had only a superficial similarity
cases
as to the points under consideration. This is the danger in reason-
ing by analogy, and is one into which we all of us fall. We
know the frequency with which relief officers reason that since
1
See face card on p. 84.
91
SOCIAL DIAGNOSIS
salt cod and beans are acceptable diet for family A, they must
be equally so for family B. The first family may be composed of
a sturdy mother with big husky boys, while the second may be a
tuberculous woman with tiny children. Both are widows with
children,and beyond that the analogy does not hold.
Our tendency
to assume more similarity than exists between the
circumstances of an old case and of a new one, and hence apply
our experience with the one to the other, often checks the acquisi-
tion of new knowledge.. This tendency may be neutralized in the
discussions of any representative case committee one made up,
letus say, of a few professional and business men, of several house-
wives, a neighborhood tradesman, a nurse, a trade unionist, and
ofsome of the social workers in the various special agencies. Unless
an opinion is imposed upon all by someone whom they respect as
an authority, each one present will at once draw inferences from the
outline of the case presented. A large majority of these inferences
willhave been shaped by analogy with the different experiences of
these people of varying occupations and background. Where dis-
cussion is free, the diversities of view tend to offset each other and
to bring out facts showing which analogy holds good and which is
unwarranted.
4. Mistaken Causal Relation. One fact shown on the face
card given on p. 84 is that Mrs. Ames' mother lives with her,
although Mr. Ames is ill and the family in need of aid.
Suppose
one infers as the cause of this situation that the old lady has less
pleasant relations with her other daughters and their husbands
than with the Ameses. Would this cause operate by itself or would
it be likely to act along with other causes to produce the given
effect? The common inclination is to seek for one cause. Social

workers, however, need to bear in mind that where cause must be
sought in human motives, as is apt to be the case in their work,
they must expect to find not that it is a single simple cause, but
that it is complex and multiple. In the case of Mrs. Ames' mother,
should it turn out that the cause after all was simple, the social
worker can test first the adequacy of this alleged causal relation.
Having accepted the mother's liking for Mrs. Ames as adequate

cause, the worker must now ask whether the operation of this
cause is thwarted by any circumstance. The mother may prefer
92
INFERENCES
Mrs. Ames' companionship only when she has her to herself. When
the husband ishome, jealousy or lack of sympathy with him
at
may seriously mar her pleasure. In this case the preference for
Mrs. Ames, although in itself an adequate cause, would be
thwarted in its action. Whether this is the case or not the worker
must apply the third test of causal relations and inquire whether
there may be some other cause for the mother's living with the
Ameses. The next alleged cause the worker must examine by the
same method as this.
Again, we see on the face card that Ames worked at canvassing
for only a month, when he returned to his old employer as door-
man. What can we infer as a reason? Either he was not efficient
at the canvassing or was not physically equal to it or he preferred
a steady job with definite wage in a place he knew. Any one of
these causes would have been adequate, none of them is thwarted
by any other cause, but all three are equally possible. We can
therefore make but a tentative inference.
The work Ames sought after leaving the
facts that the first
tuberculosis sanatorium was canvassing, and that this was not his
usual occupation, suggest that he had received medical advice to
get outdoor work. This inference answers all three tests. While
this may not be the only conceivable reason for his doing this
work, certainly the most probable one. In reasoning on peo-
it is
ple's behavior, one would seldom arrive at more than a strong

probability of truth.
Mrs. F, a mother of growing girls, insists on keeping a man
lodger and living in a wretched tenement over a saloon, in spite
of generous offers from relatives of better living conditions. Shall
we infer lax standards of living? This cause is adequate, it is
thwarted by no other circumstance, but is it the only possible
cause of her apparent stubbornness? She says herself that the
objectionable tenement is near the children's school and that the
landlord has been good to her. 1 1 is also conceivable that she is
not eager to move near her relatives. Our inference, therefore, as
to her standards is not justified except as a hypothesis to be con-
firmed by more evidence.
93
SOCIAL DIAGNOSIS
IV. THE RISKS ARISING FROM THE THINKER'S STATE OF MIND

1. Predispositions. Besides the risks involved in thinking as
such, there are risks arising from the thinker's state of mind. The
social worker, like all others, has certain personal and professional
predispositions against which he needs to be on guard. What do

we mean by predispositions? For our present purpose we may
stretch the application of the word somewhat to include the sum
of all those personal and professional habits of thinking and all
those feelings and inclinations with which we approach each new
problem. Our predispositions are both equipment and handicap.
They are an equipment in that they are essential to individuality;
they are a handicap in that they limit knowledge in one direction
or another. For instance, when social case work agencies first
became aware that their records showed a confusion between fact
and opinion, they tried to meet the difficulty by instructing their
workers to omit impressions, opinions, and inferences of their own,
"
and to enter upon case records nothing but the facts," reporting
"
each of these colorlessly, as it happened." Workers who attempted
to follow this rule produced records which have been likened to
unstrung beads; in the attempt to eliminate all prejudice, they
eliminated the judgment and discernment which would have given
to the whole investigation unity and significance.
1
Predispositions may obscure for us the significance of one set

of facts by leading us to exaggerate the importance of another set,
while at the same time they are so much a part of us that we may
easily be unaware of their existence and consequently of their
danger. Such an
effort to disregard the fact of our having predis-
positions as that shown by the case work agencies who wanted

"nothing but the facts" from their visitors is likely to hamper
investigation by deceiving the mind into a belief in its own impar-
tiality. the worker's very awareness of his special predis-
It is
position on which depends the reliability of his observation and

judgment. Once he brings a prejudice into the light of day, he
can offset its influence on his thinking.
1
A critic of these pages, who has examined many case records of late in many
different parts of the United States, adds: "Not only 'unstrung beads' but all
about the same size. Wherever the 'only the facts' rule applies, the tendency is for
every fact, big and little, to occupy about the same space in the record. Everything
is brought to a dead level."
94
INFERENCES
2. Assumptions. As professional workers become experienced

they are apt to gather a set of salted-down rules, or more correctly
assumptions, which they thereafter apply as needing no further
proof. Some of these assumptions are warranted, others are not.
In dealing with cripples, for example, social workers may adopt
unhesitatingly the assumption that physical handicap is the cause of
unemployment. Closer acquaintance with cripples would show
that many do well in employment, and that of those who do not,
some fail through temperament, some through the limitations of
their earlier industrial experience, and some through one or
another physical cause unrelated to the handicap in question. In
fact, the common assumption that the cripple's industrial diffi-
culties are insurmountable is his most serious handicap.
Again, there is an assumption among not a few workers that
laziness is within a man's control, whereas, while we may not be

able to say it is never so, we know that it often is not.
A few years ago it was assumed among social workers in some
communities that a girl with a second illegitimate child was hope-
lessly degraded and that therefore no private agency should at-
tempt to cope with the problem; public authorities should give the
necessary care. Indeed this feeling was so strong that private
rescue homes receiving these girls were thereby somewhat dis-
credited. Today courageous intensive endeavor has shown that
some of the most successful work of reconstruction can be done
with the unmarried mother of two children.
The reason assumptions such as these persist is that they are
not examined; they are taken on faith. If, however, a worker
knows his assumption to be what it is unproven he may ven-
ture to act upon He may know, for instance, that a given
it.
man's laziness mayconceivably be a manifestation of disease, yet,

barring any other indication of illness, he may think best to assum
the fellow's culpability and push him to get work.
In any profession one acquires certain predispositions, or habits
of thought,from the conditions of one's allotted task and particular
occupational environment. A worker in a child-helping or a family
rehabilitation agency in a large American city, working among
recently arrived foreigners who have become dependent, may re-
gard immigration as a menace, unless his own racial prejudices
95
SOCIAL DIAGNOSIS
happen to offset this idea. The child-placing agent sometimes

assumes that a family home is the best place for every child, and
the institution worker may lean too far the other way. The charity
organization worker easily takes economic independence and
family solidarity as being invariably the first considerations, while
the health worker readily slights both. Each specialist, therefore,
should ask himself to what particular overemphasis he is rendered
liable by the nature of his task, and at that particular point he
should be at especial pains to collect with impartiality the evidence
on which he bases decisions.
3. Some Other Habits of Thought. There are, besides untested
assumptions, other habits of thought that case workers of any kind
are liable to fall into. We found that, until our case reading
revealed the fact, some workers were unaware that they consulted
the same favorite sources of information habitually, to the exclu-
sion of other sources equally good or better, or that they co-
operated heartily with only a certain few agencies usually with

those most accessible. Such methods mean a narrowed resource-
fulness, with a few favorite remedies applied, a few combinations
of stops pulled out, no matter what the demands of the situation
or the resources available. Moreover, in changing from one city
to another or from one field of social work to another, a worker
must guard against holding fast to habits which may have been
time-saving originally but which are useless under changed con-
ditions. 1 If a municipality's department of health or of correction
has been unco-operative, one who faces a new administration or
who leaves that community for another must be ready to drop
the habit of doing without this help from public officials and must
welcome a changed situation.
Again, the trend of modern social ideals often confirms in the

more sophisticated case worker a habit of thinking in averages.
Sometimes a case worker tends to become overabsorbed in the
individual case, but a commoner failing of the modern type of
*"Wnen at shearings or markings they run the yearlings through a gate for
counting, the rate of going accelerates until the sheep pass too rapidly for numbering.
Then the shepherd thrusts his staff across the opening, forcing the next sheep to
jump, and the next, and the next, until, Jump! says the flock-mind. Then he with-
draws the staff, and the sheep go on jumping until the impulse dies as the dying
peal of the bells." Austin, Mary: The Flock, p. 1 14. Boston, Houghton, Miffliiv
and Co., 1906.
96
INFERENCES
worker is that, oppressed by the condition of the mass, he misses

a clear conception of the one client's needs. He thinks of him as
one of a class. No client will meet with successful social treatment
if so regarded, because it is usually his particular situation and not
that part of his circumstances which he shares with others that is

the immediate point at issue. Sidgwick has this general truth in
mind when he says, "In forming a careful conclusion about a
particular case, no one with any sense will use the method of proba-
bilities if he has an opportunity of getting behind it and under-
standing the causes at work in the special case." Sidgwick means

1
by his warning about the "method of probabilities" that, though

a certain manifestation may have been proved statistically to have
one significance in ninety-seven instances out of a hundred, and
a quite different significance in the three others, this ratio, useful
for action affecting a hundred in the mass, has a different sort of
value in dealing with a single case about which more intimate
knowledge is available. The value of such a ratio for the single
case is thatnecessarily gives rise to a hypothesis that the case
it
in question is one of the ninety-seven. This hypothesis is useful

in that it guides the inquiry which may or may not show the single
case to be one of the majority. An assumption to this effect, how-
ever, where more knowledge is available about a particular case,
the ratio does not justify. Were the case worker himself one of
the three, would he care to be treated by a social practitioner
whose habit it was to assume his client to be one of the ninety-
seven? At the same time it would hardly be an intelligent prac-
titioner who did not under these circumstances look upon it before-
hand as probable that the client would turn out to be one of the
ninety-seven.
There always a risk that one's personal likes and dislikes may
is
influence judgment. Take, for example, the prejudices and special

tendencies that belong to the various racial and social groupings.
Even those comparatively rare persons whose knowledge of the
characteristics of many different social groupings of people is broad
enough to have overcome mere class prejudice in themselves still
belong to a certain habit-group and are attracted or repelled by

like or unlike customs and manners in others. People of narrower
1 The Application of Logic, p. 69.
7 97
SOCIAL DIAGNOSIS
opportunity are almost without exception warped in their judg-

ment by one class or racial prejudice or another, while at the same
time they assume that social bias exists only in the other fellow.
As such personal predispositions, when allowed swing, hinder his
work, the social case worker needs to learn to set them aside.
Besides the risk in drawing inferences which arises from personal
and professional predispositions, there is a risk that springs from
the thinker's own desire in the particular instance, (i) to see his
hypothesis confirmed, and (2) to secure prompt action. Such a
hypothesis, for instance, as that about the Irishman with the prison
record 1 becomes, because of its very ingenuity, the favorite child
of our brain. In this case, it is true, the worker sought corrobo-
rating evidence. Nevertheless, the danger that commonly besets
case workers is that of becoming so fond of some particular hypoth-
esis that it will seem in no need of proof. This tendency may
have especially serious consequences in the case of a first hypoth-
esis that we have to make in a more or less obscure case in order
to get started. The whole diagnosis may be vitiated by an un-
warranted assumption at the beginning.
The worker's own desire to secure prompt action in a particular
instance isalso often responsible for invalid inference. In the case
cited on p. 350, Chapter XVI 1 1, in spite of contradictions in the evi-
dence, the worker in his hurry to get an answer to the district attorney
drew inferences in favor of the wife;whereas, had he stopped to
test these inferences, he would have been led to get at once the
additional facts that showed the husband to be the better of the
two.
If we may count, as two essentials of the social diagnostician's
equipment, his ability to weigh the risks involved in the types of
evidence described in the chapter on Definitions, and his ability to
measure and allow for the characteristics of human beings as wit-
nesses a topic which has also received attention there is still
the third essential; namely, the ability to discriminate between
fact and inference and, through inference, to deduce new facts.
Then, when the items of evidence in a case seem to be at hand,
there comes a time for considering them as a -whole. The same
reasoning and testing that has been applied to its separate items
1
See p. 86 of this chapter.
98
INFERENCES
must be applied deliberately to the evidential mass. We shall

return to this later in Chapter XVIII, in considering the com-
parison of part with part, as well as the final act of interpretation,
the act of social diagnosis itself.
When weface each situation of our work with a mind alert to

receiveand follow suggestions, alert to utilize experience, and to
make, try, and test one hypothesis after another; when we start
out with entire willingness to prove or disprove our every inference,
then the well tested inference reveals new fact, and new fact sug-
gests new inference until gradually our case work acquires a strong,
closely woven texture and our case histories become documents
that will well repay study. It is upon such case history study,
in fact, that social case work will have to depend, in large measure,
for advancing standards and new discovery. Before turning to the
practical details to which so large a part of the remaining chapters
of this book will be devoted, it should be said with emphasis that
there can be no good case work without clear thinking; that in
social diagnosis sound reasoning is fundamental.

1. Inference the reasoning process by which we pass from known fact to fact
is
that is unknown. From many particular cases we may infer a general truth, or,
as happens more often in case work, from a general truth we may infer some new
fact about a particular case.
2. A first-stage or tentative inference is called a hypothesis. Resourcefulness
in making and patience in testing hypotheses are fundamental to success in case
work.
3. Corroboration of a tentative inference may have to be gathered deliberately

or it may lie in our past experience.Past experience may also suggest a variety of
hypotheses the richer the experience the greater the variety, and the greater also
the likelihood of discovering the particular one which will prove to be correct.
4. Gaps in evidence may make it necessary to seek confirmation of a hypothesis
through experiment, though the conditions of controlled experiment are achieved

with difficulty in social work.
5. In addition to the risks involved in testimony which may be incompetent or

biased, there are risks in the process of reasoning from testimony even when it is
known to be reliable, including risks in the reasoner's own state of mind.
6. The risks involved in the reasoning process may occur in four ways: we may
have a mistaken general rule, a mistaken particular case, a mistaken analogy, or a

mistaken causal relation.
99
SOCIAL DIAGNOSIS
7. General rules that apply to human conduct are never of universal application.
Often also the particular case assumed to come under a given general rule is different
from what it is supposed to be, and therefore does not come under the rule in
question.
8. Resemblances between two cases may exist, but at tie points under considera-
tion the resemblance may be only superficial. This is the danger in reasoning by
analogy.
9.The common inclination is to seek for one cause. Where cause must be sought
in human motives, however, we must expect to find that it is not a single simple
cause but complex and multiple.
10. The chief risks arising from the case worker's own state of mind are found
in his personal and professional predispositions and in his assumptions in the
salted-down rules, that is, which are the product of his experience.
1 1. The
best safeguard against predispositions is to be aware of them. Once a
personal prejudice, for example, is brought into the light of day, its influence upon
thinking can be offset.
12. In the same way, if a worker knows his assumption to be what it is un-
proven he may venture to act upon it in the absence (after search) of evidence
proving it to be unwarranted. Unwarranted case work assumptions persist because
they are not examined and are taken on faith.

13. Other ways of thinking against which case workers may be warned are the
habitual use of a few favorite sources of insight or co-operation, the continued disuse
under changed circumstances of a source which was formerly not available, the
habit of thinking in averages, and the habit of regarding with especial favor a first
or an ingenious hypothesis.
100
PART II
THE PROCESSES LEADING TO DIAGNOSIS
CHAPTER VI
THE FIRST INTERVIEW

TURN now to the details of social case work method.
WE It will be necessary to remember that in any art

the description of its processes is
clumsy than are the processes themselves. In the last analysis

necessarily far more
moreover, the practitioner of an art must discover the heart of the

whole matter for himself it is of the essence of art that he shall
win his way to this personal revelation; but an intimate knowledge
of the successes and failures, the experiences and points of view of
his fellow practitioners will be found to be essential too. The
thirteen chapters that follow attempt to analyze the experiences
which lead
of case workers in their daily use of the four processes
to social diagnosis.
These four processes are (i) the first full interview with a client,
(2) the early contacts with his immediate family, (3) the search for
further insight and for sources of needed co-operation outside his
immediate family, (4) the careful weighing in their relation to
one another of the separate items of evidence thus gathered and
their interpretation. By interpretation is meant the attempt to
derive from all the evidence as exact a definition as possible of the
client's social difficulties the act of interpretation is the act of
diagnosis.
It cannot be assumed that any one of these processes is always
completed before another begins. When the First Interview is

held in the client's home, contacts with the family often overlap
our first contact with the client. As soon as we have two state-
ments instead of one, whether these come from the family or from
outside sources, we begin to reason about them, to compare them,
and to draw certain tentative inferences from them. Nevertheless
there are these four processes, distinguishable despite their inter-
play.
103
SOCIAL DIAGNOSIS
Many workers are of the opinion that the most difficult

social
and important the first the initial interview. Probably this is
is
the part of the diagnostician's task in which personality, as con-

trasted with technique, counts for the most, for here he should
establishsome basis of mutual understanding and get some clues
to the evidence which will shape his judgment later. "I am
more and more convinced," wrote the secretary of a large family
"
agency years ago in a personal letter, that the finished skill of
a good social worker is most shown in this first visit or interview.
No knowledge of general principles, no cleverness in gaining co-
operation, no virtues in the worker, and no committee, however
wise, can make up for want of skill in gaining quickly the confidence
of the family, and getting the foundation for all good work to
follow." Though this emphasis is usually justified, it has two
possible dangers: It may discourage us, when ground has been
lost in the First Interview or not gained, from pushing forward
to win the needed understanding later. It may betray us, on the
other hand, into resting back upon the outcome of an apparently

satisfactory first statement and failing to put forth our best en-
deavors in the further necessary steps.
I. MODIFYING CIRCUMSTANCES
Among the circumstances which must modify everything said
about First Interviews, four groups are important enough to be
kept always in mind: these are circumstances relating to (i) the
nature of the task, (2) the origin of the application, (3) the place
of the interview, and (4) the recorded experience available as a
starting point. To clear the ground for consideration of scope and

method these must take precedence.
1. The Nature of the Task. The form of service to be under-
taken can be interpreted narrowly or broadly, of course, but in
either case a number of variations of method are traceable to the
nature of the particular case worker's task. If an agent of a
society to protect children from cruelty knows that he may be
cross-examined by the lawyer for the defense as to what took
place in his First Interview with the defendant, inevitably this
will modify his mode of approach, for he must be able to testify,
upon occasion, to the exact form of his questions. Or if, to take

104
THE FIRST INTERVIEW
another kind of service, a probation officer is known to come from

the court and to represent it, certain conditions, favorable and the
reverse, are created by this fact; the officer has more authority
but less freedom than a worker who lacks the court back-
social
ground. He often finds the minds of those

it difficult to lead
directly concerned in a court case away from the immediate to the

wider issues. 1 A worker who was formerly with a charity organi-
zation society and then became the agent of a state department for
the care of children found it much harder to get information in her
second capacity than in her first. People applied to her for a per-
fectly definite object, namely, to have their children taken by the
public; they were tremendously on their guard against giving
information that would be likely to interfere with that object.
On the other hand, the agent of a private charity known to control
a large relief fund finds his interviews hampered by this fact at
every turn. The immediate material benefit looms large; the

other beneficent functions of the organization and the steps taken
to carry them out are little understood or are even thrust aside
with impatience. 2
The hospital and theschool furnish admirable means of approach
for socialwork; people like to talk about their ailments and about
their children. Both have this disadvantage, however, that the
X
A former probation officer writes, "Conversation that had to do with the
offender was easy; talk that would go deeper into the family situation taxed in-
genuity and tact."
1 "On
my first movements through the poorest parish in Glasgow, I was thronged
by urgencies innumerable, because of my official connexion with the secular charities
of the place, and which did invest me with the character of an almoner in the eyes
of the general population. What I judged and apprehended as the conse-
. . .
quence of this was, that it would neutralise the influence which I wanted to have
as a Christian minister. I saw that this would vitiate my influence among them.
I felt that it would never do if I were to go among them, first as a dispenser of tem-
poral good things, and then as urging upon them the things which make for their
everlasting peace. felt the want of compatibility between the two objects, and,
I
I determined to cut
rather than defeat my primary object, my connexion with the
city charities . . . and
not forget the instant effect of this proceeding
I will
when it came to be understood the complete exemption which it gave me from the
claims and competitions of a whole host of aspirants who crowded around me for
a share in the dispensations of some one or other benevolent trust or endowment of
other days; and yet the cordial welcomes I continued to meet with when, after 1
had shaken loose of all these, I was received and recognised by the people on the
simple footing of their Christian friend, who took cognisance of their souls, and gave
himself chiefly to do with the scholarship of their young, and the religious state of
their sick, and their aged and their dying." Chalmers on Charity, p. 154 sq.
105
SOCIAL DIAGNOSIS
task which is easily understood and easily explained tends to be-

come limited in scope to ignore the relation, for instance, be-
tween health questions and economic questions, between questions
of child welfare and those of family responsibility. Short tasks
of any kind seem, on their face, to make thorough diagnosis an
unnecessary preliminary. Much of our social work is so cut up

and subdivided at present that it drifts into rapid-fire, hit-or-miss
forms of treatment. If the nature of a particular form of service
makes a careful definition of the client's social difficulties seem
impertinent, there is always a chance that the details of its program
are in need of revision, that it should operate in a smaller territory
or attempt to benefit fewer people and really cover the ground. 1
2. The Origin of the Application, (a) The client comes in
person to the social agency of his own initiative; (b) or with a
letter of reference from some individual or organization, or with
an oral statement that he has been so referred; (c) someone acting
in his individual capacity or as representative of an organization
comes personally, instead, in the client's interest; (d) or sends his
request through the mail or by telephone. Thus we find our First
Interview modified at the very start not only by the nature of our
own interest but by the way in which it is evoked. If the client visits
us, whether of his own initiative or otherwise, our program varies
somewhat from that following a request to visit him. If individual
citizens or organizations in some way concerned for his welfare make
the request, we have one advantage in that a possible outside source
of insight and co-operation is available from the very beginning.
3. The Place of the Interview. The place in which the First
Interview held depends in part upon the nature of the task and
is
its origin, but not wholly upon these. Societies dealing with ques-
tions of family relief and, in these later days, with family rebuild-
ing have changed their policy several times with regard to the place
of the interview. Following the line of least resistance, the older
type of worker usually conducted First Interviews at his office
desk, with record form before him and pen in hand. He asked
each question in the order indicated by the items on the form, and
1
Another excuse often given for hasty preliminary inquiry is the probability that
the case will be transferred to another social agency for treatment. See Chapter
XVI, Social Agencies as Sources, on the advisability of thorough diagnosis before
transfer, p. 313.
1 06
THE FIRST INTERVIEW
filled ina short summary of the perfunctory reply before going on

to the next: Assistance asked? "Coal and groceries." Cause
of need? "Out of work." Any relatives able to assist? "No."
As a reaction against this stupid compiling of misleading items,
many American case workers have abandoned the office inter-
view, except in emergencies and in dealing with the homeless.
It is their practice to take only time enough, when application is
made at the office, to assure themselves that treatment is probably

needed, and then promptly to make a visit to the home, where, in
an unhurried talk, the basis is laid for further acquaintance.
The arguments in favor of holding the First Interview in the
home instead of in the office are, in family work, (a) Its chal-
lenge to the case worker at the outset to establish a human rela-
tion, at the risk, if he fail, of coming away without the simplest
and most elementary data. In the office, clients are on the de-
fensive and justify their visits by their replies. In the home,
the social worker is on the defensive; the host and hostess are at
their ease, (b) Its avoidance of the need of so many questions,
some of which are answered unasked by the communicative hostess
and by her surroundings. To the quiet observer the photographs
on the wall, the framed certificates of membership in fraternal
orders, the pensioner's war relics, the Sunday school books, the
household arrangements are all eloquent. And far more revealing
than these material items are the apparent relations of the members
of the household to one another the whole atmosphere of the
home, provision of natural openings for a frank exchange
(c) Its
of experiences. "The great facts of birth and death alone are
sufficient to make the whole world kin," and these and the uni-
versally interesting comparison of diseases form a good basis for

that kind of informal intercourse which belongs to the fireside.
Then, if some of the children are present for a part of the time at
least, there is a good chance for comparing notes about brothers
and sisters, their ages, names, namesakes, etc. 1 (d) Its further
emphasis upon the personal side when there has been no visit by
the client to an office, but when his situation has been reported
there instead by others; its relegation of official paraphernalia
and attitudes, in such instances at least, to the rear.
1
See Miss M. L. Birtwell's pamphlet on Investigation.
107
SOCIAL DIAGNOSIS
A few years ago these arguments in favor of the home interview

would have been regarded as inadequately offset by the counter-
arguments of greater convenience, accuracy, and saving of time in
the office interview. But now a certain number of social workers,
even some of those specializing in family work, are beginning to
feel that there is much to be said in favor of the office interview, if
properly conducted. They assume that the one who conducts it

will later visit the home, that there will be no lesion at this im-
portant point through a division of the task between two work-

ers. The return to the older method is a return with a difference
a return with office equipment which assures entire and uninter-
rupted privacy, ample time, no herding of waiting clients, and no
record form or other bit of officialism in the foreground. 1
Inquiry as to current practice in other forms of social work shows
interesting variations. The general secretary of a society to pro-
tect children from cruelty feels that it is most important to see
the home environment before making any inquiries outside. The
agent of a public department for dependent children finds that
clients come to the office of the department braced and tense.
She urges that only a clerk see them, and that the First Interview
be held in their own surroundings. On the other hand, a charity
organization worker tells of stolid Bohemian housewives who pay
little attention to visitors at their homes, continuing their house-
work so unconcernedly during an entire interview that it is im-
possible to make any real progress. The strongest evidence in
favor of the office interview comes from the medical-social group.
One of these, who was formerly a district secretary of a charity
organization society, furnishes the following memorandum:
The hospital social worker always has a good straightforward introduction to
the patient in the perfectly definite request or inquiry made by the doctor: "In-
1
"We have found," Mrs. Chesley of the Paine Fund writes in the Survey for
May 22, 1909, "that the best place to obtain this knowledge [of the client's point
of view] has been in the privacy and seclusion of the little room of the Parish House
which the committee uses for an office. Of course, applicants are seen in their
homes, often times, but people are much more self-conscious in their homes,
many
especially if we go
as strangers and our visit is unexpected. In the majority of
homes we are never free from interruptions from children or neighbors, and we can
never be quite sure that there is not someone in the next room listening to all we
say."
The statement as to self-consciousness may be open to question, but the lack of
privacy in many crowded city neighborhoods is undoubtedly a real difficulty.
108
THE FIRST INTERVIEW
struction in hygiene," "sanitarium care," "light work," "medicines don't help

what is the trouble at home?" "help in buying brace, $9," etc. The patient can
almost without exception see the connection between the worker's questions and
this definite object. Hence he is not suspicious or puzzled, and you are freed from
any temptation to indirectness, subterfuge, concealment or ambiguity, into which

you might drift in spite of yourself while striving to help a poor person referred by
somebody "who does not wish his name used," or who thinks the poor family "so
proud and sensitive that they must never know the associated charities is called in,"
or by that wealthy relative who would like to help but "does not wish the poor
cousins to know where the money comes from." Such situations seem to me to
involve positive deception. I know they have entangled more than one C. O. S.
worker, and it seems to me that a definite stand should be taken and a way out
found, as the final results of such work can only be an injury to all concerned.
In the hospital no such situation can possibly arise you can proceed by the
shortest and most direct route to the matter in hand. The air is clear, and you can
look your patient straight in the eyes and say, perhaps, "The doctor naturally can't
stop to discuss with you how you are going to get this expensive brace, but if you
will explainto me just how you are situated, we will talk over possible plans." This
leads quite naturally to a businesslike discussion of income and expenses and re-
sources of all kinds, without any "fishing for facts." As a result, (a) the first inter-
view takes place at the hospital; (b) the introduction is easy and the approach to
the immediate problem direct and businesslike; (c) extended explanation is some-
times needed to make the patient see the relation of the interview to his recovery
this is done frankly and seldom fails. (1 recall only two cases of failure in the year
and a half I have been at the hospital.) (d) The co-operation of the patient in
revealing his story is pretty sure.
Two medical-social workers suggest one exception in favor of

the home interview. Deaf patients often come to the social ser-
vice department from the clinical examination too sick and tired
to stand another long interview. If questioned at all, they must
be questioned so loudly that they become conscious of being over-

heard and are too embarrassed by this to talk freely. In such cases
only those statements are taken which are needed to identify the
1
patient in the confidential or social service exchange, and the
First Interview is held in the home.
Some interviews are best held on neutral ground, as at a settle-
ment or some other neighborhood center. A children's worker
describes a painful interview with a domestic who had applied to
have her child boarded out, held in the front room of the house
in which she was at service. It happened to be a doctor's office,
and she was so fearful of the return of the doctor that it was im-
1
For description see Chapter XVI, Social Agencies as Sources, p. 303 sq.
109
SOCIAL DIAGNOSIS
possible to get her to talk freely. The interview should have been
postponed to some other time and place.
It would seem, to sum up, that wherever the sense of strangeness
may be worn away most quickly, wherever a good understanding
with our client may be established most easily, is the right place
for the first long talk; and whether this place be the home or the
office must depend upon conditions which vary with locality, with
the nature of the work to be undertaken, and with the tempera-
ment and equipment of the worker. The preoccupation of the
client with the immediate crisis is one of the things to be avoided in
the choice of a place; no conditions should interfere with our efforts
to lead his mind back to the events that will reveal the deeper-
seated difficulties of his life, and forward to the possible ways out.
In so far as the home and its familiar objects suggest the more
normal aspects of his life, they are a great help. Some places in
their very nature emphasize the crisis a court room does, or the
waiting room of a busy relief bureau. This emphasis is a barrier
between case worker and client.
4. The Recorded Experience Available as a Starting Point.

It will save the client's time and assure him better service to dis-
cover at once whether he has ever before been a client of the social
agency now about to take up his application. For a dozen rea-
sons the fact that the agency has offices in different parts of the
city, has removed its offices, has changed its workers, or is one of
a number of organizations doing similar work he will not always
be able to answer this question correctly; sometimes he may not
wish to do so; but data enough to settle whether he or other
members of his immediate family are already known should be
procured before the full interview with him gets under way. Action
can be taken more promptly and intelligently and many prelimi-
naries be dispensed with, if the earlier record, should there be one,
is consulted without a moment's delay.
If the client makes his application in person, this is easily done.
At the very beginning of talk with him, first names of his immediate
family, ages of children, present address, and former addresses (if
the last removal was recent) can be had, and these will enable a
clerk to find the previous record, if any, in the office files. It
no
THE FIRST INTERVIEW
would seem unnecessary to mention this, if some social agencies

were not known to be very careless in the matter.
Wherever a confidential or social service exchange has been
established among the social agencies of a community, the clerk
can take the further step, at the same time, of telephoning to the
exchange. In the absence of an exchange, other social agencies
which have been mentioned by the client or which are likely to be
interested can be inquired of, but the service that an exchange
can render, as developed fully in a later chapter, becomes a great
protection to everyone concerned, most of all to the client him-
1
self.
When the exchange reports, in reply to inquiry, that certain

other agencies which it names have also inquired about the client
on such and such dates, their experience should be had before our
first visit to his home, and preferably before our first full interview.
The details of these consultations are also described under the

heading of the Confidential Exchange; they need not detain us
here, except to add that, where the data first given reveal no record
and fuller data names of relatives, etc. are at hand a little later,
after the fuller interview, there should be a second inquiry of the
exchange, and a second search, of course, of the agency's own files.
II. SCOPE
It might be said that the circumstances which modify a First
Interview most of all are the case worker's own knowledge of
social disabilities, and his conception of the possibilities of social

treatment. But these are something more than circumstance;
they are the medium, the surrounding atmosphere of all his en-
deavor. His attitude toward social disabilities and their treat-
ment, plus his native instinct for the facts and values of human
nature, are an important part of his social philosophy. Every item
in the processes leading to diagnosis, from the first moment of the
First Interview, through the unwinding of the last clue, to the final
step of defining in as specific terms as possible the client's actual social

situation, will be shaped by this knowledge and by this philosophy
or will be marred by their lack. Formative in its influence also is
1
See section, the Confidential Exchange, in Chapter XVI, Social Agencies as
Sources.
Ill
SOCIAL DIAGNOSIS
the clear determination to make the treatment of which diagnosis

is only a first
step helpful.
Starting with these assumptions, what should be, in general,
the objects and scope of a First Interview?
The establishment of a good understanding at this point has
seemed to some workers so important and they have so overrated
its difficulty that they have advocated confining the First Inter-
view to expressions of friendly interest and sympathy, in the hope

that the clues upon which outside inquiries depend may be gradually
elicited later. But dodging the difficulty makes more difficulty.
If a good understanding were our goal, this might be the way in
which to begin; but our purpose is to get something done, and

usually the saving of time is a most important part of getting that
something effectively accomplished. The social diagnosis that is
not made with a reasonable degree of promptness may be made too
late. This view is emphasized by a case worker of long experience
in a letter written to one of comparatively short experience, who,
working in a family agency, advocated delay because clients so

often in their first contacts with him seemed to have "framed up"
their story. The adviser wrote:
Is not themade-up story you hear usually focussed upon today's situation, and
is not a part ofit really true? There are a few deliberate frauds who are clever
enough to make up a long tale and have it hang together, but most people, well-to-do
or poor, are not quick-witted enough for this. A kindly listener who hears what the
applicant has made up his mind to say, and sympathetically draws him on to talk
of other things, getting a story which runs back through all his life and looks forward
to the future, has got something of which the made-up story forms a very small part.
If the mind of the person in distress is all on the present, one may say, "Well,
suppose I am able to arrange just what you ask, what about next week or month or
year?" secretary likes, when she can, to say to a man, "Now suppose you
One
could arrange life just as you wanted it, what work would you really like to be
doing?" thus getting at a man's ideals and encouraging him by letting his mind
dwell on them for a moment. Sometimes she is able to turn things that way or
to some task more congenial than the old one. That for the future. As to the past,
one of myfriends has learned that the question addressed to a husband or wife of
"How did you two happen to get acquainted?" will often lighten present distress
by a memory of happier times, and also bring a flood of information as to the rela-
tives on both sides, former home and occupation, the standard of living to which
they were then accustomed, and so on.

From points which do not seem to them essential, and would not to the investi-
gator but that earlier omissions have proved them so, one gets clues not only to
112
THE FIRST INTERVIEW
possible inquiryfrom others, but to the character and psychology of the family
itself. Afterward what proves to be untrue
may be ignored, and between the family
and the investigator a common knowledge of what is true may be taken for
granted.
Are you quite sure that your own attitude the feeling that what the applicant
isgoing to tell you when he first appears "is a story well framed up" one that will
"not hold good upon investigation" is as free from the suspicion that you depre-
cate as is the method 1 advocate? Guiding the conversation does not mean ques-
tioning, necessarily. . .
You remember pointed out in the

I M
record that you had to go twice to
the hospital and doctor because you had not got in the first interview with either
of them all they were willing to tell. The same waste of time and energy is avoided
by a full first interview with the family, and it is sometimes not so easy to get in-
formation in the second interview with a family they believing that they have told
before all that is necessary as it is from a hospital or a doctor to whom one can
more easily explain.
As to the family's attitude, it is often like that of a patient who for the first
time finds a doctor who really gets to the bottom of his trouble, taking in not merely
obvious present symptoms but showing unexpected insight into matters of whose
relation to the trouble the patient has been unconscious. The patient goes away
with new hope and fresh resolves to do his full part. Of course, not everything is
gained in one interview. That is to be supplemented by outside inquiries, and when
one can arrange for continued personal relationships, by the gradual unfolding that
comes in these. Sometimes later interviews prove of equal value. But without
exception in my experience, investigators who have taken your view as to the first
interview have been the least successful in the average outcome as to their families.
Here, then, we have the attitude: a cheerful willingness to listen

to the present symptoms which seem so important to the one inter-
viewed, but a quiet determination to get below this to a broader
basis of knowledge, by carrying the client's mind forward to hopes
and possibilities ahead, and backward to the happier, more normal
relations of the past. 1 And since, if we would help him, we must
break through the narrow circle of our client's own view and get
into the wider one of those who know and understand him, we must
depend upon the First Interview for those clues which are most
"
I never mean to
likely tosupplement and round out his story.
leave a family," says a case worker of long experience, "until I
have some clue or other for obtaining outside information, no
matter how long it takes me to get it."
1
Emergency interviews may seem to present an exception to this general state-
ment. They are discussed later, p. 131.
8
113
SOCIAL DIAGNOSIS
It would appear, then, that the objects of a First Interview are

fourfold:
1. To give the client a fair and patient hearing.
2. To establish, if possible, a sympathetic mutual understand-
ing a good basis, that is, for further intercourse.
3. To secure clues to whatever other sources of information will
give a deeper insight into the difficulties of his situation and their
possible solutions.
4. To begin even at this early stage the slow process of develop-
ing self-help and self-reliance, though only by the tonic influence
which an understanding spirit always exerts, and with the realiza-
tion that later the client's own level of endeavor will have to be
sought, found, and respected.
1
These apparently separate and sometimes apparently conflict-

ing tasks are four parts of one purpose. We wish to serve, and we
desire to influence in order to serve, but influence exerted in a mis-
taken direction would be worse than futile; we wish to serve, and we
desire to know in order to serve, but knowledge is an impotent
thing in the hands of one who has lost, through impatience, the chance
to use it. Consideration of this aspect emphasizes the difficulty.
The way out of the difficulty is to see clearly that frank and in-
formal talk can be a help both in winning a common understanding
and in securing clues to the coadjutors who can help us to understand
still better. How soon the ground already won can be lost with-
out their co-operation any candid examination of social case rec-
ords would prove only too conclusively. Social work is team work.
It must be conceded that good will and patience will not always
bring the needed data; possible to waste time by pushing
it is
stubbornly and immediately for every available clue. In a small

minority of interviews, it is better to trust to finding more clues
outside in the course of following up the few that are grudgingly
1
"The study of defectives and failures brings home to us most forcibly a funda-
mental fact of economics, that certain persons are adequately endowed for small
demands, but are bound to fail under an excessive demand. There would be far
more happiness and real success in mental hygiene, if more people would realize
that at every step, every person can do something well and take a satisfaction in
doing it, and that this satisfaction in something done is to be valued as ten times
greater than the satisfaction taken in mere thought or imagination, however lofty."
Adolf Meyer: What Do Histories of Cases of Insanity Teach Us Concerning
Preventive Mental Hygiene During the Years of School Life?
114
THE FIRST INTERVIEW
revealed ; and, with a still smaller remnant, treatment has to be-
gin in an experimental way before any evidence can be brought

to light upon which a plan of treatment can be solidly based.
III. METHOD
1. The Approach. As
often happens, the best description of
method comes to us from practitioners in other fields. Dr. Adolf
Meyer in an unpublished document instructs the psychiatrists
who are his students as follows:
For any examination, the mode of approach is absolutely decisive of the result.
The reserve of the patient is usually a factor to be reckoned with, or, if not the re-
serve, at least the unwillingness to show a clear picture of decidedly peculiar ex-
periences. It is, therefore, necessary to gain the confidence by treating the patient
"as a sensible man or woman," and, wherever the patient does not speak freely,
to begin with questions about whether they have all they need for their comfort,
to pass to some of the least irritating topics, such as will most likely elicit a pleasant
answer and create a congenial starting point. In perfect privacy and, as Head says,
with the choice of a quiet confidential hour and the precaution of changing the sub-
ject when irritation begins to adulterate the account, and before the patient has
been exposed to the influences of the ever present blase fellow patient, the state-
ments can usually be obtained quite fully, often with a feeling of relief in the patient,
and a between physician and patient. That any chances
distinct gain in the relation
for self-humiliationmust be eased with verbal suggestion and that any appearance
of obnoxious ridicule or dictation or correction and unnecessary argument must be
avoided, should not require special insistence. It certainly requires a great deal of
knowledge of man to choose the right moments and it is to such an extent a matter
of inborn tact, that it is doubtful whether any written rules can do more than bring
out in a more definite order that which one has already.
Privacy, absence of hurry, frequent change of topic, with some

deliberate padding to ease the strain, particularly "when irrita-
tion begins to adulterate the account," and yet through all a clear
conception on the part of the interviewer that a certain goal must

if possible be reached, and a slow, steady, gentle pressure toward
that goal this, in brief, is our program.
Giving the client all the
time he wants often leads to that fuller self-revelation which saves
our time and his in the long run. Pressure of work! Lack of
time! How many failures in treatment are excused by these two
phrases! But, wherever else the plea of lack of time may be valid,
peculiarly inappropriate at this first stage, for no worker ever
it is
has leisure enough in which to retrieve the blunders that result

SOCIAL DIAGNOSIS
inevitably from a bad beginning.

1
Save time, if need be, at some
"
stage of treatment, but not at the First Interview. The physician
"
who comes in like a gust of
wind," says Dr. Paul Dubois, looks at
his watch, and speaks of his many engagements, is not cut out to prac-
tice this psychotherapy. 1 is necessary, on the contrary, that the pa-

1
tient should have the impression that he is the only person in whom
the physician is interested, so that he may feel encouraged to give
"
him all his confidences in peace." And again, Let your patient
talk; do not interrupt him even when he becomes prolix and diffuse.
It is to your interest as well as his to study his psychology and to
lay bare his mental defects. Help him, however, to get on the
right road, and to give correct expression to his thoughts."
2
"A
great many witnesses," says Gross, "are accustomed to say much
and redundantly, and again, most criminal justices are accustomed
to try to shut them off and to require brief statements. That is
1
silly." This ability to feel and to show concentrated interest in
a client's individual problem is a fundamental condition of good
social case work.
The following illustrations gathered from case workers may
contain some suggestions as to method of approach, though the
beginner who attempted to copy them instead of trying to under-
stand the spirit behind them would be making a mistake. Further
illustrations will be found in the reports of First Interviews in
Appendix I.
An agent for a state department for dependent children says that it is impossible
to "frame up" any introductory speech. She never knows what she is going to say
until she sees her client face to face. She was sent to visit a woman who had lost
sight of her eight-year-old illegitimate child for a long time. Through relatives
the agent had been able to trace the mother, who had married and now had a young
"
baby. She found the woman in a neat flat, and said at once, I have come on a
most unfortunate errand and I wish that it had not been

necessary for me to come;
won't you let me come in, please, for feel sure that you would rather that we were
I
not overheard." When she went into the kitchen where the little baby was in a
cradle, she spoke to the child and talked to the mother about it until the mother
was more at her ease; then she told the object of her visit. The mother at first
tried to deny the relationship, but finally, when she realized that the agent was sure
'For a fuller discussion of the time element in diagnosis see Chapter XVIII,
Comparison and Interpretation, p. 361.
*
Psychic Treatment of Nervous Disorders, pp. 242-3.
'Criminal Psychology, p. 18.
116
THE FIRST INTERVIEW
of her position, she acknowledged the child and promised to pay regularly for its
care.
A district secretary of an associated charities in her First Interview with Mrs. G.

found her "very melancholy and at first reserved and silent." The six-year-old
who was present was wearing spectacles. Pleased at the perfectly natural
little girl
interestshown in Bessie, in her attempts at writing, in the history of her eyes, etc.,
the mother soon thawed out, and began to tell her story.
An associated charities worker who had learned to be leisurely and had also
learned to avoid points of irritation tells of an old woman who entered her office
with the exclamation, "Now, ma'am, don't begin by telling me to go to the alms-
house, because that's just what I don't want to do." There was a circus parade
going by, and the secretary said, "Well, anyway, let's go and see the parade."
After watching the parade about half an hour, they started back to the office, and
the woman, catching hold of her sleeve, said, "Now, I just want to say I am willing
to go to the almshouse if you think it best."
An S. P. C. C. worker who much

to do with wayward girls gets them seated
has
in the best chairand "mentally comfortable" through friendly chatter before she
begins to talk to them about the painful happenings that have brought them to
her desk.
There entered a charity organization society's office one day a woman soon to
become a mother who demanded a warrant for the arrest of her husband instanter.
She had no time to waste; the children would be coming home from school and must
"
have their luncheon. The secretary looked at her watch and said quietly, School
is not dismissed before twelve o'clock. You have a whole hour and a quarter before
your children can possibly get home. Do sit down and make yourself comfortable."
Then, seizing the natural opening, "Where do the children go to school?" This led
on naturally to a great deal of talk about the children, before the irritating behavior
of her husband was allowed a full half-hour's elucidation.
Dr. William Healy says of his interviews with the parents of juvenile delinquents:
"The opening of the interview with some such friendly and reasonable statement
as the following has been found in itself to have a rationalizing effect. One may say:
'Well, you people do seem to have a difficult affair on your hands with this boy.
Let's down and talk it all over, and study it out together how it all began and
sit
what's going to happen. I'm at your service. Did you ever think it all out care-
fully?' . The response is nearly always gratifying. The attitude of all
. .
concerned becomes much the same as when the family physician makes a complete
study and inquiry into the possible causes for an obscure ailment or defect. We
get accounts of characteristics, and environments, and forebears, and other antece-
dents, and even histories of offenses unknown to the authorities, that throw often
a great, new light on what should be done with and for the offender. Just this
alone shows how vastly necessary it is to have, as in any other business like endeavor,
the attitude that wins success." 1
With regard to interviews with people not born in this country, some workers,
1
The Individual Delinquent, p. 35.
117
SOCIAL DIAGNOSIS
who happen to have many applications from immigrants coming from one part of
Europe, provide their offices with maps of that region. A large map of Ireland
showing the smaller places, hangs in a certain district office. Often the district
secretary and an exiled Irishman pore over it together to find the mark which indi-
cates the whereabouts of his native hamlet. In one of the district offices of another
charity organization society an office in the Italian quarter clients who came
originally from the vicinity of Rome and those from small villages in the south of
Italy are often reminded of the old life and started talking about it by two pictures
on the wall, one Roman and one a country scene.
Where interviewer and interviewed cannot speak the same lan-

guage the approach is doubly difficult. The objections to making
it through the English-speaking small children of the family are
obvious enough, though this is often done. Some large organiza-

tionsemploy case workers of the several nationalities from which
they have the largest number of non-English-speaking clients.
Where these workers know more about the foreign language than
they do about the special problems of the immigrant or about
social work, the results are not happy, but it is becoming increas-
ingly possible to find case workers with the double equipment.
The use of interpreters is an expedient which is full of difficulty.
"He is, of course, a necessary evil," says Miss Ida Hull of the interpreter in a
paper on South Italians already quoted, "unless the social worker himself speaks
Italian and understands the dialects. The professional interpreter is ubiquitous.
Since he usually represents himself as the friend of the family it is not always easy
to determine just what his standing in the case really is. Appearances are often
deceptive, as he may live in the neighborhood and may respond when the family
calls from the window. Such professional interpreters are retained by their clients,
not to translate the family's statement, but to achieve some desired end. They soon
come to know about what sort of story will win attention, and to act accordingly.
They receive from fifty cents to five dollars a trip, or sometimes a lump sum for a
certain result, beit easy or difficult to attain. One such interpreter, in a burst of
indignation against a client 'friend' who had not paid, spoke of a widower who had
been a 'perfect gentleman' and had at once handed over the ten dollars which she
had asked for inducing the city to take charge of his children.
(And the Associated
Charities thought had been responsible for that!) Since these professionals
it
'repeat' they gradually become known for what they are, sometimes fairly honest
and sometimes utterly unreliable; but always, of course, in the work as a business
proposition.
"The interpreter who may be considered a prominent citizen, and who goes out
to interpret only when he has a personal end to gain, is a more perplexing factor.
His connection with the problem is doubly difficult to discover when he adds the
role of interpreter. One such man, of good business reputation, came to ask the
118
THE FIRST INTERVIEW
assistance of the Associated Charities for a young woman in trouble, who had been
given his address in another city and who was then stranded and alone except for the
shelter which he was forced to give temporarily. He stated the case briefly, and a
call was promised and planned for an hour when it was hoped that he would be out.
He was on hand, however. To the first question, 'How long has she been in this
country?' the girl replied in Italian 'three months.' Her business manager turned
to the investigator and translated 'one year.' When the investigator replied 'but
tremesi does not mean one year,' and added that she understood Italian, the inter-
view was really over though it took a half hour of polite interchange before it ap-
peared to be terminated; and then this prominent citizen had decided to assume
all responsibility himself.
"Many investigators try to secure as interpreter an Italian connected with some
sort of social work. This seems the easiest way at the outset, but there are disad-
vantages. Such an interpreter is almost certain to explain rather than to translate.
While much explanation may be necessary, all investigators will certainly want to
know just what the family said as well as what they meant by what they said. Then
it may very well happen, that, in proportion as the interpreter can speak authori-
tatively, the conduct of the case falls into his hands. A first investigation can hardly
be conducted as a partnership enterprise. An instance of the failure of such an
attempt concerns a most competent and co-operative Italian social worker who acted
as interpreter in the case of a deserted wife. This wife, when asked if she had men
lodgers, replied in the negative, and then the investigator begged for further ques-
tions as to the owners of three coats, all in the same stage of decay, which were
hanging in a bedroom. Instead of pursuing that subject, however, the interpreter

stopped to explain in detail that a Sicilian wife could not keep men boarders in the
absence of her husband, as such a course would be regarded as highly improper.
The interpreter regarded further questions along that line as insulting and the
investigator could not courteously press the point. The information given as to
Sicilian etiquette was unimpeachable; but, alas! later developments showed that
this particular Sicilian woman had done many things which could not be sanctioned
even by less rigid codes of conduct.
"Picking up an interpreter at randomis a dangerous expedient. The difference
in dialects may make impossible for the family and interpreter to understand
it
each other well. Then the family may object for a variety of reasons to telling
their troubles to that particular person. The chance interpreter may be a gossip
in whom the family cannot safely confide; she may be a creditor; she may seem
their social inferior because of having been born a few miles too far south.
"Perhaps on the whole the best way to arrange for the first interview is for the
investigator to go to the house and to look so brim full of interesting things to say
that the family will seek the interpreter they prefer. The one they choose is likely
to be in sympathy with their point of view and to try to present it. If the first
interpreter proves inadequate, others may be sought for later interviews. Checking
one by another is a way of correcting interpreters in their mistakes, both intentional
and unintentional, but the most successful way of treating the interpreter problem
is to learn the language and so either to eliminate or to control them."
119
SOCIAL DIAGNOSIS
2. Clues and Questions. A number of case workers have been

asked to write as careful an analysis as possible of the process
of some of their own recently held First Interviews, stating the
physical and social conditions under which the interview took
place; the first five minutes of getting under way; the direction
taken by the first full flood of talk; any efforts made to direct the
stream; the obstacles encountered and how overcome; the dis-
tinct points of illumination and insight, and how these were led up
to; the clues to the experience and points of view of others in-
terested in their client, and how these clues were secured; im-
patient pressure, if any, for premature action, and how it was set
aside; possible centers of soreness and how they were avoided;
and what understanding about the next meeting, if any. As might
have been anticipated, some of the best interviewers proved to be
the worst possible analyzers of the process, but a few of the analyses
secured are given in Appendix I.
These analyses were not needed to prove, though they do prove,
that the worker must at once begin, as soon as the interview opens,
to draw certain tentative conclusions they are little better than
conjectures at this stage and must also be prepared to abandon
these as the interview and the later story develop. Take, for
instance, one of the analyses at hand in which a man, out of work
for several months, applies to a family agency in a city to which
he had just come with his wife and child. In answer to the first
comment of the interviewer that she understands he is a locomo-
tive engineer, he volunteers the statement that he was disqualified
by "nervous trouble" in November and has not worked since.

At once there comes to mind some outline of the things that the
vague phrase "nervous trouble" might cover. Is the disease
physical? Mental? A result of some habit, of alcoholism or
drug-taking? The very first line of questioning takes the direc-
tion of finding out what kind of medical care the man has had.
This brings the name and address of a doctor in another town,
whose advice can be sought later. But the possibilities further
suggested by "nervous trouble" such as drug habits, etc. lead
the worker somewhat later to cover carefully the man's where-
abouts since his discharge, his means of maintaining his family,
his reasons for leaving his farmer father with whom he and his
120
THE FIRST INTERVIEW
family have been staying, etc. At any moment, either during the
interview or later, information obtained may show that some one
or more of the hypotheses that prompted the questions asked
are untenable. They must never be clung to obstinately. This
warning has been given in earlier chapters, but it will bear repeti-
tion.
In the interview with a deserted wife, given in Appendix I, this
same process appears again and again. Husband and wife got on
well when they were in another city, the client says. Though the
man may not return and though further inquiry may easily prove
that the statement is a mistaken one, still make a mental note of it.
It may have a bearing upon diagnosis; it may have a bearing upon

treatment. If the man "got her into trouble" before they were
married, as the wife states, this suggests complications with rela-
tiveson both sides of the house, and a forced marriage, perhaps,
in which there was little affection. The very next questions follow
this line of thought, making allowance, however, for the chance
that after the children came the father's sense of family responsi-
bility developed. This wife comes to the associated charities
office homeless, after a violent quarrel with her mother. But has
she no other place to go? Yes, there are relatives and some of
them can be and are communicated with by telephone. The fact
that they have telephones is in itself an indication of certain
material resources, at least, and so on.
These processes of reasoning, of inference, of making a first
hypothesis as a tentative starting point, have been considered in
Part and, following the gathering of evidence, its correlation,
I,
as discussed much later, involves a reweighing of inferences al-

ready drawn but any interview in which the social worker was not
;
using his reasoning faculties in this way every moment would be

lifeless and useless. The habit of weighing, comparing, consider-
ing must be understood to belong to all the processes described in
every part.
It would seem, from the analyses received, that interviewers
may be divided into those who follow a fairly fixed order of pro-
cedure, and those who begin wherever the situation suggests a
natural opening and let the interview develop as it will, bringing it
back from time to time to cover some absolutely essential point,
121
SOCIAL DIAGNOSIS
but checking off mentally the unasked questions as they happen

to be answered. Under some conditions, when conducting an
interview through an interpreter for instance, direct queries are
unavoidable. Both of these groups recognize the disadvantages
of rapid-fire questioning, however, and realize that the more
clearly an investigator has in mind the things that he ought to

know, the more completely can he avoid the manner of the official
examiner; they differ in that the one holds a loose rein and the
other a tight one.
One interviewer in the "fixed order" group tries if possible to
get the person interviewed to begin with his birthday and develop
his story in chronological order. Another, though not holding
herself strictly to any established order, strives usually to get the
"family make-up" first, including names, ages, and birthplaces of

the father, mother, and each child, and of any other members of
the family group. Birthplaces suggest previous residences. She
"
then tries to muster in her own mind what she calls the physical
and industrial resources," the transition from the first to the second
grouping being easily made by some such remark as, "Well, this
certainly is a big family. How do you manage? is your What
husband doing?" This leads on to earnings, employers, physical
condition, etc. The beginner is often even more precise than this.
Not only does he memorize what is known as the face card of the
case record that he will later have to fill in, but he makes the mis-
take too often of allowing his interview to be shaped by the acci-
dents of the size and arrangement of the card. 1
There is no one way of conducting a First Interview, and it
may be that upon occasion any one of the foregoing methods might
have to be resorted to, but the more flexible method of the worker who
keeps his mind open to all natural avenues of approach and utilizes
them to the full is likely to yield better results in the long run and
in the majority of cases. An interviewer who is an advocate of
the freer method writes that she lets the story go on as it will,
beginning anywhere that may suggest itself by accident or by the
situation at the time of her arrival, but adds that she has trained
1 "To who began without a face card," writes a case worker, "and
those of us
made one our convenience, the beginners who allow themselves to be tied down
for
by it seem tragic objects. Anything we can do to disabuse their minds of the idea
that they get information in order to fill out the card will be well worth while."
122
THE FIRST INTERVIEW
herself to put the facts as she gets them in a chronological scheme,

and to keep in mind gaps that must be filled dates, addresses,
specific names, numbers, etc. as the opportunity arrives. In
one hospital social service department, two workers specializing
in nervous diseases use different methods. One keeps quite closely
to a carefully prepared outline; the other starts with the problem
because of which the patient is referred. If her department has
been asked to help in finding more suitable employment, for in-
stance, she takes employment for her first line of questioning and
leads the patient into other avenues through this natural approach.
She prefers direct questions to subtler methods, stopping to explain
the reason for each question whenever this is necessary.
Everything that has been said about methods
in earlier chapters
questioning, and more about 1

of especially leading questions,
applies especially to the First Interview. Not only should we
frame our questions in such a way as to bring truthful replies,
but we should put aside, to be sought elsewhere, all information
that can be secured just as well or better from an outside source.
Employers and fellow workmen are better witnesses as to a man's
habits than he or his immediate family. Ages and property
things about which all sorts and conditions of men are secretive
are often matters of public record. 2 Economy of means marks the
skilled worker; he asks no useless questions, he gets fewer mis-
leading replies. Misleading replies are never just that; they are
barriers between ourselves and those whom we would help, which
is the best of all reasons for aiding our clients to bear truthful
witness.
Certain questions must be asked, of course, but it is important
to bring them forward at the right time. When we ask the head
of the family seeking material assistance whether there are any
relatives able to assist, he will almost invariably say "no," be-
cause his mind is bent upon securing other help. 3 Note the mis-
1
See p. 71 sq.
* "
remember an instance of an agent's getting first one story, then another,
I
and then another, about the property left and the guardianship of the children,
when a visit to the probate court in the first instance would have saved a great deal
of trouble and made the matter clear." From a private letter,
See upon this point Chapter XIII, Documentary Sources.
1
Sometimes clients are quite sincere in saying that their relatives will not or
cannot help or advise and yet they are mistaken. "An old man assured a worker
123
SOCIAL DIAGNOSIS
take traceable to this cause made in the interview reported in
Appendix I,
1
and how quickly the ground
lost was recovered.
All of our clues are best won as "by-products of cordial inter-

course," but a few of them are too important to be omitted.
Those that are most frequently needed from the initial interview
are (a) relatives, (b) doctors and health agencies, (c) schools,
(d) employers, past and present, and (e) previous residences and
neighborhoods.
(a) By far the most difficult clues to secure usually are the
names and whereabouts of relatives, but for reasons explained in
the chapter on Relatives as Sources these are, outside the im-
mediate family, often our most important sources of information.*
The questioning which associates relatives and the idea of assist-
ance is, as just noted, psychologically unsound, but the formal
"
question, Have you any relatives in this city or elsewhere?" may
also bring vague information about one or two and nothing about
the most important ones, namely, those that are the most intelli-
gent sources of information. Clients sometimes develop no small
degree of ingenuity in keeping the social workers who are inter-
ested in them and their relatives far apart. After all plans of
treatment have failed, it is too late to begin looking up the only
people who can fill in gaps in previous history.
Information about relatives comes most easily in the discussion
and happier times, in the talk about the normal rather
of earlier
than the abnormal periods of the family history. After making
mental note of them during this part of the interview, it is corn-
that he had absolutely no one who could help him; he had lived a solitary life,
collecting natural-history specimens for a livelihood and studying the Bible and
preaching in all his leisure hours, until he could neither collect more insects nor sell
those he had accumulated. After much persuasion he was induced to bring the
address of some relations in Canada of whom he had long lost sight, but he only
did it because he thought the lady had taken a kindly interest in him and that he
might as well satisfy her whims just as in the same grateful spirit he brought her
some pretty green beetles as a gift. The dreamy, gentle old man was perfectly
honest in thinking this inquiry useless; but by return of post there came 10 from
Canada, and news that the applicant was entitled to a sum of money under a will,
which sum had been waiting for him until he could be found." Lawrence, Miss K. L.,
in the London Charity Organisation Review for March, 1912, p. 121.
1
See p. 464 sq.
*The term "relatives" as used throughout these chapters applies to those
kindred and connections by marriage who do not now form a part of the client's
immediate family group, or share his family table.
124
THE FIRST INTERVIEW
paratively easy later on to go back and say, "Where are your

brothers and sisters now?" checking them off mentally as de-
1
ceased, as in the old country, as in this country, etc.
"Years ago," said an experienced case worker at a charity organization
meeting, "before this society was founded, I became interested in a young girl of
seventeen. She appealed to me greatly. She had no mother, and claimed that her
father was not good to her, and her brother and sister far away. She was attractive
and much alone. knew no one who knew more of her than I did myself, and was
I
often puzzled how to advise her. She was anxious to take a vacant position in a
family known to me, and after some consultation she went. It was the mistake of
a lifetime. I see her now from time to time and never without realizing the mistake
I made in
permitting her to enter that family. If an agent's investigation could have
preceded my first visit, the agent would have made a chance to see the father,
would have learned the fact that the brother and sister were less than a mile away,
that the girl had made so much trouble in the household that she was forbidden
the house, and that the father was greatly puzzled to know what to do with her.
With this knowledge, how much more wisely I could have advised her!"
There are exceptional circumstances in which the looking up of

relativesmay do more harm than good. It is usually possible to
learn from some unbiased source whether the circumstances are
as exceptional as they appear to be.
One case record examined contains the formal vote of an associated charities
district conference that a certain woman "is too sick to be urged to give the addresses
of the relatives in Seattle at present." Later they were secured without difficulty.
A woman's relatives were not seen by the agent of a charity organization society
because, according to her, they had disapproved of her marriage and she would not
for the world have them know that her husband was out of work and applying for
aid. After persistent effort a good job was found for him. Four months later his
wife applied because he had deserted her and her two small children for the third
time, going off this time with another woman. The wife had been terrorized by
him into refusing, at the time of the first application, to give her mother's name
and address. A visit to the mother revealed a long history of cruelty and abuse
from the man. In other words, four months had been wasted in securing adequate
protection for this family the real clients from a social work point of view because
the diagnosis that should have read, "Wife and children in need of protection from
a vagabond husband and father," read instead, "Hard-working head of family out
of work." The former employers seen had shielded him; his mother-in-law would
not have done so.
(b) Doctors and health agencies (Chapter X) come naturally

As noted elsewhere, relatives often appear at times of sickness
1 or of death.
The doctor and nurse may be able to name relatives that they have seen at such
times.
125
SOCIAL DIAGNOSIS
and without difficulty, usually, in the unfailingly interesting de-

tails of sickness.
(c)Schools and teachers (Chapter XI) are seldom withheld when

there is any talk whatever about the children.
(d) Employers, past and present (Chapter XII), come readily
enough usually, especially when there is any question of securing
more work or of accounting for a decrease of income. Former
employers that are not mentioned, however, are even more im-
portant than those that are, if an all-round view is to be had. It
must be remembered that the workmen of a large concern are often

known by number instead of name, and that for purposes of iden-
tification it is necessary further to have the name of the particular
shop and of its foreman.

(e) Previous residences and neighborhoods (Chapter XIV) come
most easily in the discussion of present rent, etc. The family has
been in the present house or apartment so many months, and be-
fore that they lived at such a place, but the addresses of the pre-
vious residences are often not specific and it is important to note
them as accurately as possible. Sometimes the vagueness can be
remedied by the use of the city directory and by inquiry of outside
sources. 1
We must not be so bent upon getting clues to outside information
that we miss our way to the even more important inside truths of
personality to our client's hopes, fears, plans, and earlier story.

In family work, we must have sooner or later a pretty clear idea
not only of the main biographical outlines of the two heads of the
house and of the older children, but some conception of their atti-
tude toward life. more important than any single item
This is far
in their story. own plans and their own ideals
Families have their
more definite ones than the social worker realizes. These must
be understood and taken into account from the beginning. All
our plans otherwise will surely come to grief.
3. Taking Notes. The psychological effect of a blank space
after a printed question is to suggest the prompt filling in of an
answer, whether the writer knows the answer or not. When in-
1
The city directory for earlier years can often be consulted for previous resi-
dences with profit before the first visit. For use of directory see Chapter XIII, Docu-
mentary Sources, p. 265 sq.
126
THE FIRST INTERVIEW
vestigation was first attempted in connection with the earlier

forms of charitable service, the filling in of a blank was very nearly
the whole of the process. Sometimes the applicant (the suppliant
almost) stood behind the investigator sitting at his desk, and the
latter delivered the questions over his shoulder and wrote down the
answers quite perfunctorily. The natural reaction from all this
a reaction carried farthest by the charity organization societies in

their earlier days led to the definite instruction, "Take no notes
in the presence of the poor." In so far as this instruction has
forced upon a large group of social workers a much more severe
drill inkeeping clearly in mind a mass of details without the help
of pen and paper, it has been a good thing. The attitude of the
average citizen toward the big corporation and its representatives
has a quite close parallel in the attitude of the average patient or
applicant toward social agencies. They seem powerful, imper-
sonal things, prone to ignore the differences of which the individual
is so keenly conscious, and his code for governing his relations with
them is a modified, a less loyal code, than that which shapes his
relations with his fellows. One of the most important results of a

successful First Interview the substitution of a personal relation
is
and sense of loyalty for the client's standard of behavior toward

impersonal institutions and agencies. In so far as note-taking
emphasizes the impersonal side, it is wiser to take no notes in the
presence of the client that would not appear to him at once as the
obvious and courteous thing to do. No rule can be laid down,
however. The nature of the task and the conditions under which
the interview held must modify our method. The worker who
is
can forget his pencil, visit a family for the first time, conduct a
First Interview full of names, addresses, ages and family details,
and then come back to his office and dictate a clear and accurate
statement, has at his command a better technique than one who
is the slave of a schedule or blank form. Beginners often exclaim
that this achievement is for them impossible; their memory is too
poor and the mere effort to remember destroys all spontaneity of
intercourse. Almost anyone can learn to do it, however, and it
demands not half the self-discipline that dozens of processes in the
other arts demand. If we take our professional work seriously
enough, we shall overcome this obstacle without delay. We shall
127
SOCIAL DIAGNOSIS
fail the first time that we try, and in successive trials, but gradu-
ally, either through visualizing our information or in some other
way that comes more natural to us, the memorizing will become
easy. The
ability to refrain from note-taking does not mean,
however, that we should invariably do so. Both methods have
their place. When note-taking during the interview has seemed
unwise, many workers make rough notes of names, addresses, and
main heads as soon as it is closed. If they are going on from one
visit to another, they often stop in the nearest drug store, or do

this in the trolley car, unburdening the memory of troublesome
details before beginning the next interview.
Three medical-social workers questioned on this point give the following varia-
tions of method: The first feels that filling out the face card of her record in the
presence of a patient is a distinct advantage, in that the patient passes from the
medical clinic into the social clinic to find very much the same routine followed in
both. The simple questions and answers, moreover, come as a relief after the physi-
cal examination of the clinic. She pursues this method even when the patient
challenges her reasons for so doing, on the ground that, as she believes it to be
reasonable, she should be able to explain it to another. In certain cases, though
these are the exception, she has to stop and explain why after almost every ques-
tion. 1
The second worker agrees with the foregoing as to routine questions of name,
address, age, etc., but when the history becomes more personal in its nature, she
is in the habit of dropping pen and pencil and all that would tend to interfere with
spontaneity of intercourse.
The third worker cannot imagine continuing the use of the blank form where
irritation appears, and believes that the question of writing or no writing ought to
be settled with each patient separately. "If, when the doctor brings a patient to
my office, he or she seems to be unwilling and hangs back, I try not to have him
even see the pen and ink on my desk. At another time the patient may seem re-
sponsive up to the time that the blank and pen are produced; in that event they
1
in La Methode Sociale, 1879, p. 222, as quoted by Chapin in
Le Play says
The Standard of Living (p. 8), that he always had the good will, even affection,
of families investigated, and thinks that it was due to his method; he observed
the following expedients for gaining the good will of the families:
"Not to be abrupt in pushing inquiries an introduction from a well-chosen
source helps in abridging the preliminaries; to secure the confidence and sympathy
of the family by explaining the public utility of the inquiry, and the disinterested-
ness of the observer; to sustain the attention of the people by interesting conver-
sation; to indemnify them in money for time taken by the investigation; to praise
with discrimination the good qualities of different members; to make judicious
distribution of little gifts to all."
This is taken from a description of a research investigation in which no treat-
ment is to follow; it is not wholly applicable here, therefore, but is at least sugges-
tive. The "judicious distribution" is open to question.
128
THE FIRST INTERVIEW
are left untouched. Many my patients take the written blank an

times, however,
a matter of course, and when they do,
Aside from the question of idiosyncrasy
I do.
the 'reason for referring' should modify our method, I believe. The man or woman
who wishes to pay for orthopedic plates a little at a time takes it as a matter of
course that you should make out a record that includes references, etc. On the other
hand, the unmarried girl who has learned for the first time that she has syphilis or
ispregnant is filled with apprehension lest her misfortune become known. It does
not seem possible to me to lay down any rule in our work for so delicate a relation
as the approach to the patient in a medical-social department."
An S. P. C. C. agent confirms the experience of this third worker. Sometimes she

goes into a family and tells them that she is going to write down everything they
say, and that they will get into trouble if she finds that they have not told the
truth. At other times she will not use a paper and pencil even for the dates of birth
of the children, necessary though these are, getting the names and the approximate
ages of the children and then going to the city registry of births for the accurate
dates. She never knows until she actually sees the people which method she is
going to use. It is not a question of nationality or of the circumstances of the family,
but something more subtle that influences her choice.
Of the unusually full and almost verbatim records needed of office interviews
with delinquents who are possibly defective, Dr. Healy writes, "It has been sug-
gested by some observers, e. g., Binet, that a stenographer should be present to
take down the subject's remarks during his work with tests. We should not at all
agree to this at any stage. There should be no onlooker or any third person even
surreptitiously taking notes when one is dealing with a delinquent. We have come
to feel that even the Binet tests are given much more freely when the psychologist
isalone with the examinee. To a considerable extent the same question comes up
when the interviewer himself takes the words in shorthand. People all look askance
when they know what they are saying is being taken down word for word. . . .
We have tried several methods, and are convinced that by far the best scheme is
to make little jottings of words and phrases and facts in an apparently careless
and irregular fashion while sitting at one's desk, and then immediately after the
interview to dictate as nearly as possible the actual words used. After a little prac-
tice one uses all sorts of abbreviations that really make up an individual shorthand
system, and from these one can later dictate accurately the essence of interviews
lasting an hour or more. This scheme works very well with us, and rarely arouses
any comment from the interviewed."
l
4. Premature Advice and Promises. Some years ago the

writer, in trying to traina new worker, did not discover that this
novice's First Interviews were crowded with gratuitous advice and
moral instruction, until, going unexpectedly to her office one day
and finding her alone, she said, "Come, am an applicant. Inter- I
view me." The case worker is indeed fortunate whose records of

1
The Individual Delinquent, p. 48 sq.
9 129
SOCIAL DIAGNOSIS
First Interviews, when read a few months after they have been
held, reveal no plans and suggestions that are made to seem absurd
in the light of further knowledge.
The First Interview who was seeking help for herself and her
with a mother
two children reads in part as follows: "She was advised to make a charge against
her husband for non-support at once. Says her relatives do not wish her to. ...
Advised with woman regarding-a position at service with the baby and commitment
of the older one. Says she would not like this arrangement, is sure that she can
care for the children as soon as she finds a good position." It developed later that
the man and woman were not married to one another.
"We have found that it is usually unwise to give much advice in a first inter-
view, because the patient needs to know us better that our advice may come with
added force from his appreciation of the friendliness of our motive. Also we need
to know the patient better in order to use his suggestibility, which is often extreme,
to his best advantage." Third annual report of the Massachusetts General Hos-
pital Social Service Department, sub-report on Psychiatric Work, 1907-08, p. 46.
feet of the beginner is the pressure brought

Another snare for the
by the interviewed for premature action or for definite promises
of action. Any one way of setting this pressure aside is as much
to be avoided as any one way of conducting the rest of the inter-
"
view. A favorite device is, My
committee must be consulted,"
but should be possible to give a more specific reason. The more
it
completely we treat our clients as reasonable beings the better.

5. Bringing the Interview to a Close. The test of a successful
interview, we should remember, is twofold. We must have suc-
ceeded in getting enough of the client's story and of the clues to
other insights to build our treatment solidly upon fact; and we must
have achieved this, if possible, without damage to our future rela-
tions, and with a good beginning made in the direction of mutual
understanding. Interviews that have covered every item of past
history and present situation with accuracy and care can be total
failures. Interviews that have led to an enthusiastic acceptance
on the part of the client of the social worker's point of view, and a
lively anticipation of much benefit from future intercourse, can
also be failures, though failure of the second kind need not be so
fatal and complete as that of the first. We are not investigating
for the sake of investigating, but for the sake of getting something
done that will be permanently helpful.
In our effort to build a solid foundation we may have had to ask
130
THE FIRST INTERVIEW
some embarrassing questions and touch a nerve that is sore. It is
most important, where this has been the case, that in the last five
or ten minutes of the interview we dwell upon hopeful and cheerful
things, and leave in the mind of the client an impression not only
of friendly interest but of a new and energizing force, a clear mind
and a willing hand at his service. Dr. Meyer is quite right. If
we know how to do it, the patient's statements can usually be ob-
tained not only fully but with an actual feeling of relief on his part, 1
and a distinct gain in the relation between client and worker.
6. Emergency Interviews. There are cases of severe illness or
other emergency in which action is too urgently necessary or the

conditions are too unfavorable to admit of more than a hasty First
Interview. Two of these are described by Miss Helen B. Pendle-
ton: 2
You cannot stop to find out whether the young Slav lying ill with typhoid in the
house came over in the North German Lloyd or the Red Star Line,
filthy lodging
or whether he embarked from Trieste or Hamburg. Uncle Sam must get along
without this particular bit of information, 3 but while you are making things happen,
do not forget your clues. You must know if Peter Novak has any relatives here or
whether he belongs to any church or fraternal order. And once poor Peter is pro-
vided for today, in a hospital if he will go or at home if he will not he is too ill to
be argued with and you have these clues for the work that ought to be done on
the case tomorrow, you will be justified in going on to your next interview.
Another story illustrates this matter of clues. . . The police had tele-
.
phoned a case of destitution. Police cases are always said to be destitute, but as
soon as the street and number were given the district worker knew that she should
find some sickening form of human suffering. The house was a rear tenement con-
taining three apartments of two rooms each. One of the three she knew as a dis-
reputable resort; in another three children had been ill with diphtheria the summer
before; and in the third two consumptives had lived and died in succession. In
these rooms she found a scarcely more than a boy, in the last stages of
young man,
consumption. He was in
a sullen state of despair and weakness and would not talk.
He had no people, he said a brother somewhere but he did not know where he
was. He had no friends and no one to care about him. He had made his bed and
would lie in it.
Just here nine charity workers out of ten, perhaps, would have hurried away,
after seeing that food was provided for the present need, to send a doctor and the
district nurse, and to order milk and eggs to be sent to the poor fellow every day
1
See p. 115.
1
In one of the short, unpublished papers referred to in the Preface.
*This refers to the preparation of schedules for a Federal Immigration Com-
mission.
SOCIAL DIAGNOSIS
until he died. This particular charity worker did nothing of the kind. It was
growing late and she had several other visits to make, but how could she leave this
poor fellow with no knowledge of him but his terrible present? Even in the midst
of filth and the ravages of disease she could discern that somewhere in the past
which he refused to disclose he had known the comforts of a good home. This
was a case for slow persistence and searching question; the social surgeon must not
falter. At last the name of a former employer slipped out. The young man learned
his trade there. Good! That former employer carried on a wellknown business
and would know the youth without doubt. Forty-eight hours after that interview,
the sick boy was under his father's roof. His parents were respectable, well-to-do
people, who had tried to bring up their son in the right way. He had fallen into
bad company and evil ways, and two years before had left home in a violent passion
after some of his wrong-doing had been discovered. Lately, his people had heard a
vague rumor that he was ill and had telephoned to the different hospitals in the city,
but had given him up for lost. When last seen by his interviewer, he had been given
the best room in his father's house, a room with the sun in it all day; his people
were giving him all the milk and eggs that he needed and would be glad to have the
nurse call. Surely it was worth while to take time for such a result. . . These
.
instances are mentioned because emergency interviews are the ones which we are
most apt to bungle as interviews. We do the right thing for the emergency, but
too frequently we do not discover the clue that will lead to our case's becoming
something more than an emergency case.
An agent of an S. P. C. C. describes a visit to a home for the purpose of conduct-
ing a First Interview with the mother of the family. When she arrived at the house
there was no one to be seen, but hearing voices, she walked through the kitchen to
the door of the next room, where she saw two women caring for a young girl sick in
bed. She asked, "Is someone sick here?" The mother replied, "Yes, Alice."
Without another question, and behaving as though she had known Alice all her life,
the agent soon had a physician in to examine the girl, an ambulance there to take
her to the hospital, and an operation performed for appendicitis all this without
a word of protest from the mother or a single inquiry as to who she was or how she
had come.

I. There are many circumstances that may modify the method of a First inter-
view. Among these are
(a) The nature of the task about to be undertaken, whether probation work,
family work, protection from cruelty, etc.
(b) The origin of the application or request for service; whether from an agency
or individual already interested, or from an applicant on his own behalf.
(c) The place of the interview, whether in the client's own home or at the
social agency's office.
(d) The recorded experience available. Any possible previous record in the
agency's files concerning either the person applying or others of his family. (Search
should be made for such a record before the First Interview and again after its close.)
132
THE FIRST INTERVIEW
Any possible previous records of other social organizations that show relations with
the person applying. (Where there is a confidential exchange, it should be consulted
for this information both before the First Interview and after.)
2. The First Interview should (a) give a fair and patient hearing; (b) seek to
establish a good mutual understanding; (c) aim to secure clues to further sources
of insight and co-operation; (d) develop self-help and self-reliance within the client's
range of endeavor.
The interview must not be hurried, therefore; it must be held in privacy, and
with every consideration for the feelings of the one interviewed, though always with
a definite goal in view.
3. Many questions have been answered before they are asked; these need not
be asked by a good listener. Necessary questions should be so framed as to make
truth-telling easy. Questions that can be better answered by someone else are not
necessary ones.
4. The most frequently needed from the initial interview are (a) relatives
clues
(b) doctors and health agencies, (c) schools, (d) employers, past and present, (e)
previous residences and neighborhoods.
5. The client's own hopes, plans, and attitude toward life are more important
than any single item of information.
6. Note-taking during the interview is often not wise, though this depends upon
the nature of the request and upon the place of the interview.
7. Advice and promises should be given sparingly until there has been time to
know more and to plan more thoughtfully.
8. The or ten minutes of the interview should emphasize the inter-
last five
viewer's desire to be helpful, and prepare the way still further for future intercourse.
9. Emergency interviews call for special skill, because, though time presses,
more important than usual.
certain essential clues are
133
CHAPTER VII
THE FAMILY GROUP

DISCUSS ON of theories of society and of the organiza-
A
I
tion of the family is no part of the plan of this book. The

social worker's convictions about the family, even when
they are those of the extreme feminist Left or of the extreme re-
actionary Right, will be clarified and to some extent modified,
however, by a type of case work which follows wherever the facts
and the best interests of his clients lead. It is true that his theories
will influence his work, but more and more, if he is in earnest, will
his work influence his theories. Our only concern here is with
family as a present-day fact.
life
a sobering thought that the social worker's power of in-

It is
fluence may extend, through his daily acts, to many whom he has
never seen and never, even for a moment, had in mind. This is
peculiarly true of all the members who are unknown to him in the
Family Groups
1
of his clients. For better or worse he influences
them and they, in turn, help or hinder the achievement of the ends
that he has in view.
As society is now organized, we can neither doctor people nor
educate them, launch them into industry nor rescue them from long
dependence, and do these things in a truly social way without tak-
ing their families into account. Even if our measure were the
welfare of the individual solely, we should find that the good re-
sults of individual treatment crumble away, often, because the
case worker has been ignorant of his client's family history. Sud-
denly and usually toolate, the social practitioner is made aware of
this, when tendencies that have long been hidden become opera-
tive. The following statement illustrates the diagnostic impor-
tance of family background. It appears in a singularly frank and
1
The term Family Group as used in this chapter and later includes all who share
a common table, though the parents and children usually the most important
members of the group will receive most attention here.
134
THE FAMILY GROUP
intelligent study of a child-placing agency's work, made by the

agency itself:
On the reception-inquiry side we found that we had accepted children in very

critical need of special kinds of care without knowing the particular defects in
heredity which made certain of our treatments unwise or dangerous. For example,
we had one exceedingly nervous girl in charge for several years before we discovered
that she had an insane grandmother; that her father and mother had both died in-
sane, and that this strain of insanity explained certain characteristics which we had
most incorrectly interpreted. We also discovered during the study that another
none too robust girl suffering with congenital syphilis had three generations of
ancestors with almshouse records, a grandmother who was insane and at one time
a state ward, and a mother who was both epileptic and an imbecile. The need of a
most protective kind of care, expressed in quietness, careful medical supervision,
and freedom from strain were indicated as clear essentials; yet in one instance we
were planning to put the child under very great discipline because she seemed stub-
born.
After giving a number of instances, of the same general tenor, the agency adds:
In no instance would it have been easy for us to have secured all this information
when the children were first received; but that we learned much of it years after-
wards is proof that in some cases we could, and should, have had it from the start. 1
The
foregoing experience was that of a placing-out agency; lest
itbe inferred that institutional work for children can more safely
ignore home conditions than can placing-out, the story of Pitts-
burgh's institutions, as told by Miss Florence L. Lattimore, should
be noted also. In her recapitulation she says:
Every time an had allowed a family to break up or sink, without

institution
was made to save it (if it were not already too late),
seeing that intelligent effort
and every time it had returned a child to a home that was unfit, it had strengthened
the forces that had created the application. Every time it had placed out a child
without adequate home study of the family to which he went and without ade-
quately supervising him after placement, it had run the risk of canceling all its
previous efforts to help him. Many of the children were like dropped stitches in a
knitted garment, and the whole family was likely to unravel unless the trouble was
caught up at the start. It was often a children's institution which received the
first hint of a situation which, if unheeded, later on involved several households.*
A report from a hospital social service department describes a first interview held
with a sickly wife at work over the washtub. She explains that her husband has
been living with his mother ever since he lost his work, and the interviewer at once
promises to secure extra milk for wife and children, without attempting to see the
1
Ruth W. Lawton and J. Prentice Murphy in National Conference of Charities
and Correction Proceedings for 1915 (Baltimore), p. 167.
1 "
Pittsburgh as a Foster Mother" in The Pittsburgh District, p. 427.
135
SOCIAL DIAGNOSIS
man. As health workers carry their services of many kinds more and more into
the home, it becomes increasingly important that they learn to think of the family
as a whole. Unless they do, their service will be short-circuited an unrelated and
unrelatable specialty. 1
The need of keeping the family in mind extends beyond the

period of diagnosis, of course. "I will return," says Dubois, "to
this necessity of not confining one's therapeutic effort to the patients
alone, but extending it to those who live with them. This is often
2
the one way to obtain complete and lasting results."
As stated in the preceding chapter, the first interview is often
held in the client's home and with members of his family present.
To this extent the two separate processes of making our first con-
tacts with the client and with his family can and often do overlap.
It is impossible to lay down any hard and fast rule about their
combination or separation. For the highly individualized diag-
nosis and treatment needed for a delinquent, however, it is evident
that such conditions of privacy as Dr. Healy describes8 are neces-
sary in the first interview. No third person must be present,
nothing must distract the client's attention or interrupt the de-
velopment of his story. Even then, not all will be revealed at
this one time or in this one way, as Dr. Healy recognizes more fully
"
than anyone who
has yet written upon his subject. 4 It is in each
man's social relations that his mental history is mainly written" 5

J
"To keep a promising boy at school after the legal working age, to provide
costly treatment for a sick girl, to force a well-to-do relative to support his kinsfolk,
to punish a deserting husband, to withdraw wage-earners from unwholesome work
may each represent to some specialist the supreme duty of organized social work in
one family where each of these needs is apparent. It may not be possible to
meet them all at once, and it may be that some cannot be met at all without sacri-
ficing other important factors in the family welfare. It is just as true in the econ-
omy of the family as it is in the economy of society at large that the interests of the
individual for his own good or for society's must be adjusted to the interests
of the whole. The recognition of this by specialists is necessary if we are to avoid
danger in social treatment. Here evidently clear thinking and honest discussion
are called for. This conflict can only be avoided if we are willing to study the whole
problem of family responsibility. Prejudice in favor of one's own specialty must
be abandoned and the matter decided in each individual case disinterestedly by
the agencies concerned, on the basis of all the facts obtainable." Porter R. Lee,
in Proceedings of National Conference of Charities and Correction for 1914 (Mem-
phis), p. 97.
* *
Psychic Treatment of Nervous Disorders, p. 44. Quoted on p. 129.
4
"We have been surprisedto find that one of the most particular portions of the
work was the interviewing of the relatives." The Individual Delinquent, p. 46.
1
Dr. James Jackson Putnam. See motto of this volume.
I
36
THE FAMILY GROUP
and no attempt to help a human being which involves influencing

his mind in any degree whatsoever is likely to succeed without a
knowledge of the Family Group of which he is a part, or without

definite co-operation with that group. In some forms of social
work, notably family rebuilding, a client's social relations are so
likely to be all important that family case workers welcome the
opportunity to see at the very beginning of intercourse several
of the members of the family assembled in their own home environ-
ment, acting and reacting upon one another, each taking a share
in the development of the client's story, each revealing in ways
other than words social facts of real significance. As regards
group versus individual, home versus office interviews, the tendency
has been for each form of social work to establish one unvarying
procedure. Better results could be had, probably, from a dis-
criminating use of all the different methods of approach.
In any case, it is evident that the relation a diagnostician has
with his client's immediate Family Group is somewhat different
from his relation with the sources of evidence and service which
lie outside the family. A former creditor or the custodian of a
medical or a birth record may give him information of the first
importance, and never reappear thereafter in the treatment which
is to follow; whereas the co-operation of the immediate family
may have to be sought again and again at successive stages of the
treatment, even when the social problem revealed is an individual
one. For instance, take the peculiarly individual problem pre-
sented by pathological lying, a disease in which the affected person
has "very little sympathy for the concern of others, and, indeed,
remarkably little apperception of the opinions of others." Yet

Dr. Healy emphasizes for its treatment the need of adequate co-
operation in the home or from someone outside with influence over
the individual. 1
I. THE FAMILY AS A WHOLE

The remaining pages
of this chapter must be taken as belonging
with certain of the questionnaires in Part III and with several
of the chapters on outside sources. The health of the family,
its educational opportunities, the occupations of its members,
1
Pathological Lying, Accusation, and Swindling, pp. 253 and 272.
37
SOCIAL DIAGNOSIS
are all matters of fundamental importance, but it has seemed more

convenient to treat each of them in a separate chapter in con-
nection with sources. 1 As regards the relation of the family
make-up to certain outstanding social disabilities, such as recent
immigration, desertion, widowhood, inebriety, and child neglect,
these matters are emphasized in the questionnaires in Part III
devoted to the particular disabilities named. The less formal dis-
cussion here of the family as a whole, of the husband and father,
wife and mother, children, and other members of the household,
may be taken as introductory to the questions relating to the fam-
ily in these questionnaires.
1. The Main Drift of the Family Life. One who has learned,
"
in the details of a first interview, to keep the combined physical
and moral qualities," the whole man, in view, will appreciate the
importance of applying this same view to the family. The family
life has a history of its own. It is not what it happens to be at
"
some particular moment or in reference to some particular act,"
but it is what it is "on the whole." 2 What will help to reveal this
trend? What external circumstances over which the family had
no apparent control, and what characteristics of its members
physical, mental, temperamental seem to have determined the
main drift?
Revealing things are any signs of affection and consideration in
the relations of its members to one another. Again, what does the
family admire? What are its hopes and ambitions? Has it shown
initiative at any time? What part has religion in the home life?
What ability has the home developed in its members to resist
temptation? What do they do with their leisure time? Do they
seek amusement together or apart? What were the two homes
like from which the parents came to make this third one? A
visitor two will not answer all these questions; the answer to some
will come from outside sources and to others only gradually, but
the worker who ignores these aspects and is entirely preoccupied
with names and ages, number of rooms occupied, sanitation, in-
1
See Chapters X, Medical Sources, XI, Schools as Sources, and XII, Employers
and Other Work Sources.
1
Jowett, Benjamin: Sermons, Biographical and Miscellaneous, p. 80. Ed. by
W. H. Fremantle. New York, E. P. Dutton and Co., 1899.
I
38
THE FAMILY GROUP
come and outgo, school attendance, etc., will never win lasting
results in social case work.
Nothing can interfere more effectually with a large and well

balanced view than preoccupation with some picturesque minor
incident. The writer remembers a family history of years ago
which was made more painful than it need have been by a series of
social treatments which lost all grasp of the main issues involved.
These failures were due to the striking circumstance that the
father of the family, which lived in great squalor, had named his
youngest child Thomas Carlyle.The literary members of several
charities were unduly impressed by this interesting incident in the
life of a gambler.
2.The United and the Unstable Family. There is a distinction,
made first by Le Play, which will help us to a better conception
of the family as a whole. With reference to their power of co-
hesion, we shall find that families range themselves along a scale,
with the degenerate family at one end and the best type of united
family at the other. Whatever eccentricities a family may de-
velop, the trait of family solidarity, of hanging together through
thick and thin, is an asset for the social worker, and one that
he should use to the uttermost. "It is not merely a question,"
says Mrs. Bosanquet (whose book, The Family, more especially
Part II, should be known to every case worker), "of how long the
members ofa family continue to live together in one house;
superficially the two types may be much alike in this respect. It
is one of the proofs of the strength of the modern family that it is
able to send its sons and daughters far over the face of the earth
without in the least impairing the bond which unites them; while
it is one of the proofs of the weakness of the degenerate family that
there is no bond to hold them together at all, or a bond so slender

that removal into the next street is enough to sever it. The real
nature of the distinction can only become clear as we study the
characteristics of the modern family at its best." 1 These charac-
teristics are admirably developed in the second half of Mrs. Bosan-
quet's book, but American readers will have to bear in mind that it
records the traits of a homogeneous population, of one that has
been exposed to no sudden changes of environment, and no over-
1
The Family, p. 193.
139
SOCIAL DIAGNOSIS
whelming temptation of newly found freedom. We find in this

country many signs of disintegration due to these surface causes,
even in families in which there is, at bottom, strong family feeling,
and we cannot understand the evils that beset them unless we are
at some pains to study the racial and national traditions that cling
so tenaciously around certain of the foreign Family Groups exposed
to American ideas, and that crumble away too quickly from cer-
tain others. 1
Whenever serious estrangement occurs between husband and
wife, or parent and child, the first the differences,
thing to study is
if any, in racial, national, and community background, with the
resulting differences of custom, convention, religion, and education.

Next to disparity of age, to marriage or remarriage for economic
reasons, and the interference of relatives, differences of nationality,
race, or religion are the most fruitful causes of trouble between
man and wife, and varying degrees of adjustment to the new world
environment are fruitful causes of trouble between parent and child.
It is difficult to illustrate briefly what is meant by dealing with
the family as a whole with a clear conception of the main drift of

the family life always in mind, but the following criticism of a
case record of a deserter and his family will give some conception
of the point of view:
The record comes from a charity organization society, and describes the efforts
Angus Doyle, a Scotch ship fitter who had left his Scotch-
of the society to find Mr.
American wife, Kate, and four children, the oldest a girl of fifteen, going off this
time, as was usual with him, when another baby was expected. He was a good
workman, but a hard drinker and abusive. By energetic correspondence and the
aid of a similar society in another state, Doyle was found, his employers were in-
terested, and the man was induced to send $7.00 a week regularly to his family.
After the fifth child was born, he came home and was overheard telling one of his
mates that it made no difference where a man went in this country now, he was
found out and made to support his family.
So far so good, and the critic of the record comments upon the good work of both
societies in influencing the man through his employer. Sometimes such an ap-
proach simply means that the man drops his work and goes elsewhere; but there are
not many shipyards in the United States, the wife was in no physical condition at
the time to push through a court prosecution, and the societies probably reasoned
that their best chance was to see the man in the presence of his superintendent, and
appeal to him to make weekly payments.
1
Some
of these traditions are suggested in the introduction to the Immigrant
Family Questionnaire, p. 384.
140
THE FAMILY GROUP
Returning to the family history (the criticism continues), we find three genera-
tions on the mother's side in one city neighborhood a neighborhood of varied in-
dustrial opportunities evidently. We have the chance therefore, if we choose to
take though the record does not help us very much, to fill in a background for
it,
Mrs. Doyle's mother, Mrs. Clayton, for Mrs. Doyle herself, and for her fifteen-year-
old daughter, Margaret Doyle.
I am trying to suggest many of the possibilities instead of
just a few of them, but
it will be evident that some, at least, have a direct bearing upon further treatment,
ifthere is to be any. What sort of homemaker was Mrs. Clayton? According to

a physician who "knows the whole family connection," she is a "rum soak"; ac-
cording to Doyle's sister (who herself "has an attractive home" and "seems very
placid and sensible") she "is not the right kind of woman and easily leads Kate
[Mrs. Doyle] astray." This same sister relates that the Doyles married when Kate
was and Angus eighteen and that "they have never agreed"; that Mrs.
sixteen
Doyle a good mother, manages her children well, and is very clean, but that on
is
the other hand, while she is not a drunkard, she sometimes drinks a statement
corroborated, as to the past, by the physician already quoted regarding Mrs. Clay-
ton. The further statement that Mrs. Doyle had "deviled" her husband
sister's
into leaving and that

if she would "hold her tongue" she ought to be able to
"jolly
him along" and keep a nice home has little evidential value, but does suggest that
Mrs. Doyle may be ill tempered or given to nagging. Altogether, there would
seem to be some fault on both sides, though scant basis is revealed for Angus
Doyle's statement that "his wife drank, neglected her home, their children, and his
meals"; according to the visitor, the "home is neatly and attractively kept, chil-
dren well mannered, woman certainly not drinking now."
As to the husband, we have
little evidence that is favorable. His employers had
put up with his "periodical sprees" because he was an excellent mechanic; and,
knowing nothing to the contrary, his fellow workers believed his statement that he
"had a dreadful life with his wife." According to the physician already quoted,
he "utterly worthless; undoubtedly a good worker, but drinks hard and cares
is
for no one but himself." His sister did not shield him as to the drink; apparently
the only virtue that she imputed to him was that he was "not lazy."
Here, then, is a situation in which there are elements, behind the obvious fact
of desertion and non-support, which render the return of the deserter far from a
final solution of the difficulty. He has learned a lesson, doubtless, from his latest
experience; perhaps it may restrain him when next the impulse to shake off family
responsibilities seizes him, though of this we can be by no means sure; but so long
as he continues to be a periodic drinker and abusive, so long as he and his wife are
unable to live in peace, it can hardly be said that the family problem is satisfactorily
solved.
With the scanty array of facts at our disposal it is impossible to say what the
next move should have been, after the deserter had been found and a regular in-
come from him insured. It would seem that at this point time might have been
taken to build in a background to learn something of Doyle's boyhood, his home

training, schooling, early work history. Inquiry of the sister might reveal, for ex-
141
SOCIAL DIAGNOSIS
ample, that he had been a trial from his earliest years to devoted parents who had
sethim an excellent example an habitual truant and runaway, let us say, who later
had refused to turn in his earnings. Or again, it might appear that his record as
school boy, son, and young worker had been excellent, and that his delinquencies
had not begun till some years after his marriage. It is evident that there would be
greater hope in the latter case than in the former of studying out, with Mrs. Doyle's
aid, theunderlying causes of the difficulty and finding a remedy. In the same way,
coming to more recent history, "it might be useful to know the effect of dull times in
the shipbuilding trade upon Doyle's habits and movements. Was he at home or
away, drinking or sober, during the panic of 1907-08? Is his work seasonal?
What is his state of health? Has he ever been arrested? Is there any court record?
Are the children fond of him?
On the industrial side, had Mrs. Doyle, who worked as a buffer in the metal
works, been so engaged when her husband was at home and working, or had she
worked in his absence only? In either case, what effect had her ability to earn and
to support the family had upon him? But for her condition, she would have been
earning $2.25 a day at the buffing wheels when the society visited her. Is this
healthful work for the mother of a family? Is it related in any way to the fact of
her drinking? How did the children fare under M

rs. Clayton's care in their mother's
absence? What about Margaret's work in the hosiery mill are conditions favor-
able to health and future prospects fair?
The society was quite right to concentrate, as regards treatment, upon the de-
sertion issue first; to find the man, that is, and put upon him the financial burden of
his family. But, having gained an excellent footing with Kate Doyle by so doing,
and the whole social and industrial environment that had been too much for the
family in the past remaining what it had been, was the chance to readjust their
relation taken full advantage of? Their earnings were larger than usual upon
the last visit a fact which should have made constructive work easier and the
drink, the instability, the likelihood of another family breakdown should have been
dealt with one by one.
Perhapsmy criticism may seem to overemphasize a string of items, but all of
them lead to one point; namely, that to organize the social services of a community
in any vital sense, we must all be working out, in at least a minority of the families
that come under our care, the synthetic relation of the industrial, physical, moral,
and social facts which affect their welfare. In other words, what might have been
a good beginning with the Doyles was mistaken for a good ending. From the very
first interview with Mrs. Doyle the possibility of this wider program might have
been kept in view and might have shaped the diagnosis.
Even where background is not kept in mind from the beginning,

it is possible to recover the ground that has been lost and achieve
synthetic results later on, though it is not so easy to do so. The
Braucher case, a summary of which is given in Chapter IX, Rela-
tives as Sources, 1 illustrates this possibility.
See p. i88sq.
142
THE FAMILY GROUP
THE HUSBAND AND FATHER

II.
1. The Man Should Be Seen. Husband and wife are not of the
same blood, be it remembered. They have a
common, but past in
each has had an earlier past apart, and, since in many forms of
social work we see much of the wife and children and little or
nothing of the husband and father, it is necessary deliberately to

keep him in mind. Faulty methods of social work may have led
him to think that his wife should do all the applying and explain-
ing, but an understanding of the plans and purposes of the man of
the family his ambitions for his children and for himself cannot
be had without early personal contact with him. It is safer and
it is fairer so, and our later planning and conferring should include
him. "It is our business to see the man in this case," writes a
"
a family record.
critic of He is probably all he is painted to be,
but he has a right to a hearing."
At one charity office, the man of the family apologized for not sending his wife,
explaining that she was too sick to come that day, or else she would have applied.
He was told that the secretary much preferred to confer with him about his family's
distress, because it was his affair, as the breadwinner, even more than his wife's.
As plans for various forms of child welfare multiply it is more easy than ever to
overlook the man
of the family. "Many probation officers fail to make the ac-
quaintance of the fathers of the children in their care during the whole period of
1 "
probation," write Flexner and Baldwin. It is generally a little difficult to get in
touch with a father, but he is often the key to the whole problem. Probation officers
should make an effort to have at least an acquaintance with the father of every child
whether or not that acquaintance can be carefully followed up by close
in their care,
co-operation with him."

An S. P. C. C. worker in a small town says that she tries to get all possible in-
formation from the family direct, seeking first the man's story, then the woman's,
then bringing them together, if possible, and getting, in this joint interview, a good
deal of new light. She appeals to them to be frank with her in order to avoid
gossip, adding, "You know how the people around here like to talk, and it will be
far better for us to settle this thing ourselves if we can."
2. Place of Interview. It is often better to see the two heads

of the family separately, making a special evening appointment
at the case worker's office or at some other convenient place in
order to dothis. There may be substantial like-mindedness be-
tween husband and wife and no domestic misunderstandings, but,
1
Juvenile Courts and Probation, p. 136.
'43
SOCIAL DIAGNOSIS
in the joint interview, one naturally leads and the other follows,
so that it is acquainted with both.
difficult to get
To attempt to see the man of the family at his work place, es-
pecially if this happens to be a large concern, is unwise, though
it issometimes possible to see him there at the noon hour. His
employer objects to having him called away from his work, and he
is not at his ease, moreover. One social worker who attempted
such an interview with a man who ran an elevator found every
few sentences interrupted by the elevator bell.
The head of a department for mothers and infants in a children's
organization, recognizing that it would be a mistake to communi-
cate with a father through the unmarried mother of his child,
always writes to the man, instead of sending him a message.
She includes in her letter the statement that so-and-so has been to
see her and told her something of their situation; that, before
making any plan, she wants to talk the matter over with him; end-
ing by saying that she will gladly meet him at her office at any
hour that suits his convenience. This worker believes that men
prefer to discuss all matters of business away from their own homes.
In a given twelve months she wrote 25 such letters to the fathers of
illegitimate children. Ten called at her office in response; seven
responded by letter and four of these were seen later, though not
at the office; the remaining eight did not reply.
3. The Unmarried Father. Efforts, such as the foregoing, to
deal in illegitimacy cases with the father quite as directly as with
the mother and child, and to do this out of court in the first in-
by the following case notes:

stance, are further illustrated
A children's society was puzzled as to whether it should urge marriage between

the father and mother of a small baby. A clergyman and other references thought
the young fellow careless and self-indulgent, and all the evidence seemed to be
against the marriage. Not quite satisfied, however, the children's worker decided
to try the experiment of having the man confronted with his own child. He proved
to be one of the few fathers of illegitimate children who had, in her experience,
shown an interest in their babies. His was at once an almost maternal devotion.
So marked was this feeling that she encouraged the marriage. The home was
happy and prosperous.
A girl with a young baby applied to this same children's society to secure support
from her deserting husband. The man's relatives claimed that he had not seen his
wife for three years and was not the father of her baby. The evidence narrowed
144
THE FAMILY GROUP
down to the conflicting statements of the two sets of relatives (his and hers)
and both were of unestablished reliability. Finally a meeting was arranged
between man and wife in the presence of the agent, and he acknowledged his
parenthood.
A charity organization society was asked by a hospital to befriend an unmarried

mother of twenty with a two-weeks-old baby. She named, as father of the child,
a young fellow who had come from a refined home. He was not in the city and
wrote to his mother denying everything. An interview arranged between the
mother and the young girl convinced the older woman that the girl was telling the
truth. This did not lead to marriage, but to weekly payments toward the support
of the child. From the community's standpoint it is quite as important to deal
with the unmarried father as with the unmarried mother.
4. The Young Couple. That the wife and one or two babies of
a young, able-bodied man should, in ordinary times, need any
social service that involves material relief also is a situation which
demands the closest scrutiny. To discover all the reasons for
the trouble, ifand deal with them one by one is more
possible,
difficult than to give temporary help, but an irresponsible inter-
ference with their affairs is worse than none. Notes on the re-
corded treatment of two young couples by a charity organization
society are as follows:
Italian couple, both twenty-three, with children four, two, and one just born.
Non-supporting. The first interview and succeeding investigations do not bring

out clearly when the man began to be neglectful; whether he had exhibited the
same traits before marriage; if they first appeared after marriage, under what
circumstances; and what or who was the exciting cause. There should have been a
much more searching inquiry among other relatives and old employers, and possibly
friends of both before their marriage. Here is a pauper family in the making. It
is either hopeful or otherwise. We do not know the woman's real character at all.
We do not know how far back the man's present slackness goes. If everything
points to absolute degeneracy on his part, far greater influence (through relatives
and others) should be used to break up the family. If not, then the case is still
left in the air, because no further treatment has been provided.
This is the case of a deserter from the Navy with a young wife (epileptic) and a
two-and-a-half-year-old child. A quite compact, satisfactory investigation, with
a good chronologically arranged first statement. A
very satisfactory use of six
sources of information, though there are reasons why the second relative should
have been seen also. But with the return of the man in February, the summary
closing of the caseon February 1 5 was not wise. The man is inclined to be lazy,
he has a very loving wife who is liable to "baby" him a good deal on account of
what she will consider the hard time that he has been through. The wife has been
put into a jani tress's position (only rent free and $1.00). The wisdom of having
10
145
SOCIAL DIAGNOSIS
her start in again todo work outside her own home is very doubtful. It will be
necessary to keep in constant touch with this man by volunteer aid or long reach
from the office letters and sometimes calls. There are all the tendencies present
for a complicated problem five years hence. Deal with them now!
S, Desertion and Inebriety. These two disabilities, which

are treated more fully in two of the questionnaires, illustrate the
controlling influence upon diagnosis of a
program of social treat-
ment. In the days when no was made between the
distinction
social treatment of the wife and children of a deserter and that of a
widow's family there was little reason for mastering the history
of the desertion or desertions and the characteristics of the de-
serter. But with the development of a new sense of social re-
sponsibility for the deserter's movements and relations to his
wife and children, with provisions for his extradition, release on
probation, payments to family through the court, etc., has come
a new reason for differential treatment based upon differential
diagnosis. he really a deserter, or are there reasons to believe
Is
that he is communication with his family and still in their im-

in
mediate neighborhood? The history of former desertions, if any,
may throw light upon the reasons for this one and upon the man's
probable movements. Even if not in communication with his
own family, more often than not he will have continued to keep up
relations with someone with his own relatives, with former shop
mates, or with old cronies. Are his relatives inclined to shield
him or are they harboring him perhaps? If there is any chance of
taking court action, proof of his marriage may be necessary. Not
all deserters are equally culpable. An understanding of their
difficulties and their points of view makes it clear that, given the
right impetus, many of them are far from hopeless as family men.
It ismore important to understand the main drift of their lives than
the one incident which brings them to our attention, whether this
is an isolated one or the climax in a series of mistaken choices.
The foundations of such an understanding are best laid in our early

contacts with the Family Group.
Alcoholism is a disability which presents quite as great a variety
of possibilities as desertion. In fact, there is no social disability
in the treatment of which more use can be made of such indices to
personality as will power, sociability, capacity for affection, and

146
THE FAMILY GROUP
susceptibility to religious influence.

1
The problem has its medical
aspects; the man's bodily and mental condition and the habits
and mentality of his forebears are often the most important factors,
but the social side is important too. Such environmental factors
as the temperament of his wife, the comfort of his
home, the family
cooking, the conditions and nature of his daily employment, the
character of his companions, need only to be mentioned to suggest
a possible relation to his drink habits. These habits themselves
vary in different men. Some
are accidental drunkards; some free
drinkers who occasionally get drunk; some are unable to touch
alcohol without being overcome by it; some always drink with
others; some are solitary drinkers; some are using drugs also or have
"
substituted alcohol for a drug. The treatment of the inebriate can
" ' "
best be expressed," says Dr. Neff, in the word individualization,' 2
and the foundations of individualized social treatment are best
laid in early contacts with and observations of the Family Group.
III. THE WIFE AND MOTHER

The household speaks for the wife, answering unasked questions
about her as it does not about the husband. The wife's maiden
name will aid in identifying her kindred and will enable references
who knew her only before her marriage to place her. (In Italian
families she is still often known by her name instead of her hus-
band's.) Her maiden name may also aid in bringing to light

the records of related families under treatment. She remem-
bers birthdays and ages and church connections better than the
man does, and is the first-hand authority on the family budget,
more especially the outgo. Her schooling and her work and wages
before marriage help to place her, as does also her account of how
1
"There is a passage in one of Miss Octavia Hill's essays that throws a flood of
light on this question. She says that the love of adventure, the restlessness so
characteristic of the Anglo-Saxon, makes him, under certain conditions, the greatest
of explorers and colonizers, and that this same energy, under other conditions,
helps to brutalize him. Dissatisfied with the dull round of duties that poverty
enforces upon him, he seeks artificial excitement in the saloon and the gambling
den. It is useless to preach contentment to such a man. We must substitute
healthier excitements, other and better wants, or society will fail to reform him."
Friendly Visiting among the Poor by M. E. Richmond, p. 128.
1
See Proceedings of National Conference of Charities and Correction for 1911
(Boston), p. 135.
147
SOCIAL DIAGNOSIS
she and her husband first met, and of their pre-matrimonial ac-
quaintance. Details of her work since marriage, of its relation to
her health, to care of home and children, to her husband's exer-
tions,and the attitude of her family and friends toward her work
are of them important.
all
If, in tracing the main current of the family life, it becomes

evident that there have been marked changes in home standards,
what has been the wife's share in these changes? If her home
standard was fair at one time and now is low, what factors have
entered in extreme poverty, too many children, overwork, her
own or other family illnesses? In estimating the physical in-
fluence of childbearing, the children who have died and any mis-
carriages must also be included. Not only her husband's habits
but her own must be known and understood. If, for example,
she is a gossip who neglects her household duties and spends much
time away from home, what poverty of opportunity and of in-
terests, what recreational need that can possibly be met is behind
this? The drink habit is not always confined to the man of the
family. Even where husband and wife both drink the one habit
may have two quite different histories.
1. Physical Aspects of Homcmaking. A household may be in
a good deal of disorder and still be essentially cleanly. The re-
verse is and the distinction is worth making. Has
true, of course,
the wife learned to sew? Does she take pleasure in making the
most of the family wardrobe, or has she lost or never had this interest
in clothes?What does she know about cooking? Is she a good buyer?
Upon questions of "income and outgo" the wife and mother is,
as has been said, the best authority. 1 Details given under this
head in the first of the questionnaires need not be repeated here,
but one important point, not capable of outside verification, should
be emphasized. The food habits of the family must be known in
many forms of case work, because these habits are so closely re-
lated to the family's health and to its efficient use of income. The
homemaker knows what food is bought and eaten, of course, but
unless she keeps accounts, her estimate as to the total cost of any
item of her family budget is worth very little. A case worker and
1
The wife does not always know the earnings of her husband and older children,
however.
148
THE FAMILY GROUP
dietitian tells of an English-speaking Polish woman with five chil-

dren who, when asked how much per week was needed to buy food
for her family, said, with a manner that indicated the amount might
"
seem excessive to her visitor, I think I must have $2.00."
No mere account of food purchases and prices, moreover, can
give the
all data needed, for details of choice, preparation, and con-
sumption are half the story. And any inferences drawn from these
details must take into account not only such obvious factors as the
size of the family, and the ages and occupations of its members,
but those conditions of health and those national and religious char-
acteristics which have a marked influence upon food consumption.
Even so definite a matter as the size of the family is complicated, in
some immigrant households, by the presence of boarders for whom
the housewife cooks food provided separately by each boarder. 1
Another modifying factor is the amount of time and skill that
the housewife has to devote to homekeeping. Most economies
in money call for an increased outlay of work and skill. In fact,
the housewife's skill is "an asset which must be included in the
2
family resources."
Any study of food questions has a very stimulating effect upon
the homemaker when she shares in the whole process. She needs
some such stimulation of interest, for her devotion to a difficult
round of tasks is often taken entirely for granted.
When we confine our attention to the strictly diagnostic aspects
of the food question, the greatest difficulty encountered will be with
the housewife who cannot keep good accounts or any. This handi-
cap means more frequent visits, some of them at meal times per-
haps. As the housewife knows what she has just bought, a start
in getting the rough outlines, at least, of food consumption may
be had by working on a day basis and trying to discover, concern-
ing each of the staple articles which every family is supposed to
have, just what has been bought and eaten.
1
What is left over commonly goes to the family, hence it becomes practically
impossible to estimate the money expended by the family or the amount of food that
they have. The visitor may judge unfairly too, when she sees the boarder's chicken
cooking and assumes that it belongs to the family. On the other hand, the family
may claim that its own bountiful meal belongs to the boarders.
*
Byington, Margaret F.: Homestead, the Households of a Mill Town, p. 74.
New York, Russell Sage Foundation Publication, Charities Publication Com-
mittee, 1910.
49
SOCIAL DIAGNOSIS
The dietitian of a public department administering mothers' pensions reports

the following items of experience: "The department requires that household ac-
counts be kept by the pensioners, and, though an untrained woman seldom keeps
accurate accounts, wilful inaccuracies usually show either (i) impossible amounts
of a given article, (a) costs whichdo not correspond with amounts purchased, or (3)
monotonous repetition of the same few items. Entire absence of some essential
is often an unintentional inaccuracy."
This dietitian finds that the best avenue of approach to the food question is an
anemic or undersized child. The attention of the mother is called to the fact that
the child does not look particularly strong, and she is asked whether he has a good
appetite. What did he eat for breakfast this morning? How does this compare
with what the other children ate? If, as frequently happens, the breakfast was
"
bread and coffee," 1 this gives a chance for explaining the value of milk and cereals.
The topic of the children's luncheon, especially that of the school children, naturally
follows. Do they come home to a hot luncheon or do they buy bakery buns and
cakes? Is their chief meal at noon or at night? Is it a meal at which all sit down
together to eat, or do the different members of the family eat how and where they
please? Is the dietary for adults and for younger children the same? When the
mothers have once realized that an interest in the health of the family and not a
desire to cut down monthly allowances is behind these questions, the response has
usually been a cordial one.
Each visitor of this department is provided with a schedule of the normal weights
of children of given ages, and secures, for the neighborhood in which she is working,
a list of prices of staple foods in the stores in which prices and quality are most
satisfactory.
After the actual food habits of the family have been clearly
grasped a thing that cannot usually be achieved in one or two
visits the question of finding the remedy for defects and inade-
quacies remains unsettled. A
fair standard of food values and
costs should be the basis of any budgetary estimate, but, as regards
each locality and each marked
costs, the modifications necessary for
change in market rates should be worked out more carefully than

they have been by family agencies. A unit of cost per person
estimated for the whole country years ago can be very misleading.
We must know also the health conditions and the family or indi-
vidual idiosyncrasies that should modify our estimate. If all of
the family are found to be in good physical condition on a smaller

food allowance than our estimated local standard, should the
standard be urged, or should this variation be ignored? All of
1
Dr. Healy says in Honesty (p. 105) that, unexpectedly, he found the overuse
of tea and coffee one of the most frequent causes of delinquency in children.
150
THE FAMILY GROUP
these matters are important; most of them do not belong here,

however, but in a discussion of the later stages of treatment.
2. The Family Housing. The following list of the housing defects
that are serious enough to arrest the attention of social workers,
no matter what their errand to the home, is an amplification of
one prepared by the writer in 1 9 1 1 .* Not all of these things can be
covered in one visit, of course, or in two, but all are important.
a. Bad, Toilet Arrangements. We visit homes frequently where there is inertia,
low even sickness without knowing definitely or taking the trouble to

vitality, or
discover the condition of the plumbing, the trapping of the waste pipes, etc. The
cleanliness of the toilets, their locationand provisions for privacy, such as inside
locks, have a bearing upon health and decency. An untrapped waste pipe means
sewer gas, probably, and sewer gas means ill health. Where there are outside vaults
a menace to health from fly infection always exists, while inconvenience of access and
noisome odors combine to make the condition one of the most serious of housing evils.
b. Dampness. The condition of the cellar, the walls, and the roof, more espe-
cially of the cellar; is its floor wet or damp, has it a dirt or a cement floor, is it
cluttered with rubbish or animals? Are the pipes leaking? Does the roof leak?
c. Dark Rooms. When these are used for bedrooms, the fact should be noted on
our records, should be related to our family histories of disease and premature
death, and should be made the subject of steady pressure upon citizens, lawbreakers,
and public administrators.
d. Overcrowding. This is especially to be noted as regards sleeping accommoda-
tions. Its vital relation to health, particularly to the spread of tuberculosis, and
to decency must be vividly realized and kept constantly in mind in all our plans for
making people economically independent. Independence built upon a standard
that ignores decency is built, of course, upon quicksand. In this connection the
taking of lodgers and boarders is especially important because of the physical,

moral, and social dangers involved.
e. Insufficient Water Supply. In the purity of the source and the amount are in-
volved the condition of the cistern or tank and its care between official inspections.
Is there running water and, if not, where is the nearest tap?
When we have trained ourselves to observe these things, we

shall find that the unhealthful conditions discovered are some of
them violations of existing statutes, others not. With regard to
the first group, we should lose no time, of course, in reporting to
the right place bad conditions that really are violations. The second
group furnish arguments for further legislation, but they do this
only when they are promptly and accurately recorded. Pending
1
See Proceedings of National Conference of Charities and Correction for 1911
(Boston), p. 327-328.
SOCIAL DIAGNOSIS
the securing and enforcement of such legislation, it is possible to

keep the worst houses and tenements empty by persuading tenants
to move, and it is possible to remedy the less serious nuisances
with their co-operation. It has also been found practicable some-
times to appeal directly to landlords who had been in the habit,

earlier, of leaving the management of their properties to agents,
and persuade them to correct the evils complained of.
IV. THE CHILDREN

Here we and all those undercurrents of
find blood relationship
sympathy and antagonism which it implies. Propinquity only

aggravates any natural lack of sympathy. Between kindred such
lacks are often fundamental. Often, however, as Mrs. Bosanquet
points out, antagonism is due not so much to fundamental dif-
ferences as to the assumption that there should be no difference.
The implacable attitude of child toward parent, parent toward
child, and of brothers and sisters toward one another is due to
likenesses even more than to differences. "That a member of
the family, sharing in its common nature, partaking in its im-
pulses, instincts, sentiments, and education, can have done this
thing it is that which wounds deeper than all the scorn or pity
from the outside, for reveals possibilities unrealized before." 1
it
A probation officer tells of a girl in her care who held a grudge

grimly against her mother for three years because she complained
of her to the juvenile court at a critical time. So often do parents'
complaints to the court cause open rebellion and permanent
estrangement that this officer strives in every possible way to
settle such difficulties without appearing in them.
One common cause of estrangement is the inability of children
to give expression to their ambitions or to find a natural outlet for
their energies. The effects of these checks are intensified in any
family that passing through a sudden change of economic
is
status, whether that change be favorable or the reverse. The

response of the different members to the outward change is a
varied response; the upheaval which depresses and alienates one
member acts as a stimulus to the energies and affections of another,
with the result that all are thrown out of their accustomed relation
1
The Family, p. 257.
152
THE FAMILY GROUP
to one another. The human situation thus created has been a

favorite theme of English fiction from the Vicar of Wakefield to
the latest best seller.
Other causes of estrangement are the unwise reticences of pa-

rents and their failure to appreciate, at critical periods, the physi-
"
cal reasons for a child's lack of control. There is the most definite
1
necessity," says Dr. Healy, "for little people telling what they have
seen and what they have done. For them to bottle up within
themselves affairs of importance is a dangerous proceeding. We
should most earnestly counsel that children should be accustomed
to go over the items of their daily life with their guardians that
there may be no hidden knowledge to be dwelled on in morbid
fashion. Of all forms of prevention of delinquency I know of
nothing comparable to the confidences and counsels between elders
and children."
It is a commonplace of child-saving, of course, that a child
placed away by one or both parents loses, in large degree, the sense
of family solidarity.
The mother's attitude toward her children and theirs toward
her are easily observed as they come and go in the home. A
medical-social worker says that if, after the immediate purpose
of her visit to a home is accomplished, she has occasion to wait
to make a train and busies herself with a book or some work mean-
while, the members of the family, ceasing to react to her, begin
to react to one another, and she gets an impression of the home
that she might miss altogether otherwise. Have the parents good
control over their children? Do the latter seem afraid of either
parent? Are they punished in anger, or is self-control exercised?
The unfortunate practice of some teachers, nurses, and social
workers of dealing with the family's affairs almost entirely through
the medium of the children has a definite bearing upon the loss of
respect for parents which is so marked a characteristic of the young
people in certain families.
Mention has been made of the failure of many children's in-
stitutions and societies to
study the family backgrounds of their
wards. Quite as grave an omission is the failure in many family
agencies to individualize each child in the families under their
1
Honesty, p. 177.
153
SOCIAL DIAGNOSIS
care. Aside from the consultation of school records and possible

court records, both of which are items to be covered outside the
home, visits to the home itself should lead to inquiries as to the
physical and mental condition of every child showing any varia-
tion from the normal, 1 and should also give us a clear impression
of the temperament of each of the children. What are their apti-
tudes, their ambitions, their small achievements? The sleeping
arrangements for the children, both with reference to their health-
fulness and their decency, are an important point. So are their
recreations. Are their small, individual possessions respected?
Have they any? What opportunities have they for sharing
pleasures and duties as a part of the family? Is there any indica-
tion that they are overworked at home duties? That they are
doing sweatshop work at home? Are they sent to charity offices

with messages which should be taken there by adults only? Are
they sent out to beg? Are they illegally employed? It should be
unnecessary to add that inquiries about the children, especially
with regard to matters involving their conduct, should not be made
in their presence.
1. The Matter
of Ages. The ages of any children in the family
who are minors may become so very important at any time
still
that the recording of them with exactness must be urged. The only
way to be absolutely sure of ages is to have day, month, and year of
birth in each case and to verify these from official records. 2 Their
importance is shown from the following list of actions and judg-

ments in which such dates must be used:
a. Prosecution of parent for desertion or abandonment of infant.
b. Bastardy charges.
c. Establishing legitimacy or a previous marriage.
d. Identification of a family (where names are incorrectly given).
e. Collecting insurance.
f. Choice of a guardian.
g. Prosecution of parent for cruelty or neglect.
h. Choice of institutions for temporary placing or for commitment.
i.
Entering in school and requiring school attendance.
j. Establishing legal date for going to work, for engaging in street trading, etc.
k. Establishing legal hours of work.
1
See questionnaires on the Neglected Child and on the Child Possibly Feeble-
minded in Part III.
*
See p. 256 sq.
"54
THE FAMILY GROUP
1. Protecting from certain injurious employments.

m. Deciding right of parent to collect wages of child or receive support from him.
n. Bringing suit for accident indemnity.
o. The age of consent.
p. Fixing period during which alimony is payable in cases of legal separation or

divorce of parents.
q. Securing special transportation rates.
1
r. Establishing the legality of a minor's marriage.
The secretary of the Massachusetts S. P. C. C. puts this matter more concretely

as follows: One day after a child fourteen he can nominate a guardian; one day
is
after he is fifteen he cannot be sent to the Industrial School; one day after he is
sixteen his case cannot be considered in court under the Neglect Law; one day
after seventeen he cannot be considered a juvenile offender; one day after she is
he is
seventeen a girl cannot be committed to the Lancaster School [girls' reformatory].
Not only the month but the exact day is essential in all the
foregoing. In recording the ages of parents, the year is usually

sufficient, unless a parent also is a minor.
2. The Older Children. The educational side of the children's
lives is discussed in Chapter XI, Schools as Sources. It need not
detain us here. When the children are about to leave school,
their special aptitudes and their ambitions become very important
matters. Are they thrust into dead-end occupations? Are they
frequently shifted about from one job to another? These are the
years in a child's life when highly individualized case work is often
needed to supplement whatever plans of vocational guidance have
been developed in the schools.
The attitude of the wage-earning child who takes the turning
over of all his earnings to his parents as a matter of course, and
1
whom the writer is indebted for most of the items in this
Miss Amelia Sears, to
list,gives the following additional reasons for seeking the exact ages of children:
"If . . . there is a lapse of three or four years between the births of two
children in a large family where most of the children have come close together, three
possibilities occur to the experienced case worker: First, the parents may have lost
a child; second, there may have been a second marriage on the part of either the
father or the mother; third, the parents may have been separated for a period.
The reply to a question concerning such a lapse sometimes reveals a former deser-
tion hitherto unmentioned; sometimes the separation of the parents at the time of
migration to America, when the father may have preceded the mother by several
years; or occasionally, a period of incarceration of one of the parents in a peni-
tentiary or a hospital for the insane. On the other hand, the ages of the children
not infrequently conflict with statements of the parents concerning desertion, mi-
gration or imprisonment. The explanation sometimes discloses efforts at deceit in
the matter of the children's ages, and sometimes the fact of promiscuous living on
the part of the parents." The Charity Visitor, p. 29.
'55
SOCIAL DIAGNOSIS
whose parents have always so taken it, may lead to insubordina-

tion later on. A natural reaction from complete subjection is
pushed too far by the spirit of his new associates and by the in-
vitations of his enlarged world. From the very beginning, the
social worker must keep these future dangers in mind and seek a
better adjustment.
Separate interviews with the grown sons and daughters of a
household, especially with those who are wage-earners, are often
necessary.
A woman of sixty-four had been known to a charitable society for many years,
but her six children, of ages ranging from thirty-two to eighteen, had not been con-
sulted about her unexplained habit of writing begging letters continually. A critic
of the record writes: "My belief is that, in order to know the real inwardness, each
and every son and daughter should be seen away from the home. Practically all the
dealings in later years have been with the woman. I observe that the last record
of any one of them being seen was made six years ago. Even then it was purely
incidental. What manner of people are these sons and daughters now? How do
they feel about these constant appeals? What influence are they bringing to bear
upon their mother? Do they countenance the habit?"
V. OTHER MEMBERS
Relatives of the husband or of the wife often form a part of the
Family Group, whether with a clearly defined share of family re-
sponsibility or with none. Sometimes they carry far more than
their share of the family burden; sometimes their influence is so
disturbing as to disrupt the home a mischief often wrought by

relatives who live elsewhere, but more completely achieved by
those under the same roof. Records studied for this book seem
toshow an undue share of undesirable relatives in widow's families,
where there is no man to send them packing.
In one case, a drunken father left the home of his more well-to-do children to
livewith his widowed daughter and her small brood just as soon as a regular al-
lowance from a social agency had been organized for them. The widow was an
easy-going person, for later she married a man that was more of a vagabond than
her father even. The givers of the allowance conditioned its continuance, up to the
time of the second marriage, upon the father's withdrawal.
In anotherwidow record, the woman's brother was boarding with her. His
influence upon the growing boys was found to be bad, and further aid was made
conditional upon his leaving.
We must not lose sight of the strong relatives who sometimes as

156
THE FAMILY GROUP
part of the Family Group, carry more than their share of its burdens;
nor of those no longer able to earn who to that extent are a
charge, yetwho may be holding the group closer together and mak-
ing a very definite contribution to the family life in their ability
to give and to evoke real affection. There can be a natural com-
radeship between grandparents and the younger grandchildren, for
instance, which, where it exists, is an invaluable part of the home
environment of a child.
In cases of desertion it isoften necessary to consider not only the
influence of relatives who are or have been members of the house-
hold, but that of any lodgers or boarders who are not kindred.
Their relations with the husband or with the wife sometimes
help to explain marital differences. In any case, their habits
have a direct influence upon the children, and the amount and
regularity of their payments are an important item in figuring
the budget.
If, in the foregoing discussion of earlier visits to the home, more
emphasis seems to have been put upon getting an idea of its back-
ground and its trend than upon the separate items of fact needed
for the face cards of case records, it must not be inferred that in-
exact and general impressions are in any wise recommended as

substitutes for defmiteness and concreteness. But a fact, however
exactly stated, has little significance until it has been intelligently
related to some other fact or facts, so that skill is shown, not so
much in the ability to accumulate a mass of data as in the develop-
ment of a sort of sixth sense for the significant facts in their true
relation to one another. It is believed that a grasp of the idea of
the main drift of the family life will keep the mind of the worker
from staggering about among a multitude of miscellaneous par-
ticulars, will help it to discriminate between the significant and
the insignificant, and will lead to a clearer diagnosis.
Another idea that will help is the concept of assets for recon-
struction. The power of family cohesion already mentioned is
one of the greatest of these. Somewhat different and equally
valuable is their capacity for affection. Other assets are capacity
for admiration, for further training, for more energetic endeavor,
for enjoyment, and for all-round social development. Nothing,
however small, that might serve as an asset in the course of treat-
157
SOCIAL DIAGNOSIS
ment and help to carry our plans toward a successful issue can
possibly be insignificant. Whether this be an affection for a
small dog, an ambition to play the accordion, or a lost or mislaid
loyalty, the social physician must be able to use, and he must be
able to recognize in order to use, such tools as these which lie ready
to his hand.

1. The good results of individual treatment crumble away often because the
case worker has remained ignorant of his client's family history, and has been un-
prepared for the sudden outcropping of tendencies long hidden.

2. Early contacts with members of the Family Group are on a somewhat differ-
ent plane from those with other sources of information, because the need of their
co-operation in treatment is usually greater, and further contacts are more likely to
follow.
3. family has a history of its own apart from the histories of those who com-
The
pose it.follows that a conception of the main drift of the family life is very
It
necessary in any attempt to discriminate between the significant and the insig-
nificant in a mass of case work data.
4. Another aid to clear thinking is the habit of classifying families with reference
to their power of cohesion. The united family "is able to send its sons and daugh-
ters far over the face of the earth without in the least impairing the bond which
unites them." In the unstable family "removal into the next street" is enough
to sever the bond.
5. This power of cohesion is only one of the assets for reconstruction in family
case work. Others are capacity for affection, for admiration, for further training,
for more energetic endeavor, for enjoyment, and for social development. Among
the children, more especially, the smallest signs of aptitude, ambition, achievement
are worth testing and developing. An ability to discover, note, and use the assets
for reconstruction marks the true case worker.
6. Among the more frequent causes of estrangement between husband and wife
are disparity of age, marriage or remarriage for economic reasons, interference of

relatives, and differences in nationality, race, or religion.
7. Social workers often ignore the husband and father and deal exclusively with
his wife and children. He should be seen and known. Especially important is
this injunction when case workers are asked to aid the families of young, able-
bodied men.
8. Desertion and alcoholism, like many other social disabilities, are not so much
separate entities as outcroppings of more intimate aspects of the individual's per-
sonal and social life. Diagnosis must lay a solid foundation for their treatment,
therefore, by pushing beyond such "presenting symptoms" to the complex of
causes farther back.
158
THE FAMILY GROUP
9. On the home's physical side, three important aspects are income and outgo,
food habits, and housing. Most difficult of these to gauge are the food habits,
which often demand special study because of their direct bearing upon health and
spending power.
10. The individualization of the children in the household must include the
prompt noting of all variations from the normal in their physicaland mental con-
dition.
n. The exact ages of the children day, month, year of birth have such vital
relation to theiradjustment to a number of social laws and institutions that this
item of fact should not be omitted.
159
CHAPTER VIII
OUTSIDE SOURCES IN GENERAL

for turning not only to a client's family group for
insight and advice but to Outside Sources have been sug-

REASONS
gested earlier. The chief reason for seeking this further
help that, to be constructively useful,

is we must be able to break
through the narrow circle of the client's own view of his situation,
and the narrow circle also of our own prepossessions and favorite
modes of procedure. We cannot afford to adopt either of these cir-
cumscribed boundaries, because none of us lives on a desert island.
Can our client's affairs ever be regarded as ready for social treat-
ment when no Outside Sources have been consulted? Measuring
by the standard of concrete result instead of preconceived theory
the answer would be in the affirmative. Cases studied for this book
show correct diagnoses that were arrived at without any follow-up
visits to outside references, but they also show a great preponder-
ance of failures traceable directly to this omission. The worker
who uses Outside Sources freely has been so trained by the practice
that he can recognize when the nature of the application and of the
task undertaken makes consultation of the confidential exchange
index 1 and of the impersonal public records described in the chapter
on Documentary Sources the only follow-up work necessary.
Always essential, though, is the re-examination of records of the
individual case, both within the agency applied to and in the agen-
cies revealed by the exchange, where there is one. This re-exami-
nation should be made just after the first interview, and whenever
later a new name comes to light, such as a name by a previous
marriage.
Essential almost always is personal communication with some
of those shown by the records or by the client's story to have known
him at an earlier time and in quite different ways. Our relations
with these Outside Sources collectively and separately will be con-
1
See p. 303 sq.
160
sidered in this and the eight chapters that immediately follow. If

their explanations seem endlessly detailed, it may again be urged
in extenuation that this is a punishment measured out to anyone
who attempts either to read about one of the practical arts or to
write about it.
I. STATISTICS OF OUTSIDE SOURCES

1. A
Study of the Sources Most in Use. Social workers have
been so busy doing their work that they have had little time in
which to formulate its processes or its results. There have been no
data available as to sources of information, for instance, either as to
those sources that were consulted at all, or as to the particular
combinations of sources that had been found most valuable in
each different form of social work. The processes in which social
agencies are actually engaged, the things that they are doing, are
often quite different from what they think they are doing. Accord-
ingly, a first, very imperfect attempt has been made to get this
matter of Outside Sources upon a basis of fact by asking a variety
of social organizations to permit the study of 50 case records in
each, taking the records chronologically. Public and private relief
departments, public and private child-placing and child-caring

agencies, societies to protect children from cruelty, day nurseries,
home and school visiting activities, juvenile and adult probation
work, charity organization societies, and medical-social service
departments were among those included in this small piece of
research. Information from certain of these social activities would,
in some have had to be very fragmentary, because often
places,
scant records are kept or none at all; but three American cities
were chosen, representing three different stages of development in
social work for individuals, and, in so far as the condition of their
social agency records would permit, the forms of work already
indicated were covered in each city. It was possible to examine the
records of 19 different types of social organization. Each agency
seen was asked to submit to special investigators the first 50 new
case records made at the beginning of its last fiscal year, 1 omitting
1
In a few instances the beginning of the current year was substituted, and in one
city the agencies filled out the schedules themselves, allowing the Russell Sage
Foundation investigators to compare these, however, with the original records
later.
ii 161
SOCIAL DIAGNOSIS
those in which there was no treatment. A transfer of the case to

another agency after diagnosis was counted as a form of treatment.
No sources were counted unless they had been consulted before the
first important decision had been made, as the purpose was to
study the Outside Sources of information upon which that decision

"
was based. Important decision" was interpreted to mean some-
thing more than merely ad interim or emergent action, but was
interpreted somewhat strictly, nevertheless, to avoid the kind of
temporizing into which too much of our treatment drifts. If a
family applied for relief and got it, or applied for institutional care
of a child or adult and got it, that was an "important decision."
Members of the family group, living in the same house with the
client and having a common table, were not counted in this enu-
meration, of course, and each Outside Source, whether an indi-

vidual or an agency, was counted only once in any one case. As
"neighbors" are sometimes "friends" and "landlords" sometimes
"employers," each was counted in the capacity in which he was
the more useful. Items of information that came not directly but
through another responsible social agency, either in the same city
or elsewhere, were credited to their true sources instead of to the
"
agency, but were marked as through an intermediary." Letters,
telephone messages, telegraphic dispatches, and personal visits were
not differentiated.
Institutions and agencies, public and private alike, were good
enough to subject themselves to the repeated visiting and question-

ing which even this small study entailed. Only a few of the tabu-
lated results are germane to this chapter. Others will be referred
to in the successive chapters on Outside Sources, and the more
detailed tables will be found in Appendix 1 1, together with the form
of schedule used in gathering the data.
In three cities, the 56 social agencies whose records were studied
consulted 10,871 Outside Sources before making their first impor-
tant treatment decision in 2,800 cases (50 studied for each agency).
This was an average of 3.88 Outside Sources per case, but a figure
which covers such varied types of work as have already been de-
scribed can mean very little. 1 It is only in comparing task with
1
These services were, in detail, as follows: Giving material relief, making loans,
procuring employment, day nursery care, other provision for dependent children,
162
task, source with source, and city with city that the figures have
any significance, and it would be easy to exaggerate the importance
of these comparisons.
There is danger in dogmatizing about the relative value of
sources and about the number of sources consulted. In work with
individuals averages mean very little. As one institution worker
protested, "A foundling picked up on the steps of the city hall
hasn't many references, you know." 1 In some cases three Outside
Sources might be too many to consult, in others thirty sources
might be too few; there must be wide variation, according to
the nature of the task undertaken and the story developed in
the first interview. But the preparation of these statistics and all
the other case reading undertaken for this volume point to many
more errors of omission than commission in the matter of outside
inquiry. Social workers in the United States are not overinvesti-
gating; at present they are underinvestigating, though the tables
of Appendix 1 1 show that some of them have discovered and are
using a wide range of sources not yet utilized by the others.

Other things being equal, the social worker who, in addition to
the sources that are almost universally valuable, consults the most
diverse sources of information for diverse tasks and diverse cases,
is doing the best work. Such breaking through routine brings new
sources to light, but a certain routine must first be mastered before
it is safe or wise to attempt to be original. And after a routine has

been mastered, should be criticized and revised at frequent inter-
it
vals. The schedule used in this study2 can be turned to account

in the criticism of daily procedure. Its first draft was tried out by
the writer with a small group of inexperienced case workers in
Philadelphia years ago. It revealed that they were neglecting
"trade unions" and "fellow workmen" habitually as sources of

insight and co-operation, and that they were covering the physical
history of the children under their care far more completely than
advice on school matters, rescue of children from neglect, correction of juvenile
delinquency, medical advice, medical care, provision for (defectives, institutional
care of adults, adult probation, advice on family problems.
1
A
critic informs the writer, however, that the Board of Children's Guardians
in St.Louis has reduced the number of foundlings housed at city expense over half
by investigations recently made. The hospital where a foundling was born has
proved a good starting point for "references."
*
See Appendix II.
.63
SOCIAL DIAGNOSIS
their school record. In discovering our weak points, such devices

have a definite use they serve also to show how even a strong point
;
may be overemphasized until it becomes a weak one. We become

superstitious, sometimes, about a favorite source or form of inquiry.
2. Nature of Sources. A certain routine must be mastered;
it will help in forming our own standard for a given form of child-
saving or family or medical-social work to discover what sources

are most frequently used by representative agencies in each of
these classes by agencies, that is, which appear to have a high
standard of treatment; and it will even help to discover what
sources are most used by those that have a low standard. All the
data gathered are quantitative not qualitative, be it remembered,
except in so far as the habitual use of a source discredited by the
experience of good social diagnosticians such a source as present
neighbors, for instance or the habitual use of the same two or
three sources and no more, gives a sidelight upon quality. It was
suggested that the schedule contain two additional columns one

to indicate the usefulness of the information secured, and the other
to show whether the person or agency consulted had shared in the
treatment later, but this seemed impracticable. In judging values
as between one relative's advice and another's, we drift easily into
the realm of individual opinion, but whether both relatives had
been consulted at all is not a matter of opinion.
Quantitatively, then, we find that omitting social agencies
from the computation the 20 Outside Sources most used by all
1
the agencies in each of the cities stand, in order of frequency, as

shown on the opposite page.
The failure in two of the cities to consult public records of mar-
riage, and in one city records of birth, is a sign of weakness in
technique. In the first city, these stand eleventh and twelfth in
the list of sources. Another indicated practice the wisdom of which
has already been challenged is the frequent use of sources belong-
ing to the present neighborhood. In the third city "present
1
The reasons for considering social agencies separately are given in Chapter
XVI, Social Agencies as Sources (p. 297). The term "social agencies" includes church
sources, private agencies (family agencies, homes for adults, homes for children,
S. P. C. C's, children's aid societies, day nurseries, settlements), public agencies
outdoor relief departments, adult and juvenile probation depart-
(charities or public
ments, municipal lodging houses, almshouses), etc.
164
a f> o-
SOCIAL DIAGNOSIS
TABLE 2. ORDER OF FREQUENCY OF CONSULTATION IN THE SEPA-

RATE CITIES OF THE 2O SOURCES* MOST OFTEN USED IN THE
THREE CITIES TAKEN TOGETHER15
Order of
neighbors" actually heads the list of sources, and it stands third

in the second city; "present" and "former landlords" in the second
city and "present landlords" in the third are also used very fre-
quently. The significance of these differences in practice as be-
tween the first and the second and third cities, and the serious dan-
gers involved in the use of neighborhood sources at all are brought

out in the chapter on Neighborhood Sources. Another difference
"
is in the use ofpolicemen," which may be accounted for by the
fact that no study of probation work, either adult or juvenile, was
possible in the second and third cities, while in the first city both
of these and a number of other forms of work in which the evidence
of the police would be important were included. The marked differ-
ences in the use of "teachers" may be accounted for by the fact
that the proportion of agencies studied which dealt exclusively with
children was smallest in the third city and largest in the second.
But when we consider that social case work in these many forms
and these different places has not been developed out of any for-
mulated and systematically transmitted experience, for the most
part, but has felt its way quite independently, often, to processes that
grew out of the necessities of the day's work, we shall find the re-
semblances in practice as shown in these statistics quite as striking
as the differences, especially if we compare the larger groupings
of sources shown in the large general Table A in Appendix II.
Here the fact stands out that, with many variations within each
group and variations as between groups allowed for, there still has
been frequent use in all three cities of the sources classified under
social agencies and churches, doctors and health agencies, former
and present neighborhoods, relatives, former and present employers,
schools, friends, and public records.
As to the shifting of emphasis upon one or another of these, as
we change from family work to children's work, from one form of
children's work to another, or from all to medical-social service, the
figures show some interesting variations. Table B in Appendix 1 1
tells the story in detail. Its most important features are brought
out in Tables 3 and 4 on the pages immediately following.

The first city was chosen for making this particular comparison
because it was the only one of the three (at the time the study was
made at least) in which the standard of treatment was quite as
167
SOCIAL DIAGNOSIS
TABLE 3. TWENTY SOURCES* MOST USED BY AGENCIES DOING

WORK WITH CHILDREN, FAMILY WORK, AND MEDICAL-SOCIAL
WORK IN FIRST CITY, IN ORDER OF FREQUENCY OF USE
Order
of fre-
quency
of use
TABLE4. USE OF THE 2O SOURCES* MOST USED IN THE FIRST CITY,

BY AGENCIES DOING WORK WITH CHILDREN, FAMILY WORK, AND
MEDICAL-SOCIAL WORK IN THAT CITY
SOCIAL DIAGNOSIS
that, in listening to these detailed statements, it is gathering valu-

able diagnostic material. "All these people," said one critic after
examining a group of case records, "seem to have been born just
about two years ago. There is a great deal set down about what
they and the charities have done since, but they have no past."
1. First Principle of Choice. When, the first interview over
and a home visit paid, we find ourselves with a group of clues, per-
haps the most important principle of action is to strike out boldly
for history and avoid, for the time being at least, those references
whose point of view is most like our own. Where there has been
an investigation already, we should profit by it, of course, but
where there has not, we cannot afford to lose a moment before con-
sulting the people who knew our client at his best, if he ever had
a best; who knew him at least at other times and in other relations.
These can give, one from this angle, one from that, the aspects that
will help us to see our subject in the round. Any notion of social
efficiency that excludes the humblest sources of knowledge and
help makes for inefficiency in the long run. Too often we confer
with the sources that are nearest to us, and neglect those that are
nearest to our client. Other things being equal, the evidence of
those who knew him before the present difficulties developed is
worth ten times as much as the evidence of those who have known
him since. But this must not be construed as referring to length
of acquaintance, merely. We can know people a long time and
really know them very little.

1
The nature of the relation and the
opportunities that it has given for self-expression are the important
things.
2. Second Principle of Choice. In order that we may never
have to pay two visits where one can be made to serve, a second
principle will be found useful in making our choice of diagnostic
sources, and in preparing, at the same time, for the co-operation
which will probably be needed later in treatment. This principle
is to seek first those sources that are likely to be rich in history only
and seek later those most likely to be rich also in co-operation.
It is wise to build in our background and get as clear a picture of
Dr. S. Weir Mitchell says of the family doctor, who belongs to this long-
1
"
acquaintance group, He is supposed to have some mysterious knowledge of your
constitution, and yet may not have asked you a medical question in months and
years." Doctor and Patient, p. 28.
170
our foreground as can be had before consultation is attempted with

those upon whose co-operation we must depend for the success of
our plan, and in part, perhaps, for its shaping. Some social workers
invariably see the relatives first, others the employers, and others
the doctors. Such rules save the trouble of thinking, but a more
flexible method to let the order of seeing Outside Sources grow
is
naturally out of the individual circumstances, having in mind, how-

ever, the need of developing history first, and then, on the basis thus
revealed, co-operation.
It is true that the yield in neither history nor co-operation can
be accurately gauged in advance, but our conduct of the first inter-

view should have helped us to some inferences. If we go to the
people whose co-operation is likely to be valuable but whose knowl-
edge is either biased or incomplete, at a time when we know little
ourselves, we are in grave danger of launching them and of being
launched upon a plan of action that must be modified almost
immediately. They may easily resent any attempt at modification
under such circumstances, and not only will time have been wasted
for our client and ourselves, but co-operative relations will have
been weakened by the false start.
One difficulty in applying this principle of choice will be with
relatives, some of whom we cannot always know which ones
may be rich in co-operation and all of whom are familiar with cer-
tain details of the early background. Though relatives are rich
in history unquestionably, the fact that this is true of all of them
may enable us, with the help of such hints as we get from our client's
story, to apply the distinction implied in the principle; we can see
first the relatives least likely to be able to co-operate actively, and
later those most likely to do so. Many accidental things will prob-
ably interfere with a strict following of this principle, however. The
distances to be covered, the hours at which people can be seen, the
need of unusually prompt action are only a few of the conditions
which will necessarily modify the order in which Outside Sources
can be consulted in the daily pressure of case work.
The two principles of action here explained are well illustrated by an investiga-
tion of a widow's family, though the social worker who made it was quite uncon-
scious, probably, of the mental processes by which she arrived at a good order of
visits.
171
SOCIAL DIAGNOSIS
The application was made by the widow's sister a servant whose employer
wrote to a charity organization society. The first interview with the widow brought
the addresses of the following: Another sister and an aunt of hers; a brother and
an aunt of her husband's; the family doctor; the hospital where her husband had
died; the Catholic church of the parish in which she had been living for a few
months; the Catholic church of the parish in which she had lived for many years;
and the Presbyterian church in this former neighborhood. Her husband had been
a Protestant, and the children had attended the Presbyterian Sunday school during
his lifetime.
The widow's only resources were help from the St. Vincent de Paul Council of the
new parish, and from the sister who was at service. There were five children under
twelve years of age to be cared for. Many workers would have gone to the present
priest and to the servant girl sister at once, as the two people most practically
interested. The sister knew the past history as well as any one person could know
it,probably, but the worker first took the trolley car for a six-mile journey to the
old neighborhood, saw the grocer with whom the family had traded before the man's
death, visited the priest who had known the wife for years, the doctor who had
attended them in their old home, and the principal of the school that the children
formerly attended. Her next journey was to the home of the husband's brother
and to his aunt, then to a politician who was have helped the family very
said to
lavishly, then to the Presbyterian church visitor who was

reported to have been
helping at the same time that the Catholic church helped. Both of these reports
were disproved at once, so that they could not come up later in a way that would
disturb the course of treatment. Then and only then were the widow's own rela-
tives and her parish priest turned to not, of course, with a view to dictating to
them the plan of action that they should pursue, but with a desire to hear every-
thing that they had to say and then, in the same interview, to confer with them as
to what permanent plan could be made for the widow's benefit, and what share
each could bear in carrying out.
its
The new knew the widow; the servant sister was bent upon giving
priest hardly
her whatever character would most promptly secure material help. But earlier
inquiries had reconstructed the normal life in the old neighborhood and had sifted
the prejudiced gossip of the deceased husband's people, leaving, it is true, some
weaknesses to be guarded against, but making it clear that here was a home worth
keeping together and a plan needed that would give the mother something definite
to count upon until the children were earning. The plan decided upon in the first
visits to the parish priest and to the sister included a regular allowance plus half the
rent from the sister at service. The church bore a share in this plan, which, with
slight modifications, was continued through a series of years.
3. Third Principle of Choice. The foregoing principles may be

greatly strengthened by careful observance of a third, which is that
we must seek out the witnesses who have been able to make first-
band observations in preference to those whose information is at
second-band. In other words, we must beware of multiplying wit-
172
nesses without getting new observations. This matter was touched

upon in Part where
I, Langlois was quoted with regard to the three
chroniclers who agreed so admirably because their parallel accounts
were all derived from one source; 1 but it deserves especial emphasis
and further illustration in connection with this division of our
subject. There are few commoner errors and few that work greater
havoc in social case work than the use of items of hearsav evidence
without any consciousness of their hearsay nature.
Let the treatment of one unfortunate case illustrate both the need of past history
and the danger of multiplying statements without multiplying observations. A
charity organization society was responsible. The head resident of a church settle-
ment referred Mrs. O, a German widow with four children and "well known to me
as a worthy, respectable woman." A
first interview brought the following items:
that the youngest child, a boy aged three and a half years, was blind; that
the oldest girl, aged eleven, could neither read nor write, and that none of the
children were going to school; that the husband had not died but had deserted, ac-
cording to the wife, three years ago; that they had come to America and this par-
ticular city eleven years back; that he had no relatives living and hers were all in
Germany; and that he had formerly worked at the shot works, while she had been
employed by certain stores and householders. A few former addresses were given,
"
but some of them rather indefinitely. Left a dollar to expend on coal and food
as there was almost nothing to eat. Mrs. O took it rather reluctantly. Seemed
almost hurt when it was offered to her. Told her she could consider it as a loan if
she wanted and pay it back when she could."
On the doorstep after the close of the interview, what clues did the social worker
hold in her hand? There were three previous addresses that were indefinite but
that might have been made less so with the aid of a set of city directories, 1 and a
definite previous address on the waterfront where the woman had lived until a few
months ago; there was a firm in town and one out of town for whom the man was
said to have worked; and there were the woman's work references before her hus-
band's departure, and the addresses of two housewives for whom she had done day's
work since. The worker went first, however, to the settlement house that had re-
ferred the client for treatment. Here Mrs. O had been known for a year and a
half. It was learned from another worker than the one who had written that Mr.
O had deserted three years before and had not been heard from since, and that his
wife was very proud, industrious, and hard-working. If the settlement workers
had known Mrs. O only a year and a half, they were not competent witnesses as to
the desertion, and "very proud" does not describe Mrs. O as well as would a plain
statement of the acts upon which this judgment was based. The worker next
visited two housewives of the neighborhood for whom Mrs. O had done day's
work. Both gave much the same evidence she was honest, industrious, hard-work-
1
See p. 57.
1
See Chapter XIII, Documentary Sources.
173
SOCIAL DIAGNOSIS
ing. Next, a letter was dispatched to Germany asking the public charities to sec
"
Mrs. O's mother, to present to her the following facts" (namely, the desertion and
the present pitiful condition), and to ask her whether she would take her daughter
back and care for the children, or what she would advise. This letter brought a
perfunctory reply of "not able to help" and no more. But meanwhile, without
further visits to possible Outside Sources, though with repeated visits to Mrs. O
herself, the society had launched out upon a plan of adequate regular allowance
for the family, the girl and the other children to be sent regularly to school, the
youngest child to be entered at the institute for the blind, etc.
This plan assumed the hearty co-operation of the mother, and the absence of
any different and irreconcilable plans in her own mind. Little things happened
that might have shaken their faith in her singleness of purpose, such as finding the
girl out after dark gathering scraps of cold food, many small excuses for not keeping
appointments, and removal without consultation back to the old neighborhood that
had never been investigated; but the social worker was so sure of her own first im-
pressions, re-enforced as theyhad been by three other impressions of the same kind,
that, whenwas found that a man had been boarding at Mrs. O's, her own strong
it
protestations of innocence were treated as more than offsetting the neighborhood

gossip; the man withdrew and the allowance was continued. But, as time went
on, nothing happened to the children that the society intended to have happen.
It had been and continued to be earnest in its efforts, but the girl was still not in
school after repeated placings. (The neighborhood was a crowded one, and the
school authorities had no abundance of school sittings, so that escape on the official
side was easy.) The blind child had never been allowed by his mother to go to the
special institution willing to receive him, or tohave proper medical care outside;
his condition at theend of his sixth year was so pitiable as to excite the interest of
many charitable people, the children were begging frequently, and, at last, the im-
pressionable and kindly friends of the family are found clamoring at the offices of
the S. P. C. C., claiming that these children are being used to secure support for an
immoral mother and must be taken immediately from a woman about whom the
complainants know very little but are forced to conjecture much.
to judge her or condemn her, for Mrs. O's shortcomings could not have
Not
seemed so bad if her past had explained them, but just to know and help her if
they could, and to protect at all hazards those four children, whose future still
stretched so far ahead, the charity organization society should have had at the very
beginning a clear picture of the O
family at its best, before charitable ladies had
made its acquaintance. There were Outside Sources of information to reveal this
picture in part, and some of these would have furnished clues to others. As to the
slight evidence that was gathered from the settlement and the housewives, only
those to whom all statements are of equal value could have regarded this as evidence
at all.
4. Fourth Principle of Choice. Another principle to bear in

mind is that we must recognise the special value of supplementary
dues of clues, that is, to sources of information not revealed in the
174
first interview orin subsequent ones with tie family group, but which
come in the course of inquiry.
to light A
source revealed casually is
less likely to be prejudiced. In the protection of children from
cruelty this distinction of the supplementary clue is clearly made,
owing to the need of legal evidence, but it is a distinction that
might have been useful in the case just cited, and that might have
helped, in combination with other elements of a sound technique,
to render the intervention of the society to protect children un-
necessary.
5. Fifth, Sixth, and Seventh Principles of Choice. Francis H.
McLean suggests three principles of choice which should be added
to the four already named:
(5) We
should see someone belonging to each of the groups able
to view the client and the family from a different angle. Two such
groups are the relatives on the husband's side and the relatives on
the wife's side. If there is not time orif it seems unwise for other
reasons to see all relatives, then some on each side of the house
should be seen. 1 In other words, we should think of sources in
groups, and tap each group for a new set of experiences.
(6) Some groups may be called one-headed groups, in

of sources
that all
constituting the group are likely to see eye to eye with
regard to the matter under consideration; but others are more
likely to develop different points of view within the group itself.
Mr. McLean places (with full recognition of the possible excep-
tions) schools, churches, labor unions, and benefit societies in the
first class. The evidence gathered from a
school principal and from
his assistants will usually be in substantial agreement; the same
is true of evidence from a minister and a church visitor. He places
the man's relatives, those of his wife, employers, former neigh-
bors, and tradesmen in the second class. There is always danger
of not finding the truth, he thinks, unless at least two sources
belonging to each of these latter groups are consulted. We should
distinguish groups whose members are likely to see eye to eye,
all of
and in which consultation with one source may possibly suffice, from
those inwhich there is likely to be diverse experience within the group.
(7) Contradictions that are apparently irreconcilable as between
the evidence of one group and that of another, or as between indi-
1
This principle is illustrated in the case cited on p. 173.
175
SOCIAL DIAGNOSIS
viduals in the same group, mean that further inquiry is needed to

reveal motives and facts which will reconcile statements either by
change or by elimination. The need of further inquiry is also
indicated, usually, when the evidence all points in one direction
without contradiction or inconsistency, but when also the sum of
it reveals no single possible next step in treatment that promises
to be useful. This arrival at no thoroughfare may be due to other

causes, such as lack of imagination and resource in those respon-
sible for taking the next step, but one cause of failure when we find
ourselves at this pass is a serious and unsuspected gap in the in-
vestigation itself. We must
recognise in contradictory evidence and
in a total of evidence that reveals no plan of action, the need of further
inquiry.
The foregoing seven principles of choice in deciding the order
of our consultations with Outside Sources hardly deserve to be
styled principles, perhaps, but from the evidence now at hand it

is believed that they will have practical value for the case worker.
III. METHOD
"Just after visiting a home you come out tingling with the
letters you want to write, the telephoning you want to do, the visits
you wish to make to other parts of the city, but by the time you
get back to the office, after making visits on one or two other cases,
all this has oozed out through your fingertips, somehow. But to
systematize what you got in your first visit, to conserve the feeling
you had when you left the house and put it right into action, is
the only way to get results." This comes from a case worker who
was at the head of a busy district office in which there were often
nine or ten assistants. It suggests the loss of power and of effi-
ciency which follows a division of work at this point, especially
when the division is carelessly adjusted. A new assistant in a large
relief office was not a little disconcerted when he was given a memo-
randum of eight "references"whom he was to see about a certain
client and without any information as to the problem
his family,
or so much as a glimpse of the case record. A division of labor is
possible, even in so delicate a process as arriving at a social diag-
nosis, but it seldom comes without dislocation at this early stage.
After the most important clues have been followed up by the one
176
who has seen the client and his family, it is often possible to utilize
assistance for visits to minor sources, though even here a full knowl-
edge of all the preceding steps is essential before attempting to
pay these additional visits.

A good deal will be said in a later chapter about communications
1
by letter and by telephone. Let it suffice here to say that evidence
given face to face and eye to eye is evidence weighed and sifted by
a subtle process that can never be applied to letters, blank forms,
or telephone messages. The witness of application blanks is notori-
ously untrustworthy. An examination of the records of an orphan
asylum which formerly based all its admission decisions upon the
answers filled out upon such blanks reveals astonishing misstate-
ments from presumably responsible public officials and from trades-
men, teachers, and relatives. There would seem to be something
2
very demoralizing about a blank form. Letters addressed "to
whom it may concern" are almost as bad; so are letters of recom-
mendation of all kinds. People sometimes say quite unblushingly,
when asked by a social agency why they wrote this glowing letter
"
about a certain weakling, Well, I hoped you'd do something for
him." When seen personally, they soon realize that the situation
is not nearly so simple as all this, and are led on, by one who quickly
grasps their point of view, to think more deeply and testify more
truthfully. The personal interview, whenever it can be obtained
without irritating an overbusy person, is the best method of
approach.
All of our clues can be quite perfunctorily followed up, however,
even when each source is personally, carefully, and exhaustively
seen. The unimaginative worker, the "overworked victim of
routine," can go through all the motions without achieving any-
thing but irritation and disorganization. We must have a generous
conception of what can and should be done, and some time in
which to do it, before these outside informants can be made to con-
tribute either useful information or friendly service. The worker
with no such generous conceptions and purposes takes just as long
to go and just as long to come back, his carfares and shoe leather
1
Chapter XVII, Letters, Telephone Messages, etc.
2
An
exception to this is in the filling out of those public documents for misstate-
ments in which a penalty is attached by law.
12 I
SOCIAL DIAGNOSIS
are just as expensive, and he is pretty sure to discover that nobody

can do anything, that all the persons consulted know very little,
"
and are chary of imparting that little to him. In these records,"
wrote a director of one charity organization society who had been
asked to criticize some of the case histories of another, "when the
investigation is really begun, there seems to be a greater endeavor
to get at facts than to get advice as to what to do; they give the
impression of clerical interviews for information rather than a con-
sidering together and a securing of co-operation from all the per-
sons interested." This result is not always due to perfunctoriness
and lack of enthusiasm. It sometimes comes from an enthusiastic
interest in our own plans and purposes. We are so full of them
that we never give the other person a chance to help in forming
them.
"One of the axioms of social diagnosis is that if a source is worth
consulting at all, it is worth consulting in the right way." Many
of the things that have been said about the method of a first inter-
view apply to interviews with the family group and to these visits
paid to Outside Sources also. We must give the one interviewed
ample time in which to develop his point of view; must not sug-
gest the answers to our questions; must utilize to the full all new
avenues of approach and all natural openings, instead of shaping
the interview to meet some preconceived idea of its content; and
yet must keep the goal of a fuller knowledge and wider co-operation
always in view.
We toward the point at which we
progress, in these inquiries,
can assembling all our data and making a social
feel justified in
diagnosis. Examination of our material as a whole is, in fact, the

most neglected of all the diagnostic processes, but its consideration
here will have to be postponed until the various groups of Outside
Sources have been reviewed. Meanwhile, we must not forget that
the reasoning processes come into play as soon as the first interview
with a client opens 1 and are needed also in every consultation with
an Outside Source. At the time of each such consultation and be-
tween the different ones, we must be comparing, reconciling, con-
trasting every statement with every other, and seeking to fill those
gaps in the evidence which have a direct bearing upon the main
1
See p. 120 and Chapter V, Inferences.
1
78
issue and its solution. A conception of the different kinds of evi-

dence described in Chapter III, and of the characteristics, detailed
in Chapter IV, of human beings as witnesses, should enter into
and shape all these contacts with Outside Sources.

1. A client's social relations are not bounded by his immediate family, nor, as a
rule, should our sources of insight and co-operation be so bounded.
2. A study of the Outside
Sources sources outside the immediate family group,
that consulted in three cities by 56 social agencies of 19 different types (render-
is
ing 14 different forms of service in the cases studied) shows in 2,800 cases (50 for
each agency) 10,871 consultations with such sources, counting, in any one case,
only the first consultation with each source used.
3. The groups
of Outside Sources frequently used, as shown in this study, are
and churches, doctors and health agencies, former and present neigh-
social agencies
borhoods, relatives, former and present employers, schools, friends, and public
records.
4. The following seven principles may govern choice in deciding the order in
which Outside Sources should be consulted, though such accidental things as dis-
tance, accessibility, and need of unusually prompt action, will undoubtedly modify
their use.
(1) Strike out boldly for history.

(2) Seek first those sources that are likely to be rich in history only, and seek
later those most likely to be rich also in co-operation.
(3) Seek out the witnesses who have been able to make first-hand observations
in preference to those whose information is at second-hand.
(4) Recognize the special value of supplementary clues of clues, that is, to
sources of information not revealed in the first interview or in subsequent
ones with the family group, but which come to light in the course of inquiry.
(5) Think of sources in groups, and tap each group for a new set of experiences.
(6) Distinguish groups all of whose members are likely to see eye to eye, and in
which consultation with one source may possibly suffice, from those in which
there is likely to be diverse experience within the group.
(7) Recognize in contradictory evidence, and in a total of evidence that reveals

no plan of action, the need of further inquiry.
5. Consultations with Outside Sources are best held by the one who has conducted
the first interview with a client and seen his family.
6. Evidence given face to face and eye to eye is weighed and sifted by a subtle
process that can never be applied to letters, blank forms, or telephone messages.
179
CHAPTER IX
RELATIVES AS SOURCES
BETWEENthe different forms of social case work, it will
A be seen that, in the first city (where such comparisons could

be most safely made), the suburban and the city charity
organization society consulted with 35 and 36 Relatives respectively
in their 50 cases each, the general private relief society with 39,
the public outdoor relief department with 42, the society to pro-
tect children from cruelty with 5 , the city and state departments
1
for care of children with 68 and 44 respectively, three child-placing

agencies with 89, 44, and 48 respectively, a reform school with 26,
a children's institution with 20, a day nursery with 29, and three
1
hospital social service departments with 1, 6, and 23 respectively.
1
Relatives were seldom consulted by the juvenile court, but in most

forms of children's work, in family work, and in medical-social
work (though here in a less degree) the figures show frequent con-
sultations. 2
What does the reading of case records and the evidence of case
workers, in so far as it has been possible to collect this in many
interviews with them, show as to Relatives? Clients often do not
want their Relatives seen. Why is this, and what mistakes of the
social worker may justify, at least in part, this position? More
and more social workers are seeking out Relatives, though more
and more they are discovering their bias, and the need of sifting
their evidence with great care. Just what is gained in accuracy
Appendix II, Table B.

* It must be remembered that only the Relatives outside the immediate family
group were counted in the outside sources study. The use of the word Relatives
in this chapter is subject to the same limitation but to no other, for it here indicates
relationship by birth, by marriage, or by descent. Brothers and sisters living at
home are counted as members of the family under treatment; if living away from
the family, they are classified as Relatives. A client's kindred and his wife's
kindred are regarded here as his and her Relatives, though the distinction between
connection by marriage and connection by descent or birth is an important one to
make in our consultations.
180
of diagnosis and effectiveness of treatment through this source

which can be had in no other way? From the data at hand, what
is the case for and the case against Relatives as helps in social ser-
vice, and more especially in its initial stages?
I. THE CASE AGAINST RELATIVES

To (i) they are partisan and
state this side of the case briefly:
prejudiced; they do not know; (3) they do not understand.

(2)
It may be added that they are often too overburdened to aid their
kindred financially without doing themselves and their immediate

families injustice. This last argument applies only indirectly to
diagnosis, but, since it does apply, it will be considered in a later
section of this chapter.
1. Relatives Are Partisan and Prejudiced. This is undoubtedly
true, as the following instances show, but a great deal of truth may
be had from a prejudiced witness, if we are careful to give his
prejudice due weight and compare his statements with those of
others who have not the same bias.
A widow, Mrs. D, 1 was a Catholic; her husband had been a Protestant. Before
a regular allowance was organized for her and her five children, the oldest of whom
was twelve, three of her Relatives and two of her deceased husband's were seen.
According to his Relatives she was a spendthrift, was getting help from both Protes-
tant and Catholic churches, had very quickly run through $300 raised for her by a
local politician, had no ambition, had shown herself entirely ungrateful for the help
already given by her husband's people, etc. Her own Relatives represented her as
an excellent mother and homemaker, as, in short, a model person. The truth was
found to be somewhere between these two extremes. The stories of the $300 and
of the help from Protestant churches proved to be untrue, but some of the com-
plaints of the husband's people were well founded, and the plan of regular assistance
under personal supervision which was adopted worked all the more successfully
because these contradictory statements had been sifted and to a certain extent rec-
onciled before the plan was entered upon.
A widower with three children (man somewhat intemperate) had been referred
to a children's aid society to make plans for the children's care, with the suggestion
that the man's sister Jane might possibly become a homemaker for the family.
The mother of the dead wife, anxious to keep the children from the father's Rela-
tives, states that under fourteen, small for her age, and unfit to care for a
Jane is
home. The widower's mother, interested in securing the opportunity for her
daughter, states that Jane is over sixteen, strong, large, and capable. A paternal
1
See p. 172 for other facts concerning this same family.
181
SOCIAL DIAGNOSIS
aunt, not so biased as the immediate family, states that Jane is fifteen, a very wild
girl and one who could not be managed even at home.
These violent prejudices as between the Relatives on one side

of the houseand those on the other often take the form of mischief-
making between husband and wife. 1 One record studied shows
1
"It is surprising to find in how many cases of trouble between husband and
wife discord is aggravated, if not caused, by the often well intentioned interference
of friends or relatives. To an outsider, even though he be a near relative, domestic
conditions are apt to appear much less endurable than they actually are to the par-
ties most concerned, and he usually makes a tolerable situation intolerable by trying
to act as a dcus ex macbina.
"As to the application of the above: A girl was born in New York City of parents
born in Germany. They brought German traditions with them, and trained their
children to implicit obedience. The wife had been chastised
by her mother even
after marriage, and conceived of disobedience to parental authority as a degenerate
thing. The American-born daughter, despite this rigid discipline, took a slightly
modified view of her filial obligations. She had a social nature and frequently
joined her young acquaintances of an evening. With the pardonable anxiety of a
girl's guardians, her parents would question her very closely on her return, and,
for that matter, scolded her roundly for gadding so much. A young Irishman
presently figured on her horizon, an amiable, affectionate young fellow, who made
much of her and grew indignant at the beratings she complained of receiving at
home. The contrast between his gentleness and parental strictness overcame her
compunctions, and one day they went to the church, she became a Catholic, and
they were duly married. Her family were, as she expressed it, 'wild,' but the deed
was done.
"In the course of time, first one child then another was born to them. The
young husband did fairly well. . . . The girl's parents, however, were never
reconciled to him. They couldn't overlook the difference of race, and their daugh-
ter's change of religion was a constant cross. Although she had taken two re-
bellious steps she was by no means free from their yoke, and not only did her duty
by going to see her mother frequently, but also felt constrained to make her mother
the confidante of her husband's failings he drank occasionally. Their first preju-
dice fanned to fury by their daughter's complaints, the parents insisted on her
bringing the delinquent into court. He was sentenced to six months' imprison-
ment. The wife, a mere slip of a woman, tried with what little aid her family could
give her to defray her expenses by taking a janitress's place in a damp basement.
The work was too much for her, and worry over her husband kept her unsettled.
She got run down, and the baby began to pine. Too ignorant to perceive that
there was occasion for anxiety, she called no doctor and was terrified and bewildered
to wake up one morning and find the little thing had died without a sound.
"That decided her. Her husband had been writing her, begging her to take
him out and promising never to drink again, yet she had hesitated. The parents
threatened that if she took him back they would never lift a finger to help her no
matter to what extreme of poverty or suffering she might come. She must choose
once and for all between them and him. She chose . .
begged the magis-
.
trate to let her husband return to her, and said that she would move a long dis-
tance away from her parents, because she was too weak, too much under their
influence to live happily with her husband if she tried to hold to them at the same
time. Her request was granted, and the young couple settled in another city.
He understood his wife's pliable nature well enough to forgive her entirely for hav-
ing overpunished him." Ada Eliot (now Mrs. Sheffield) in Charities for March 29,
1902. [Revised by the author.]
182
endless trouble made by the wife's sister in a family where the

husband was already inclined to be jealous.
2. Relatives Do Not Know. Sometimes the most important fact
in the life of our client, the one most vitally affecting his welfare,
is not known to the Relatives at all. As has been said in an earlier
chapter, kinship makes not only for sympathy but for antagonism.
The mere closeness of the bond often leads to concealment.
3. Relatives Do Not Understand. Even where there has been
no concealment, they do not understand the situation as well as
they think they do; they cannot choose wisely between the effec-
tive and the ineffective plan of action; they have not themselves
a sense of social values.
"
I remember," writes a former district
secretary of a charity organization society,
"laboring with a dear old man, an elder in a Baptist church, to convince him that
some radical change was needed in the manner of life of his brother's family, which
consisted of a drunken father, a bedridden wife, and three daughters, on two of
whom the burden of support fell. Their wages were insufficient for the family of
five. All that I could get from him was that the past must be buried and that Jim
must be helped now even if he had done wrong in the past. It was odd that the
girlshad not mentioned their distress, but he would go down there at once. That
the girls should have better jobs, that the woman should have hospital care, and
that the man should be supplied with light work and watched faithfully, were ideas
beyond his range."
A society to protect children from cruelty in a large city finds

Relatives so likely to interfere disastrously in court cases of neglect
that, as a rule, where the conditions are obviously bad, it does not
see the Relatives at all until after court action. The society finds
that this involves less danger of making trouble in the family, and
makes it easier to turn to the kindred on both sides, who are seen
later of course, either for the care of one or more of the children
or for active assistance in helping the family to establish a home
standard that will warrant the return of the children.
One of its cases was that of a father up for neglecting to support his children.
The man was sentenced to the workhouse for a year, but appealed the case. The
decision was reversed on the evidence of a brother-in-law and
in the superior court
a sister, both of whom
had been strongly urging the S. P. C. C. to do something
about the wretched conditions of which they made complaint. In court they
testified that the father had been doing his very best. Before taking the case into
court at all the society had consulted a landlady, a previous landlord, a policeman,
and three Relatives, and had itself inspected the home conditions on several oc-
I8 3
SOCIAL DIAGNOSIS
casions. In the presence of theircommon enemy, the court, Relatives often give
directly opposite testimony from that which is secured in private interviews.
A country society to protect children reports that kindred in

its rural neighborhood can be seen far more safely before a court
trial than in the city, and that their co-operation, both in court
and out, can be better counted upon. The work of the society
seems to be better understood and to be taken more seriously.
One reason for this, is that public opinion, for better or
probably,
worse, is more completely
unified in the small place and more in-
fluential there for that reason. In the large city there are many
and conflicting community standards, and the standard that has
found expression in a law or a social agency may not be the one
that is most compelling within a certain neighborhood group.
A public department for dependent children found it impossible to secure court
action in the case of a feeble-minded woman who had given birth to her third
illegitimate childand obviously needed custodial care. This was owing to the ap-
pearance of the Relatives with an offer to care for her and her children. The chil-
dren were later found to be neglected, but the mother was then in Canada beyond
the jurisdiction of the court. A critic of this example writes, "Could not the public
department have persuaded the court to put these relatives under bond to keep the
woman and children off the public? If, among them, they were able to care for a
whole family minus the man they should have been able to give some sort of
security."
A probation officer whose work shows more than the usual degree
of skill states that she deems itinadvisable to see Relatives except
in those cases in which it seems impossible to get at the situation
without consulting them, or those that involve the taking of a
boy or girl out of the family. Ordinarily she believes that seeing
the Relatives "stirs up a lot of talk and leads nowhere." In many
of the families known to her the family connections feel no shame
whatever about a boy's being brought to court, nor does the boy
himself feel any. There is little reticence about such matters, and
she feels that the only way to help the family to a proper sense of
shame is to say to them, "You surely do not intend to talk this
thing over with your sisters' and brothers' families. If I were
you I should be so ashamed of it that I should never let anyone
know that it had happened."
From this same probation officer, however, comes a memoran-
dum of a boy on probation whose mother had two married sisters
184
and a brother just learning his trade. Through an interview with

one of these sisters the officer gained sufficient confidence in the
family's sense of solidarity to arrange a conference of all the Rela-
tives, at which she succeeded in persuading them to place the boy
1
in a Catholic college and pay his board there. By way of recon-
ciling these two entirely different modes of procedure she would
only need to point out that she was dealing with two entirely dif-
ferent groups of people. In her first statement she was probably
referring to a group that were as little attuned to legal processes
as the Aran Islanders described by John Synge. The law courts,
which had been superimposed upon this primitive people and were
presided over by outsiders, were often used as playthings by the
Islanders. A whole family connection would come down to the
court and swear against all the representatives of another family
connection until they became bitter enemies. "The mere fact
that it is impossible to get reliable evidence in the island not
because the people are dishonest, but because they think the claim
of kinship more sacred than the claims of abstract truth turns
the whole system of sworn evidence into a demoralizing farce." 8
Without giving too much weight to any of the foregoing argu-
ments, it be acknowledged that social workers often show a
may
lack of discrimination as to which Relatives to see and when. A
qualitative standard is more important than a quantitative one
not only in the study of sources in general, but in their daily use.
If, as a story develops, the most important factor in the situation
seems to be lack of employment, it is foolish to see five Relatives

on one side of the house and four on the other, and then omit for
lack of time all of the three previous employers. number of the A
case records examined showed a rather heedless running about
from one Relative to another, apparently for the sole purpose of
checking their names off as "visited" upon the face card of the
record.
Another mark of careless work is the tendency to turn children
over to the care of Relatives simply because they are Relatives,
when the truth of their statements, their character, habits, and
1
For another instance of co-operation with Relatives in probation work, see
p. 193.
1
Synge, John: The Aran Islands, p. 98. Boston, Jno. W. Luce Co., 1911.
SOCIAL DIAGNOSIS
circumstances have not been inquired into at all. The practice

is a common one, and will continue to be so, probably, so long as
public departments and private agencies do not require and pro-

vide for individualized inquiry and treatment, or so long as their
appointed agents are mentally and morally sluggish and inclined
to do the thing that is easiest.
An C. C. had occasion to take up a complaint involving two small children,

S. P.
a boy and a girl, who were living with their grandfather. It was found that an
overseer of the poor, who had been aiding the family of these children before the
death of the mother, had allowed them to be taken by the Relatives without any
investigation whatever. The boy, who was lame, was not receiving proper care,
the girl was out of school, and the whole family were living in an old shack of one
room.
An argument that can hardly be included in this case against

Relatives, yet that nevertheless has some bearing, was well put to
the writer by a man applying for transportation to Chicago. It
transpired that he had a brother-in-law in the railroad business,

and when correspondence with this Relative was suggested, the
man said frankly, "No, madam, I'd rather not have him communi-
cated with. I'd much rather have help from you, because I shall
never see you again." From the client's point of view one objec-
tion to Relatives, as sources of help at least, is the sense of mutual
obligation that is involved in a permanent relationship. The

feeling is seldom expressed so frankly, but it is often there.
II. THE CASE FOR RELATIVES

Experience throws into bold relief the prejudice and the un-
wisdom of Relatives, but there is plenty of evidence on the other
side which shows that in actual daily practice social workers are
not only securing (i) individual and family history from kinsfolk,
but are finding them a fountainhead of (2) insight (a more im-
portant matter than history), and also an effective source of (3)
backing and active co-operation.
1. Individual and Family History. "Too often," writes a case
worker, "we consider simply the individual family and say, 'This
man drinks,' 'This woman is not a good housekeeper,' when as a
matter of fact a study of the family background would give us an
insight into causes. This background comes best from the rela-
tives." Far-reaching inquiry such as eugenic studies call for is of
186
course out of the question, but the gathering of certain facts con-
cerning the nearer Relatives is an important part of social diagnosis
because it has a direct bearing upon treatment.
In cases, for instance, where the social worker has reason to
suspect the presence of mental disease, he must aim to get at
facts of heredity which would assist a physician in forming an
opinion of the patient's condition. The pertinent data would

cover the condition of health and cause of death of parents, grand-
parents, brothers and sisters, uncles and aunts. The items should
be especially clear and detailed whenever, in any of these Rela-
tives, there seems to be a question of consanguineous marriage, of
miscarriages, of tuberculosis, alcoholism, mental disorder, nervous-

ness, epilepsy, cancer, deformities or abnormalities, or of any ex-
ceptional ability. Relatives often have knowledge of these things

which members of the immediate family have not, and often they
are less reticent. The case worker, for his part, must be familiar
enough with the symptoms of the diseases mentioned to note at
once any casual reference to them and then follow up the reference,
making a point of getting all the facts he can about the health of
the person in question.
The warning will be given elsewhere, but it should be stated
here too that in recording this evidence of Relatives the social
worker should mention symptoms only, excluding diagnosis ex-
cept as it comes from competent medical authority. Even in so
clear a case as pronounced imbecility, he should record, for ex-
ample, "John's uncle says that John's sister Mary was 'not right/
that she could never learn to sew and cook," etc., including all the
evidence but drawing no conclusion.
Relatives, then, are our main reliance for family history, for
the story of those traits and tendencies, those resemblances and
differences in a family stock which we are learning to regard as of
far-reaching importance.
A large orphan asylum, which is giving a very good education to its inmates and
wishes to limit its admissions to normal children, now not only depends in making
its selections upon a school examination and certain mental tests, but tries to see as
many Relatives on both sides of the family as possible. Especially in the cases
about which there is some doubt, the asylum's investigator feels that a personal
interview with each Relative is necessary. In making 55 investigations prelimin-
ary to the admissions of one month, this worker made 79 visits to Relatives, and
SOCIAL DIAGNOSIS
in studying 25 other cases of children whose fitness for admission was especially in
question, he saw Relatives 94 times.
2. Insight Some items of evidence have social significance

because they suggest new sources of information or possible helps
in treatment later on, while others are valuable because they help
us, at a time when we have felt balked and unable to decide how
to proceed, to grasp at once the core of the difficulty. Relatives
are not the only sources that can give these sudden insights, but
they so often point the way in what have been no-thoroughfare
situations, that case workers have become almost superstitious
about the one Relative who has not been seen.
Even when the Relatives are unco-operative their stories are revealing. "I
remember one instance," writes a worker, "where the mother flatly refused to aid
the daughter's family in any way, where the brothers and sister were too self-
absorbed to share with their sistereven in her great distress. Yet the stand these
people took, in all its ugliness, pictured the story vividly a disobedient, ungrateful
daughter and a selfish and careless sister, a woman who would, in all probability,
make an indifferent wife and mother. This knowledge was of service in planning
the method of attack in that particular family."
Illustrations of securing from Relatives the one essential clue essential, that
is,to any effective treatment are so plentiful that it is difficult to choose. Take
these two found in desertion cases. "We had been dealing with a desertion case
quite a while," writes a district secretary of a charity organization society, "without
getting anywhere. Upon visiting the wife's mother we got information that the
husband was living at his own home; we went there in the evening and found him."
Another charity organization society made an extensive canvass of Relatives in a
desertion case, but omitted the mother of the man. After the society had assisted
the family for fourteen weeks and made fruitless attempts, legal and other, to find
the man, the wife had a letter from her mother-in-law inviting her to visit her, and
two days later a letter from the man saying that he was at his mother's, where the
woman and children joined him.
A case record that came to the attention of the writer last year covers more
than a hundred pages in reporting successively thework of four different districts
of one charity organization society with the Braucher family, the man an American
in his late thirties with a South American wife and two small children. His story
is told at some length here, because the narrative will be referred to in a later chap-
teron Comparison and Interpretation. In transferring the treatment of this fam-

ilyfrom the third district to the fourth, the secretary making the transfer wrote
that it had been impossible to verify most of the family's statements, that Braucher
had failed to follow instructions when good medical care had been procured for him,
and that the family "showed industry as beggars but in no other way."
About fifty pages of the record are filled with accounts of futile attempts to get
some basis of fact on which to operate, followed by attempts to befriend the family
188
and to improve, on the very inadequate data at hand, their physical and economic
condition. The man's people lived in another city, but the local charities there had
given nothing more definite, in reply to inquiries, than the statement that the Rela-
tives had been known to them and that they had "a discouraging record."
The secretary of the fourth district, taking advantage of a trip to the neighbor-
hood of the man's early home, visited the charities formerly interested in his Rela-
tives, read the "discouraging record," found that her client's mother was still living
(he had reported her as dead, and seems to have believed that she was), looked up
her address with the aid of directories, had a long talk with her and gave her the
first news of her son in many years. He ran away from home when he was only
sixteen, and his father, it appeared, had deserted the family before that. This
personal visit to another city gave the charity organization society its first real in-
sight into the background of its client. The mother revealed strong family feeling
and she and her immediate family showed a certain degree of resourcefulness.
The secretary returned with a cordial message from her and an offer to entertain
one of the little grandchildren, whose very existence had been unknown to the Rela-
tives before. Armed with this invitation and with news of the man's people, a
fresh appeal was made to him; his plans and purposes were reviewed in a long
friendly talk, and, from that time, it was evident that an interest which appealed
to him, a plan of life which touched his imagination, had at last been presented.
His first ambition was to make a good appearance when he visited his mother, as
he did soon after. His wife also began to share with him the ambition to have a
better home, to which his mother could be invited on a return visit. At last there
seemed to Braucher to be a good and sufficient reason for taking the few steps
necessary to make medical treatment, so ineffective before, truly effective.

In less than a year's time after the discovery of these Relatives, the charity or-
ganization society was able, with the aid of the family affection and the new social
interest brought into their lives, to transform these difficult clients into people who
carried responsibilitymore cheerfully and were more interested in their little home.
The steps by which this was achieved are apparent enough in the matter-of-fact
pages of the record, which show that no magic was employed, and that the measure
of success achieved was no accident, based, as it was, upon the insights and the
interests which a group of Relatives in no sense remarkable they had once been
described as "difficult" had been able to supply.
3. Backing and Active Co-operation. If they are close at hand,
the attitude of the Relatives is seldom an entirely passive one.

The illustration just given shows that not only insight but active
co-operation may be won from Relatives, and emphasizes the im-
portance of communicating with them even when they are at a
distance. Still less can we afford to ignore members of the family
connection who live in the same city and who often have very
definite ideas with regard to our clients. If they are not with us,
they may easily be against us. It is no unusual thing to find in
189
SOCIAL DIAGNOSIS
one group of Relatives almost every variety of social and anti-

social attitude, from utter indifference on the one hand to deep
devotion and self-sacrifice on the other. The best of the Rela-
tives are often as thoughtful and as eager to help as any social
worker ever was. Sometimes we are dealing with situations in
which the Relatives have failed those in which they have en-
tirely succeeded are not usually known to the social worker but
even in the history of these failures we may find that the Relatives
have almost as strong a claim upon our sympathies as our clients
have, and that they welcome our new, more hopeful, and more
resourceful handling of an old difficulty. They have had much
to bear perhaps; they have lost their influence and are glad to
help through another in cases in which they despair of helping
directly and effectively.
Thecase record of a single woman of middle age is commented upon by one of
the case readers as follows: "This is one of the most real examples I have ever seen
of bringing a woman up on her feet and helping her until she had confidence to stand
alone. Her great happiness in at last being able to do so is pathetic and genuine."
This woman was the last of her immediate family. Her father had been a hard
drinker, thehome had been an unhappy one, and after its breaking up her Relatives
had wearied of helping one who seemed never to rise to her industrial opportunities.
The charity organization society that attempted to befriend her interested a doctor,
who reported that she was not mentally unbalanced, as they had suspected, but
was undernourished, sensitive, and unpractical. Work was finally found for her
inan office, but it took a good many months to make her self-supporting, and mean-
while a cousin, who had was made to understand her real situation
lost all patience,
and persuaded to aid regularly through the society.
The financial help of a well-to-do Relative is all very well as

far as goes, but the experienced social worker welcomes as his
it
strongest ally in a difficult case the Relative who shows tact,

courage, and patience. The personal and moral backing of the
Relatives shown in the following instances was a great social asset.
Mrs. Chesley of the Paine Fund, Cambridge, Massachusetts, writes of a weak
woman who had never been married to the deserting father of her four children,
and of the way in which four Relatives, each showing a different mental attitude
toward the situation, worked for the common good. "We wrote twice to the [pa-
ternal] grandfather of those children, trying to arrange an interview at his con-
venience, but received no replies. Wewrote to the [woman's] single brother twice
with the same result. The married brother worked at night. We wrote him that
we would call on a certain afternoon at four o'clock. He then would have had his
usual amount of sleep and be ready to see us. We found him a kindly, easy-going
IQO
man with no very decided opinions. After considering the facts he thought it
wise for his sister to keep the children together and for his mother to remain with
them. His own financial situation was straitened. He had five children a son,
who was a widower with one child, living at home and out of work; two other sons
of working age, also out of work; one girl at work and another in school. The
family was held together by his small wages and what the daughter earned. He
was in debt for rent and other necessities. He was willing to give his mother a
home, or would contribute toward her support, and thus help his sister too. We
had to show him why, under the circumstances, he was not justified in helping others.
He agreed to wait until the income of the family was larger and then do what he
could.
"On visiting the married sister we found that the income of her husband was
only for the support of the immediate family. Again no financial aid
sufficient
was promised. In the sister, however, we found a strong moral character with a
keen appreciation of all the difficult elements in the situation, and a realization of
her duty to stand by her weaker sister and the children. Because of the lack of
family resources she had urged that the children be placed in homes. She readily
accepted the other plan, however, and we left her, feeling that there was at least
one person on whom we could depend for the most sincere and cordial co-operation.
She regretted her inability to help materially and we hope she took a little comfort
from our assurance that her genuine moral interest and oversight were the indis-
pensable elements, the real hope, of the situation. We found she was a woman
very much among whom she had lived all her
respected in a certain circle of people
life. Her pride and were strong, and she realized that at any time her
self-respect
sister's real story might be known. This did not deter her her sister was her sister
through good or ill repute, and that ended the matter.
"We had now to see those two men who had not replied to our note. We called
on the grandfather of the children one evening. He apologized at once for not
writing, and when he explained in detail the way his time was occupied by his work
and the care of an invalid wife, we did not wonder at the delay. With him we had
to face a most delicate and difficult situation, one that took all our courage. Here
was a quiet, dignified man who had always been fully competent to guide his own
affairs. He had positively decided that his future course as to this family of his
son was to treat them as though they were non-existent. He stated his reasons for
such a course good reasons, almost unanswerable from one point of view. Years
before he had done all he could to prevent this union. He had seen Mrs. X, as we
still call her, and told her that his son had a wife from whom he had not been di-
vorced. His efforts were fruitless. He had, too, given much financial help during
the past twelve years, and now he felt he owed all he could spare to the care of his
sick wife and their approaching old age. Our sympathies were with him and we
told him so, although we could not quite agree with his conclusions. We led him
to consider the future of the children and his responsibility regarding them. Finally
afterdue deliberation, he agreed to co-operate for six months by giving one dollar
a week, through us, toward their support.
"We also called in the evening on the single son and brother. He boarded with
191
SOCIAL DIAGNOSIS
awoman living on the second floor of a tenement house. The family thought this
woman received most of his wages. She was certainly in his confidence, for when
we inquired for him through the tube she would not give any information or open
the door until the name was given. Then the man came rushing downstairs ex-
'
claiming, as soon as he opened the door, I have not answered your letters because
I want nothing to do with my sister, and anyway have been out of work, and I I
haven't any money to give her.' We said, 'Good evening,' and then he said,
'
beg your pardon,' and we began our talk on a more friendly basis, continuing
I
the interview on the steps outside, which seemed preferable to the possibilities of
the apartment upstairs. His attitude, plainly stated, was that he would not help
support Mr. X's children. They might be cared for by the state or in any way
the community provided for such children. We finally found ourselves discussing
frankly his sister's life and character, and his own duties in relation to her. He
saw that, in ways he had not realized, he had been a detrimental influence. This
thought affected him more than anything else. His whole attitude changed and
the result was that he promised one dollar a week and some oversight over the
children, especially a troublesome nine-year-old boy. For five months he has kept
his promise.
"Our next step involved an extension of the family idea. We asked a group of
peoplewho were constantly studying the best interests of children, the trustees of a
home for children, if they would consider giving this mother a cash allowance so
that with the other resources she might keep the family together. This they
unanimously voted to do although it was the first time in the history of the insti-
tution that such a course had been taken.
"Summarizing the situation, we find:
"First, that the grandfather who felt his duty ended saw a further duty; second,
that the brother who acknowledged no
obligation to a weak sister saw that he had
not helped her to be strong; third, that the married brother was deterred from his
unwise self-sacrifice; fourth, that the sister came to realize that her strong moral
support was of more value than financial aid; fifth, and lastly, that the trustees of
the home took, as it seemed to us, a progressive step away from institutionalism." 1
One record submitted for study opens with a picture of an educated man who
had lost his eyesightthrough a drug habit, a wife also addicted to drugs, who a
little later becomes insane, and their little boy, whom the mother neglects but to
whom the father is so devoted that he refuses to let him be taken away. The
woman's Relatives in another state did not reply to letters. The man's sister and
brother, who lived still farther away, wrote that they did not wish to have any-
thing more to do with him. A little later, however, a third member of his family,
another sister, who had heard indirectly of the previous correspondence, wrote a
letter full of intelligent questions: "Is it true that my brother has attempted to
take his Will he not probably attempt to take it again? Was drink or pov-
life?
erty the cause? Is he in a rescue home, a hospital, or where? Is he a confirmed
drunkard, and do you see any conditions that would reform him? As I under-
"
1
Chesley, Annie L. : The Responsibility of Family Life." Survey, May 22, 1909,
p. 269.
IQ2
stand, he will not be separated from the child. Is he strongly attached to his wife
also?" The letter goes on to explain that the writer had not heard from her brother
for more than ten years and did not even know that he was married. She is eager
to do all that she can, but is a widow in delicate health and could not provide for
all three of them. Then out of the depth of her interest more questions: "What
caused the blindness? Is there no hope that he will ever see? It is a cruel thing to
separate a family under normal conditions, but sometimes it has to be for a time
at least. How old a woman might his wife be? Are you a friend, a nurse, a mis-
sionary, or a sister of charity? Excuse the inquiry. Do not lose sight of him until
I can hear from you. If should write to him, would it be wise? I have decided
I
to help him if I can, but that will not be by sending money there. I ...
cannot think he has the thirst for drink that makes drunkards. Some strong out-
side influence, poverty or a weak character, must be at the bottom. Tell the
particular cause of the blindness, and if there is any hope that it may not be per-
manent."
These questions were answered as fully as possible. Meanwhile, a further
efforthad been made to find the woman's Relatives. A clergyman in their town,
whose name had been found in a church directory, was asked to visit them, since
no charitable organization could be found to do so. His intervention brought a
reply at last written by the stepmother of the woman. It was full of expressions
of sorrow, and offered to give a home to the little boy, provided he could be sent
at the society's expense. The next day brought a second letter withdrawing this
offer, and adding that if the little boy is as unruly as his mother used to be, it would
be impossible to take care of him. "You will have to get him a good home some-
where through the Children's Home, or whatever other means you have of making
such arrangements. I am awfully sorry that we cannot under the circumstances
do anything for him, and if he goes to the bad I would feel myself responsible."
The man's sister was made of other clay. None of her family would join her
"I stand alone as far as my family are concerned, and whatever I undertake I
must try and be equ?I to." Nine days later (the wife had meanwhile become
"
violent and been removed to an insane asylum) comes a third letter. now beg I
to say I have had time to think in a more collected way and come to better con-
clusions than when I wrote you at first." Then follow instructions as to just how
to send the blind man and his little son to her home. Two weeks later the sister
"
writes again, I think it only courtesy on my part to write you that my brother
arrived safely in due time, found some one ready to assist him in the necessary
changes, and is now comfortable. The little boy is in school and seems to be rather
a desirable child. ... I would think as I observe my brother that it will be
a long time before he sees, although he seems to be very hopeful. He has a good
appetite, and says he rests much better here than he has for a long time."
Complaint was made to a probation department about a girl of seventeen by her

mother, a widow whose record was not above reproach. The probation officer
saw the paternal Relatives, and was much impressed by the two aunts, who were
far more careful in their statements than "in-laws" usually are. The officer,
realizing the seriousness of bringing a court complaint against the girl, felt that the
13 193
SOCIAL DIAGNOSIS
case could safely be left with these Relatives, and told them so; but the aunts were
rather frightened at the responsibility and said that they did not know how to talk
to their niece. The officer advised them to "put it straight up to her" that they
had heard she was going with a disreputable man, and to make the most of the
affectionate disposition which they said she had. They succeeded in getting from
her a confession and a promise to give the man up. The probation officer con-
tinues to make suggestions, but has not had to appear in the situation in any way.
With reference to several of the foreign groups, it is necessary to

bear in mind that godparents hold a relation to the family quite
as close as that of Relatives, and that their co-operation is invalu-
able. In their own country the ties of kinship even of kindred
not nearly related are close, and it is pitiful to see the dropping
away of this interest and sense of responsibility wherever America's

social agencies are many and careless. 1
4. Further Considerations. In addition to the importance
of Relatives as sources of interest and backing, it may be urged
that they have a moral right to be considered the same right,
whenever they have tried to do their duty, that any church or
other social agency interested in a family would have in like case,
only their claim is somewhat stronger because the relation is more
personal.
Miss Mary Breed gives an instance of this: 1 "One experience came from a
I.
woman left a widow, and doing her best to support her two boys.
of great worth,
She was aided generously and given the friendship of a sympathetic visitor. Her
family were not seen, because of her claim that they had refused all help. When
she developed a mental malady her children were given into the care of the city and
then an agent of the city saw the woman's brother. He was justly incensed that
he had not been consulted before, as he had been both able and willing to help.
His sister had been alienated from her family, and her bitterness toward them was a
part of her mental disease."
Moreover, Relatives are themselves a part of the community,

potentially a helpful part, and any agency interested in co-ordinating
the social service of a community cannot afford to leave them out.
One interesting by-product of social work is the occasional re-
establishment of family relationships and the wearing away of
misunderstandings.
1
For a discussion of the co-operation of Relatives in institutional work for chil-
dren see "Pittsburgh as a Foster Mother," by Florence L. Lattimore, in The Pitts-
burgh District, Civic Frontage, p. 398 sq.
* In one of the short, unpublished papers referred to in the Preface.
194
Miss Breed gives an illustration of this also: "We know a Jewish widow who,
after the death of her husband, had been helped most generously by her family
until they lost all hope, and ceased aiding because of what seemed to them her
incurable laziness. When a medical diagnosis showed that she had neurasthenia,
and when a set of teeth and a long course of good food and fresh air had made her
another woman, an uncle felt so contrite for his past neglect that he set her up in a
small grocery shop."
An S. P. C. C. worker was applied to by a young man who had been placed out
from a foundling asylum when he was three years of age. Now grown and doing
well in a farming community, he wished to find his four brothers. Through cor-
respondence with the foundling asylum and the town clerk of the community
from which they originally came, their whereabouts was discovered, one of them
"
writing, If you wanted to see a happy young lad, you ought to have seen me. I
satdown and wrote my brother a nice long letter of eight pages, and the next
Monday I got an answer from him and his family's pictures. He wanted me to
come rightdown. ... It makes a fellow feel happy to know he is not alone
in the world, and that he has some folks."
QUESTIONS OF SUPPORT FROM RELATIVES

III.
from Relatives and

Questions of support (complete or partial)
of temporary relief to be given by them are often allowed to de-
moralize our diagnosis and hamper our treatment. Those who
turn to Relatives for nothing but material things are unlikely to
use them wisely for even this one object. The case records of
public departments and of private agencies abound in such penny-
wise-and-pound-foolish policies, in overemphasized legal responsi-
bilities and underemphasized
social opportunities.
Responsibility for support can be enforced by the state, which

" "
has the right of recovery from Relatives, if of sufficient ability,
in the direct line of descent. Support laws vary in the different
states,but quite generally the two parents and four grandparents
are responsible for the support of children, and children who have
attained their majority are responsible for the support of dependent
parents and grandparents. Public departments and institutions
1
receiving public subsidies are often very careless about the en-
forcement of these provisions. When they bestir themselves to
enforce them at all, they tend to become so interested in the finan-
1
Children are definitely held responsible in 35 states, parents in 32, grandchildren
in 22, grandparents in 20, brothers in 13, and sisters in 12; in a number of these
states, however, responsibility is restricted, in cases where intemperance or other
bad conduct is the cause of distress, to parents and children. See Summary of
State Laws relating to the Dependent Classes, United States Census, 1913. (This
material has been brought up to date in Social Welfare Laws of the Forty-eight
States, Wendell Huston Publishing Company, Des Moines, 1930.)
195
SOCIAL DIAGNOSIS
cial side of their relationswith Relatives that they refuse to inter-

view any kindred whose responsibility could not be enforced by
law. They will confer with sons and daughters, parents and grand-
parents, that is, but not with brothers and sisters, uncles and aunts,
nephews and nieces.
An associated charities record of a homeless man shows that it discovered in the
first of acquaintance with him facts that had remained unknown for sixteen
month
years to the public insane asylums in an adjoining state. The process by which,
through a slender clue, his people were found in a third state is described in another
part of this volume, but the point to be made here is that the failure of a state's
1
public institutions to discover this man's family, who had been eager for news of
him all these years, is not so much a failure properly to adjust a question of legal
support as it is a far graver failure. It is true that the state at the present per
capita cost of maintenance had expended $3,160 for his care, but it had done some-
thing more wasteful than this; it had neglected through this whole period to utilize
a therapeutic agency of the first importance. The man's family proved to be ster-
ling people, whose affection and sympathy achieved wonders for his mental health
even after years of lost opportunity. The man had been a runaway from the
insane hospital when he applied to the associated charities; he was discharged and
living with his own peoplewhen the case record was closed.
A record from a public departmen t shows one of its agents journeying from end
to end of the state to find the father of a dependent child whose mother had deserted
it. The man when finally found explained that he had feared to make inquiries
because of the wife's behavior. He has since been paying regularly for the child's
support.
Public agencies often handle questions of support in a more

perfunctory way than this, but they are not the only offenders;
the financial side is too much dwelt upon by private agencies
also,both in the earlier consultations with Relatives and in co-
operation with them throughout the period of treatment. It is
undoubtedly true that any community is appreciably poorer in

which the sense of family solidarity has been weakened either
through carelessness on the part of social agencies or through
sentimentality among the well-to-do; but to a wooden and undis-
criminating enforcement of family responsibilities may be traced
a reaction in some quarters against urging any who are not com-
2
fortably off to care for their own.
1
See use of directories in Chapter XIII, Documentary Sources, p. 266 sq.
"
See correspondence entitled "A Misplaced Burden? in Charities and the Com-
*
mons for Oct. 13, 1906, p. 1 18, in which Mrs. Simkhovitch protests against the
"custom of calling upon relatives for support, or the general theory that families
ought to have pride enough to look after their own. Where there is some member
196
Questions of relief and of support are an important but always

a secondary part of treatment. The social worker whose technique
has more than one dimension, who thinks constructively about
the cases under his care, is not likely to overlook the social welfare
of each reference visited, including that of the Relatives. In the
case cited on page 190 it will be noted that Mrs. Chesley not only
refused help from one Relative who offered it, but heartened an-
otherwho had nothing material to give by suggesting a different
and better way in which she could be helpful. The relief side is
of the family amply able to relieve the poverty of another member, it seems a
natural and suitable thing to expect such care. But when, as is so often the case,
a committee of some powerful charitable society with large resources to draw
upon, decides in a given instance to call upon a struggling relative for aid, the de-
cision cannot but strike one as discreditable, and from an economic point of view
wasteful."
Miss Zilpha D. Smith presents the other side: "The best charity workers I
know, in approaching relatives, go to ask their counsel, their co-operation, to offer
an opportunity of service; and they are so frequently rewarded with as much or
more than they expected, even from relatives said to be unfriendly, that they take
pains never to promise not to communicate with a relative. There may be occasions
when a good charity worker deems it best to delay the letter or the interview, but
these grow fewer as experience teaches how to make such inquiries with sympathy
and discernment to learn much and tell little.
"The response to such an approach usually discloses the character and the
resources, financial and otherwise, of the relative and his attitude toward those now
in need. It may be that because pride or resentment, poverty or illiteracy made
communication difficult, they have allowed the family acquaintance to weaken.
Those inquirers who go, not with decision already made as to what the relative
ought to do, but to talk the matter over with an open mind, do not find as Mrs.
Simkhovitch implies, that family pride is the chief motive which brings help but
rather affection and loyalty to one's own, the traditions and memories they have
in common, enhancing ordinary human sympathy. Even if the charitable society
had more ample resources than any I know, it could not afford to let these human
values go to waste.
"When it is pride that offers help, should not the poor man choose whether he
would rather part with his pride than his dollars? If a friendly interest in him, as
well as in the person in need, continues, it will be possible later to suggest a lessen-
ing of the burden, if that is wise. A
state superintendent, whose new and struggling
institution had difficulty in getting sufficient appropriation, nevertheless undertook
to persuade and did persuade a relative to cut down a payment of $5.00 a week to
$3.50.
"Not only those in want feel the bitterness of the burden their own helplessness
lays upon those who are near and dear, many who have been ill, though with
money enough for ordinary needs, have felt this deep sorrow. But there is an ex-
perience even more bitter, when one finds himself in illness or in want and there
is no one but a stranger who cares enough about him to make a sacrifice.
"
I cannot believe that
many charitable societies do push relatives to the wall.
My observation is that they are often unwilling to take the trouble to consult
relatives unless they think they are going to get a good deal of money out of them,
not realizing what a great advantage, other than money, the practice of going to
them brings."
197
SOCIAL DIAGNOSIS
often the one that seems most important to the Relative we are
interviewing, and we must aim to interest him in the other aspects,
to carry his mind beyond a justification of his own position, more-
over, to a consideration of the other person's difficulty in and of
itself. The following are examples of a less flexible method. They
show some of the weaknesses of our present practice, and emphasize
the importance of keeping constructive treatment always in view.
A charity organization society was asked to befriend a family in which the man
was out of work and beginning to keep bad company and the woman was expecting
her second child in a few weeks. Both of the man's brothers were written to in the
following vein: "Your brother (giving name and address) has been out of work for
a number of weeks and his family have got behind in their expenses. They owe $16
rent and a store bill of about $12. His wife is unable to help with the income owing
to her present condition. She expects to be confined next month. Will it not be
possible for you to help your brother and his family until he is again on his feet?"
Not only the further developments in this case but the situation as revealed in the
first interview pointed to the need of insight into the man's character, work rela-
tions, domestic relations, health, etc. His two brothers would also have been better
witnesses than he, perhaps, to the size, whereabouts, and resources of the whole
family connection, but the two letters were not answered. In all probability this
lack of response was due to too early emphasis upon the matter of relief.
The subject of letters of inquiry is treated in a separate chapter, 1 but it may be

well to cite here another letter which brought no reply; it was addressed to a young
man's father by a charity organization society. After stating the condition of
distress inwhich the son and his wife and his two children were found, the letter
continues, "We should be glad of information in regard to man's previous record
and your idea as to his ability to take care of his family. This information will be
considered confidentialif you desire it. Would you feel inclined to assist the family
financially, provided Mr. J makes every effort to get employment?" Here the
error is a double one; financial assistance is led up to as the climax; "previous
record," "man," and "the family" are technical, non-human terms in what should
have been a very human document.
Comment upon an Italian record submitted for study includes a reference to
support questions. The man of the family had attempted to assault his own daugh-
ter at one time when he was drunk and had been shot by one of his sons, who was
trying to protect the girl. The charity organization society did faithful work later
to improve the broken health of the father and to befriend his better-grade wife-
The two older sons entered the United States Navy and were induced by the
1
society, in co-operation with the government, to send part of their pay home.
1
Chapter XVII, Letters, Telephone Messages, etc.
* A circular letter addressed by one of the United States Naval Training Stations
"to the parents of apprentice seamen" reads in part: "The Commanding Officer
has no authority other than to advise a man under his command as to sending money
198
The commentator says, "You are following the orthodox view, of course, in en-
couraging the United States to get half pay out of Giorgio and Giovanni. All
the back family history may have had the effect of simply embittering them,
though, and making them feel that this additional demand is part of the general
injustice of living.Giovanni's letter gives a hint of this, and Giorgio is stationed
near enough to your city for you to learn at first hand, perhaps, his theory of things.
1do not mean that the payments should stop, but I wish that they might be made a
part of plansworked out with these young men for saving the younger children from
the awful mill that the older ones have been through."
Comment upon another Italian case record reads as follows: "One outside visit
was made; namely, to the sister who had furnished transportation. It brings, for
result, the one item that the 'sister can do no more,' Presumably she was asked to
relieve, or this idea was allowed to get in the foreground. . . Here was a
.
sister able on relatively short notice to transport two adults and seven children from
Italy evidently a person of some resource. ... I am advocating not a

demand for relief from this relative, which brings almost inevitably a negative
response, but an approach that would have brought out her knowledge of the old
life on the other side, of the shop and the home and the daily happenings, together
with the names of the other relatives that had come over from time to time. De-
cidedly, those who lean heavily upon the modern child welfare devices, as against
the old devices of uncles and aunts and parental responsibility, make a pitiful
showing sometimes they do in this family, where, thus far, the health, the school-
ing, and the industrial start of these children have been hampered by the lack of
history which the relatives could easily have supplied."
These criticisms of a method that thrusts relief into undue

prominence must not be taken as implying that the enforcement of
financial responsibility upon Relatives is foolish. Often the mere
enforcement brings with it wholesome social readjustments. In
cases of family desertion, for instance, the throwing of the resulting
relief burden upon the man's people, when they are well able to
bear it and when there is reason to believe that they know his
whereabouts, has been found to hasten his return. Some social

reformers have taken the position that Relatives will be more
home. Encouragement to do so, however, is given, and on simple request, provided

the amount is available on the books, and the object seems worthy, the pay officer
issues a check for the amount requested, and charges it to his account. Until after
two months at this Station, an apprentice seaman has very little money available,
hence little may be expected until after that time. Later, after transfer to a sea-
going ship, any man has the privilege of alloting a part of his pay to his home; that
money is drawn through the mails each month, by the person to whom it is allotted,
and without regard to any further request on the part of the allotter." A letter
from the commandant at this Training Station adds, in further explanation: "When
we are informed that the parents of one of our young men are in needy circumstances
and need the help in a financial way of the recruit, our policy is to interview the lad
and endeavor to impress upon him his responsibilities in the matter."
199
SOCIAL DIAGNOSIS
interested in the welfare of their less fortunate kindred when the

state relieves them of all sense of financial obligation. If this
position prove, after experiment, to be psychologically sound, it
will reversethe judgments of both educators and social workers.
IV. METHODS OF APPROACH

For merely objective matters of fact, those sources of information
which are the most impersonal are the most satisfactory. 1 But
Relatives are of all sources the least impersonal; and, for this
reason perhaps, we find them difficult witnesses. Most social
workers realize the importance of Relatives, and also the difficulty
of interviewing them for the first time. Next to the first interview
with the client himself, here is the greatest danger of a false start,
with the added danger, moreover, of making trouble between
kindred. A social worker with only one year's experience, but
with a natural with people, writes in
gift for helpful relations
answer to a question, "In three cases in particular, I interviewed
relatives when I was almost convinced myself that more harm than
good would be done. Yet in two of those cases breaches of years'

standing were healed, and in the other I obtained information that
made all the difference in the world in dealing with that family.
That harm is not more often wrought by the visits of the social
worker in quest of information and co-operation seems to me to be

due to the fact that, if properly approached, relatives are not apt
to question her right to such a deep interest in the family, and with
an almost unnatural frankness open their hearts to utter strangers.
If I remember aright, I have had only one actual rebuff this winter
and half an apology was afterwards made for that by another

member of the family."
"If properly approached." No mere instructions can be of
any value here. To be really interested, to be able to convey this
fact without protestations, to be sincere and direct and open-
minded these are the best keys to fruitful intercourse. When
a worker comes back again and again with the statement that the
Relatives do not know or will not tell, he has probably mislaid
or never had some one of these keys.
Information of how much the Relatives have done already comes
1
This idea is developed in Chapter XIII, Documentary Sources.
2OO
with a word, and their reasons for being seriously displeased are
proffered easily. It is true that too often they have been much
put upon. Listen, get their point of view, remember that even
the irrelevant things that they say will help you to estimate their
value as witnesses, then push beyond to the things that more
immediately concern your client, being careful to seek, even here,
only those items of evidence that each particular Relative seems
fitted to give. Confer with them about the possibilities already
"
in mind. Relatives are often indignant to find we have made a
pretence of consulting them merely to foist upon them our own
plan." The consultation must be genuine. Sometimes their own
resourcefulness puts ours to shame.
After a number of Relatives have been seen, their plans may
conflict or their adherence to any one plan of action may be half-
hearted. In that case be well to follow up the separate
it may
interviews by arranging a conference with all of them together.
This makes for clearness of understanding and dignifies their part
in the treatment that is to follow.
The approach to Relatives is made more difficult sometimes by
the fact that the social worker is the bearer of bad news.
An S. P. C. C. was notified by a day nursery of a mother's serious neglect of her

young baby. The woman was only twenty-one, had come to the city to study at a
technical school, and was receiving money regularly for this purpose from her pa-
rents in another state. They knew nothing of her illegitimate child or of her mar-
riage to its father three months after its birth. The society wrote as follows:
"We have been interested for some little time in the welfare of your daughter,
Mrs. and her daughter, Ethel, and, on account of the neglect of the
,
child's parents, the Judge of the Juvenile Court has placed the child temporarily
with a state agency. We might have allowed this matter to go on without bringing
it to your attention, but, at the request of the Judge, who has dealt in a most kindly
way with your daughter, we are asking you to come to her assistance and to save
her from the degradation to which she now seems destined unless those who are
most concerned about her can work vigorously for her redemption. Instead of
going into the details, we should like to ask whether you or your wife or both could
not come to this city and consult with us or send some one equally interested to
represent you with whom the whole matter can be talked over."
Two days appeared and her mother soon after simple
later the girl's father
country people and both very helpless. But another daughter of the family proved
to have the necessary strength of character. She was given the legal guardianship
of the child, and mother and child went back later to the country home.
201
SOCIAL DIAGNOSIS
The effort to get in direct communication with these particular

Relatives, not trusting to letters only in so delicate a matter, was
prompted by a sound instinct. Relatives are often at such a
distance that personal interviews are impossible, however, and
this is especially true in the United States, where frequent migra-
tions within the large cities, and migrations from county to county
or state to state make our communications with Relatives at once
more difficult and more necessary. 1 Immigration is a further com-
plication. It has been said that many of our social clues run into
the Atlantic Ocean, thus compelling us to communicate indirectly
through mayors, consuls, etc., in other countries.

1. The statements of this chapter do not apply to Relatives in the immediate
family of a client, but include all others whether related by birth, by marriage, or
by descent.
2. It is necessary to keep in mind in all our contacts, however, the distinction
between relationship by birth or descent, and relationship by marriage, for the latter
is associated, often, with a peculiar type of prejudice.
3. Discrimination must be used as to which Relatives to see and when; they

should not be seen to the exclusion of other important sources. It is possible also
to overestimate the claims of kindred, irrespective of character, habits, or circum-

stance.
4. The chief failings of Relatives as witnesses are (i) their prejudice, (2) their
assumption that they know more than they really do, (3) their lack of understand-
ing of a social situation and of social values.
5. On the other hand, differential diagnosis and treatment would be sadly im-
poverished without their characteristic contributions of (i) individual and family

history, (2) insight, (3) backing and active co-operation.
6. Aside from their ability to serve, Relatives have a moral right (whenever they
have do their duty, that is) to be consulted. Our consultations with them
tried to
should be genuine; they should be given a chance to aid in shaping our social poli-
cies, instead of having plans of treatment imposed upon them ready-made from with-
out.
1 In schools of 78 American cities

a study of the thirteen-year-old boys in the
city
(places of between 25,000 and 200,000 inhabitants) it was found that only one in
six of the fathers of these boys was living in the city of his birth, and that among
the boys themselves, only a few more than half were living where they were born.
Of the fathers 40 per cent, of the boys 9 per cent were foreign born; but the migra-
tion of 44 per cent of the fathers and 33 per cent of the boys was within the United
States. See Some Conditions Affecting Problems of Industrial Education in Sev-
enty-eight American School Systems, by Leonard P. Ayres. Pamphlet of the
Division of Education, Russell Sage Foundation, 1914.
202
7. Responsibility for support from near Relatives can be enforced by the state.
Public social agencies charged with the administration of support laws often fall
into the error of ignoring the other and higher services that Relatives could render.
Private agencies make when they approach Relatives with the
a similar mistake
sole object of procuring relief. does not follow, however, that Relatives should
It
be relieved of any financial responsibility that they can bear without endangering
their own social welfare.
203
CHAPTER X
MEDICAL SOURCES
ON the basis of the social case work records then available
for study, this book had been written fifteen years ago, it
IF,would probably have been found that the outside source of
information consulted oftener than relatives even was employers.
But there has been a shifting of interest from data about earnings
and occupation to data about health and disease. All of these
groups of facts are closely interrelated, of course, and the change is

merely one of emphasis. So marked is it, however, that there may
be need later of new emphasis upon another group of sources to
preserve our social center of gravity.
The lists of outside sources used by the 56 social agencies whose
records were studied show that Medical Sources were consulted
two and a half times as often as employers and other work sources.
In 2,800 cases, to be exact, 1,828 Medical Sources were consulted
and 743 work sources. 1 The multiplication in recent years of
medical agencies both curative and preventive, especially in large
cities likethose included in our study of sources, accounts in part
for this; it is due to the fact that some agencies for the
in part,
care of the sick now have social as well as medical records social
records that can be consulted with profit, that is. But part of it is
alsodue to a change in the attitude of non-medical social workers
toward their own task. In seeking to remedy bad social conditions
they have come to recognize more fully the great handicap of bad
physical conditions, and have learned to welcome, in the effort to
remedy these, the aid of a newer and more constructive medical
science. Their awakening is due, in part, to their own deepened
experience of human need, but even more is it due to the socialized

members of the medical profession, who have led the way in many
departments of social endeavor a way in which the lay social
workers have been only too glad to follow.
1
See Appendix II, Table A.
204
MEDICAL SOURCES
The kinds of Medical Sources most often consulted by the 56
agencies were physicians, hospitals and sanatoria, dispensaries,

medical-social service departments, nurses, and public health de-
partments. It must be conceded that socialworkers have been
handicapped, often, in their use of these sources of information by
knowledge of even the most elementary facts about
their lack of
disease and bytheir lack also of understanding of the organization
and discipline necessary in a hospital or dispensary. But, as these
pages are an attempt to estimate the social value of the various
sources of evidence, and as the case records studied show not only
the great serviceableness but the occasional failure of Medical
Sources, it be well to follow the plan already followed in the
may
chapter on Relatives and illustrate these failures at once, even at
the risk of seeming to overemphasize them. It will be evident a
little later that much more can be said on the other side.
I. WHERE MEDICAL EVIDENCE SOMETIMES FAILS

Case notes under this head made in the course of our extended
case reading tell their own story of (i) a non-social attitude, (2)
conflicting diagnoses and prognoses, and (3) faulty medical records.
1. Non-social Attitude. Let two illustrations suffice. It may be
that both show poor medical work also, but the writer makes no
attempt to pass judgment upon their medical aspects:
A child-saving agency found a little girl of seven in a boarding house where she
had been placed by her mother, a waitress. This mother was described as "suspi-
cious, quarrelsome, and altogether difficult." Her child was illegitimate. The little
thing's eyes were seriously inflamed, her whole face swollen, eruption behind ears
and on scalp; she had been in this condition for two months, often seen by mother,
but no medical care procured. The public health department had diagnosed the
child's condition as syphilitic five years earlier. The mother was persuaded by the
society to permit them to place the patient in a hospital, the hospital authorities
agreeing to report to the society's agent a few days before discharge. Later the
hospital reported that the child bad been discharged, at the request of the mother's
physician, or at the request of someone representing himself as such over the tele-
phone. Only the last name of this physician was known at the hospital.
On complaint of a commission for the blind, a physician was prosecuted by an
S. P. C. C. for failing to report a case of ophthalmia neonatorum. The eyes of a six-
weeks-old baby had been irreparably injured by this disease. The physician em-
ployed was fined $50 and appealed the case. Among other witnesses for the prose-
cution was an eye infirmary. A copy of the prosecuted doctor's letter to the board
of health was also entered in evidence against him.
SOCIAL DIAGNOSIS
None the results of these non-social acts or of failures to

feel
co-operate with social workers more keenly than do the more pro-
gressive of the physicians themselves. There is marked advance

every year among these latter in the development of a deeper social
concern.
2. Conflicting Diagnoses and Prognoses. These often delay
social work very seriously, just as conflicting plans of social treat-
ment must hamper medical work. Some of this delay is inevitable,
for medicine is an experimental science, but in all probability some
of it is due to unevenness in the standards of medical practitioners,
and some unquestionably is due to the uneven development just
referred to in the medical profession's sense of social responsibility.
A society for protecting children from cruelty finds that, when it
brings a physician into court to testify to certain conditions, the
defendant in the case can usually find some other doctor to swear
that the facts are just the reverse.
I n one case, a tubercular mother had been reported to a child-saving agency because
she refused to allow her six-year-old crippled son to go to a school for cripples. The
boy was sleeping with his mother, and one of the physicians at a certain children's
hospital said that the child could make no progress if left at home. A settlement
nurse and the family physician reported that the mother was careless and was likely
to infect her children. A board of health doctor objected to home surroundings and
advised sending the child away. In court, however, the family was able to produce
a letter from a second physician at the same children's hospital, objecting strongly
to the removal of the child, as his disease was incurable, and adding, "We are willing
to give the mother advice and help whenever it is necessary." This was further
reinforced by another medical institution, the nurse from which reported a well-kept
home.
The following memoranda summarize the various diagnoses and treatments
advised in one case that was under the care of a hospital social service department:
Oct. 31. Girl aged sixteen, pretubercular, needs a country home. Nov. 13. Tuber-
cular. Too hysterical to go to a hospital; must be treated at her own home, where
medical supervision will be constant and expert. Dec. 1 1. Operation advised for
ovarian cyst. Not tubercular; hospital care. Feb. 8 of the following year. En-
tirely well, needs nourishing food before she commences work. Apr. 18. Tubercu-
losis, first stage. Sanatorium advised. Jan. 28, year succeeding. Patient quite
well. Reported not to have gone to a sanatorium. Apr. 18. Major hysteria; needs
long care in hospital.
The uncertainties of prognosis scarcely need illustration.

Acharity organization society was caring for a wife and five children while the
husband was in a hospital. On March 8, hospital reports man may have to remain
206
MEDICAL SOURCES
two weeks longer, and that it may be a month before he is able to work. His trouble
is sciatica; there is nothing that can be done for it except to see that man has
absolute rest. April 12, hospital reports that man has tuberculosis of the spine;
willnot be able to work for at least six months, possibly more. May 8, hospital
reports at present man has not tuberculosis of the spine; the trouble he is being
treated for is sciatica and he seems to be responsive to treatment. If he continues
to improve he will probably leave the hospital soon.
In an Italian family already mentioned in another connection 1 there were several

medical diagnoses three of the father of the family (who had had facial paralysis,
apparently, after he had been shot in the jaw), one diagnosis of the son-in-law, and
none, though one was needed, of the daughter, aged sixteen. A commentator adds:
"I realize that delay is accounted for by the contradictory diagnoses of Mr. 's
condition. The doctors are as fallible as we are, and we must expect to lose time
while they are finding out what to do."
It should be repeated that the faults of social reports to physi-

cians are quite as grave as any faults here noted in medical reports.
"
have seen many examining physicians discouraged," writes the
I
head of a medical-social service department, "by the poverty of

social workers' reports, which are so increasingly important to a
proper clinical examination and diagnosis of, for instance, a feeble-

minded child."
Faulty Medical Records. Some conflicting diagnoses and

3.
prognoses could probably be traced to failures in the original

records, or to failures in their interpretation by custodians. Dis-
pensary records would seem, from our case reading, to be far less
dependable than hospital ward records, though there are notable
exceptions to this. An extreme instance of faulty method would be
that of the dispensary which could never identify a patient or his
record by name, age,and address, but always added, after its gen-
eral disclaimer of any previous knowledge, "Tell him to come and
bring bis bottle, and then we'll know." Past medical history is
often of such medical as well as social importance that dispensaries
which attempt to keep records at all are surely justified in keeping
them in such a way as to identify the patient recorded.
II. COMPLEMENTARY NATURE OF MEDICAL AND OF SOCIAL

DATA
The discovery of the possible assistance of social history in the
medical field is so relatively new that there is small wonder to find
1
See p. 198.
207
SOCIAL DIAGNOSIS
it used awkwardly on both sides as yet. Two examples found in a

group of hospital social service records illustrate the
complementary
nature of medical and of social data. Each is an instance of mis-
taken diagnosis in its own field, corrected by evidence from the
other field later.
A physician referred a worrtan of twenty-six to the social service department for
a.
pelvic disturbance needing home supervision and treatment. A home visit brought
out a history of convulsions up to the age of twelve, and morning "spells" to the
present time. Re-examination in the nerve clinic followed, with the result that the
patient is now in an institution for epileptics.
The other side is illustrated by a diagnosis of insanity made in

a dispensary.
The patient in question had been reported to an S. P. C. C. for maltreating her
children when in drunken rages. Unable to discover any trace of alcoholism the
society had dropped the complaint. At the dispensary, the woman confessed to
the fear that, in acute attacks, she had abused her children. The S. P. C. C. could
have protected the children if the mother's mental disturbance had been discovered
earlier.
The complementary nature of the two fields of work is well
by the difference between

illustrated prescribing braces or other
apparatus and securing their proper use. A critic of the case
record of an Italian family referred to on the preceding page wrote
to the social worker responsible for their treatment:
I distinctly question the wisdom of putting on your blank forms of inquiry
addressed to doctors of dispensaries the following question: Does patient need care
which dispensary cannot give? The psychological effect of blank space after a
printed question is to suggest the filling in of the answer, whether the writer has
one or not. This may not have been the case with Dr. , but his prompt filling
in of the Taylor brace led to an equally prompt ordering of it without any considera-
tion whatever of the son-in-law's willingness to wear it or ability to get any good
out of it. The son-in-law got in a huff and returned the brace later, 1 which only
1
This brings to mind a passage in Dr. Richard Cabot's address at the National
Conference of Charities and Correction (Baltimore) in 1915: "In the orthopedic
clinic of the Massachusetts General Hospital we treat cases of spinal curvature.
They are often aided by the application of a plaster jacket which forces the deformed
chest gradually back into something like correct position. It seems like a simple
mechanical problem. But it isn't, for there are people who will wear a plaster jacket
and there are people who won't. To make these jackets costs something; hence the
social workers in that clinic are now trying to find out in advance what people will
wear plaster jackets and what people won't, as it does not pay to apply plaster
jackets to people who won't wear them. If there is any field for psychological
study less promising than the problem of spinal curvature, I do not know it. Yet
we have obtained already a rich harvest there." Proceedings, p. 224.
208
MEDICAL SOURCES
shows what a child you had to deal with. The other social agencies should stand
behind the medical agencies, and do their best to get people well, whether by relief
or by other treatment, but the question and answer in this particular case threw
the relief out of perspective. It would be interesting to trace the actual results in
individual cases of a generous "handing out" of diets, appliances, etc., on the order
of doctors and nurses who were given to understand that all they needed to do
was to ask.
in order to get
Another medical aspect of which seems to have been overlooked is
this case
the statement by Mrs. E is "not quite normal."
that Concetta This is made in
February and repeated in March in a letter to the doctor. Work had been found
for Concetta previously and work was urged for her later. Her heredity and earlier
history suggest the need of a most careful physical and mental examination.
It is evident that both groups of public servants the social and

the medical will serve the public best when they have thoroughly
mastered in all its details the technique of working together. The
following examples of the kinds of report that have proved helpful
from one group to the other may further illustrate relations be-
tween the two:
A charity organization society was interested in a family in which the father had
tuberculosis, themother was sick also, and there were two children at home. The
father was sent to the country. The doctor who examined the mother made a
diagnosis of umbilical hernia, from which she had been suffering for fifteen years.
She was very stout, and this fact made an operation more difficult. In response to
an inquiry, the doctor sent this very clear letter:
"An operation for Mrs. J is not an absolute necessity; with a carefully made belt
or truss, strangulation probably will not occur, but if it should occur wearing a
truss would increase the difficulties of an operation at least 50%; of course, in case
of hernia, whether umbilical or otherwise, strangulation is what every surgeon fears.
If the operation was done for simple umbilical hernia upon Mrs. J, I should say
the chances of her getting well were between 65 and 75%; if strangulation took
place, her chances of dying would be about the above. She should not be ill longer
than four or five weeks and she should be able to be back at work in about eight
weeks."
This statement made it possible to do two things. First, to help Mrs. J to make
a deliberate choice of operation or no operation. She chose the former, and says
now that she has not felt so well since she was a girl of sixteen. Second, it enabled
the society to secure without difficulty the necessary relief and care for the children.
The doctor underestimated the period of convalescence, but it was easy to extend
a plan well started; it is going to be increasingly difficult to launch one that is
vague and formless.

A doctor who had been inclined to regard social diagnoses as a fad received the
following letter from a charity organization society:
"Mrs. K has promised to go to the dispensary on Monday. Mrs. K has three
14 209
SOCIAL DIAGNOSIS
children, aged nine, seven, and six. She had a miscarriage between the seven and
six year old.Her husband was a drinking man and very brutal to her. She was
injured (lacerations, she says) when her second child was born. When the youngest
was only four days old, she was up and moved, with a severe hemorrhage as a result.
She left her husband several times, and finally two years ago she sent him away for
good and all. Since that time she has supported herself and the children in various
ways. Last fall she took the apartment where she now is, $16 a month, and worked
at the factory days and at home nights sewing. For days at a time, she would
work until i or 2 a. m., then get up and go to the factory at seven. She has
had trouble with varicose veins, backache, and general bearing down pains. Her
head and eyes have bothered her also. She has had no regular physician, but was
told at the Hospital that she had a tumor. We are planning to pay her rent
for a few months and see how she makes out on dressmaking. Her flat is pleasantly
situated and seems fairly good. The kitchen is in the basement, and four rooms
(one inside with double doors into the parlor) are on the first floor. They have a
good bathroom."
The doctor copied most of these statements into his medical record. It should
be added that the social worker who wrote the letter had had the benefit of a short
period of observation in a hospital social service department, to which she had gone
to study ways of strengthening the relation between her own work and that of the
medical agencies.
With the new interest in public health, and the developments of

public health departments of the modern type, there should be
many ways in which the non-medical social agencies and these
departments can be of service to one another. The New York
Charity Organization Society, for example, reports service from the
city's public Health Department in the following ways:
Department nurses give prenatal care to prospective mothers, and frequently

persuade unco-operative mothers to take their babies to the Infants' Milk Station
for examination and advice about proper feeding. Special examinations for workers
in restaurants and laundries are given. In homes where there are contagious
diseases, nurses visit and report needs. In the summer, when many persons, both
children and adults, are sent for fresh air outings, the Health Department is de-
pended upon by the Charity Organization Society for many of the required physical
examinations. Photographic copies of records in the Bureau of Vital Statistics are
frequently obtained. The Department effects forcible removal of tuberculous
patients in infectious condition and forces unco-operative patients, who have been
told to return sputum for examination, to do so. It maintains a special clinic for
venereal disease, making blood tests whenever possible. The Board of Health main-
tains a special class for children having rickets, a whooping cough clinic where serum
isadministered, and dental clinics for school children. It reports conditions in
two-family houses which do not come under the supervision of the Tenement House
Department. It inspects lodging houses and attends to the segregation of tuber-
2IO
MEDICAL SOURCES
culous patients found in them. One of the greatest helps from the Health Depart-
ment comes from the daily receipt by each district office in the Charity Organiza-
tion Society of the contagious disease bulletin and also the receipt of the monthly
bulletin. The Health Department is also helpful in giving information about
midwives, as from this department midwives' certificates are issued. As the tuber-
culosis clinics connected with the Health Department use the Social Service
Exchange of the Charity Organization Society, it is always possible to know when

a clinic is interested in a family known to the society.
III. SOCIAL RESPONSIBILITY FOR EARLY MEDICAL DIAGNOSIS

Medical authorities are agreed that any way by which medical
diagnosis could be had earlier than at present would add materially
to the number of cures. It is at this point that the non-medical
social worker might easily hold a strategic position, by cultivating

a watchful eye for the possible indications in family and current
history, in personal appearance and in mental attitude, of those
physical and mental breakdowns that happen to have been pre-
ceded by social breakdown. The non-medical worker, if he is
wise, will never attempt to make a medical diagnosis, even of the
most tentative kind, but he will utilize promptly every opportunity
to bring together the possible patient and the expert medical
diagnostician. Early diagnosis is a very important element, for
instance, in the cure of syphilis, cancer, stomach ulcer, and lead-
poisoning, while the prevention of infant blindness is a matter of
hours not days. This is no plea for a general interest in health
campaigns, which is almost universal and often most in evidence

in those very family agencies that are neglectful of their oppor-
tunities to cure and prevent in the individual case. The im-
portant thing to emphasize here is the daily exercise of our interest
by leaving no stone unturned, by making the concrete application
in the detailedwork of whatever kind for which we stand respon-
sible to the community.
Comment on one of the case records of a large family agency reads as follows:
"Visitor has certainly shown patience and sympathy, and has tried to align all
available sources for relief. Is it not possible, however, that time and money might
have been saved ifa careful examination of the man had been made at once, in-
stead of trying for two months to help him get work which he was physically unable
to do?"
"
I remember with shame," writes a supervisor of case work, "a case that I had
myself years ago where a man who was thought to be very lazy really had intestinal
21 I
SOCIAL DIAGNOSIS
tuberculosis. In these days a good many case workers would be quick to sea the
possible significance of symptoms such as his and would arrange for a medical ex-
amination promptly, but there are hundreds of others all over the country who
would not. We cannot emphasize too strongly, it seems to me, the importance of
securing medical examinations in all doubtful cases, as one of the most important
principles of social treatment."
A charity organization society secured surgical care for a woman whose health
had been injured, according to the society's record, by running a foot machine in a
factory. As soon as she recovered she returned to the old job, where she could make
good wages, and her daughter was permitted to start at the same kind of work.
Any list of the particular things relating to health that are to be
kept most in mind by the non-medical worker will change yearly

with the rapid advances in medical knowledge and with the equally
rapid gains in the public control of disease. Since the preparation
of this book was begun, there has been a marked change in the
matter of workmen's compensation (to take an illustration that is
both industrial and medical), but the responsibilities and awkward-
nesses from which these new compensation laws have released the
social case worker will enable him to make his work for individuals
1
tell all the better in the allied
field of occupational disease. Social
case work continue to show, in its future development, this
will
frequent throwing off on the one side and annexing on the other.
To those who may be tempted to complain that too much is ex-
pected of the social case worker, this is the answer. His task con-
tracts in a cheering way only as he deliberately extends it in direc-
tions that are carefully chosen and then steadily advanced.
Owing to the rapid changes just referred to, not even the most
tentative list of health matters to be kept in mind by the social
diagnostician can be given here, but medical men are beginning to

write for social workers, and their statements should be studied
There are excellent manuals relating to
carefully at first hand.
and recently we have had a Layman's Handbook of
tuberculosis,
Medicine prepared "with special reference to social workers" by
Dr. Richard C. Cabot, 2 in which, among many other things of use
to us, he is at pains to name those diseases in which, owing to the
1
For illustration of the type of case work still needed in the compensation field,
however, see Chapter XII, Employers and Other Work Sources, p. 248.
Cabot, Richard C.: A Layman's Handbook of Medicine. With special refer-
ence to social workers. Boston, Houghton Mifflin and Co., 1916.
212
MEDICAL SOURCES
importance of past history in their diagnosis, the social worker

can be of especial service.
IV. METHOD
It remains to gather up, from notes made in the course of case
reading, such criticisms and suggestions with regard to the rela-

tions of case workers to Medical Sources as will possibly help to
strengthen social diagnosis on the health side.

1. Ask for Prognosis. It is not enough to learn the name of our
even more important are the medical predictions
client's disease;
as to duration and probable outcome the physician's prognosis.
We should also be at great pains to learn what social treatment will
hasten recovery and what will help him to avoid a recurrence of
the trouble. In this way the medical prognosis may become the
cornerstone of the social diagnosis.
2.Economize Resources. This lesson is needed at every stage
of treatment and in the use of every source of information, but it
is especially needed at this point by workers in the larger cities,
for in these Medical Sources multiply very rapidly, and are some-
times consulted wastefully and heedlessly by the social agencies.
The very willingness of doctors, hospitals, and dispensaries to
serve is a temptation to the social worker. They should be con-
sulted freely, of course, but should be chosen with care, and for
better reasons than the social worker's own convenience. A knowl-
edge of the special facilities and the limitations of medical agencies
in the worker's own city is essential; and once consulted, these
should be utilized to the full; should be given the benefit, that is,
of whatever is known already, and should be given a free hand to
make as complete a diagnosis as possible. The medical diagnosis
given with encouraging promptness is not always the fullest or the
best, and social workers should have a special respect for the physi-
cian who hesitates to pronounce judgment hastily.
Nowhere, perhaps, can the scientific axiom, "observations are
not to be numbered but weighed," be more fittingly applied than
to the following of medical dicta. The testimony of one physician
who knows is worth the testimony of fifty who do not know. We
should discourage the needless multiplication of Medical Sources,
therefore, by consulting, at whatever cost of time and trouble to
213
SOCIAL DIAGNOSIS
ourselves, the very best available, and then should abide loyally
by their findings.
In the small community, even the mediocre specialist may not
be available for mental and nervous examinations, and it may
devolve upon the social workers there little fitted as they may
feel themselves for the task to interest one of the younger doctors
to make special studies in this field. Many similar gaps remain to
be filled; there are communities in the South where no physician
has any special knowledge of the treatment of pellagra, and others,
both North and South, where, even now, no expert diagnosis of a
case of tuberculosis can be had.
But in the city of many physicians and medical agencies, how
shall we discover who are the best available? Often doctors have
been consulted before the social agency appears upon the scene, and
it is necessary to turn to medical judgments already formed and
to act upon these. Consequently it will sometimes be necessary
to make inquiry about the standing of the doctor in a given case
among his own fraternity. The etiquette of the social worker's
relations to a reputable but relatively incompetent private physi-
cian who is in charge of a difficult case requiring the best diagnostic
skillhas yet to be worked out, but the patient's interests demand a
not too easy withdrawal from a situation which calls for both tact
and persistence. It is disheartening to read in social records
even showing the deepest concern for the welfare of the
in those
client whose treatment is recorded entries of hasty and contra-
dictory opinions given by doctor after doctor, hospital after hospi-
tal, with blind faith in all on the part of the recorder, and with no
consciousness of failure, apparently.
Dr. Cabot comments upon a social record submitted to him as follows: "The
lack of medical co-operation, that is, lack (in the first place) of ability and (in the
second place) of frankness on the part of the doctors concerned in the Boyle-Carey
family, has been pointed out by various of our social workers at the Social Service
Department, and doubtless by many others. But the point that I want to make
about it is this: It may very well have been impossible to secure adequate medical
co-operation, and the workers on the case may therefore have done everything that
could have been done to avert the evils that came from the lack of such co-opera-
tion. But it is not at all evident that the workers were themselves aware that they
were being checkmated and put on false scents so frequently owing to the short-
comings of the doctors. When a person is quite unavoidably balked by such means,
214
MEDICAL SOURCES
it seems to me that the records should show some indication of his rueful awareness
thereof, just as, when a surgeon tellsa patient that he should be operated on and the
patient refuses, the surgeon is careful to make it clear in his record that the subse-
quent disasters are not his fault but are due to lack of proper co-operation."
3. Seek First-hand Information. This also applies elsewhere,

but when the statements are as technical as medical diagnoses and
prognoses are likely to be we must guard this point especially. In
the gathering of medical evidence we must avoid both oral and
second-hand reporting, whilst using every possible device that will
save the time of the physician and his busy hospital and dispensary
assistants. The written diagnosis is no substitute for a personal
interview with the doctor, in which his suggestions as to social
treatment and his fuller statement as to prognosis are procured;
it saves many misunderstandings, however, and should not be
omitted. The secretary of a state commission for the blind now

asks for a written statement of diagnosis, and, when this is refused,
indicates on the record that the diagnosis came by word of mouth
only.
It will not always be possible to follow this rule, but it is quite
possible to foreswear the gathering of medical information by hear-

say. To ask a patient what the doctor said about his condition
and write down the answer is to quadruple the chances of error,
for the doctor may not have told him the whole truth, fearing that
it would unduly alarm him; the patient may not have understood
what was said; he may not remember accurately; or he may have

reasons of his own for not telling all that he remembers. Some one
or more of these objections applies to all evidence at second hand,
and its use when the source is accessible is a sign of faulty technique.
A worker in a child-placing agency heard a rumor that Mrs. B, with whom twins
had been placed to board, was tuberculous. Accordingly, fearing for the health of
the agency's charges, she telephoned the charity organization society's district sec-
retary, who had known Mrs. B. The secretary stated that Mrs. B had been treated
and that one of her children
at a certain hospital three years before for tuberculosis
had had tubercular glands. Knew nothing more recent of physical conditions, but
felt there was absolutely no danger at this time. Agreed with child-placing agent
that it might not be a good place for a long residence. The twins were removed
from the home immediately, though, save for Mrs. B's health, it was a suitable one.
A case reader comments upon the record of this treatment as follows: "I find
faultwith this action, first because the hospital record was not consulted, and second,
for the unsound deduction that the home might be safe temporarily but not per-
215
SOCIAL DIAGNOSIS
manently. If the woman was in an infectious stage of the disease, there was danger
to the children during every minute of their stay with her; and if she was not, they
could stay with her indefinitely provided she was examined from time to time."
4. A
Medical Diagnosis Should Have a Date. The illustration
just given serves to emphasize the further point that physical and
mental conditions change, and that a diagnosis of six months ago
must be brought up to date before we can safely make it the basis
of social action.
5. Beware the Medical Opinions of the Non-medical. It is only
natural, perhaps, that non-medical social workers who see much of
sickness should not only become alert to its signs and symptoms
this much they should always be but that they should also begin
to pride themselves upon this alertness, and air their views of
matters strictly medical. "There is nothing," writes a hospital
social worker, in commenting upon a group of case records in which
this tendency appears, "that will more quickly antagonize a physi-
cian than for the social worker to make even a suggestion of a
medical diagnosis. The more medical training one has, the more
cautious one grows about this." We should be at great pains to
give the doctor any social facts that seem to be significant, but we
should spare him, in so doing, our medical guesses. Otherwise, we
are likely to find in him, at the very moment that we most need an
open mind, a closed one.
"
A medical-social worker says of her instructions to new assistants, I
always
caution them, in asking a physician to examine a patient, not to make a diagnosis.
'
For example, instead of taking a child to the doctor and saying, I think Johnnie
has adenoids,' say, 'Johnnie sleeps with his mouth open. Is there any obstruction
in his nose?'"
A nurse records that a certain woman is "extremely thin and delicate looking;"
a non-medical social worker describes the same woman as "thin and consumptive
looking." This last term should not be used until after a physical examination.
A district worker in a charity organization society sent a girl to a nerve clinic
"
with this memorandum: Mary has a delusion that she is pregnant." She was found
to be three and a half months pregnant and a shocking condition of neighborhood
immorality was unearthed by the discovery.
6. Doctor to Doctor Is More Frank. The Hippocratic oath 1 is

now interpreted more broadly than formerly, and doctors are often
1
It interest social workers to know the exact terms of the Oath of Hippoc-
may "
rates. Theyare as follows: I swear by Apollo the physician, and Aesculapius
and Health [Hygeia] and All-heal [Panacea], and all the gods and goddesses, that,
2l6
MEDICAL SOURCES
willing to give information, in confidence, to social workers whose

use of it clearly will be not only social but for the best interests of
the patient. As court procedure becomes more and more socialized,
physicians will probably be more willing than now to place their
information at the service of judges, especially in cases involving
the welfare of children or the protection of the community. As
social work is more done, they will treat social practi-
skilfully
tioners with a measure of confidence than at present.
still larger
Meanwhile, social workers must recognize that, in difficult cases,
doctors who do not know them well or understand their methods
ofwork and are therefore unwilling to give them information are
more likely to deal frankly with doctors who do understand and
who are enough interested to act as intermediaries.
The social service department of a dispensary sought the report of a diagnosis

made three years before by a large public hospital, explaining that it might throw
light on the problem of present treatment. They received promptly a diagnosis of
"pelvic disturbance." But the dispensary doctor who was treating the case, by
communicating directly with the hospital later, secured a diagnosis of "venereal
infection."
The secretary of an agency for the care of girls reports that she always prefers
to get a medical opinion, especially in perplexing cases, through a wellknown physi-
cian who is an active member of her directorate. One letter sent by the head of an
according to my ability and judgment, I will keep this oath and this stipulation
to reckon him who taught me this Art equally dear to me as my parents, to share
my substance with him, and relieve his necessities if required; to look upon his
offspring in the same footing as my own brothers, and to teach them this Art if
they shall wish to learn it, without fee or stipulation; and that by precept, lecture,
and every other mode of instruction, I will impart a knowledge of the Art to my
own sons, and those of my teachers, and to disciples bound by a stipulation and oath
according to the law of medicine, but to none others. I will follow that system of
regimen which, according to my ability and judgment, I consider for the benefit of
my patients, and abstain from whatever is deleterious and mischievous. I will give no
deadly medicine to anyone if asked, nor suggest any such counsel and in like manner
;
I will not give to a woman a pessary to produce abortion. With purity and with
holiness I will pass my life and practice my Art. I will not cut persons laboring
under the stone, but will leave this to be done by men who are practitioners of this
work. Into whatever houses I enter, I will go into them for the benefit of the sick,
and will abstain from every voluntary act of mischief and corruption, and further,
from the seduction of females or males, of freedmen and slaves. Whatever, in con-
nection with my professional practice or not in connection with it, I see or hear,
in the life of men, which ought not to be spoken of abroad, 1 will not divulge, as
reckoning that all such should be kept secret. While I continue to keep this Oath
unviolated, may it be granted to me to enjoy life and the practice of the Art, re-
spected by all men, in all times! But should I trespass and violate this Oath, may
the reverse be my lot!" Genuine Works of Hippocrates, trans, from the Greek by
Francis Adams, Vol. II, p. 278-80. New York, Wm. Wood and Co., 1886.
21?
SOCIAL DIAGNOSIS
institution for the feeble-minded in answer to the inquiry of this physician is as

follows: "It appears that is about two years behind in school work, perhaps
a little more, but her defect seems quantitative rather than qualitative, and I do
not believe that she is defective enough to warrant her commitment at this time.
I told the young lady who brought her that I thought the problem would have to
be worked out further before anything could be done. Her responses to the labora-
tory tests were not convincing, but she has the natural feminine subtlety and
reticence,and I do not believe that a single examination would begin to map out
the entirefield. Should her dishonest habits continue [the girl had been stealing
money] she might be committed to the reform school, and there they would have
the opportunity and are properly equipped to make a thorough study of the prob-
lem."
7. Careful Reporting Wears Away Prejudice. An unco-opera-

tive attitude on the part of physicians, where the social worker
needs their help in securing social action (whether in individual
cases or in other ways), can sometimes be accounted for by the
inability of the non-medical social worker to make his daily con-
tacts with Medical Sources as helpful as they should be. Written
summaries of the social side of any case reported for diagnosis or
treatment are aids to this, provided they are accurate, clear, and
without irrelevant detail.
Dr. Adolf Meyer, in commenting upon the same record that was submitted to
Dr. Cabot, 1 points out the shortcomings of certain medical reports in the case and
adds: "They probably also never had a written summary of the type of the one
sent Mrs. Scott [superintendent of the girls' reformatory]. . . . Now a consulting
alienistsuch as was to be appealed to would really have been unjustified in making a
far-reaching estimate without such documents or copies of documents."
A critic of this criticism submits that, while it is well to present a written social
summary, the doctor does not always read it. A better way, according to this second
critic, would be to make a report orally to the doctor, to interest him in the material
that the social worker has to give, and then hand him the written summary before
leaving. At the time, it might mean little to him, but two months later, when he
knew his patient better, some part of it might mean a great deal.
When a Medical Source has been helpful in a given case, it would

be well worth while to report briefly to that source later in just
what manner the help had furthered social treatment, thus
strengthening the relations of the two kinds of work at their point
of intersection.
8. Miscellaneous Suggestions. The following suggestions as to
the detailed use of Medical Sources need no illustration:
1
See p. 2 14.
218
MEDICAL SOURCES
To
establish the identity of a record or of a patient in a large
hospital thename or number of the ward, and, in large dispensaries,

the number of the patient's dispensary card, will be found useful.
The lodge doctor can frequently give some medical report and
other information about the men of the family. This is especially
true in foreign families, where it often happens that no other physi-
cian has been consulted.
Medical records sometimes contain non-medical information of
value. New York hospitals, for instance, record the names and
addresses of the two nearest
relatives or friends of the patient.
A tuberculosis sanatorium, by recording the name of the person
responsible for the payment of board, helped a non-medical agency
to discover several years later a co-operative relative. One hospital
record brought to light the approximate amount and the where-
abouts of money in bank.
The physician who has treated some family regularly for years is
able to throw light on other home matters than the health of its
members. At times of sickness and death relatives appear who
have not been heard of before, and the family doctor is in a good
position to estimate the depth of their interest, as well as the close-
ness of the bond within the immediate family group.

1. So marked is the emphasis now put upon data about health and disease in
nearly all forms of social case work, that any failures of Medical Sources as witnesses
stand out in bold relief. These failures fall under the three heads of (i) non-social
attitude; (2) conflicting diagnoses and prognoses; (3) faulty medical records.
2. Parallel failures should be noted in the witness of social work sources to the
medical profession. Conflicting diagnoses and prognoses are even more common in
socialwork than in medicine.

3. The two types of data social and medical are complementary. It follows
that social workers might hold a strategic position, were they better equipped to
recognize and report upon the early signs of impending physical or mental break-
down. Earlier reporting of these signs would add materially to the number of cures.
It is impossible to overstate the importance of cultivating a habit of awareness at
this point, of being alertly watchful for the more obscure signs of breakdown.
4. In all relations with doctors, hospitals, etc., we should

(i) Ask for prognosis as well as diagnosis, for the probable duration and outcome
of the disease, and for ways of helping to hasten recovery and avoid recurrence
219
SOCIAL DIAGNOSIS
(a) Economize medical resources, by selecting the best sources and using them
to the full
(3) Seek first-hand information, and not depend upon hearsay statements of
"what the doctor said"
(4) Note the date of a medical diagnosis before making it the basis of social
action
(5) Beware the medical opinions of the non-medical
(6) Seek the mediation of a physician in securing important medical information
not otherwise procurable
(7) Report with special care the social side of medical cases.
220
CHAPTER XI
SCHOOLS AS SOURCES
are sources of information that seem to have been im-
perfectly used as yet by social workers. It is true that
HERE many of the agencies studied consult school officials (they
were consulted 687 times in the 2,800 cases already referred to),
but an examination of the individual items seems to show that
both family agencies and those for the care of dependent children
do not confer with educators often enough. 1 The children's agencies
have many charges that are under school age, but, even after
allowing for this, consultations with School Sources are too infre-
quent, if the statistics at hand are at all representative of the
usual practice.
A formal school report giving a child's grade, and his marks
for scholarship, attendance, and deportment, leaves many of the
most important questions about him unanswered, as the following
comments, written by one who was making a survey of the case
work of a certain charity organization society, indicate:
A driver, supposed to be intemperate, a wife, and four children, thirteen to three.
Known to the society since December 24,
1908. An unsatisfactory record cul-
minating in a "sob" story in the newspapers. I notice that what to me is the most
important source of information more important than landlords and former resi-
dences was not consulted at all, namely, the school in which two or three of the
children must have been entered. The physical condition of the children, any evi-
dences of the moral background of their home which came out at the school, indi-
cations of their mental condition, whether they were laggards or not, whether they
came to school looking well cared for all of this would be extremely valuable in
further treatment. In other words, is there a leverage upon this family through
their love of the children revealed in proper care, or will more coercive remedies be
necessary? For the children's sake, this family cannot be dropped.
1
This impression has been strengthened recently by the findings of the Spring-
feld (III.) Survey. The failure of the Associated Charities of Springfield to consult
School Sources about the families in which it was interested had kept it ignorant
of one of the most serious evils permitted by the city administration; namely,
irregular school attendance. See Francis H. McLean on The Charities of Spring-
field, pp. 89-93.
221
SOCIAL DIAGNOSIS
An Italian couple with three children, eleven, eight, and six. The man has open
sores,but earns $4.00 a week; the wife is supposed at first to be tuberculous but
afterwards this is found to be incorrect. It is determined that there is no hope of
this family itself, and an attempt is made to have the S. P. C. C. take the children
away by court proceedings. They are now with their parents on parole to March 8.
Here again I notice that one of the most important sources, the public school, was
not consulted regarding the condition of the children, though what would have been
gathered there would have been of the utmost importance either in strengthening
the appeal to have the children taken away, or in indicating, as so often happens
unrevealed sources of income and of strength (through
in Italian cases, that there are
family connections) which could be utilized. This might have required specially
arranged observations on the part of the school teachers.
Societies for the protection of children from cruelty seem to

consult teachers habitually some of them to the exclusion of other
equally valuable sources, and nothing that is said in this chapter
as to the great value of school evidence must be interpreted as an
"
argument for the exclusion of other points of view. The neglect
case" is one that especially attracts the teacher's attention. The
child comes to school ill clad, unclean, suffering often from pedicu-
losis, and sometimes sick. The medical inspector's reports have
not been heeded at home, the parents have been sent for and inter-
viewed with no effect. Naturally, in such cases, teachers have
direct evidence to give to agents for protection from cruelty and
to probation officers. They are able to see direct benefit, more-
over, from their co-operation with both, for the very terms of pro-
bation require, in the case of school children who have been de-
linquents, a satisfactory report to the court by the probation officer
of school attendance, conduct, and scholarship.
These are the marked social failures, however failures in which
the family neglects the most elementary duties to the child, or
in which, through lacks within the home or outside, the child and
society are brought into apparent conflict and there is obvious

need of readjustment. At many earlier stages, before such neg-
lect develops, school evidence could come in with even greater
effect than it can later to prevent these sharp collisions. The
early symptoms of social breakdown are quite as important as the
early symptoms of bodily disease, and the teacher is in an admirable
position to observe these social symptoms in so admirable a posi-
tion, indeed, that many social activities may be centered in the
222
SCHOOLS AS SOURCES
schools temporarily, some of them to be very soon removed again.

For in the long run teachers themselves will see the importance of
concentration upon their own task: they will realize that they can
give better social evidence and make a better contribution to social
welfare when their time is freed from a variety of social work items
such as home visiting, vocational guidance, health matters,
etc. for teaching under conditions that make a very high grade of
individualized instruction possible. A public school system in a
large city lists seventeen points upon which its teachers are marked
for renewal of license, but unfortunately the ability to individu-
alize their pupils is not one of the seventeen. Our case reading
shows that many teachers are already eager to win the co-opera-
tion of thosewho know the home background intimately, because
the home background will help them to do this very thing, to
adapt their teaching to the needs and capabilities of each child.
THE SOCIAL EVIDENCE OF TEACHERS

I.
What are some of the things that teachers who individualize

their pupils can tell the social worker? What light that cannot
be had elsewhere are they able to throw on social situations? And
what can the social worker do with this information that will
bring direct benefits into the school room? These questions are
considered under the subheads of grade, scholarship, attendance,
behavior, physical condition, mental condition, home care, and
results of social treatment.
1.Grade. Taking the simplest thing first, grade is a matter of
record,and the mere fact is one about which the individual teacher
need not be troubled. 1 Some agencies seek records of grade and
the other school marks as a matter of routine. This is good as
1
Cumulative, individual record cards giving the school history of each child
have been introduced into most of the progressive city school systems. The form
used is one agreed upon by the United States Bureau of Education and the National
Education Association in 1911. These records pass from teacher to teacher and
from school to school as the pupil is promoted or transferred. They give for each
child information under the following headings: Last name, first name and initial,
place of birth, date of birth, vaccination, name of parent or guardian, occupation
of parent or guardian, residence, school, date of admission, date of discharge, age,
grade, room, regularity of attendance, health, conduct, scholarship. These records
may be found in the individual class room, in the principal's office, or in the super-
intendent's office; hence careful inquiry should be made before assuming that they
are not kept.
223
SOCIAL DIAGNOSIS
far as it goes, but the routine entry of a child's grade upon a social
record has little significance except in relation to other facts, such
as the age of the child when first entered at school, the family re-
movals from city to city, and from one city neighborhood to an-
other, school absencesdue to sickness and to other causes if any,
the child's knowledge of the English language, etc. The general
school standards of the community must also be known, such as
the usual age for each grade and the extent to which school over-
crowding, seat overcrowding, and part-time classes enter into and
modify the particular condition under review. If these facts are
allat hand, they can be co-ordinated and inferences of a certain
value can be drawn from them without a personal interview with
each teacher.
It must not be forgotten that a child gets much more out of
school if a grade with children of his own age. The waste
he is in
of social efficiency that comes through failure to win promotions
at the normal rate makes this question of school grade an important
one in itself; as a symptom it is even more important, related as
it is to all the items that here follow. It will be seen that most
of these need the personal interpretation of the teacher or principal.

2. Scholarship. A
general scholarship mark is not so significant
as are marks showing relative standing in different studies, and
these again are not so significant as the teacher's own observations
of the child's mental reactions. Often these observations come out
when the social worker asks questions based upon his own inexpert
inferences from school marks.
A charity organization society was helped by three school principals in its treat-
ment of a widow with three children, who was in receipt of a private allowance from
the society. First a grammar school principal induced the society to undertake the
training of the girl of eleven for the profession of teaching. She had unusual ability.
Then the older boy in the family was found to be a number two student at the high
school. He was taken to the principal of a mechanical high school for advice, and,
after a long interview between the boy and the principal, it was decided that the
boy would probably do better in commercial studies. He was taken also to the
principal of the commercial high school, who confirmed this judgment. After a
year's trial, it seems to have been a wise one, as the boy has done much better than
in the academic course.
In more progressive communities, scholarship, grade, and at-

tendance tests are combined with physical tests to replace age re-
224
SCHOOLS AS SOURCES
quirements in determining the time at which children shall be per-

mitted to have their working papers. But there are other and better
reasons for keeping informed about these school matters. Social
workers can be too eager to get children ready for the minimum work
requirement; they cannot be too eager to get them ready for life.
3. Attendance. Non-enrollment is not the chief evil, even in
communities that have no compulsory attendance laws; irregular
attendance is a still greater evil, and one which most cities are
dealing with through special departments and special officers. In

the 2,800 cases reviewed, attendance officers had been consulted
77 times as compared with 485 consultations with teachers and
school principals. Educators feel that the attendance officer's
task is need of reorganization. As now interpreted his is un-
in
doubtedly a narrow specialty, and his social evidence is crippled

by this fact.
1
He can testify to the condition of the home as he saw
it at the time of his visits, and, if the visits are well timed, this
yields something, but not very much. No such revealing observa-

tions by attendance officers have been discovered in the course of
our case reading as the following from a school principal:
Visit made to school in the interest of an Italian widow's family; five children,
three in one school as follows: Maria fifteen, John eleven, Angelo eight. Maria's
"
report for September, Deportment excellent, scholarship fair, attendance two half
days excused." is in high seventh grade and will pass into eighth
Principal says she
in February. He
looked up her grades for last year and said she must have done
very well, as the teacher she had was a very strict marker. Regards her as a wonder-
very straightforward and competent.
ful girl,
now at the truant school, was a chronic truant, a cigarette fiend, and
John,
generally incorrigible. The former principal, whom this one succeeded nine months
ago, used to let the boy stay away from school without hindrance, as he was so
great a problem when there. The present principal found that John was roaming
the streets and made every effort to keep him in school; would send for Maria and
she and her mother would scour the streets until they found the boy. Was a boy
of nomadic tendencies that must be reckoned with, so gave him permission to leave
the school whenever he came to the office and asked for it. Later gave him the
task of watching and entertaining the kindergarten children between 11.15 when
they were dismissed and 12 o'clock when older brothers and sisters called for them.
He was remarkably successful in this, but it did not solve the cigarette smoking or
the truancy entirely.
1
From one city, however, comes the testimony of a competent social case worker
that the only effective case work that she could find there was being done by the
attendance officers.
15 225
SOCIAL DIAGNOSIS
The principal found that an eighth grade boy in another school was leading John
and a companion in all their misdoings. They used to go to the home of one of the
boys and "cut high capers." . .
Boy was kind and lovable at times but had
.
a bad temper and was vindictive when crossed. A physical examination had
brought out the fact that he had rheumatism and heart trouble and the teachers
were afraid to discipline him. This, with a number of other factors, contributed
to the thorough spoiling of the boy. At one time a charitable lady had taken a
great interest in him gave him money to buy candy as an antidote for the cigarettes,
perhaps, but dropped him later more spoiled than ever. Finally principal had sent
him up for truancy in order that he might have to do without cigarettes for a while.
He was in the third grade at the time. [Report on one other boy in the family
follows.]
In families that are in receipt of regular allowances from an

agency, public or private, it is possible for the agency to regulate
school attendance by arranging with the children's teachers to
furnish a written school report each week, and then making relief
conditional upon a good attendance record.

4. Behavior.This should be taken to cover a good many
personal characteristics not usually covered by the more formal
word "deportment" or "conduct." If a girl seems to have the
idea that the world is against her and shows it by repelling friendly
advances from her classmates, that is a more important fact than
"
that her deportment is poor." We must learn to seek for the
description of the child's acts, motives, desires, tendencies, in-
stead of for the reactions of the teacher to her more or less un-
pleasant experiences. Sometimes it is necessary, as tactfully as
possible, to push beyond the initial school statement.
A probation officer reports a boy of eleven who the teacher thought was feeble-
minded but the doctors said was not. His teacher was urged to try a class in raffia
work and so give the boy a chance with his hands. General statements as to this
work and as to his mental work were analyzed, by close questioning, into the fol-
lowing: In the first hour he did fairly well; second hour, work less satisfactory;
third hour, nothing. By probing still further, it was found that the boy came with-
out any breakfast. This was not due to poverty but to carelessness and to the boy's
lack of appetite. Both parents were seen about it, and, by special permission, the
boy was sent home at recess for extra feeding.
Her stepmother had decided to put a girl of thirteen away, but the parish priest
urged the judge not to commit the girl and appealed to the child's school principal
to justify his judgment by doing her best to make a good girl of one who screamed
wildly on the streets until the neighbors complained, stayed out to play with rough
boys after ten at night, refused to do any work at home, etc. The girl was referred
every day for two weeks to the principal's office for bad behavior in the class room,
226
SCHOOLS AS SOURCES
and was then referred to a home and school visitor, who had quiet talks with her in
which the before-mentioned acts were discussed in detail. The visitor decided that
she needed the advice of a neurologist. Consultation with one brought a diag-
nosis of the early stages of St. Vitus's dance. Treatment, a course of dieting, salt
baths, long hours of rest, temporary withdrawal from school, country outing for
two months, two more months with an aunt in the suburbs. Result, return to
school in good mental and physical condition.
Physical Condition.
5. A teacher who has had a few such ex-
"
periences as the foregoing is tempted to suspect the early stages
of St. Vitus's dance" in all her more troublesome pupils. Social
workers make
equally hasty generalizations. Among the earliest
of the physical disabilities to win a commanding position as an
explanation of trouble in the school room were positional defects;

but adenoids, eye strain, and now (among the mental difficulties)
feeble-mindedness either have been or are very popular. Needless
to say, the discovery of all these conditions is of the gravest im-
portance in the right place in the place, that is, where they really
exist. The teacher must not play physician, but, like the social
worker, he can help to get his pupils to the right specialist at the
earliest possiblemoment, suspending judgment meanwhile, and
keeping watch for the evidence that disproves his explanation.
Medical inspection in the schools is neither thorough enough nor
frequent enough at present to relieve the teachers entirely of this
duty. Certain individual variations in children that are due to
physical or nervous disturbance are evident, moreover, only to
one who has them under observation continuously.
From a hospital social service department comes this memorandum: Diagnosis
of a girl was epilepsy, and our department was asked to follow this up by inquiries
at the home and the school. Teacher said, "Child has far fewer attacks when she
is not noticed." This gave a clue. A period of observation in a hospital was ar-
ranged for, and the suggestion that the child had hysteria was confirmed.
Mental Condition. The illustration just given might very

6.
"
well have been placed under this heading instead of under physi-
cal condition," but it has been allowed to stand where it is because
observations of physical habits and temperamental dispositions,
of aptitudes for one or another study, of variations in response to
stimuli at different times of day, days of the month, seasons of the
year all these things have a direct relation to both physical and
mental states.
227
SOCIAL DIAGNOSIS
A case worker, in commenting upon the record of a difficult girl who was later
committed to an institution for the feeble-minded, calls attention to the fact that
the girl received low marks in arithmetic, grammar, domestic work, and sewing,
all requiring reasoning and action based upon reasoning, while in memory studies
geography, history, spelling in deportment, which may be largely imitation, and

in the mere mechanical keeping of things in place in her room, she had much higher
marks. Until the psychologists can speak with more assurance, however, it would
seem unwise to put great confidence in comparative marks in different subjects.
The teacher's own observations concerning the child's abilities are more trust-
worthy.
Commenting on another history of a girl also committed later, another case
worker writes, "The visits to the teachers brought nothing but generalities. Not an
illustration is given, merely obscure terms, such as 'on the whole consider her bad,'
'of average ability,' etc."
Writing about the questionnaire on a Child Possibly Feeble-

"
minded in Part III, a distinguished psychiatrist says, In reality,
the questionnaire of a Feeble-minded Child is a list of all the ques-
tions that may be asked about any child" ; and if the questionnaire
about which this comment was made had been intended as a blank
to be filled out, instead of as a series of suggestions to be examined
carefully by the social worker, the criticism would have been a
damaging one.
At the time that the study of case records for this book was pro-
ceeding, agitation for the segregation and humane care of the
feeble-minded child was just beginning to make new headway
under the impetus given to it by recent eugenic studies, so that a
good many illustrations are at hand of school initiative in trying
to secure transfers to institutions for the feeble-minded. The
records studied show that some of these children were feeble-
minded and that some were not.
A probation officer was asked by a teacher to interest herself in a boy who was
"certainly feeble-minded, for nothing could be done with him in the school room."
Under probationary treatment, however, and with the heartiest co-operation of
the teacher, the boy began to bring better and better reports. For instance, on
a certain day the boy appeared at the probation office with a report of which he
was particularly proud, to find only a substitute in charge. His disappointment was
so obvious that his teacher was at great pains to communicate with the probation
officerpromptly, and to make the boy feel that both teacher and officer regarded
that report as a matter of real moment.
In a case submitted for study by a child-saving agency the agency, after a period
of observation in a hospital, had placed a girl of seven at board in one of the smaller
228
SCHOOLS AS SOURCES
towns of the state. The diagnosis was "a mild form of chorea. With proper
management in a home outside will improve rapidly." Four months later, the
child was reported as taking great interest in exciting the other children in school.
Next month, the superintendent of schools, with the endorsement of the school
physician, writes to the agency that child is mentally defective. Again, three
months later, he writes more urgently, and a physician of the state institution for
the feeble-minded is consulted. The girl is taken there under observation. First
"
report, Brighter in many ways than most of the children at the school. She seems
to have no moral sense." Report after seven weeks, "I am convinced that the
little girl is deficient mentally."
The choice between leaving a child who can be described as

having "no moral sense" in contact with normal school children
for months, and branding her as feeble-minded when there is
reasonable doubt, is not an easy one to make. In cases such as the
one just cited, of a child bright in some ways but abnormal, the
highest available authority should be consulted promptly. The
school superintendent urged that the little girl had "the attitude
and the motions of many of the school for feeble-minded children,"
but was not more specific in his statements. He was correct in his
inference, however, and school evidence will have to play an im-
portant part in the discovery and segregation of defectives.
7. Home Care. It has already been suggested that teachers
are excellent witnesses as to the signs of home neglect. 1 They

are equally able to give testimony as to good home nurture. This
is partly due to the fact that they have a basis of comparison in
the procession of classes coming under their care. It is also true
that, as regards home matters, teachers belong in the group of

"supplementary clues" mentioned on page 174; they are not in-
cluded usually in the list of neighbors and personal references put
forward in the first interview by a new client as prepared to vouch
for him. Seeing things from a less acute angle, teachers are able
to throw a clearer if less intense light upon the family characteristics
than comes from more personal sources.
In nearly all of 100 widows-with-children records examined by the writer, the
school had been visited, though only once, by investigators who were studying
the administration of a public pension to mothers. Twenty of these records have
been taken at random and examined with reference to this question of the new light,
if any, that can be thrown on home problems by a single visit to the school. There
were 53 children of school age in the 20 families. The department administering
1
For a questionnaire regarding a Neglected Child, see Part III, p. 405.
229
SOCIAL DIAGNOSIS
the pensions had consulted the school previous to the special inquiry in one of the
20 cases; and in 9 of the 20 no new light on the home as a whole was had by the
In the remaining 1 1 the following results were
special investigator's school visit.
obtained: In one the teacher agreed to see that there was no longer an excuse for
the absence of an older sister by taking the youngest child into the school. In
five the need of these enumerated readjustments was made evident: (i) change of
mother's work, (2) mother must show more interest in children's condition, (3)
children's breakfast must be prepared, (4) older children must be sent to school
much more regularly, (5) special care needed in diet of children. In five families
the home care was discovered to be especially good, and in one of these five the
mother had been to the school on her own initiative to discover how the children
were progressing. It will be seen that all of these items have a direct bearing upon
any plans for family relief or other care. They are fairly representative of the con-
tribution that the school can make in case work. Three-fourths of the schools
visited were public and the rest parochial.
A boy whose conduct in class was excellent but whose attendance was irregular
made his teacher suspicious that home conditions were not all right by often falling
asleep in school. A home was asked to look into the matter, and
and school visitor
discovered that the boy's stepfather was sending him out early to sell papers, and
punishing him severely when he failed to return with a certain amount daily.
Many interviews were held with the stepfather himself, who found the visitor willing
to listen to his own and to help him to more regular work, but quite de-
difficulties
termined to protect the boy. The newspaper selling was stopped, the boy sent to
the country for a month, and his scholarship after his return markedly improved.
The investigation as to the home's share in the boy's condition did not center around
this one fact of neglect it could not if he was to remain with his own people and,
by pushing beyond into the industrial and other factors, the home itself was very
much improved.
8. Results of Social Treatment. The elements with which social

work has to deal are so many and so intermingled that any tests
of the results of the work itself are applied with difficulty. It is
possible for our clients to one or another condition urged

fulfill
upon them from without, or to appear to fulfill it, without any

essential change of goal. Here once again, in this matter of
measuring results and testing the efficiency of case work, the co-
operation of the teacher who knows his children well would be
invaluable, especially to the family agencies. On such a date, at
the beginning of social treatment, the children of the family exhib-
ited, from the school point of view, such and such characteristics.
After so many months of family treatment, the children, under
conditions of observation that are practically identical, show what
changes, if any? Not all of these changes, favorable or unfavor-
230.
SCHOOLS AS SOURCES
able, could be credited to or charged against the family agency,

but the connection between its work and this group of results
could be studied carefully and a reasonably accurate balance
could be struck.
In so far as general inquiries and requests for special observa-
tions put any new burden whatsoever upon the teachers, we must
be at great pains to see that the thorough putting through of our
own task really helps theirs. In some cities there have been board
of education rules requiring that all access to teachers must be by
letter. In one, for a little while, the rule was promulgated, even,
that no public school teacher should give any information to a
social agency. The results were so disastrous in their effects upon
school work that the rule was soon set aside. No teacher should
be called from his class-room work to answer a question that some-
one else can answer just as well; when the record contains what is
wanted, the record should be made to serve. No routine ques-
tions asked for the sake of filling out a face card and leading no-
where should be allowed to interrupt his busy day. But the co-
operative result in which the social agency helps the school quite
as much as the school the agency is the thing to aim for. Any-
thing that influences the character of a child must concern its
teachers. They are concerned with, though not directly responsi-
ble for, improvement in home conditions; they are interested in
the segregation of the mentally defective; in the cure and preven-
tion of physical and mental disease; in the reduction of irregular
school attendance, improper and under-feeding, and dead-end
occupations; in the abolition of premature employment; and in
the prevention of that waste of unusual ability which comes from
lack of longer training. It would be foolish to make teachers re-
sponsible for these reforms, but they are vitally interested in them.
From the illustrations already given it is evident that social workers
are interested too are deeply interested in all of them, and have
already borne no small part in the improvements achieved in these
very directions. To utilize to the full this common interest is a
fundamental part of the technique of consultation with School
Sources.
School Sources of information are among the very best, but every
source has the defects of its qualities. Teachers see home condi-
231
SOCIAL DIAGNOSIS
tions from one point of view only, and, unless they have had oc-
casion to think of human relations in disadvantaged families from
other angles also, they are liable to fall into the error of thinking
that any home adjustment which meets school needs, even tempo-
rarily, must be the right one.
A large institution for orphans or half-orphans finds that the testimony of teachers,
though absolutely necessary, is often biased by the idea that certain statements will
get the child into the institution and that certain others will keep him out. If
the teacher "sorry for his mother," or eager to get a troublesome pupil out of her
is
classes (to give two reasons often encountered), her personal bias even leads some-
times to suppressions or misstatements of fact. A number of records submitted
for study illustrate this. The misstatements are more often made on the applica-
tion blank, however. When seen face to face, with an opportunity to have explained
to her the real uses of the institutionand the possible alternative plans, in case the
application is rejected, she is usually quite frank, both in her description of the
pupil's characteristics and in her explanations of her former statements.
II. METHOD
A probation officer finds that she secures definite vantage ground
for a first interview with the parents of a boy or school age girl of
who has been arrested, by going first to the school. She gets what
she can about age, disposition, physical, mental, and moral calibre,
from the child's own teacher, and also such information as the
teacher has, though this is often very incomplete, about relatives
and home conditions.
Needless to say, such inquiries any inquiries in fact must not
be made in the hearing of the other children, or in such a way as to
attract their attention. Sometimes school officials do not seem
to realize the dangers of public questioning and public discussion
of home and personal affairs a principal will send for a child and
question him, if not before his own class, then before another.
This must be discouraged, of course.
It is difficult to make any suggestions about the choice between
seeing principals and seeing individual teachers that could be ap-

plied to all school systems. In some cities, social workers always
go to the principal first, who calls the teacher if necessary. The

principal may know other children in the family, and the teacher
only the one child; the principal has the record, but the individual
teacher, on the other hand, has had better opportunity of observing
232
SCHOOLS AS SOURCES
evidences of home training, and of noting the health and personal

characteristics of his pupil.
Whenever information of value has been procured from a teacher
that has later been put to use with definite results, or whenever
new developments or new plans might possibly be of interest to
him, the opportunity should not be lost of showing how his work
is related to that of the social worker. A
letter written, a message
sent, or a visit paid may increase co-operation later. Many failures

in co-operation are directly due to the failure to knit more closely
the temporary contacts and natural introductions that come
through case work.
It sometimes happens that a social agency is able to justify
and explain a teacher's position, where it has been misunderstood,
as in the following instance:
A boy of twelve who became insane seemed to have been particularly excited
over his school teacher's cruelty. The family and the family doctor (a neighbor-
hood practitioner) were inclined to feel bitterly toward the school. The medical-
social service department interested in the case made an investigation and became
convinced that the boy's school treatment had been good. The department's
"
record adds, Letter written to family doctor explaining to him that investigation
made by social service does not reveal any abuse in the school. Social service is
anxious for him to understand this, as he might be influential in the neighborhood
in correcting any misapprehension."
Whatever has been said here about the utilization of the edu-
cator's experience and point of view applies equally, of course, to
home and school visitors, to teachers in settlements, to boys' and
girls' club workers, directors of playgrounds and recreation centers,
librarians of children's rooms in public or special libraries, and to
Sunday school teachers. Fellow pupils must be consulted in a

few child-protective tasks, and the characteristics of companions
and of the gang leader (where there is one) must be taken into ac-
count in many of them.
Last of should be noted that a certain lack of sympathy
all, it
and understanding as between home and school has been due, in

part, to the very scale upon which our educational processes have
been carried on. Definite steps, also on a large scale, are being
taken to overcome this, but every social worker who enters a home
often and also knows the school to which its children are sent
should be striving to make the home more helpful to the school.
233
SOCIAL DIAGNOSIS

1. The teacher who is the best educator, who is able to individualize his pupils
and adapt his teaching to their needs and capabilities, is the best social witness.
2. The failings of teachers as social witnesses are traceable to those school con-
ditions which make any individualization of their pupils impossible, and to their
tendency to think that whatever social adjustment meets school needs, even
temporarily, must be the right one.
3. The social evidence of teachers may be classified under evidence about (i)
grade, (2) scholarship, (3) attendance, (4) behavior, (5) physical condition, (6)
mental condition, (7) home care, (8) results of social treatment.
4. Grade means little except in relation to other facts, such as age of child when
firstentered at school, the family removals from city to city, school absences due to
sickness, child's knowledge of the English language, etc.
5. A general scholarship mark is not so significant as are marks showing relative
standing in different studies, and these again are not so significant as the teacher's
own observations of the child's mental reactions.
6. Behavior covers something more than can be shown by a conduct mark. We
must learn to seek for the description of the child's "acts, motives, desires, ten-
dencies."
7. Certain individual variations in children that are due to physical or nervous

disturbance are evident only to one who has them under observation continuously.
Teachers are in a better position to give this evidence than anyone else, unless some
members of the child's family happen to be good observers.
8. School evidence must play an important part in the discovery and segrega-
tion of defectives.
9. Teachers who have never seen the homes of their pupils are able nevertheless
to give excellent witness as to the signs of good home nurture and those of home
neglect.
10. As a measure of the results of social treatment in the home, a teacher's
testimony taken at the beginning of treatment and at intervals later would have
definite value.
11. As with medical sources, careful social reporting to School Sources by case
work agencies and brief supplementary reporting on new developments later,

strengthens co-operative relations.
234
CHAPTER XII
EMPLOYERS AND OTHER WORK SOURCES

period of the world's history is a period of transition,
of course, yet the institutions with which the social worker
EVERY has to deal seem to be changing at a far more rapid rate in
our own day than in any other. Developments that have been
continuous but hidden are now at last bearing visible fruit. In
the hospital, the school, and the workshop reorganizations are
in process that should soon make the doctor, the teacher, and the
Employer more effective agents of social advance and better

witnesses in the gathering of social evidence than they have ever
been. The Employer differs from the teacher and the doctor,
however, in that he is farther removed in daily habit from social-
ized action, and is often controlled
by quite another set of motives.
Even when, as sometimes happens, his motives are completely
social, this fact not easily recognized, because he is hampered by
is
imperfect forms of industrial organization. By the earlier kinds

"
of social work, Employers were used habitually as a favorite refer-
ence" to vouch for clients in a general way as worthy or unworthy,
industrious or lazy, sober or drunken. Like most things that we
have always done, our regular practice of consulting with these
industrial sources has become perfunctory. The case illustra-
tions at hand show even less constructive planning on the industrial
side than on the health and educational sides. There are probably
other reasons for this than that the social agencies have been doing
an old thing in an old way. Changes from small industrial plants
to large ones, with the corresponding multiplication of middle-
men, and the almost complete failure to individualize the laborer
in most of our wholesale processes, have made it increasingly diffi-
cult to get the information that may be had about his work, and
the information that may be had is less revealing.
There are signs from many quarters that the handling of labor
as though it were scrap iron is soon to end, and that the workshop
235
SOCIAL DIAGNOSIS
of the future will be supervised by trained observers, who will be

far more keenly alive to mental and temperamental differences
than the small Employer ever was. Our immediate business, how-
ever, is not to indulge in prophecy, but to consider, first, the scope
and use of a work record; second, certain failures of Employer
testimony regarded as social evidence; third, differences in the
social worker's relations to former, to present, and to prospective
employers; fourth, methods of approach in different types of cases;

and last, miscellaneous work sources those other than Employers.
I. USES AND SCOPE OF A WORK RECORD

1. Uses. The least constructive use of any source of informa-
tion merely to verify another source. An extreme instance
is
would be that of the visitor who returned to a family agency with

an air of satisfaction and the sole statement, "Well, I find the man
did work for the firm that he said he worked for." Verification is
necessary, but usually it should be merely the by-product of more

fruitful inquiries.
The
ancient Teutonic trials (which were not trials in the modern
legal use of the word) were often by ordeal. If the accused per-
formed the ordeal, he won; if he failed, he lost. 1 Comparable to

this rude justice is the work test of modern charity, which soon
ceases to be a test, even, and becomes a doling out of woodyard or
other work
tickets as a substitute for discovering the right thing
to do. There is, however, a place for the test which is carefully
planned to reveal capacity when it is not discoverable by other
means for investigation by experiment, as it may be called. An
interested Employer, who understands the end in view, may be
helpful here in creating conditions that make the test a fair one.
Beyond the formal verification of a statement or the testing of
a man's willingness to do any work whatever, the reasons for study-
ing a client's work record are many and various.
In the first unemployed, that fact alone does not classify
place, if
him. He may be a man who

has held a permanent situation for a
long time and lost it through some change in the nature or organiza-
tion of the industry; he may be accustomed to discontinuous work
lasting longer or shorter periods but with necessary breaks between

1
Encyclopaedia Britannica, Eleventh Edition. Article on Evidence.
236
the jobs; he may be a casual laborer who is chronically under-

employed, who works only a few days in each week; or he may
be unemployable. 1
In the second place, industrial conditions, though we speak of
them in the mass as good or bad, are, within limits, as various as
the conditions of the composite group of the unemployed, and are
quite as much in need of analysis if we are to replace or to advance
an unemployed workman. Studies made within the last decade show
how little work conditions have been standardized 2 and how various
are wages and industrial environment in the same processes of the
"
same industry. The bearing of this on individual case treatment,"
writes Miss Mary Van Kleeck, in a paper addressed to charity
3
organization workers, "is obvious. Because the average wage of
women in factories in our community is $6.00 a week is no reason
for being content with supplementing from charitable sources a
working woman's earnings of $6.00 in a cigar factory, when a

1
For a discussion of these classes of the unemployed from the English point of
view, see second volume of Minority Report of the English Poor Law Commission:
The Public Organization of the Labor Market, Chapter IV, pp. 163-230.
2
Thus, from the 1912 report of the Massachusetts Commission on Minimum
Wage Boards it appears that in the candy industry one factory paid no woman or
girl less than $5.00, while 69.6 per cent of its women and girl employes received
$8.00 or more; in two other factories, on the other hand, 30 per cent and 47 per
cent respectively of the women employes received less than $4.00 while only 7 per
cent and 3 per cent were paid as much as $8.00. Not all of these factories were
situated in the same community, but the contrast was nearly as great in the case of
six department stores in Boston where the percentage of female employes receiving
under $4.00 varied from i to 24 per cent, while from 13 to 58 per cent received $8.00
or more; and in the case of 13 laundries in Boston and Cambridge, in which from
o to 29 per cent of women and girls received under $4.00 and from o to 45 per cent,
$8.00 or over. (See pages 62, 118-119, and 160.) A similar state of affairs in the
millinery trade was revealed by the New York State Factory Investigating Com-
mission (Fourth Report, 1915, Vol. II, pp. 437-439); and the United States Bureau
of Labor's Report on Conditions of Employment in the Iron and Steel Industry in
the United States (1913) gives the results of a study of wages paid in the Pittsburgh
district which reveals notable contrasts as between the different concerns. (Vol.
Ill, pp. 261-267.)
Furthermore, factories in the same industry differ greatly in the extent to which
the size of their working force varies from month to month. Thus in 12 Massa-
chusetts candy factories the minimum force employed in any month varied from
22.7 per cent to 76 per cent of the maximum force. (Minimum Wage Report, p.
67.) A
similar variation in 18 large retail stores in New York is revealed by the
New York Factory Investigating Commission's Fourth Report (p. 607), where it
appears that the minimum force employed forms anywhere from 47 to 85 per cent of
the maximum force. Similar conditions prevail in the men's clothing trade, as may
be seen by consulting the United States Bureau of Labor's Report on Condition of
Woman and Child Wage-earners in the United States, 1911, Vol. II, pp. 174-179.
3
One of the short, unpublished papers referred to in the Preface.
237
SOCIAL DIAGNOSIS
frank talk with her employer or her transfer to another factory

would increase her wages." Fatalism is too common on the in-
dustrial side of social case work.
"This is a case," says a critic of a certain family record, "where the husband is
working as driver for a trucking company and is only paid when there is work on
hand, but has to report every day. No attempt is made to straighten out this
matter by making a further investigation into the man's industrial record, to learn
whether the case committee should not advise him to look for other work and pos-
sibly assist in this direction. His is just the sort of irregular work in which his
tendency to drink may get the better of him, and he appears to be of good stuff,
wellworth rehabilitating now instead of waiting until things get worse."
"
The same critic says of another case, This man has been allowed to get down to a
$12 a week income, and is in an occupation which does not hold promise of advance-
ment. I believe there should be a consultation with the former employers to learn
how skilled he is, and whether at a later date he should be encouraged to make
efforts to get back into his former occupation."

"
And of another case he writes, Here is a man who has been in this country
still
for twelve years, and is said to be earning only $3.00 or $4.00 a week. That is
something which requires righting. Somewhere and somehow the real life of the
family and condition of the man can be revealed."
In the third place, advancement as well as reinstatement must

be the aim, and for this the facts are needed. The prospective
employer is more easily interested by one who has the facts of
work history. Even where the
Employer is indifferent to them,
there is lossof influence with him
and nothing but loss to the work-
man when we recommend the latter for a kind of work that he is
incapable of keeping.
In the fourth place, the former employer is not merely a means
of completing our work-history record, he is not just a source but
is often a resource, and, in most interviews with him, the possi-
bility of reinstatement must be kept With the present

in view.
employer, where sickness of the workman

not the trouble, but
is
where he is failing to spend his wages on his family, the chance of

persuading his Employer to "trustee" the wages or to bring in-
fluence to bear in some other way is worth considering. Thus
the two purposes of social diagnosis first to arrive at as exact
a definition as possible of the difficulty, and second to assure that
this definition is so procured that it can be followed by effective
and co-operative action help one another and are to be developed
simultaneously.
238
2. Scope. Having regard to the gathering

of data only, the
following is a than
fuller outline
will be necessary in the study of
any one work record. Like all the outlines in this book it is in-
tended to be suggestive and is not a schedule to be filled out. Nor
is all the information indicated to be procured from any one source
a comparison of the statements of client and of Employer will

lead to correction of the inaccuracies of each.
Names and addresses of former employers.

Nature of occupation or occupations with each former employer (first the in-
dustry, then the exact process engaged in, for it is necessary to have both).
Between what dates employed.
If large concerns, worker's number, department, and foreman.
Wages earned at each place.

Worker's record at each for speed, accuracy, regularity, sobriety; relations with
fellow workmen; peculiarities of habit and temper revealed.
For present occupation, the foregoing, and
Week's work or piece work.
Full, seasonal, occasional, or part-time work (if seasonal, how many weeks lost
in a year).
Hours of work daily and weekly, and amount of overtime.
Nature of the material worked in and healthfulness of the process.
Sanitation and safety of surroundings.
Opportunities for advancement.
Full analysis of wages (how much when working full time, amount of fines,
of overtime pay, of gratuities, commissions, or bonuses; earnings at present
allowing for part timeif any, etc.).
Is there a mutual benefit society or an insurance system in connection with the

establishment?
If the employe is sick, what assistance has been given by Employers? by fel-
low workers?
If out of work, how long and cause of leaving last employment.
Time out of work during last twelve months.
Age at which first went to work, nature of work, nature of preparation.
For the relation of the facts suggested in this outline to the other
social facts ofa family history, sec questionnaire on Any Family
in Part 1 1 1 and the questionnaires that follow it on a Deserted
Family, Inebriety, and a Homeless Man. Where any of these

three conditions complicate the task, there are important varia-
tions in theground to be covered.
Under a Deserted Family, oi' example, these questions among others: What
opportunities for development did man's earliest occupations give him? Has his wife
worked since marriage and if so the effect on her health, on his wage-earning, on
239
SOCIAL DIAGNOSIS
the home, on the children? Have his children's earnings had any effect in les-
sening the father's sense of responsibility?

Under Has the patient met with business reverses?
Inebriety the following:
Does the nature of employment expose him to temptation? Does he work long
his
hours in extremes of temperature? Does he work under trying conditions of dust
or ill ventilation? Has his wife been forced to become a wage-earner?
Under a Homeless Man Was he ever a newsboy or messenger? First occupation,
:
itsnature and wages. Did he ever learn a trade? Longest time at any one job.
What does he consider his true occupation? How long ago was his last work? If his
work has usually been seasonal, how has he been accustomed to live between jobs?
II. CERTAIN FAILURES OF EMPLOYER TESTIMONY

The comparison of sources on page 166, Table 2, shows that
(omitting other social agencies as a source, since these bear a
different relation to diagnosis) Employers stand, in frequency of
use, as follows:
First City Second City Third City
Former employers 5th 7th 6th
Present employers loth loth gth
This shows greater uniformity of practice than in the use of any
other one source, with the possible exceptions of dispensaries and
relatives. Present are not consulted so frequently as former em-
ployers. Is this due solely to the fact that, in cases of unemploy-
ment, there are no present employers, and that former employers

are, case by case, more numerous? In the 2,800 cases examined,
former employers were communicated with 470 times as against
232 consultations with present employers. Interviews with case
workers and a study of their records reveal another reason for the
difference. Former employers can be seen with far less danger of
injuring a client's industrial relations and status. They are ac-

customed to be used as work references, and no prejudice is created
by the inquiry if it is made with any discretion. The information
that they are able to supply often makes communication with a
present employer unnecessary, though this is not invariably the
case, as will appear later.
What can be value of
said, in general, of the social evidence
Employer testimony? Employers' statements have greatest value

in matters strictly industrial, and are too often quoted in social
records as conclusive with regard to matters about which their
knowledge is merely hearsay.
240
Ashome conditions, the character of the wife, etc., the "shop"

to
usuallyknow what the breadwinner of the family has told them
and no more. This does not mean that work references can give
no evidence of value on these matters, but that the usual tests
should be applied the identity of the original informant must be
known, and any signs of bias must be noted.
An Employer sometimes states the maximum earnings at full
time, or names the rate at which a workman is paid, without giving
(unless specifically asked) the number of hours actually worked.
"The most accurate way," says Miss Sears, "is to know what his
[the employe's] last pay envelope contained."
1
The only way to
be absolutely sure of this, of course, is to see the envelope.
Letters of former employers about a workman addressed "to
whom it may concern" are valueless; they express too often the
good natured one who is well rid of a burden, while a pres-

relief of
ent employer sometimes tempted to conceal the truth about a
is
particularly useful employe. These two forms of bias are illus-

trated in the following instances:
A man's Employer wrote, "This is to certify that has worked for me off
and on for the last four years. His work has been very satisfactory, and he is a
thoroughly good, all-round man, and I think you will find him very valuable."
The man's foreman, when seen later, said that he was a plausible fellow who im-
pressed everybody favorably at first, but who spent his money as fast as he got it on
drink and on women. Had once said that he was married but later denied it. His
Employer wrote the letter because he was "down and out," and no one wanted to
give him another knock. This client had tuberculosis and needed care, but the form
that the care took had to be modified by the existence of a wife and children (he
had claimed to be single), and by the presence of inebriety and syphilis conditions
all brought to light in the course of inquiry.
An Italian widow with children, who claimed that their only support came from
a sister of hers who worked for a tailoress for $2.00 or $3.00 a week, had her story
confirmed by the sister's Employer. Later the payrolls of the shop showed that
these two women and the daughter of one of them (whose whereabouts had been
reported unknown) had been earning steadily from $10 to $18 a week, and that their
average earnings had been between $\2 and $13. Various charities and individuals
had supported the family meanwhile, at the request of the charity organization
society. The tailoress explained that she knew that help which was not needed
was being given; but the women were so valuable to her that she could not afford
to offend them.
*The Charity Visitor, p. 31.
16
241
SOCIAL DIAGNOSIS
III. THE CO-OPERATION OF EMPLOYERS
Former Employers. The former employer may be an un-

1.
satisfactory writer of letters of recommendation, but when seen in

his own surroundings, where payrolls, foremen, and shop mates
can be consulted, or where it is possible to refer the inquirer to
one or the other of these, his evidence assumes a very different
character, especially when he is not too busy to hear, in a few words,
the circumstances and plans that give his own statement a definite
value. By showing the relation of his testimony to constructive
work that is in progress, it is often possible to interest him in the
future of his old workman and in the family's future too. Some-
times the former employer becomes the prospective employer.
Where there is a good chance of this, he should be seen quite late
in the course of the outside inquiries, to spare him a second visit,
if possible, and to make his co-operation fit in with the other plans
developed by consultation.
1
The degree of interest felt and ex-
hibited by the inquirer, and the amount of knowledge of the real
situation that he shows will have a direct relation to the kind of
co-operation secured.
An office for the care of the homeless and transient poor reported one of its appli-
cants as the "raggedest creature that ever came in here." The man had only one
was broken, he last worked for a contractor as teamster, and
leg, his artificial leg
had a record of drink. The former employer was induced to take him back and to
pay $5.00 a week out of the man's wages toward $50 advanced by the agency to buy
another leg. This was in May. In August the man had one lapse, was arrested for
drunkenness and neglected to pay his fine. When re-arrested the Employer paid
his fine and took the fellow's habits actively in hand. Three months later he was
doing well, and his Employer was looking for another man to work with him
one of steady habits who would not lead him into temptation.
The former employer who has not been mentioned in a first
interview, but whose name comes to light in the course of outside

"
inquiries, is what has been called a supplementary clue."
2
He
is often a valuable witness.
has been said that Employers and fellow workmen know little
It
about home conditions, but the matters about which they do know
are intimately related to the home, and their items of evidence have
all the more value because they are circumstantial and indirect.
If we know how to piece them together and weigh them as against
1 *
See p. 170 on the order in which outside sources should be visited. See p. 174.
242
other testimony, our work in the home will be better rounded.

Just as the teacher who studies her pupils gives revealing evidence
about home conditions and habits, though she may never have
entered the home, so the Employer's facts and first-hand observa-
tions have a relation to these same things, though his inferences
and opinions may be of little value.
In attempting to gauge the possibilities in the father of two boys (aged eleven
and three) who was said to be neglecting them, a charity organization society re-
ceived the following estimate from a naval station Man was in the marine corps for
:
fifteen years, was promoted to sergeantcy and in charge of a prison guard. Began
to drink some, and they felt he would be better in the Philippines. While there,
saved the life of his commanding officer and received commendation and a medal.
On his return to this country, was again given the post of sergeant of the guard.
At this time, was drinking more and more and was less reliable mixed up in a
number of scrapes. At the end of enlistment was honorably discharged. Then
went into the labor department, where he held an important clerkship. Discharged
for being drunk in working hours. Conduct was poor but work was excellent.
Fine fellow, above the average in intelligence, and could have been advanced con-
siderably in the service but for his drinking habits.
The same society was able to get a portion of the family background needed in
planning for an Italian widow with three children from an Employer's report on the
work record of her deceased husband, who was a stone mason Not like the ordinary
:
Italian; began with low wages but worked up to $2.75 a day. Got into debt and
used to ask for extra work, so that he sometimes earned $19 or $20 a week. If the
Employer wanted anyone to help him set up a gravestone always asked C, and he
was ready and willing. Non-union man, no benefit society so far as known, worked
at this one place until a few days before his death. Debts were contracted first,
it was thought, owing to illness of little boy and of wife, who was sick a good deal.
Then his brother got into trouble by buying on the installment plan, and C had to
help him out.
A boy of fourteen complained to an S. P. C. C. of the treatment that he received
from his father. His case was taken into court, but, under questioning by the
judge, his statements were contradictory. The boy's former employer was then
seen, who said the boy had lost money while working for him, and had been dis-
charged for carrying tales about the office which were without foundation he was
very untruthful, in fact. No doubt about his neglect at home, however, as his
clothesand shoes would hardly hold together, and they were obliged to fit him out
themselves. The young woman stenographer, seen separately, agreed that the
boy was untruthful, but added that his parents bought him no clothing whatever
during the whole winter of his employment. This warning as to the boy's romanc-
ing and the confirmation of his neglected condition would both have been useful in
preparing the case for its first presentation in court.
The same S. P. C. C. was dealing with a non-support case, involving four chil-
243
SOCIAL DIAGNOSIS
dren under the age of six. The proprietor of a garage reported that he had given
work to the children's father at the request of a former employer who knew and felt
sorry for the family. No signs of liquor during the eight weeks that the man worked
for him, but he often failed to come to work. Shiftless and lazy. Was warned
that if he did not do the work properly he would be discharged. But for his care-
lessness might have had the work indefinitely. (This last statement had a direct
bearing upon proof of non-support.)
2. Workers in family and in child-saving

Present Employers.
agencies agree that inquiries of the present employer are difficult
and to be avoided if possible, unless the head of the establishment
or its foreman is known to be one who can be interested. Complete
avoidance of the risk, however, would work great hardship to
innocent people.
Upon a complaint from a wife with two children that her husband drank and did
not support his family, a letter of inquiry was written to the office by which the man
was employed, stating the wife's grievances. This brought a request for further par-
ticulars, but soon after a second letter came stating that the man had been dis-
charged because they could not keep anyone in their employ who drank. The dis-
charge may have been hastened by the inquiry, and the possibility of some such
action ought to make agencies very careful about sending letters to unknown Em-
ployers, though a simple request for the man's work record might have been harm-
less enough.
Probation officers find that they have to be very careful about

seeing the Employers of their boys and girls. With some firms
the mere discovery that a child has been brought into court leads
to immediate discharge. There are others, however, who take
more boy on probation than in one who needs no over~
interest in a
sight. Obviously, an important part of a probation officer's

equipment is a knowledge of the attitude of the factories and shops
toward their young people.
of his district
In non-support cases requiring court action the evidence of
present employers is even more important than that of former em-
ployers, for the prosecutingagency must be able to give the man's
exact earnings, the duration of his employment, the number of
times that he has been absent from work, and the supposed causes
of absence, as well as the occasions and amounts of wage attach-
ments for debt. Often the man exaggerates the number and
amount of these attachments.
An S. P.C. C. received a complaint that a father was leaving four children, rang-
ing in age from four to eleven years, alone at home not only in the daytime but all
244
night. The father's present employer was not seen before the trial, and the judge
decided that the neglect was not wilful, because, when a witness testified to the fact
of night absences, the father claimed that he had been away only one night, when he
had changed shifts with another man. After the trial, the contradicted witness
obtained a letter from the man's Employer giving thirty-six dates on which he was
recorded as having done night work during the last six months.
The following are instances of co-operation with present em-

ployers whom it was possible to interest and from whom useful
information was had:
A public department for the care of dependent children had as its wards two chil-
dren aged eleven and nine whose mother had eloped with a man not their father,
the whereabouts of the father being unknown to the guardian of the poor who com-
mitted the children. A journey the length of the state by the department's visitor
brought no trace of the father, save a statement that he used to be well known in a
certain town. The police station of this town reported that the man had been
favorably known for years, and had formerly worked there for a barber. This
barber knew the present employer's address, which happened to be in the city in
which the children's department had its headquarters. Personally seen, this Em-
ployer gave the man a good name; said that he worked faithfully and well, had little
initiative, and drank very occasionally. The Employer was interested in the story
of the children, offered to increase the man's wages at the first opportunity and to
encourage him to make a home for his children. This last the father has not done,
but he has paid for their care regularly for three years.
A charity organization society was able to interest a group of present employers
in a family in which the chief breadwinner had developed tuberculosis. The Em-
ployer of the man had known nothing of his illness. He undertook to move the
whole family to the country and to aid in other ways. The firm employing the
oldest boy gave a good report of his work and prospects. The girl's Employers in-
creased her wages upon hearing of her father's illness, but gave reasons for thinking
that she would do better at other work in the long run. The case reader who studied
this record says, "Its investigation also seems to show what I miss in many others
the possibilities in the particular work, and the suggestion (where this is the case)
that the employe might do another kind of work better."
Since a delicate matter to establish relations with present

it is
employers, necessary though their help may be in the treatment of

certain cases, a good general rule is to seek their help late in our
inquiry, when must be sought at all.
it
3. Prospective Employers. Sometimes a prospective employer

is so well known to a social agency and so interested in its work
that his establishment becomes an experiment station for the test-

ing of unknown capabilities, the training of handicapped or diffi-
cult people, and the interviewing of unemployed men whose work
245
SOCIAL DIAGNOSIS
record can be secured better by a business man than by a social

worker. Sometimes a prospective employer may know our client
well already, and may have a real interest in his welfare.
But usually a prospective employer should not be seen. His
interest is slight, and the one fact that he alone can bear witness
to is the offer of work. Sometimes it is necessary to have this
fact. If, for instance, an agency dealing with homeless or non-
resident men is asked to pay the board of a number of them until

they can get their first wages, the statement that work awaits
them must be verified in some way, and it cannot always be veri-
fied without inquiry of the prospective employer. In such cases,
the client's interests must be safeguarded; the promise of work
must be confirmed without telling anything of the worker's affairs.
IV. METHOD
In addition to the analysis of a work record and the discussion
of the social worker's relations to Employers, past and present,
certain details of method should be mentioned, some of which
apply generally and some only in accident cases, or to the work of
the foreign day laborer.
1. The Approach. Addresses of Employers can be made fuller
and more accurate by reference to the city directory. In choosing
among a number of former employers, those for whom a client has
worked the longest in recent years and the one for whom he worked
the longest of all are the most important to see, though contra-
dictory evidence may make it necessary to see all the others. Some-
times an Employer knows our client in other ways, as fellow member
ofsome church or social organization, as an old friend of his family,
etc. These relations that are outside of business should be noted.
There is need of communication with the Employer direct, in-
stead of through the former or present worker or his family.
An Italian widow told a family agency that her daughter of seventeen was earn-
ing from $5.00 to $6.00 a week in a stocking mill, and the girl herself confirmed this.
At the mill she was found to have averaged $8.50 a week for the last eight weeks.
A boy of eighteen, who was believed by his mother, a widow with a consumptive
daughter, to be earning $4.00 a week, and so was paying only $3.00 into the home,
was found, upon inquiry, to be earning $8.00. An interview with the boy confirmed
the social worker's opinion that the mother did not know.
246
Often a wife does notknow her husband's earnings, and her state-
ments, made in good faith, are not accurate.
From what has already been said it is evident that personal
visits to industrial establishments are far more fruitful than tele-
phone messages or letters. An appointment, though, to see the
best member of the establishment at the best hour for him should
usually be secured over the telephone. Unfortunately, letters
are the only means of communication in some large establish-
ments and in some Rules forbidding personal
large communities.
interviews may possibly be set aside, however, by seeking the co-
operation of proprietors through channels that are particularly
influential with them. Perfunctory responses should not be ac-
cepted as the only ones procurable without making a determined
effort to win social interest higher up. On the other hand, good
service can be had through letters and telephone messages when
all inquiries about work records in a large concern are handled by
one person, and the agency or worker inquiring happens to have

already established a good understanding with this interested
source. In industrial establishments employing a social worker
the fact should be known, of course, and the approach be made
through him.
Get the Employer's point of view before deciding how much
can safely be told of a client's affairs, though more of what he
knows will be revealed, usually, after he has been told a good deal.
Often a reference to the foreman is the best result that can be had
"
from the business office of a firm. In our dealing with a certain
railroad," writes Miss Florence Hutsinpillar, "we invariably get a
1
negligible result by telephoning to the office, but never yet have we

failed to get information of value when we pick our way through
the yards to the shops where we can find the foreman."
Equally emphatic testimony is at hand as to the value of fore-
women. One social worker believes that the forewoman of a
factory has a rare opportunity to do constructive social work for
girls, and cites instances of the influence of certain forewomen who
are still the exception.
2. Accident Cases. In cases of accident coming under the new
compensation laws, procedure must be regulated by the provisions
1
247
SOCIAL DIAGNOSIS
of the state law. Social case work in what used to be a most un-
satisfactory group of cases has been greatly facilitated by these
new laws. They have not done away with the need of individual
social work altogether because there are countless adjustments to
be made, and social case workers who have the detailed facts and
are seeking no personal advantage can be of great service, more-
over, to the arbitration boards responsible for fixing standards.
A group of case records brought to the attention of the writer
illustrates the way in which one family case worker was able, by
energetic inquiry, to challenge with success an unfair ruling of the
accident insurance companies as to the average wage of longshore-
men. The decision of an arbitration board in the first of these
cases established a new and higher standard of compensation.
For cases not coming under a compensation law and for which no
lawyer has been engaged, Miss Hutsinpillar warns the social worker
to distrust his own legal knowledge. It is necessary to hear the
Employer's side of the accident, but, in doing so, to compromise

the employe's interests in no way, and to commit him in this first
"
interview to no settlement. However pressing the necessity of
the family, let the need be met in some other way until the evi-
dence is fully in hand. When the employer assures us that there
is no case but says that, because we come in the name of charity,
he will give the employe's widow $100, it is here that the long sight,
the view into the future, is much needed." Miss Hutsinpillar
recommends compromise later, however, in those cases in which,
after good legal advice, it is evident that no legal claim can be estab-
lished under existing laws.
3. Foreign Workmen.
Occupations in the old country furnish
clues to industrial aptitudesand possibilities over here. If a man
has been a skilled basket maker in Italy, it is a pity to let him con-
tinue to sort rags in New York or Chicago. Often the foreign
workman is known by another name arbitrarily given to him by
his foreman or mates at the shop, and it is necessary to discover
what this name is before he can be identified at his work place.
In large concerns he has a number, and may have his number tag
or metal check with him at the time of the first interview. If he
speaks no English, it may be necessary to name over the leading

Employers of his neighborhood in order that he may recognize his
248
own place of employment. He may have a preference for seasonal

work instead of a steady job; he may object to working in mid-
winter, for instance. If so, how has he made out before at dull
times in his kind of work, and how are his fellow workers managing
to get on?
Sailors (foreign and native) are given discharge papers from the
boats on which they have served, stating, among other things,
seaman's name, age, place of birth, date of entry and discharge,
place of discharge, character, ability, capacity in which he served,
and seamanship. The usual entries regarding character, ability,
" " " "
conduct, and seamanship are G for good and V for very G
good; the Cunard Line uses only "G." "D R" (decline to re-
port) is used when a record is unsatisfactory. Discharge cer-
tificates containing anything less than "V G" (or "G" from the
Cunard Line) have a way of getting lost. Inability to produce a
may be due to another cause, however, for in the Amer-
certificate
ican service, especially the coastwise service, the law requiring the
issuance of these certificates is very slackly enforced; in the Eng-
lish service it is strictly enforced.
The work record of a day laborer is more difficult, because he

may work for contractors whose operations are now in one place
and now in another. Every day laborer knows where he was last
paid and by whom, however, and it is possible, as Miss Sears points
out, to get his Employer's name in this way.
1
The Italian bank
may be mentioned, in passing, as a place that is often the employ-
ment agency for Italians, and often closely related to the padrone.
In the family of an Italian day laborer which applied to a charity organization
society, the woman was sickly, there were four children under twelve, the man came
and went as he pleased, and seldom supported his family. Upon one of his periodic
returns he claimed to have earned only $60 in six months over and above board and
travelling expenses to and from a small place 628 miles away in which he had done
pick and shovel work on the railroad. The local office of the railroad that employed
him provided the society with the name and address of the construction depart-
ment chief in the city nearest to the small place where he claimed to have worked.
A night letter dispatch to the charity organization society in that city secured the
interest of this construction department. The dispatch had asked length of time
working, pay, cost of board, reason for leaving, whether he worked full time, and
whether cold weather had interfered with his work. All of these points were cov-
ered in the answer, which showed that the man had been earning enough, over and
1
249
SOCIAL DIAGNOSIS
above his expenses, to have sent money home regularly, and that he left of his own
accord.
MISCELLANEOUS WORK SOURCES

V.
The miscellaneous work sources consulted in the three cities

studied were trade unions, fellow workmen, welfare managers,
store detectives, employment offices, and, in one case, the super-
intendent of a school for telephone operators. Store detectives
appear in the records of adult probation departments only. Em-
ployment offices, as now organized, are of little value in any search
for detailed knowledge of a worker's possibilities.
Unions and fellow workmen are the most important members of
though neither seems to have been used
this miscellaneous group,
very frequently. One reason, perhaps, for the infrequency of con-

sultations with unions is the difficulty of discovering where and
when the union secretary may be seen.
In one of the cases studied, a bricklayer's union helped a child-saving agency to
discover a deserting father; in another a Russian cigar maker who was incurably
ill was given complete support through union sick benefits and through special
subscriptions from union members; in another case, also that of a cigar maker, the
man was not a union member, but was suffering from a disfiguring and progressive
skin disease, and the cigar makers' union raised $60 which it turned over to a hos-
pital social service department to be spent for him, also offering to be responsible
for his funeral expenses. In this same hospital social service department was found
the record of a man who had been expelled from a trade union because he had ac-
cused of dishonesty.
its officers Later it came out that, at the time, he had had
the morphine habit. After the hospital had practically cured him of it, his union
agreed to reinstate him if the hospital doctor would state in writing that the man's
inability to tell the truth had been due to the habit. This the doctor was able to do.
Fellow workmen are especially generous in cases of sickness,

either the sickness of their shop mate or of one of his family. A
visit to the shop of a sick breadwinner often brings out the fact
that "the boys in the shop" have taken up a subscription for the
man. The one who has this subscription list, as Miss Hutsin-
pillar notes, is a valuable source of suggestion and co-operation.

He knows the sick man and has a warm personal interest in his
affairs; the social worker, on the other hand, knows more than he
about the medical and social resources of the community and how
to use them.
In preparing the questionnaire on desertion in Part III the
250
writer received from Mr. C. C. Carstens, of the Massachusetts

Society for the Prevention of Cruelty to Children, the important
suggestion that deserters rarely cut themselves off from all com-
munication with their former surroundings, and that this communi-
cation is often through "cronies" in their former shop or former
neighborhood. Appeal to these friends is more successfully made
for the children than for the wife. If she has lost her hold, the
man is still eager for news of his children, and even when this
interest does not bring him back, it leads him to write to mates
who can send news of them.
At the beginning of this chapter it was said that the material

gathered for it seemed to show less constructive relations on the
part of social workers to Employers than to physicians or teachers.
As case workers realize more fully the need of making their case
work better by linking it with a knowledge of mass problems, and
as they see that one bridge between the two is supplied, in the field
of industry, by an intimate knowledge of conditions in the estab-
lishments that they themselves visit, their work will broaden. It
will become more intensive and more inclusive more intensive
as they seek the precise items that show the relation of their client
to the particular bad condition discovered, and more inclusive
as they ask advice and co-operation from those who are study-
ing conditions of this type. This co-operation would mean the
substitution of a developing program for a static one. The use
of Employers to get and record a few routine facts about
wages and habits, or to secure for our clients an occasional contri-
bution or an occasional job, is surely a static program in a field
which presents infinite possibilities of usefulness in return for
greater discrimination and deeper insight.
1
"
1
A critic of these pages writes,If this point of view were in the mind of the case
worker every interview with an employer, it would mean the accumulation of
in
exceedingly valuable information for the social agency with which the worker was
associated. The information procured would be not merely a contribution to the
study of mass problems, but would constitute material for constructive work in
individual cases. This suggests the possibility of indexing interviews with em-
ployers in a file, referring back to the original case record entries. I hesitate to make
this suggestion, since it would appear to increase the amount of clerical work, but
it would surely be of value to the case worker to be able to refer quickly to former
interviews held by other case workers with an employer unknown to him and to
whom he may now be turning with a specific problem."
251
SOCIAL DIAGNOSIS

1. The
reasons for studying a client's work record in detail are (i) the great
variation possible in degrees of employment, unemployment, and employability;
(2) the lack of standardization of wages and work conditions in the same processes
of the same industry; (3) the possibilities of advancement for a client; (4) the
possibilities of reinstatement.
2. A case worker who studies the work record of a client with the aid of the out-
line given in this 239) should interpret the facts thus secured in the light
chapter (p.
of the other facts of his client's history facts of health, training, family background,
etc. A work record has little significance in case work without this context.
3. Employers are often quoted in social records as authorities upon matters con-
cerning which their knowledge hearsay, such as home conditions, character of an
is
employe's wife, etc. Other drawbacks of Employers as witnesses are that their
statement of wages earned may be the maximum of possible earnings unless the
hours actually worked are asked for; that their written letters of recommendation
"to whom it may concern" may be valueless; and that they may sometimes be
tempted to conceal the truth about a particularly useful workman.
4. Former employers can be consulted with far greater freedom than present
employers, and the information that they are able to supply often (though not in-
variably) makes communication with the latter unnecessary. The most important
former employer witnesses are those for whom a client has worked the longest in
recent years.
5. In certain cases the evidence of present employers is essential. In non-
support cases, for example, it is necessary to know exact earnings, duration of em-
ployment, number of times absent from work, supposed causes of absence, and
number and amounts of wage attachments for debt.
6. As a rule, though there are exceptions, prospective employers should not be
interviewed.
7. Personal visits to industrial establishments and interviews with foremen

especially are far more fruitful than communications by letter, though some firms
refuse to give information in any other way than by letter.
8. In accident cases not coming under the compensation law care is necessary to
avoid compromising the employe's interests.
9. The work record of a day laborer working for contractors, especially when the
laborer is foreign, presents certain difficulties, but every worker knows where he
was last paid and by whom.
10. Aside from Employers, the most important work sources are trade unions
and fellow workmen.
11. An intimate knowledge of work conditions in the industrial establishments
visited by the case worker will make him a better diagnostician and also a better
co-operator with those who seek to improve conditions of industry.
252
CHAPTER XIII
DOCUMENTARY SOURCES
work would find it an illuminating exer-
of social
cise to make a numerous places in which some one
list of the
ATUDENTor more of the facts of his own life are on record, and then
examine the entries, in so far as this is possible. He would find that
the most personal of these, such as the date of his birth, his stand-
ing in school, his inheritance, purchase, or transfer of certain forms
of property, his marriage, his fatherhood, the deaths of those dear
to him, are matters of public record; and that in many professional
and business records besides those of physicians, dentists, insur-
ance companies, banks, and retail dealers, to name only a few
some of the most intimate facts about him are neatly indexed and
filedaway. In addition to the witness of these unprinted docu-
ments, he would find himself recorded, perhaps, in city and tele-
phone directories, in professional directories and periodicals, in
church year books, in the advertising and news columns of the
daily papers, and in the membership lists of professional, graduate,
political, benefit, and social organizations. However uneventful
his life, however would discover that he
retiring his disposition, he
was already very much on record; he is destined to be still more
so, indeed, as community life becomes more highly organized. ;
In the course of his inquiry, he would also find that the docu-
ments in which his name appears fall into two large classes into
documents of original entry and those that are copies or in some
other way derivative from the originals. The documents of origi-
nal entry would not always be accurate, perhaps, but the copies
could not possibly be so unless their originals recorded the truth
about him. In fact, everything that he had learned, in the course
of his work, about the superiority of first-hand information would
be found to be applicable in his scrutiny of these documents. He
might have been in the habit of regarding himself as the best
possible source of information about everything that concerned
253
SOCIAL DIAGNOSIS
him individually. In that case, he would soon find that he was

mistaken; that the record made at the time corrects not only
inaccuracies but aberrations of memory. If the experiment is
tried with any degree of thoroughness, he will be less afflicted
thereafter by what one case worker calls "clue blindness," and will
have learned to consult documents oftener in his daily work, despite
a prejudice against them which is common among social workers.
This prejudice against the written word is due, probably, to the
too great confidence often reposed in it by the case worker's clients,
with many of whom anything that is written and signed is regarded
as satisfactory proof. The "testimonials" that are proffered by
clients, and the blank forms that are so cheerfully filled out by
" "
their are often worthless because they have been
references,
prepared, however honestly, for the occasion and with conscious
or unconscious bias. Then too, even where the document tells
truthfully all that it purports to tell, and even where it is not prof-
fered by the one most concerned but reaches the social worker in
some other way, it often conveys only a small part of what is
needed and of what its writer could reveal if seen face to face.
There would seem to be a distinction, then, between the docu-
ments that record in a colorless way events, dates, and places, and
those that sum up more or less subjective experiences and impres-
sions. The social worker is fortunate in that, dealing for the most
part with contemporary data, he can seek the source behind the
document in the many cases in which the document does not suffice,
and the document itself in those many other cases in which the
memory of an individual cannot be depended upon. Generally
speaking, the individual's testimony is least satisfactory in regard
to those matters of time, place, amount, and procedure in which
accuracy is vital; and the document is least satisfactory in those
matters of personal experience and human relation in which the
motives and capacity of the witness, the atmosphere and spirit
of his statement, are all important.
For objective matters of fact, the more impersonal our sources
the better. to listen to the conjectures and opinions
It is foolish
of a dozen witnesses, none of them wholly disinterested, about a

matter that was recorded under circumstances that precluded all
thought of the point now at issue, when this colorless, disinterested,
254
DOCUMENTARY SOURCES
and, perhaps, accurate record is accessible. Disinterestedness and

accuracy are not synonymous, of course; records are to be handled
critically, as all our evidence must be; but it marks a tendency to
consult the wrong sources for objective matters that the social
agencies in two of the three cities studied were found to be consult-
ing original documents in the rarest instances. Out of ,600 case i
records examined in these two cities, there was found not a single
instance of the consultation of a marriage record; birth records
were examined 14 times (n of these records were foreign); bap-
tismal records, 6 times; property records, 5 times; court records,
29 times; immigration records, 6 times; passports, 3 times; and
miscellaneous records, 1 1 times. In the other city (see analysis of
sources in Appendix II, Table B) the value of records had been
discovered. Out of 1,200 cases examined, the consultations of
records were as follows :
Marriage, 143; divorce and legal separa-
tion, 16; birth, 139; baptism, 36; property, 36; death, 28; con-
tagious disease, 19; insurance, 15; guardianship, 7; insanity com-
mitments, 30; court records not otherwise counted, 21 ; immigra-
tion records, 4; miscellaneous records, 7. An examination of a
number of other cases in this same city in the course of the case
reading for this book shows a firmness of texture in treatment that
can be traced directly to this habit of consulting Documentary
Sources. The habit should be formed wherever such records are
available, and, wherever they are not, social workers should be as
much interested as the bar and the medical associations in securing
better public records.
It maybe noted, in passing, that here also is an opportunity to
relieve the overburdened case worker. The work of consulting
records either in person or by correspondence can be delegated
without the loss of efficiency that often results when other impor-
tant parts of social diagnosis and treatment are delegated. In an
agency employing a number of workers, some one of these can
master the details of consulting records near by and at a distance,
and can do all of this work that needs to be done.
I. PRESENT USE OF DOCUMENTS

As brought to light in our case reading, the present social work
uses of documents are fairly obvious ones. They fall, roughly,
255
SOCIAL DIAGNOSIS
under a search for facts about birth, death, marriage, divorce,

whereabouts, property, immigration, and conduct. The docu-
mentary evidence of social agency records will be considered
separately in Chapter XVI, Social Agencies as Sources.
1. Birth and Death Records. Reasons for discovering the exact
age of a child not merely the year and the month but the day of
the month have already been given. 1 The documents in the
family's own possession that are used to establish births are family
Bibles, certificates of baptism, and passports. The original records
are usually those of churches made at the time of baptism, or of
doctors and midwives, who are required by law, in many places,
to report all births to the public department of health or, in smaller
2
places, to the town clerk or the health officer. The church register
of baptisms is, in some countries, the sole source. When any
question arises as to a child's age, it is always well to try to procure
a transcript of the birth record. 8
Some states have established state archives, in which the birth
records of the entire state are assembled. These are not the original
documents, but direct transcripts from them, subject only to the
kinds of error due to copying.
An S. P. C. C. records several cases of moral danger to girls in which, before any

steps could be taken or any extended inquiry made, it was necessary to consult
the public records and discover whether these girls were over seventeen (as they
claimed to be), or seventeen or under. Because of certain legal restrictions, a plan
of treatment could be much more effectively carried out in the latter case than in
the former.
A public department for the care of children notes that, in one case, where the
father and mother were named John and Mary and their last name was a common
one, it would have been impossible to identify the birth records of their children
Seep. 154-
1
A worker who examines applications for work certificates in a large city
social
instructs her assistants to address inquiries about birth certificates in any American
city to the registrar of births. Even where there is no official so named the letter
is delivered and answered.
1
Birth certificates in New York City cover the following items:
Name of child Father's name Mother's birthplace
Sex Father's birthplace Mother's age
Color Father's age Number of previous chil-
Date of birth Father's occupation dren
Place of birth; that is, Mother's name and maiden How many now living in
street and number name all
Mother's residence
256
DOCUMENTARY SOURCES
without the maiden name of the mother. Marriage records seldom can be identi-
fied without this item.
The four kinds of documentary evidence named in New York's

child labor law are (i) certificates of birth, 1 (2) certificates of grad-
uation accompanied by evidence from school that the child is
fourteen years old, (3) passports or baptismal certificates, (4)
"other documentary evidence" satisfactory to the board of health.
Until the board is satisfied that no certificate of birth can be
obtained, no other evidence is accepted.
The "other documentary evidence" that has proved acceptable
to the board includes (i) the manifest sheet at the immigration
station, (2) father's naturalization papers, (3) insurance policies,
(4) Bible records, (5) Bar Mizvah certificates, (6) circumcision
records, (7) confirmation records, (8) court records, (9) hospital
records, (10) children's institution records, and (n) other social
agency records.
The board finds that the record at Ellis Island is more likely to
understate than overstate a child's age, because parents often seek
to avoid paying fare for their children. Bible records are good if
the Bible is not too new and the entries are in ink. One family
Bible presented as evidence of a birth supposed to have been
recorded in 1895 was found to have been published in 1904. The
Bar Mizvah certificate testifies to the performance of a Jewish
ceremony which usually takes place when a boy is thirteen, but
may take place, if his father has died, at twelve. Circumcision
records (the ceremony usually on the eighth day after birth) are
is
good evidence, but difficult to obtain when, as often happens, they

are in the custody of elderly men unwilling to make an affidavit.
Confirmation and first communion records are regarded as good
evidence; so are hospital records when the treatment was given
more than two years before the application for an employment
certificate. Day nursery records are better than those of other social
agencies, because they were made when the child was very young.
Among the kinds of documentary evidence of age that the
board of health has found unsatisfactory are statements of private
physicians, personal affidavits, and school records. Some parents
1
See How to Obtain Foreign Birth Certificates, a leaflet printed by the New
York Child Labor Committee.
17 257
SOCIAL DIAGNOSIS
overstate their children's ages to get them into school before they
are of school age. In general, the board regards records made less
than two years before the application for work certificates as
likely to be untrustworthy. Where facts were recorded a number
of years before the work certificate questionwas a pressing one, this
particular incentive to misrepresentation probably was not present.
Death records present few difficulties, and are usually accepted
as proof that the death actually occurred on the date recorded.
Entries of death as filed at the board of health and in hospital
records often give clues to other needed evidence besides proof of
death. 1
2. Marriage and Divorce Records. Marriage records vary in
form and in place of custody with the marriage laws of different
states. In some, a religious ceremony is the only legal one; in
others, civil marriage and even common-law marriage, or public
acknowledgment of the relation, constitute a legal bond. Civil
records of marriage licenses and church records are the chief
sources; both are better than marriage certificates. The existence
of a record not conclusive proof of the legality of a marriage.
is
It may have been solemnized when one or the other was married
already, or when one was of an age which requires the consent of
parent or guardian. If the marriage took place in another
state from the one in which both parties to it resided, a search for
the reason sometimes reveals serious irregularities.
A young couple with two small children were under the care of a charity organi-
zation society for some months before the disappearance of the man, who had com-
mitted a felony. After his disappearance the woman acknowledged that they were
1
New York City death certificates call for the following items:
Place of death; that is, borough and Maiden name of mother
street number Birthplace of mother
Character of premises Former or usual residence (This is given
Full name in cases where deaths occur in hos-
Color or race pitals or institutions and when the
Single, married, or widowed deaths are those of non-residents or
Date of birth recent residents)
Age Cause of death
Occupation Physician's name and address
Birthplace Where was the disease contracted if
If foreign born, how long in the United not at the place of death
States and how long in New York City Place and date of burial
Name of father Undertaker's name and address
Birthplace of father; that is, state and
country
258
DOCUMENTARY SOURCES
not married. A much earlier search for evidence of marriage would have saved
the woman, who was apparently far better than the man, from months of abuse and
humiliation.
A legaJ aid society bestirred itself, in one of the cases reviewed, to procure and
actually obtained a separate support order for a woman from her alleged husband,
who drank and neglected her. It came out later that the woman's record was even
worse than the man's and that there had been no marriage.
One woman, whose affection for the man whom she called her husband seemed
slight, refused to swear out a warrant for non-support. The hospital social worker
interested in her affairs discovered that the pair were not married.
In one case, where a marriage record was not at first discovered, the man had
been married, as the public department interested in his children found out later,
under an assumed name. He had deserted from the Navy, and so wished to conceal
his identity.
Proof of legal marriage is very necessary in family desertion and
in separation and non-support cases. It is also a protection to

children whose legitimacy is in question.
A child-saving agency had moral but not legal proof that a child was exposed to
moral danger in the custody of its mother. A search for her marriage record led
to her acknowledgment later that she was not married and to the commitment of
the child.
In the same agency a search of both birth and marriage records established the
paternity of a child and reunited its parents. The father, who had been at sea at
the time of its birth and for some months before, had been told, probably with
malicious intent, that it was born five months after his marriage. The public
records proved that the child had been born eleven months after the marriage.
In looking up marriage records it must be borne in mind that

there are various reasons for minor differences of date. The date
of the public record may be that of the issuing of the license,
whereas the license may have been held a good whije and the date
of the marriage (the date given by the client) would thus be a
later one. Sometimes a marriage has taken place, but there has
been tardiness in making the return to the bureau of licenses, or no
return whatever has been made.
Divorce records may sometimes have to be consulted to establish
the rights of children or the legality of a later union.
A case committee was asked to suggest the best thing to do for a couple living
together as man and wife. There were two children one by a former union of the
woman's to a man who had left her years before, and to whom she claimed to have
been married. Some of her advisers, feeling that there was real affection in the
present home, offered the aid of a lawyer to obtain the annulment of the woman's
259
SOCIAL DIAGNOSIS
marriage on the ground of her husband's long continued absence, and thus make it
possible for her to marry. But the wife took no steps to this end, and later itcame
to light that there had been a third and earlier relation to a man who must have
been married to her because he had obtained a divorce. These facts raised two
questions in the minds of the committee, who decided that no suggestions as to
treatment could be made until they had been answered. First, had the woman
been married to the father of the older of the two children? The record had not
been looked up. Second, what were the circumstances of the still earlier marriage
and divorce? The record had not been examined.
3. Records Indicating Whereabouts. Frequently it is difficult

to discover the present or previous whereabouts of a relative of a
client, or some other interested person. Directories are the first
resource in such cases, and their use is discussed in some detail
on p. 265, but a number of unpublished lists and records have also
been found to be useful. Besides formal records of birth, death,
marriage, property, etc., which often reveal the whereabouts of
someone other than the principals, illustrations are at hand of
reference to voting lists, enlistment records, police precinct books,
receipts of foreign drafts, and cemetery records.
The social service department of a dispensary failed to find a patient at the ad-
dress given when he did not return for much needed treatment. The voting list
of the district was consulted, and this showed his transfer to another voting dis-
trict. In this second district he had not yet registered, but it was suggested at the
registration office that the ward boss be seen. Through him the man's address was
discovered.
A family case worker reports that, when the city directory fails to make an ap-
proximate address more definite, she usually consults the voting list before attempt-
ing a house to house inquiry.
Voting lists are also consulted by an S. P. C. C. to discover the whereabouts of

fathers who have left their families but are believed to be in the city. This same
society often consults the Army and Navy enlistment office records in seeking a de-
serter who is young enough and strong enough to have been enlisted. He often
gives an assumed name at the recruiting station, but can sometimes be traced
by his description and by the date of enlistment. He claims to be single, of course.

In one such case, where the man had enlisted in the Navy, the society got a prompt
and satisfactory reply to the following letter: "We learn from the enlistment office
in this city that you enlisted August 10 after taking an oath that you were a single
man and, therefore, can be arrested for perjury. You left your wife and two chil-
dren under two years old without support. We learn that you will receive your first
pay October 10. Now if you will write your wife saying you will send her a large
portion of this money, so far as we are concerned there will be no further action
taken."
260
DOCUMENTARY SOURCES
A postal card from Fort Slocum written by a runaway boy to his father said
nothing of enlistment but furnished a clue which was followed up by a letter to the
commandant of the fort. This brought the reply that the boy had enlisted and
given his age as twenty-one years and two months. His real age was seventeen.
Information about the character of a particular neighborhood or house or store
can sometimes be had at the police station in that district, where the police precinct
book may reveal police relations with the place in question. This form of inquiry has
been found especially useful just before helping to move a family into new quarters.
Some large police departments have a lost and found bureau which consults am-
bulance and hospital records on request in cases of sudden disappearance.
A young Armenian was returned to Constantinople by an agency for the care of
homeless men. There was some doubt as to whether he would go to his destination,
but a. foreign draft for his use in getting established there was found to have been
paid and duly receipted for, which established his whereabouts.
After a factory fire in which many foreign girls lost their lives, the records of
banks in the foreign quarter revealed the addresses of the families of some of those
who had been sending money home through the banks. The records of foreign
drafts at the post office were also consulted.
A social worker who has been making some eugenic studies finds cemetery records
of value. is research work, which has a technique different from that of case
This
work, but the suggestion may well be used by case workers in difficult situations.
Writing of a certain cemetery that keeps good records, the investigator says,
"Given one name and the approximate date of death, the records show names and
dates of burial of all persons buried in a certain grave or family plot. Then still
other records show, for each interment, age, place of birth, occupation, cause of
name of attending undertaker. This makes vague
death, residence at time of death,
information more definite and introduces to relatives not named."
A few illustrations of the incidental use of more formal public

records as a means
of revealing whereabouts follow. The first
bears indirectly upon a matter that often puzzles the social worker,
especially in the use of public resources, namely, upon legal resi-
dence. often happens that a long and difficult social treatment
It
process suddenly checked and made of no avail by the discovery

is
that the proposed inmate or beneficiary has no legal residence in

the state in which he is living. The use of private resources is not
so rigidly restricted, and the settlement laws that limit the action
of public agencies in some of our states will undoubtedly become
less rigid in time. Meanwhile, it is necessary to have legal residence
in mind and to know how to establish it.
A state department for the care of children discovered in the course of verifying
the ages of the 1 1 children of a certain family by means of the state registry of births,
26l
SOCIAL DIAGNOSIS
that several of them were born in a town in which their parents were not known to
have lived, but in which they had had a legal residence.
In a manuscript on Investigation at a Distance, Miss Alice Higgins (Mrs. Wm.
H. Lothrop) tells how the examination of a marriage record revealed the maiden
name of an absent wife and her birthplace in a small town in another state. A
letter to a clergyman there led to his advertising for her in the local newspaper.
This advertisement was seen by the wife's cousin, who promptly notified her, and
caused her to visit the offices of the associated charities. She was able to give
information and intelligent advice in a perplexing situation.
Consultation of the court records in a town where a family had lived only a few
weeks revealed to a charity organization society the earlier movements of the
family's deserting head.
A record of death in a hospital's files brought to light the whereabouts of the only
responsible relative of a deceased Italian, whose family were in distress and applying
to a charity organization society. The accuracy of the return on the death record
had been attested by a cousin of the man, and this cousin was able to give other
needed information.
A family case worker reports that a baptismal record often reveals a valuable
source of co-operation by giving the name and address of a child's godfather or god-
mother.
A child labor committee reports that scbool census records, where they are fre-
quently amended, are useful in searching for addresses.
4. Property Records. Facts about property are far more com-

pletely on record than facts about people; the less highly organized
the community the greater the disparity in value between these
two kinds of record. The use of property data of records, that
is, of real estate, inheritance, insurance, bank deposits, pensions,
and cemetery lots is so well understood that it need not be dwelt

upon at any length, though social workers are still too likely to
take hearsay evidence and rumor with regard to property instead
of having the records searched. 1 Their examination can be effected
more quickly and accurately with the aid of someone in a law office
who is accustomed to this work.
Mr. L. H. Levin, secretary of the Hebrew Benevolent Society in Baltimore,
1
gives an instance of this tendency as follows:
Not long ago an investigator reported that an applicant was supposed by the
neighbors to own the house in which he was living, and this belief was strengthened
by the fact that he had sold a house a few years previously and had moved into this
one ostensibly as landlord. The applicant and his married son, who with him
1
See footnote, p. 123.
1
262
DOCUMENTARY SOURCES
occupied the house, gave conflicting statements as to its ownership, and as the re-
sult of numerous conferences and parleys, the investigator reported the applicant
as the probable owner, basing his judgment on the opinion of the neighborhood, rein-
forced by the conflicting statements of the occupants
of the house. After the report
was the matter of the ownership of the house was referred to the Legal Aid
in,
Bureau, which reported that it had belonged to the applicant, but had been sold a
short time previously for a small sum above its encumbrance. If the investigator
had known that the ownership of the house was a matter of record, and that the
information could be ascertained in a few minutes, not only would he have saved
time and trouble, but he would have been able to bring in an accurate report.
It is especially difficult to get any clue to the possession of prop-

erty by members of certain foreign groups. Their standard of
living is low, they are apparently destitute, and are more than will-
ing to add to their resources by seeking help from funds that seem
to them inexhaustible and to be intended for the aid of such as
themselves. These people are not necessarily adventurers, but
they are aliens and their sense of individual responsibility toward
our country's social institutions has not yet been developed. A
charity organization society in a large city furnishes the following
illustrations of the concealment of property in the Italian quarter;
the habit of mind referred to is, of course, not confined to Italians.
An organ-grinder with four children, oldest aged nine, complained to the society
of the laziness of his wife, who refused to accompany him on his street journeys.
She was found to be seven months pregnant and in wretched physical condition.
Hospital care was secured at once, but the child was born prematurely and its
mother died. The widower continued to apply for relief in winter, for aid when
his organ went to the factory for new records, and for the correction of his children,
who were being cared for by his aged mother. The Italian-speaking agent of the
society,happening to pass the family's door one day soon after relief had been given,
remarked to the grandmother that she would never be able to raise vegetables in
the small flower pots over which she was working. Whereupon the old lady re-
plied that their contents would soon be transplanted to the lot that they owned.
Public records showed that the man had already paid $146 on a lot upon which he
still owed $89.
A woman widowed claimed to have received only $10 after the Italian
recently
benefit society had paid her husband's funeral expenses. Records of the court
showed, however, that the mother had been appointed guardian of her eleven-year-
old son's estate and had given bond in the sum of $ 1,000. This led to the discovery
that the benefit society had paid her $200 and that there was a $1,000 insurance
policy besides. The widow had been granted a mother's pension of $20 a month
from public sources, but this was revoked after these matters of record came to light.
A fruit peddler was always claiming that he was too sick to work and received,
263
SOCIAL DIAGNOSIS
accordingly, sick diet orders, clothing for the children from their schools, free day
nursery care for the younger ones, etc. It was learned later that sick benefits had
been paid by his Italian society at the same time. Finally a dispensary doctor (not
Italian) examined him, said that he needed work, and that his trouble was nervous
indigestion which would be helped by outdoor employment. Started in a fruit
stand, he seemed to prosper and to have a good stock, but continued to appeal for
relief. After repeated but unproved rumors that the man had $600 in bank, it
was suggested to him that he sign a paper turning over his property before further
relief was given to his family. This he refused to do.
Bank accounts are private records, of course, and as such can-

not be consulted at will. In some states, however, public relief
officials are given by law the right to obtain information from banks
about the deposits of any recipient of public relief.

The pension bureau at Washington is willing to give information
regarding recipients of government pensions, but not only the name
and address of the soldier or sailor inquired about must be given,
but the full name of the organization in which he served, with the
dates of enlistment and discharge.
Property, pension, and bank account records are consulted, of
course, not only to discover what clients have in the way of re-
sources, but to find out what they are entitled to have. In a
certain case where the damages awarded a workman against his
employer had not been collected, the record of a transfer of prop-
erty by the employer to his wife had to be looked up to learn
whether the transfer had been made at about the time of the in-
stitution of the suit. This was done in order to lay the basis for a
suit to set the transfer aside.
5. Immigration Records. Records at the port of entry give not
only the immigrant's age and last residence, but the name and
address of his nearest relative in the country from which he came
and the name and complete address of any friend or relative whom
he may have been going to join in this country; also a statement
regarding the money in his possession on landing, and many other
data less likely to prove of value to the social worker. In order to
tap successfully this source of information it is important to be able

to give the immigrant's full name, his nationality, the name of the
steamer and line that brought him to the United States, the port
of embarkation, and the exact date of arrival; though information
264
DOCUMENTARY SOURCES
from the records is known to have been obtained when it had been
possible to furnish an approximate date only.
Neither the immigration record nor the passports and other
papers in the possession of the immigrant himself are first-hand
documentary evidence as to age or birthplace. The passport con-
tains all data needed for the identification of the immigration
record.
6. Records of Conduct. If the question has to be settled of
placing a delinquent boy or girl on probation in his own home or

elsewhere, the court records of father, mother, or older brothers
and sisters have a direct bearing upon the decision. If our client
has broken the law and been arrested, his previous arrests if any
must be taken into account. All work for prisoners and proba-
tioners, adult and juvenile, is very much hampered, at present, by
the condition of court records, especially those of the minor courts.
Police records of arrests are equally unsatisfactory; the names
given on the docket are often aliases, and other arrests may be
recorded in any one or more of a dozen different places. There is
need of a central registration of arrests and trials, with identifying
data that will be accurate and unmistakable. Lacking this, public
officials and social workers must know how to use such facilities as
are now at their disposal, must know where to go or write for a
copy of a court entry, must know the shortcomings and possibilities
of the records of indictment, the docket entries, etc.
II. USE OF DIRECTORIES AND NEWSPAPER FILES

Before turning to the few suggestions under the head of method
that are sufficiently applicable to the use of documents in different
parts of the country to be given here, the consulting of printed
lists names and addresses and of the files of newspapers should
of
receivesome attention.
City directories are the most useful printed lists not only the
current directory of one's own but the directories of earlier
city,
years and of other cities. These be consulted for a small
may
charge at the local directory publication office, which keeps on its
shelves the directories of all the larger cities at least. Some large
manufacturing concerns have collections of directories and the
current directories of other cities can often be consulted at the local
265
SOCIAL DIAGNOSIS
board of trade. 1 Business directories are less satisfactory than

telephone directories, which contain all the business concerns of
any size and are revised oftener. There are also special telephone
directories in which subscribers are classified by the nature of their
business.
In some states year books are published that contain lists of the
public officials of the state and counties, lists of city and town offi-
cers, salaries, terms of office, the membership of the legislature, its
committees, the court calendars, the banks and newspapers of the
state, county maps, etc. A few cities publish a civil list of all city
and clerks, with their addresses and salaries.
officials
There are a number of trade directories such as the one issued

by the American Iron and Steel Association, Hendrick's Com-
mercial Register of the United States for buyers and sellers, etc.
Professional directories of the clergymen of a given denomina-
tion, of the lawyers of a given city, of the physicians, of the pub-
lic school teachers, etc., are valuable. Many religious denomina-
tions publish a year book for the whole country which may not
only be used in getting more accurately the name of a clergyman in
a distant place, but may discover there a very serviceable corres-
pondent. A few cities publish special directories of their social
agencies, public and private, and of the medical, educational,
remedial, and custodial resources of the community.
The following instances illustrate both the value and the method
of using directories:
A charity organization society telegraphed to a sister society a thousand miles

away in the East that it had been applied to for a loan by two women who formerly
lived in this eastern town at addresses unknown. Search of a city directory five
years back gave an entry of removal to another state, but an earlier directory
gave a city address. Inquiry in the neighborhood revealed their former church
attendance, and the minister of the church was able to give a sympathetic picture
of the background and characteristics of these clients.
The head master of an English school wrote to an American charity organization
society to discover the whereabouts of a brother, who had left England eighteen
years before and had not been heard from for fifteen years. At that time he was
living in a small town in the same state as the society, but had his mail sent to a
railroad office by which he was employed in the society's own city. The town
1
The New York Public Library has a large collection of the directories of Ameri-
can cities, going back in some instances as far as the '6o's. It also has many Cana-
dian and English directories.
266
DOCUMENTARY SOURCES
directory of nine years back in the smaller place gave the man's address at a hos-
pital where he had served as porter, but the hospital had lost all trace of him. A
clergyman in the town was appealed to, who learned that the man went to a large
city in another state after he left the hospital, and had married there, maiden name
of wife unknown. The charity organization society in that city was written to and
asked to search marriage records and back numbers of its city directory. The
marriage records revealed nothing, but the city directory did give an English family
of the same name, who became interested in the search and found the missing
brother after two months' delay.
On p. 196 the story is told of a homeless man, Albert Gough, who was found to have
escaped from an insane asylum and whose whereabouts was revealed to his relatives
sixteen years after he had last been heard from. The process of finding these rela-
tives is what now concerns us. Cough's address sixteen years ago in another state
and citywas sent to the charity organization society there, with the name of a sub-
urb in which he had also lived, and the name of the husband of his sister Martha,
one Joseph Flynn, who had formerly worked for a firm of Jones on Water Street.
Another sister, Alice, was the wife of Peter O' Brian. These relatives were all found
in five days, and the method used was as follows:
All the names mentioned in the letter of inquiry were first carefully looked up in
the confidential exchange. 1 None of the names was found there, and the inquiry
was turned over to one of the society's least experienced workers with the sole
suggestion that a city directory was often a case worker's best friend. After a
careful search of every city directory between the years 1890 and 1910, a list was
made of the Joseph Flynns, Peter and Alice O' Brians, and Albert Coughs contained
in each, with their occupations and home addresses. The total entries thus listed
were 56. Notwithstanding Cough's statement that he had not lived in the city
for sixteen years, it seemed worth while to search the directory for his name as well
Nothing was found, however, more recent than 1893, when an Albert Gough had
been employed as carpenter and had boarded on Camden Street, in the neighbor-
hood of Norton, the suburb where Gough claimed to have been. This gave some
hope from the very start that his story was true.
Then came the important task of drawing the right inferences from this mass of
material. The investigator put her wits to work and decided that only Flynns and
O' Brians who were living in the city sixteen years ago would surely warrant a fol-
lowing-up, and that of these only those recorded as still living there could easily be
traced. Only one Joseph Flynn clue fulfilled both these conditions. The follow-
ing day, therefore, with lively expectations of at once discovering Cough's brother-
in-law, the worker made a call at this one address, to find that the family had moved.
She made another call at their new address, discovered with difficulty, to find that
they were all out for the day. To save time, therefore, and to allow for the possi-
bility that this Joseph Flynn might not be the one that she was seeking, she decided
to work also from the other end and try to discover whether this Flynn, an up-
holsterer, was identical with a Flynn, a belt maker, who from 1890 to 1904 had
boarded in another part of the city.
1
See p. 303 sq.
267
SOCIAL DIAGNOSIS
The neighborhood proved Jewish, and children volunteered the information that
"no Christians live down here." Proprietors of nearby grocery and clothing shops
were also ignorant of Flynns, but at last a young woman in a bake shop was found
who remembered the family very well; the father, an upholsterer, had died nine
years ago, and his son, a belt maker, had moved to Duane Street. The young
woman did not know whether the younger Flynn's wife was named Martha or not,
but her age corresponded with the probable age of Albert Cough's sister. Duane
Street corresponded with an address found in the directory for 1905, and assured
the investigator that this was the same family that she had been seeking the day
before. As they would not be -home until the following day, she devoted a part of
the afternoon to looking up a Mrs. Alice O'Brian and making sure that she was not
Cough's sister. Early the next morning a visit to the first family of Flynns left
her very downhearted, as, despite the fact that her name was Martha, Mrs. Flynn
proved not to be the sister. Thus the clue offered by the case worker's best friend,
the directory, proved elusive. There remained, however, the Jones firm on Water
Street, for the letter of inquiry had mentioned this additional clue, fortunately, and
itwas found from an old directory that a hardware firm, Jones Brothers, had been
situated there eight years ago. From an elderly clerk in a nearby book shop it was
learned that one of Jones Brothers' former clerks had a little office on the top floor
of the building formerly occupied by the firm. Here he was found in a little attic
room. He had known the Joseph Flynn employed by Jones Brothers, thought that
he was now living at Glenside, and knew that he was working for the Multiple
Insurance Company. A telephone message to the insurance company brought the
Flynn address at Glenside. Less than twenty-four hours later Albert Cough's
sister had had her first news of him in sixteen years, during the greater part of
which time he had been an inmate of a hospital for the insane in a state in which
he had no friends or relatives.
"We have had occasion several times to use the year books of the various religious
denominations," writes Miss M. L. Birtwell.
1
"A few years ago we were trying
to help a widow with an aged mother and an obstreperous young son dependent
upon her. The woman was peculiar; we did not feel that we understood her and
she would give little definite information about herself. The old mother was feeble,
almost in her second childhood, and much inclined to beg, so not helpful in enabling
us to get at the real needs of the family. The woman had a sister, but she declared
she did not know her exact name and address. She was married, she said, to a
Universalist minister named Taylor, whose Christian name was a Bible name, and
she lived 'somewhere in Vermont.' We
telephoned a request to the Harvard Di-
vinity Library to consult the Universalist year book. They found an Amos Taylor
listed as pastor in the village of K. Mr. Taylor's wife proved to be the sister of the
woman we were interested in, and by following up this clue we learned the story of
the woman's life, which enabled us to deal with her with a far more sympathetic
understanding than had been possible previously."
The case reading for this book brought to light no illustrations

1
268
DOCUMENTARY SOURCES
of the use of newspaper files and news indices to establish the date
of one event by associating it with another, or to discover the notice
of an accident, an arrest, an award, a death, a disappearance, or
any of the thousand and one happenings that are recorded in the
daily press. Such clues are now made more accessible to the case
worker by N. W. Ayer and Son's annual list of all newspapers
printed in the United States, by the publication of indices to some
of the leading papers, and by Bowker's Index to Dates of Current
Events. The latter aims to cover news in the United States which
is of permanent interest and has more than a local appeal. The
date given is that of the event, not of the report of the event. The
index goes back to 1912 only as a separate publication. Indices
to the following years and newspapers, which include their personal
news, are also available: 1863-1904, New York Times; 1875-
1906, New York Tribune; 1891-1902, Brooklyn Daily Eagle;
1903-1904, 1908-1909, Street's Pandex of the News; 1913 to
date, New York Times. 1
III. METHOD
"
In the early days," says Thayer, 2 "they did not stick, it would
seem, at showing the jury any document that bore on the case,
without even thinking of how the writer knew what he said."
This is the first question to ask of ourselves How did the writer
know the truth of what he says? The second is quite as impor-
tant; namely, What interest, if any, had he at the time that he
wrote in representing things as they were not? And the third,
Was he trained to be accurate or did his lack of training render
inaccuracy probable? These questions for the document in the
writing, but its custody since also has a bearing upon our discus-
sion. We may say that there is no record because we do not
know how to spell the key words that would identify it, or because
it has been misplaced, wrongly indexed, or not indexed at all by
itscustodians, or because, since it came into their custody, it has
been changed or stolen. Public records have been well kept for a
long time in some places, in some they have been well kept for a
little while only, and in many they are still abominably kept. If
1
The list is of indices on the shelves of the New York Public Library, omitting
those that index no personal news.
1
Preliminary Treatise on Evidence, p. 520.
269
SOCIAL DIAGNOSIS
a document is printed, a new element of error creeps in. It is
obvious that the mere failure to discover a record after diligent

search is negative proof at best and not final. The record, when
found, is usually evidence, sometimes proof, but seldom a conclu-
sive demonstration.
"There are three principles which apply to the use of records,
"
whether public or private," says Miss Zilpha D. Smith. 1 First,
to get a general knowledge of what records are available, and, in
order to determine their value, of the methods by which they were
gathered. Second, to use the earliest record of a certain fact as
the most trustworthy. Third, to consult the record when it will
serve our purpose instead of seeking an interview, because use of a
record does not stir other people to prejudice or action."
Public records in other parts of the country may be consulted

through public officials. There is a charge in most states for
transcripts, especially certified transcripts, and care must be taken,
in writing to mayors, town clerks, clerks of court, chiefs of police,
and others, to give all possible identifying information with ac-
2
curacy and to offer to repay the necessary expenses of the search.
A search for a record should not be limited to one spelling of
names or to one The dictionaries used to remind us that, in
date.
order to find a word, we must know how to spell it. This is not
strictly true, of course, if we are able to think of a number of spell-
ings each of which might possibly be the right one. For foreign
proper names, more especially, no small degree of ingenuity is
necessary in the searching of records, because the owners of the
names do not always know how to spell them, and the custodians
ana mdexers of documents certainly do not. Then too, when an
Italian Darber named Cellini suddenly changes his name, under
influences social or political, to Kelly, the effect upon an index is
disastrous. The list of variable spellings given in Appendix III
was prepared by the registration clerks of the New York Charity
Organization Society from the much more extended groupings in
daily use in their Social Service Exchange. Each community
should work out its own list, with reference to its local needs.
1
1
The New York City Bureau of Records, which is under the Department of
Health, now assures greater accuracy by issuing photographic copies of its records.
270
DOCUMENTARY SOURCES
With the list 1 1 1 in his

given in Appendix pocketbook, the agent
of a child-saving agency would have been saved a second visit to
the public record office in the following case:
A seeking separate support from her husband asked the children's society
girl
to take her case into court. As there was some doubt about her marriage, the
records were searched, but without avail. A few days later a letter was received
from her signed Margaret Koch. She had spelled her husband's name as Cook at
the time of her visit, or so the agent had understood it. Going back again to the
record office, the agent found the record of marriage under the new spelling.
A worker in an agency that has had much experience with forced

marriages instructs her assistants, in their search for elusive public
records, to look forward of the date given when they are looking
up marriages, and back of the date given when they are examining
records of births. This would not be a safe rule if the birth or
marriage record of a girl who claimed to be over eighteen when she
was not so old were in question; in fact, it is not a rule at all, but
it contains the suggestion that we should look both before and after
the date given, looking first in the direction in which the variation
is most likely to have occurred.
A word of caution about translators. When a document is in a
foreign language and no trustworthy translator is at hand, it may

be well to seek the aid of the consular office of the country whence
the document came.
In the foregoing statements about public records and where to
find them, it has been impossible to give more than a generalized
view, because there is no uniform record system in our 48 states.

A social case worker should know what public records are available
in his own city and state, should know in general their lacks in
fullness, accuracy, and accessibility, and should be prepared to do
his part in procuring a better system of records.

Documents both printed and unprinted may be divided into original and
1.
derivative. The derivative record, when a copy, cannot be accurate if the original
is not.
2. Documentary Sources are most satisfactory in those objective matters of time,

place, amount, procedure, which accuracy is vital. They are least satis-
etc., in
factory in those matters of personal experience and human relation in which the
motives and capacity of the witness, the atmosphere and spirit of his statement,
are all important.
271
SOCIAL DIAGNOSIS
3. Social case workers consult documents most frequently for facts about birth,
death, marriage, divorce, whereabouts, property, immigration, and conduct.

4. Many documents are utilized in establishing dates of birth, such as certifi-
cates of birth, baptismal certificates, immigration records, naturalization papers,
insurance policies, Bible and other religious records, court records, hospital records,
children's institution records, and the records of other social agencies. Not all
of these are of equal value. The record made at or near the time of birth is the
most trustworthy.
5. The chief sources for proof and for date of death are the records of the board
of health and of hospitals.
6. The sources for proof and for date of marriage are the records of marriage
licenses and marriages (civil) and of marriage ceremonies (church). There are
often minor differences of date, such as differences between the date of issuing the
license, the date of the ceremony, and the date of reporting the ceremony.
7. Records of birth, death, marriage, property, etc., often reveal the whereabouts
not only of members of the immediate family but of their friends and connections.
Other sources for whereabouts are directories, voting lists, enlistment records,
and cemetery records.
police precinct books, receipts of foreign drafts,
The most and accessible source of all is the directories, both special and
useful
general, for current and earlier years. Boards of trade, certain large manufacturers,
the publishers of directories, and a few large libraries have files of the directories
of other cities. Every case worker should learn to consult directories promptly
and skilfully.
8. Property data appear in records of real estate, inheritance, insurance, bank

deposits, pensions, and cemetery lots.
9. Records of arrest and of trial often give important data as regards conduct.
10. The date of an event may sometimes be established by its association with
another event, the date of which is matter of record. Newspaper files and an index
to dates will be found useful in this connection. Back files of newspapers and their
indices also bring to light notices of such personal incidents as an accident, an arrest,
an award, a death, a disappearance, etc.
11. and use of documents we must consider in each case the

In the search for
and the carefulness of their custodians. How did
disinterestedness of their authors
the writer know the truth of what he wrote, and what interest had he in writing it
thus and not otherwise? Then failure to find a record may be due to our or to the
writer's misspelling of the key word, to wrong indexing, or to theft.
12. A
search for a record should not be limited to one spelling or to one date.
Lists of variable spellings, especially of foreign names (see brief example in Ap-
pendix III) will be found serviceable.
272
CHAPTER XIV
NEIGHBORHOOD SOURCES
come now to a group of sources that, measured by their
WE
dence is
value to the diagnostician, are on a lower plane than
any that have yet been discussed. Neighborhood evi-
often the synonym for gossip and inaccuracy. There are
situations in which the testimony of a present neighbor may be
indispensable, but in social work these are the exception, and no
fact could better illustrate the crudity of much of our social treat-
ment than the discovery that, at the time that our statistics of
outside sources were gathered, present neighbors were found to be
more frequently consulted in one of the three cities studied than
1
any other one source. Neighborhood Sources in order of frequency
of use in the three cities ranked as follows:
First City Second City Third City
Present neighbors 9th 3rd ist
Present landlords 2 i8th 4th 5th

Present local tradesmen agth 24th aoth
Former neighbors I3th I2th I5th
Former landlords i6th 5th i6th
Former local tradesmen 33rd 36th ayth
Reference to Appendix 1 1, Table B, shows in the first city (where

no evidence was found of a general tendency to lean too heavily
upon Neighborhood Sources) a good deal of diversity of use as be-
tween one agency and another having the same general purpose.
One placing-out agency consulted present neighbors not once in
its 50 cases, and another consulted them 27 times. On the whole,
however, their use in this city seems to be largely confined to the
protection of children from neglect, to the public care of children,
and to adult probation. They are usually avoided by the family
rehabilitation agencies and still used, apparently, by other relief
administrators.
1
Excluding social agencies as a source.
1
Including owners, agents, and janitors.
18 2 73
SOCIAL DIAGNOSIS
In the sections that follow, the use of Neighborhood Sources is
considered under the subheads of present neighbors, former neigh-

bors, landlords, and other Neighborhood Sources.
I. PRESENT NEIGHBORS
The worst example of interviewing present neighbors that has
come to the attention of the writer is that of a public outdoor relief
agent who habitually visited neighborhood tradesmen, janitors,
before seeing the family, and tried, by leading questions, to
etc.,
draw out anything unfavorable about them that could be either
suggested or uncovered. These are the methods not of the diag-
nostician but of the inquisitor. Such abominable practices are
not confined to public outdoor relief departments, of course. Un-
fortunately the reaction against them, wherever they are found,
easily takes the form of protest against every kind of inquiry.
The objections to present neighbors as sources of information
may be stated in a word. They are likely to be biased by a desire
to do a favor or to pay off a grudge. Their questioning works un-
due hardship, moreover, to the subject of the inquiry, exposing
him to gossip and humiliation without securing any insights that
"
could not be arrived at better in some other way. My mere ap-
pearance at a family's door," said a probation officer, "advertises
to the whole neighborhood that there is trouble in the family, and
I have as to do with the neighbors as possible."
little have "We
to use them
for court evidence," writes the head of a society for
"
the protection of children, but we use them as little as possible,
and always try to secure other evidence in addition, realizing that
their evidence is of the most prejudiced kind, either strong for the
family or else harboring a grudge."

The circumstances under which we are justified in seeing present
neighbors have been so well described by Miss Amelia Sears in a
short paper 1 that it is given here practically in full:
The visiting of present neighbors has been compared to that last resort of the
surgeon the exploratory incision, permissible only when every other means of
diagnosis is exhausted and the condition of the patient admits of no delay. Perilous
situations permit of untoward measures; danger inherent in the family situation so
serious as to necessitate immediate and decisive action justifies recourse to any ex-
pedient. Physical and moral danger within the family indicates one of two condi-
1
One of the unpublished papers referred to in the Preface.
274
tions mental instability or moral turpitude. Illustrative of the former we have

the spectacle of an epileptic insane father of three small children. He suffers from
frequent seizures and is shielded by the mother who, by her defense, blocks all efforts
to have him judged insane. He is finally placed under confinement by the testi-
mony of present neighbors.

In spite of the harshness incident to the visiting of present neighbors, it is con-
ceivable that the process may prove beneficial to families needing legal protection.
A refined German widow and her son, a mechanic of thirty, were both possessed of
fixed delusions of persecution, delusions which precluded their giving information
about friends or relatives. a physician, who had
The mother, when interviewed by
called at the visitor's request, was cunning to conceal her mental state
sufficiently
and send him away convinced there was no condition which justified his interference.
The next step, a deliberate and systematic canvass of the neighborhood, revealed
many startling facts about the couple but nothing sufficiently conclusive until a
neighbor stated that a physician had been seen to enter the home some weeks before.
The clue was followed up, and upon the evidence of this second physician, who was
an alienist, both mother and son were placed in a state hospital for the insane.
Many as are the manifestations of mental instability which threaten family
integrity, they do not present the intricacies of investigation which are offered by
the various types of immorality, including licentiousness, theft, fraud, begging,
begging letter writing, abuse of children other than physical, brutality, and extreme
intemperance. These latter conditions not only justify but they demand recourse
to any and every means that may give needed protection to children.
The investigation of such family situations, besmirched as they often are, pre-
sents exceptional difficulties; not only must the truth be discovered regarding people
who are interested in evading discovery and many of whose associates are of ques-
tionable character, but also the truth must be discovered so conclusively that it is
possible to provide witnesses possessing first-hand knowledge of the degraded con-
ditions and willing to testify to the same. Often only through a united effort of the
charity organization society and the court agencies is there a chance of discovering
the facts and of securing evidence sufficient to safeguard the children whose welfare
is involved.
For instance, the investigation of the cause of disintegration of the D family
began in the court and was carried thence to the charity organization society. The
original action was brought by the father, who requested that the judge of the
juvenile court place his children in institutions, claiming that his wife drank
heavily and failed to give them proper care. On the first hearing, Mrs. was D
exonerated, the children sent home, and the father ordered to contribute weekly
to their support. Mrs. D instituted the second hearing, claiming that Mr. D was
disobeying the court order, whereupon Mr. D was incarcerated in the county jail
for contempt of court. Interviews with the wife in the home and the husband in
the jail were contradictory in the extreme, and relatives and references of both
were so partisan as to make it well-nigh impossible to learn conclusively if the wife
drank to excess, which seemed to be the crux of the situation. An unsophisticated
drugstore clerk interviewed during a canvass of the neighborhood cleared up this
275
SOCIAL DIAGNOSIS
whole matter by naively stating he was in the habit of selling liquor to the D chil-
dren for their mother's use; a statement of quantities, dates, and hours at which it
was sold brought, when produced in court, the first conclusive evidence to the atten-
tion of the much
troubled judge.
Similarly, court officials and the charity organization society united to secure
data sufficient to satisfy the judges of two courts in which various members of
the C family were simultaneously arraigned. Pending the collection of evidence,
Mrs. C was released from the municipal court on suspended sentence, having been
charged with open and notorious adultery, and the children were paroled from the
juvenile court, pending the disposition of their mother's case. The school and the
landlord and various relatives were willing to give general statements; it remained,
however, for the neighbors in the rear tenement on the same lot to produce the evi-
dence of an eye witness necessary to convict the mother.
The rule of visiting present neighbors only in cases necessitating court evidence
holds in relation to families in which possibly there is little viciousness, but where the
abuse of the children is the result of ignorance and of low standards.
The grandmother and the drunken uncle to whom Grace and Johnny M were
old
paroled from the juvenile court never meant to harm the children, but still the
home was unfit and a menace to the children, both of whom were subnormal. The
efforts of the probation officer to secure sufficient evidence to remove the children
from this home were curiously frustrated by the fact that during the last months
Johnny had improved continuously and unaccountably in health, appearance, and
even weight, in view of which fact it was difficult to persuade the judge that the
home was entirely unfit. The explanation came when the visitor seeking evidence
of carousals in the home unexpectedly found the "good neighbor" in the baker's
wife, who proudly accounted for Johnny's improvement by the fact that she had fed
him regularly for weeks and, of late, mightily interested in his improvement, had
also been weighing him regularly.
The justification of the use of any method of investigation as harsh as this visiting
of present neighbors exists only in its beneficent results to the family. If we grant
that, as stated in the beginning, the use of this method is limited to such family
situations as contain inherent dangers, and keep in mind the solution of the family
difficultiescompatible with the best and lasting interest of all concerned, it is con-
ceivable that this conquering, this gaining the ascendancy through force mental
not brute, it is true, but still through force may prove the only means of aiding the
family.
This was written when Miss Sears was the district secretary of
a charity organization society and itgives the point of view of a
family rehabilitation agency. Its findings are confirmed by our
case record reading in other social agencies.
The records of an S. P. C. C. show many instances of the usefulness of present

neighbors in securing proof of insanity, of immorality, of the need of other guar-
dians for children, or of their physical abuse. These records also show that neighbors
are capable, out of pure spite, of lodging unjustifiable complaints against parents.
276
A hospital social service department finds neighbors invaluable in insanity cases.
One such case was that of a woman about whose daily ways, as evidence of her in-
sanity, was difficult to get any information. A neighbor in the same house helped
it
the department to procure a clear picture. Another patient came to the hospital
in such an excitable state that she was probably too dangerous to leave at large.
One of the hospital social workers took her home, but found no one there. A neighbor
in the same tenement house gave the necessary addresses of the patient's children.
A woman who was keeping a disorderly tenement petitioned the court for a revo-
cation of the decree that made a social worker the guardian of her thirteen-year-old
daughter. The mother's petition was denied after a long hearing. She afterwards
told a probation officer that the case was going her way at the trial until a neighbor
testified whose apartment was immediately over hers. When seen before the trial,
the woman's landlord and the police had denied that anything was wrong, though
the tenant had been in before on the charge of keeping a disorderly house.
jail
In court, however, the police confirmed the neighbor's story.
There is great difficulty in persuading neighbors to tell in court

what they know about the neglect and physical abuse of children,
and often no other witnesses can be secured to testify to the
specific acts of cruelty justifying removal.
A school
principal complained to the S. P. C. C. that a stepmother was suspected
of abusing her husband's children. One neighbor said, when seen, that the step-
mother had been drinking and carousing for more than two years back. A second,
a city employe, said that he could tell a horrible tale if he would, but that it was none
of his business. A third had seen the small girl hard at work before 5 a. m. The
city employe was summoned at the trial but did not appear, and the court returned
the children to the home to see whether they would not be treated better. But
how was this to be ascertained? The wife of the witness who failed to appear was
seen and reported further fighting, indecent talk, and the girl's being dragged into
the house by the hair of her head by the stepmother, but this informant would not
go into court because she was afraid of the woman in question. Another neighbor
confirmed this story, but also refused to testify. There was no difficulty in getting
a number of statements that tallied in all important particulars, but there was not
a court witness among them.
The same society received an anonymous complaint that the children were neg-
lected in a certain family. Their mother said that the complaint must have come
from colored neighbors with whom she had quarreled. The policeman on the beat,
the visiting housekeeper of the charity organization society, and the children's
teacher all believed that the charge was unfounded. The family was persuaded to
move to a better neighborhood, and the charity organization society continued its
visits.
Critical comments on the records of a large family agency con-

tain the following: "Much of the information gathered from
present housekeepers and janitresses is contradictory and of nega-

277
SOCIAL DIAGNOSIS
tive value. Often it is one-sided, and often totally misleading.

The reason for using this source and statements from previous
residences which are near the present one is that they are easiest
to get." Consultation with such sources to the exclusion of better
ones, or their frequent use at all in cases not requiring court action,
marks a low degree of social skill.
II. FORMER NEIGHBORS

Under the head of former neighbors may be included the tenants
at each former residence, the neighbors living nearest to these who
were there at the same time as our client, the local tradesmen, and
the landlords or real estate agents who rented to our client, also
the housekeepers, janitresses, etc., connected with the properties.
Landlords and tradesmen will be considered separately.
When removal has been only a short distance away, or when the
community is a small one, some of the objections made to inter-
viewing present neighbors apply also to seeing former ones. In
neighborhoods well removed from the present residence inquiries
quietly made do no harm and sometimes reveal facts of value,
especially in those obscure cases in which the evidence is very
contradictory or in which clues are not plentiful. The former
neighbor's experience is removed from the enthusiasms and irrita-
tions of daily intercourse and has acquired a certain degree of
perspective. It is still open to the objection, however, that it is
liable to be the experience of one who is not a good observer.
Especially important, in recording such statements, therefore, is

the habit of writing beneath them an evaluation of the witness's
personality. Such brief impressions must be clearly set apart as
impressions only, though it is often possible to add to them the
testimony of others, such as, "has a good name in the neighbor-
hood for trustworthiness," "said by the local tradesmen to be
quarrelsome," "standing in the community unusually good; re-
garded as a leader by his fellow-countrymen," etc.
When our list of clues includes five or six previous residences, a
good principle of choice is to select those in which the client has
lived the longest during the last five years. It may be necessary,
should we obtain contradictory statements from these, to visit all
the others.
278
If a family has arrived from another city and has immediately
become dependent, previous residences in other places may be our

only clues outside the family group at first, and out of these scant
materials a plan of treatment must be devised. Where there have
been many changes of both residence and neighborhood within the
same city, the character of the different neighborhoods is some
indication of an upward or downward trend in standard of living
often too the very time at which the stream of the family life was
bent from its natural course is thus suggested.
Sometimes unfavorable rumors in present neighborhoods are
disproved by a former neighborhood record. Sometimes, on the
other hand, the withholding of all clues to trustworthy informa-
tion is one sign among others of an anti-social purpose, and it is
necessary, for the protection of innocent people whose welfare
is directly involved, or even for the protection of the community
in some push forward with whatever slender thread may

cases, to
be discoverable. Here, too, the first clue is likely to be a previous
residence. Thus, we are able to utilize former neighborhoods in a
number of ways that are not only different from but less hazardous
than present neighborhood uses.
The matron of a children's charity reported of a certain cobbler whose family
were in distress that a relative of hers,who lived in the neighborhood, heard that
theman was employing three assistants and doing unusually well. At the cobbler's
former residence and shop this rumor was discredited.
In a city in which the charitable work for families had recently been reorganized
and an attempt made to substitute the idea of rehabilitation for the old, promiscu-
ous dosing, a citizen asked the reorganized agency to visit a woman who had been a
persistent beggar for many years, adding, in the letter containing the request, this
suggestive sentence: "Our agencies have looked after her many times, but I feel
that some action should be taken to change the general condition of her life, so that
neither an organisation nor individuals should be called upon to make so many decisions
per year in her behalf." Expert after fifteen years of experience with the aimless
questioning of many different givers, the woman would give very little information
about herself, except a long recital of misfortunes and the statement that her only
childwas feeble-minded. She did happen to mention one previous residence, however,
and near it was found a housewife who had lived in the same place for years and
knew that her former neighbor had several children, one of whom was a police-
man. When the policeman was seen at his home, he told of three married brothers
and sisters, and of seven uncles and aunts, some of them well-to-do. So far as
could be discovered, none of these had ever been conferred with before by the
agencies that had been making the "many decisions per year," nor had any evi-
279
SOCIAL DIAGNOSIS
dence been brought to light before that the woman's begging was a monomania, as
proved to be the case.
These supplementary clues to other sources (in the case just

cited clues furnishedby the former neighbor to the married chil-
dren and by them to the other relatives) are among the best
results of former neighborhood visits.
There is a great deal of evidence at hand, as a result of case
reading, of the extreme untrustworthiness of the ordinary run of
former neighborhood opinion. The following are fair examples:
"At 302 E Street landlord not at home; neighbors said family were a hard lot;
man and woman drinking all the time; evicted on account of non-payment of rent.
Had lived in house five years. Man had been discharged from the railroad because
he ran over a child and killed it. Said he was all right except for drink, but woman
was a wicked, bad creature." The evidence of the former landlord, seen later, of
the former employers of the man and of the woman, and of the family doctor proved
that these statements were altogether untrue.
The
janitress at the former address "has lived there about five years. Knew
allabout the family. Says she is a beautiful lady, and that the husband gambles.
'She drank a little but nothing to hurt,' and more in the same strain." Further
inquiry brought out the truth the janitress and the subject of the investigation
used to drink together, and both were untrustworthy.
"It is necessary to remember," writes Francis H. McLean,

"
that while others whom we consult may mislead . . . here
we enter the domain of mere gossip. . . Is it not fair to say
.
that one ordinarily cannot expect to receive a just picture of the

whole family from the angle of the old neighborhood connections,
but that they may bring certain concrete elements into relief?"
1
So much for neighborhood statements, but we must not forget

that neighborhoods, both past and present, speak for themselves,
that the physical condition of the house lived in 2 and its environ-
ment the character of the shops, the streets, the local amusements,
the play facilities are all eloquent to one who brings to them an
observant eye and a good basis of comparison.
III. LANDLORDS
Here as with employers and neighbors we must discriminate
between present and former. The present landlord is to be avoided,
1
*
See p. 151.
280
usually, by any agency whose connection with a tenant, if known,

would be liable to create prejudice against him. The landlord has
been known, also, to take advantage of any new philanthropic
interest to secure better returns from his property, and, as the
relation between landlord and tenant is a business one, it had
better remain undisturbed. When this statement was made to a
group of social case workers, two of them protested. One of these
worked in a small southern city where, in his experience, landlords
were actually more lenient with their tenants when they knew that
the associated charities was trying to help them. The other worker
was a district secretary in the Polish section of a large city, where
many of the Polish landlords reported their tenants to the district
office for assistance as soon as they failed to pay their rent promptly.
The first knew best a group of landlords who wished to share the
social agency's the second had in mind a group who
burden;
wished the society to help them rather than their tenants. The
divergence of view illustrates the importance of knowing local con-
ditionsand of accepting no social formula without testing it anew
with reference to these conditions. A kernel of truth remained
unchallenged, however; it was that the social worker must protect
from all unnecessary annoyance, and must get the needed
his client
factsfrom sources that will assure this protection.
Like foremen in large industrial establishments, the agent of
the property is often the right person to see, instead of the land-
lord. He collects the rent and so is in and out among the people.
Sometimes the landlord is also a tenant and sublets. In that
case heis a neighbor and is to be dealt with as such. In addition
to the neighborhood causes of bias, he is likely to be influenced by
an additional one in that the tenant who has paid his rent is a
model citizen, and the one who has not is under grave suspicion.
The landlord who is not a neighbor can show this same bias. An
unfounded complaint made to a society to protect children from
cruelty that a certain man's family and children were neglected
came from the man's landlord at a time when the rent was unpaid.
On the other hand, there is evidence at hand that landlords,
former ones more especially, can often give the one needed clue
the name and address, or information about relatives, work con-
nections, etc. that leads to helpful co-operation and a possible
281
SOCIAL DIAGNOSIS
solution. In addition to this, their account books are evidence of

the amount of the rent, of the way in which it was paid, and when.
In writing of janitresses or caretakers, Miss S. F. Burrows points
out 1 that we cannot draw conclusions from information secured at
former addresses without taking into account the type of house-
keeper interviewed, the differences between the family that for-
merly lived there and herself in nationality and religion, and the loss
to her if the tenant moved away in arrears for rent. Despite these
drawbacks, Miss Burrows feels that such caretakers can give us
some insight into "the attitude of the members of the household
toward each other as well as toward their neighbors; the class of
relatives or friends frequenting therooms; their habits of clean-
temperance, and morality."
liness, She would agree with Mr.
McLean, of course, in urging the most rigid analysis of all evidence
from old neighborhoods.
IV. OTHER NEIGHBORHOOD SOURCES

The local tradesmen are the most important Neighborhood
Sources not yet mentioned. The grocer, the druggist, and the
saloon keeper are the best known of these. The grocer is pre-
eminently a neighbor, but his account books reveal purchasing
habits and food habits. The druggist's value is illustrated by
Miss Sears, who is quoted on page 275. We should know the laws
regulating the sale of opiates, and realize that the druggist who
observes such laws strictly, especially while they are still new, is a
very unpopular man
some neighborhoods.
in
In most foreign neighborhoods there is some one man who stands
out as the representative member, the spokesman of the foreign
group. His position is not an official one, though he is often inter-
ested in local politics. He is a mine of information about the family
life of his compatriots, but he must know and sympathize with the
inquirer's interest before he will be frank.

This fellow-countryman
need not always be a present or a former neighbor. In the smaller
foreign groups, he is likely to know any of his own people who are
living in the same city.
One very important Neighborhood Source the social settle-
ment is not included in this chapter because the valuable evi-
1
282
dence thatit can give about the neighborhood background and other
important matters is considered under Social Agencies as Sources.

1. A tendency to lean heavily upon evidence from Neighborhood Sources marks
a low degree of diagnostic skill.
2. Present neighbors are often biased witnesses, because they wish to do a favor
or to pay off a grudge. I n

questioning them there is also risk of humiliating a client.
3. difficulties cannot be solved without the evidence of present neighbors,
Certain
however. These situations usually center around the need of legal protection or of
physical protection for someone whose welfare is seriously endangered.
4. It is possible to utilize former neighbors in a number of ways that are less
hazardous than are consultations with present neighbors, especially in cases in

which other evidence is contradictory or in which clues are not plentiful. In the
latter case a former neighborhood will often supply a supplementary clue.
5. The evidence of neighbors aside, neighborhoods speak for themselves, and
their physical, moral, and social characteristics those of the house lived in, of the
shops, the streets, the local amusements, the play facilities should all be noted.
6. Present landlords should be avoided usually by representatives of any agency
whose connection with a tenant, if known, would be liable to create a prejudice
against him.
7. The local tradesmen the grocer, the druggist, the saloon keeper are Neigh-
borhood Sources.
8. In foreign neighborhoods there is often some one man whose co-operation is
valuable because he stands out as the group leader, as the natural spokesman and
representative of his compatriots.
283
CHAPTER XV
MISCELLANEOUS SOURCES
review of outside sources of information and their uses
isnearing its conclusion. One of the most important sources
THIS of all is the social agencies themselves, but treatment of this
source has been reserved for the next chapter for reasons there
explained. The other sources to which no attention has yet been
given fall into three groups: (i) public departments not directly
engaged in social work, (2) business sources other than employers
and neighborhood tradesmen, (3) fraternal orders. None of these
requires very extended notice.

It was hoped that even a limited inquiry into the outside sources
now being used by social agencies would discover some useful ones
which were still quite generally neglected. As a matter of fact, a
number of these have been unearthed. Every new source evalu-
ated and held in reserve for the right occasion enriches social case
work and gives it greater flexibility. There is crudity everywhere
in the processes of an art so new, but the only discouraging case
work practice is that which settles back into a certain routine, a
certain round of things invariably done, without any fresh thought

or spirit of adventure. By comparison with the efforts of those
who are less experienced, such routine work may seem, on first
examination, fairly good, but there is a blight upon it; closer
scrutiny shows that no experiments are being tried, no established
method is being revised or discarded. Work not half so good may
contain far more promise, therefore, if it bears marks of dissatis-
and its manipulation.
faction with the tool
One marks is the habit of seeking unusual sources of
of these
knowledge and co-operation. Without imagination we do not find
even the obvious source that has been overlooked. Like Mr.
Deland's advertiser of carpets, 1 who realized that families were
1
Deland, Lorin F.: Imagination in Business, p. 43. New York, Harper and
Brothers, 1909.
284
more likely to buy floor coverings when they moved to another

house and then, after repeated experiments in wrong directions,
discovered that the one man who always knew when people were
going to move was the moving van proprietor, we must be able to
think of familiar things in a fresh and unfamiliar way. The unusual
sources mentioned in this chapter under business sources are
mentioned not so much for their value in themselves as for the
process by which they were brought to light. The same enterprise
that, in the agencies studied, discovered and used these will dis-
cover and use others.
I. PUBLIC OFFICIALS
Educational and health authorities have been discussed in earlier
chapters, and public charitable and correctional agencies and in-
1
stitutions are more appropriately considered under social agencies

than under miscellaneous public agencies.
1. Police. From one point of view the police seem an impor-
tant neighborhood source, so identified are they with the neighbor-
hood life. Nor are they infrequently consulted. In two of the
three cities studied, they rank seventeenth and eighteenth respec-
tively and in one even third in frequency of use.
The idea has often been advanced that the police forces of our
cities should be made up of men with the point of view and the
training of social workers. Boies in 1893 was probably the first
one to take this view, 2 but even a quarter of a century later the
actual situation hardly justifies the classification of police depart-
ments under social agencies, though advances in that direction
have been made, notably in New York City, under the adminis-
tration of Police Commissioner Woods. A probation officer some
of whose case histories were studied for this book declares that
the policeman is a too much neglected factor in social endeavor,
that he knows the families on his beat thoroughly, and is very
sensitive to the critical attitude taken toward him by some social
workers; after his personal friendship is won, there is nothing

that he will not do. True enough, but the attitude thus described
1
See Chapters XI, Schools as Sources, and X, Medical Sources.
1
Boies, Henry M.: Prisoners and Paupers, p. 241. New York, G. P. Putnam's
Sons, 1893.
285
SOCIAL DIAGNOSIS
is not the professional but the neighborhood state of mind. It is

only in the capacity of social witness, of course, that the policeman
is here considered, and even so the country as a whole, not any one
of its cities, is in mind.

Often the policeman holds so many rela-
tions, political and other, to the people who live on his beat that
he is not willing to tell what he knows when the telling would have
great social value and would be in no wise subversive of discipline;
nor is he always willing to discover the things which it is his special
task to discover.
A
worker in a child-protective agency suggests that, in cases
where such personal and political complications are likely to inter-
fere with the patrolman's usefulness, it is often better to seek
information through the sergeant of police. He is in line for pro-
motion, is anxious for court work for that reason, and, though still
closely in touch with his district, is no longer so dependent upon
the good will of its people. The individual policeman has been
known to withhold testimony against a family whose children were
neglected, for the reason that he was indebted to them for a useful
tip or for some other favor. Moreover, the statements of those
members of the force that are known by the judge to be untrust-
worthy are likely to be discounted in court.
After these drawbacks are given due weight, it is still not only
necessary to consult patrolmen in a good many instances, but per-
fectly possible, often, to establish an understanding with them
which win very valuable co-operation.
will
Usually three men patrol each beat, one in the daytime and
two who alternate at night. There is no record system. What
each one knows is known to him only, so that, where it is important
to cover the whole ground, each one of the three must be seen. It
is necessary to know the hours at which patrolmen and different
special officers can be found at the police station. The night

officers are particularly useful in child neglect cases, as the disor-
derly conduct that will be accepted as proof of neglect often takes

place at night.
In the search forrunaway boys and mentally disturbed adults
who have disappeared, it is necessary to communicate with the
police both in town and elsewhere. The chief of police in smaller
places is consulted a great deal by social workers at a distance,
286
who seek from him information as to the standing of former and

present residents, as to records of arrest, etc. If it is possible to
judge by case record reading, the police departments in these
communities are giving a better grade of social service than in the
large cities. They deal with many problems that are divided
among the varied agencies of the large place, and this fact alone
develops in them a degree of social experience.
2. Other Officials. The list of Miscellaneous Sources actually
used in the 2,800 cases reviewed shows occasional consultations,
though these are by no means frequent, with the following state
and city departments or officials: State, employment bureau, de-
partment of labor, controller, board of insanity, penal commis-
sioner. City, district attorney, city solicitor, assessor, treasurer,
sheriff, street inspector, store inspector, superintendent of news-
boys, town clerk, chairman of the board of supervisors.
Courts are not included here because, often, they have proba-
tion officers and other social workers associated with them and are
consulted as social agencies. More often still their official records
are the real source, and these are considered under Documentary
Sources. When it is necessary to consult an official of the court
it be found that the clerk remembers the case
will usually in ques-
tion better than the judge. In like manner, the town clerk in
small communities, or the official whose duties correspond to those
of the town clerk, is the one who knows most about his fellow
citizens. The town librarian is another possible source of com-
munity information, though he does not appear in the statistics
gathered.
Social workers must remember that most of these city officials
are desk men and
take a desk point of view. The impressions that
they get, aside from the documentary evidence that passes through
their hands, are the impressions not of those who work in the open
but of those who hear only the client's stories usually, and who
accept or reject these without the analysis or the readjustment of
view that follows naturally upon frequent home and neighborhood
visiting. Whereas the policeman is too much exposed to neigh-
borhood influences these others are not enough so. It is often the
social worker's task to explain to them the modifying circumstances
of an individual case as the facts come to light. Only in personal
287
SOCIAL DIAGNOSIS
interviews, where the desk man has the opportunity to explain

his own
point of view at length, can he be induced to modify it.
Again, the official who is already interested in a personal problem
is antagonized by letters and telephone messages, unless he has
had enough experience with social work processes to understand

their details without careful preliminary explanations, which are
given much better face to face.
The federal officials most often consulted are those in the bureau
z
of immigration, postmasters, l United States consuls, and officials
of the War and Navy Departments.
Foreign consuls appeared frequently in the case records read for

this volume. Here are a few of the matters about which they
were consulted: 8
A German consul in an American city was appealed to about a young German
officer who claimed that he had been obliged to leave the army because the death
of a relative had reduced his income. He asked to be sent to New York, where he
was sure that he could get work with the Hamburg-American Line. The consul
was able to throw some light on the young man's finances and on his chances of get-
ting work in New York.
An knew the region from which a miner, blinded through his
Austrian consul
own had originally come. There was no provision for the blind there
carelessness,
and the man had no family. The consul's first-hand knowledge of this Austrian
province determined a hospital social service department against deportation and
in favor of training for work in this country.
A Greek consul in one of our states undertook to get information in another about
the mother of a Greek girl who had run away from home because, as she claimed, her
mother had abused her. The consul, after inquiry by letter, gave the woman a very
good name, but a social worker, sent to the mother's own community later, dis-
covered that the girl's charges were more than justified.
A Greek consul helped a widow whose children were still in Greece, first by paying
her board while she received special treatment to recover the use of her arm; second
by asking his own sister in Athens to secure certain information about the children.
II. CERTAIN BUSINESS SOURCES

4
Employers and neighborhood tradesmen by no means exhaust
the list of business sources that may be used in social diagnosis.
1 *
See p. 336. See p. 336.
1
These were all consultations before August, 1914. The European war may
have modified the method of approach and the service procured in some instances.
4
See Chapters XII, Employers and Other Work Sources, and XIV, Neighbor-
hood Sources.
288
A firm with whom our client has had business dealings in the past,
or someone who
an authority on the fluctuations of a certain
is
market, or on a certain industrial process may be an invaluable

witness.
Sometimes it happens that the business dealings may have been
of the most casual kind the moving of furniture, its storage, its
purchase on the installment plan, the collection of an insurance
premium, the delivery of an express package but the details of
the transaction may reveal some bit of evidence that is all the more
valuable because it is circumstantial and not originally related to
the matter at issue.
A charity organization society was helping the drinking wife of a workman em-
ployed in another city. The wife was on probation, and the husband was sending
money to the society for the support of his family. Two insurance agents who
called to collectweekly premiums at the woman's home were able to give clues that
aided later in the protection of the children. The relation of such agents with the
homes that they visit is, of course, only a business one; these men were not willing
to have the information obtained from them used as evidence in court. It was
treated as strictly confidential.
A girl who came was so dangerously ill that she was transferred
to a dispensary
to the city hospital. The medical
diagnosis was obscure, and the only social in-
formation was her address. This was a lodging house to which she had recently
come; the landlady knew nothing but the name of the expressman who had brought
the girl's trunk. From him was procured an earlier address and from that previous
residence a pertinent history.
A summons for the father of six neglected children could not be served because
the family had moved, present residence unknown. The former landlady was able
to give the license number of the moving van that took their goods, however, and
through the police this number was traced to a local firm. They kept no record
when a family paid for the moving in advance, as this family had, but they obtained
the address from the driver of the team.
A charity organization society over 1,100 miles away wrote to an S. P. C. C. in

the interest of a child whose mother had deserted her home in the society's city,
had taken her little boy with and was living with a man not her husband. A
her,
neighbor known was asked by them to take the number of the

to the S. P. C. C.
moving van, if this couple moved away. As a matter of fact, however, they were
found in another city through the records of a sewing machine company from which
they had made an installment purchase. The father of the boy was sent to this
third city and there secured the legal custody of his child.
An Italian family, upon its first application to a relief agency,

often claims to have no relatives whatever. Where there has been
19 289
SOCIAL DIAGNOSIS
a death in the family, the undertaker often knows the name of the
male relative that managed the funeral.
One visit to an undertaker
in a large city brought an unexpected piece of informa-
tion. A middle-aged man

with a young wife and one small child had applied to a
charity organization society for relief and help in getting work. As the background
of his story was very scant, a' memorandum was made of the name of the under-
taker, in a neighborhood five miles away, who had "buried" his first wife. This
information had been volunteered, not sought. The undertaker knew all about the
first wife; she was a neighbor of his, still living and in excellent health. There had
been no divorce, her husband had simply disappeared one day, but she had no desire
to see again the man whom she had formerly had to support.
A somewhat unusual use of a business source of information is the following: A

hospital social service department was interested in an alcoholic case, a woman
whose only near relative was a daughter. The mother was unable to give this
daughter's address, as was also a cousin who was visited. The latter knew, how-
ever, that she was engaged to marry a professional baseball player whose name he
was able to give. The sporting editor of a daily paper supplied an address at which
the player was found.
III. FRATERNAL ORDERS

Benefit societies of the insurance type often have to be consulted.
They belong halfway between references of a business and those
of a social nature. The fraternal feature is more marked in the
foreign benefit orders, for in these the ties of a common past are
more binding. A
point worth remembering is that the one who
proposed our client for membership in the order is usually a person
well acquainted with him and with his family.
Of the fraternal societies, not of the insurance type, the oldest
and the one that appeared most often in the case records studied
was the Masons. This society's relations to social workers may well
stand for those of the whole group of sources to which it belongs.
Membership in the Masonic fraternity, even if a generation or
more back, is a fact worth knowing, as the society interests itself
in the descendants of members who died in good standing. In
some of the cases studied, members not in good standing were
helped generously, if not by their own home lodge, then by one
in the city oftemporary residence. This generosity is so generally
known has been imposed upon in the past, and the society
that it
has found it necessary to establish a "black list" of those who are

making fraudulent claims of membership and are begging from city
290
to city. The best approach for information with regard to a client

who is a Mason is by letter to the master of the particular lodge of
which he is or has been a member. If this is not known, a letter
to the grand secretary for the state will usually bring the name of
the master of the particular lodge and its address. Inquiry of the
client's lodge should include a definite statement as to the reasons
for asking information, give the possibilities of his case so far as
known, and ask for advice. Non-resident Masons in need of assist-
ance are usually cared for by a local Masonic relief association;
the order is not a relief body, however, but a fraternal one.
A hospital social service department was interested in a man whose arm had been
disabled by a fall. A
Masonic lodge in another city sent assistance, but explained
(through the local Masonic relief association) that the recipient had often been de-
pendent before the accident. As his arm got
better, he showed little inclination
to find work for himself, and the relative and the Masonic lodge that had been
helping both agreed to give their aid through an agency for homeless men which
powers of self-help.
tried to stimulate his

1. The unusual source newly discovered and evaluated and then held in reserve
for the right occasion is one test of diagnostic skill. It is a better test than the
attainment of a certain minimum (even of a fairly high minimum) of ground in-
variably covered in every case.

2. The policeman's strong points as a source of information are his intimate
knowledge of neighborhood standards and his first-hand witness of the goings and
comings within the neighborhood. His weak points are his political and other rela-
tions to the people, which tend to make him as unsatisfactory as any strictly neigh-
borhood source.
3. If the policeman is too much exposed to neighborhood influences, many public

officials, who are desk men, are not enough so. As a means of arriving at a common
understanding, personal interviews with them, in which their exclusively desk point
of view can be supplemented, are far better than letters.
4. Among the business sources cited in this chapter are some implying relatively
slight contacts, such as insurance collecting, the moving of furniture or trunks, the
sale of a sewing machine, etc. These are mentioned, not because they are frequently
of value, but because they illustrate the process by which an item of circumstantial
evidence may be so used as to uncover important data.
5. Benefit societies of the insurance type have more marked fraternal features
in the foreign groups. The one who proposed a given person for membership in
such an order is frequently well acquainted with him and with his family.
291
.CHAPTER XVI
SOCIAL AGENCIES AS SOURCES
some of us the team sense, which is the psycho-
work, never ex-

WITH logical basis of co-operation in social
"
tends beyond a rather mechanical and listless belong-
ing"; with others it develops and attunes every faculty. The
"
team, according to Joseph Lee, is created by assuming that it
exists and acting boldly out from that assumption. It grows as its
members have power to imagine it and faith to maintain, and
act upon, the reality of that which they have imagined." 1 All
co-operation is primarily an act of faith. It implies vision, trust,
and a common goal.

Though this theme is an inspiring one, which invites digression,
its consideration here must be confined to its relation to social
diagnosis.
The writer was at one time chairman of an informal committee
of charity organization workers which attempted to give advice
by correspondence to colleagues in widely scattered communities.
One such fellow worker, who had just become executive secretary
of a society long established but with a none too prosperous past,
wrote for suggestions about co-operation and added, "The investi-
gations made by this society are very good indeed, but there is
no co-operation whatever among the social agencies of the com-
munity." As gently as possible, an attempt was made to discover
the diagnostic habits of this organization, which had so completely
with its social environment. Inquiries
failed to establish relations
were fruitless. The
reply came back that their investigations were
"all right," and that what was wanted was light on an entirely
different subject.
Case work co-operation of some sort is possible, perhaps, with-
1
Lee, Joseph: Play in Education, p. 339. New York, The Macmillan Co.,
1915.
292
out intelligent diagnosis, and a very poor sort of diagnosis is pos-

sible without the co-operation of case workers in other social
agencies, but, wherever the processes of co-operation and of inves-

tigation have progressed far enough to have genuine social better-
ment for their aim, they might almost be described as one piece
of goods. In its relations with client, client's family, and outside
sources, diagnosis with a social aim is a fine exercise in working
together. Gross is quoted at the beginning of this book as saying,
"The trained man understands how little the mind of an individual
can grasp, and how many must co-operate in order to explain the
very simplest things." Working together in order to understand
and achieve is always a more fruitful process than co-operating
in order to co-operate.
There seem to have been in this country four stages of develop-
ment from competition to co-operation in social work. Needless
to add, all four of these stages exist today just as the phrenolo-
gists still exist (and prosper apparently) in the very communities
that have given to the world some of the important discoveries of
experimental psychology.
(1) The first or competitive stage was chaos. Some of the
charitable conditions of that earlier time actually created a demand
for child inmates among certain groups of institutions, and stout
objection to any reform that "cut down their figures" extended
to many charities besides those for children. The absence of com-
mon understandings, of any unwritten code governing the behav-
ior of social practitioners toone another, was another ugly char-
acteristic of this competitive period in social case work.
(2) The approaches to social co-operation were like the

earliest
earliestapproaches to social diagnosis they were made in vacuo.
The competitive period was succeeded by a series of extremely
awkward attempts most of them unrelated to replace competi-
tion by co-operation. As a result of this awkwardness, the latter
word came to have some unpleasant associations. Miss Birtwell
has noted 1 that at this stage our facts were gathered together,
then our plans were made, and later the investigating agency
"
appealed for co-operation wherever there was promise of support
"
for those particular plans. We took to heart," she adds, the mild
1
293
SOCIAL DIAGNOSIS
reproach of a Catholic priest, who once said to one of our young

'
workers: You make your investigation and form your plans, and
then assign me a part in them; but I want to come in at the very
beginning, where my people are concerned.'" The method thus
complained of was characteristic of the period of co-operation
in vacua.
Further attempts to conquer chaos were by a routine division
(3)
of caseson the basis of territory, of nature of need, etc. Here belong
also the beginnings of any systematic interchange of information
through registration bureaus, confidential exchanges, or social

service exchanges, as they have been called at various times and
in various places. l These emphasized the avoidance of duplication,
at first, but now regard elimination of waste as a by-product of
more constructive gains. Some of the agreements and reforms of
this period have led to excellent results, and co-operative develop-
ment would have been impossible without them, but traces of their
inauguration as found in the case records of organizations that
made the mistake of leaning too heavily upon the new devices
suggest that all such arrangements have their dangers. Through
unimaginative or selfish use, they may develop the characteristics
of those agreements in the business world which ignore the interests
of the consumer with us the client. The social diagnostician
must, of course, consider his relations with his client as of even

greater importance than his relations with the social agencies of
his community. To accept every statement of a social agency at
its face value, to regard every professional opinion as equal in
specific gravity to every other, may be a convenience when the
confidential exchange first becomes available; this acquiescence
may save trouble to the consultant and to the agency consulted,

but the assumption can do the social case worker's clients grave
injustice nevertheless.
Just after "joint traffic agreements" among social agencies have
become popular in a community, one may expect to find in its
case records the conclusions of co-operating agencies accepted

without any of the data upon which they are based, may expect to
see recorded many duplicate descriptions of the present situation
of clients, and may observe the gossip and guesses of workers with
1
Described p. 303 sq.
294
differing standards promoted to the dignity of "an investigation."

All of this is part of the price of progress, probably, but no time
should be lost in progressing beyond it. It is distressing to find
unfavorable data overemphasized. Perhaps records of arrest and

imprisonment were not open to the social agencies previously;
when they became accessible through the exchange it was easy at
first to put too much emphasis upon the mere fact of a previous
arrest, without seeking the details that would have explained

its possibly accidental nature. Or perhaps a previous application
for relief had come to light automatically under a new plan of
interchange between agencies, though the client had denied having

made any previous application for help. Is he a fraud? Not
necessarily. Many harmless men and women might be given a
bad name in this fashion, or, to take the opposite possibility, a
client's record might bristle with respectable social authorities and
endorsers, yet contain few facts and fewer insights. What is

needed and this need, be it remembered, cannot be well met with-
out complete interchange of information among agencies is a
sense of the main drift of a client's life, a summing up at some one
stage, preferably an early one in each case, of the assets and liabili-
ties in character and environment with which social agencies have
to deal if they would win their way to a helpful result. Variations
in points of view, provided that each is based upon a real experi-
ence, help us to think. We are most helped, in fact, by the ex-
perience of the agency least like our own, but the right of each to
compare its experience with other experiences and to reason about
itshould not be abrogated. When it is, we encounter the chief

danger of the period of joint traffic agreements.
These frankly stated drawbacks are no argument, however,
(4)
for a return to chaos. They urge us, rather, to push on toward the
logical next step in co-operation toward the kind of honestly
evaluated sharing, toward the increased social responsibility, which
not only avoids mischievous interference with the client's best
interests, but can be of inestimable value in furthering them.
Devices have their place in such a development; understandings
of a formal sort have their place. At one stage it may be neces-
sary to have a more or less arbitrary division of work. For ex-
ample, it may be wise to have an agreement between the charity
295
SOCIAL DIAGNOSIS
organization society and the visiting nurse association that the

nurses will turn "family problems" over to the family agency, and
that the family agency will turn over all "health matters" to the
nursing agency. It is illogical to assume that there is any clear
line of demarcation between these two things, but some such
division may be a working necessity.
A truer co-operation will soon cut a gateway in the fence thus
put up, however, and will be sure to find in addition a section of
ground which must be occupied in common, if the best work is to
be done. When this more highly developed stage in working
together is reached, the understandings growing out of it will defy
statement in a bald formula. 1
Co-operation based on responsibility for the result of our social
acts, co-operation advanced by sound and thorough professional
training, fostered will, by social zeal, and by unhampered
by good
freedom of discovery, leads us away from "understandings" and
into a daily deepening understanding. This latter is a matter of
the spirit. Freedom to learn, to grow, and to serve is fostered by
co-operation of the spirit. This is the fourth and highest period
of social co-operation, for which the other periods are only pre-
paratory.
I. TWO DISTINCT FUNCTIONS OF SOCIAL AGENCY TESTIMONY

Returning to the statistics of outside sources once more and for
the last time, we find that, even when the medical, social, and school
sources considered in other chapters are excluded from our total of
social agencies, there remains a larger number of consultations with
this lattergroup than with any other. Relatives (next in order of
frequency) were consulted 1,187 times, whereas public and private
1
My apple trees will never get across
And eat the cones under his pines, I tell him.
He only says,"Good fences make good neighbors."
Spring is the mischief in me, and I wonder
If I could put a notion in his head:
"Wby do they make good neighbors? Isn't it

Where there are cows? But here there are no cows.
Before I built a wall I'd ask to know
What I was walling in or walling out,
And to whom I was like to give offense.
Something there is that doesn't love a wall,
That wants it down." Robert Frost in North of Boston. London, David
Nutt, 1914.
296
social agencies the deductions just named having been made

were consulted 2,243 times, or, if we
include church sources, 2,748
times. If the plan of presentation adopted for outside sources
had been followed strictly, social agencies would have been pre-
sented first of all. But, as sources, these agencies seem to belong
upon another plane. In order to emphasize this difference, they
have been reserved for separate treatment at this much later stage.
Somewhat different tests must be applied to the evidence given
by social agencies to social agencies from those applied to the state-
ments of any other outside sources: first, because the relation that
these organizations have held to a client is in many respects similar
to the relation now held by the inquirer; and second, because of
the variety both of the tasks that social organizations perform and
of the attitudes that they at present take toward the processes lead-
ing to diagnosis. The variety of their tasks is shown by Table 5,

on the next page, and the nature of their relation to their clients
brings us to the most important distinction to be made in evaluat-
ing social agency testimony.
This distinction is based upon the fact that social agencies can
be called upon to fulfill two different functions as witnesses:
1. To Supply Data from Their Own Experience. They may
have had a social experience of their own with a client, and
we may need to know that experience. Even when the ser-
vice undertaken for him was quite from that which
different
we ourselves are about to attempt, it may have fulfilled all the
1
difficult conditions of an "investigation by experiment"; in that
case, it may help us to know the client's reactions and may give
us a key to certain of his personal characteristics. Social agencies
are often at their very best as witnesses, when they are reporting,
without bias, a first-hand experience of this kind an experience
acquired in the course of treatment. Of course, the better they
understand their client's background, the more intelligent will be
their interpretation of this experience.
Institutions for adults and for children frequently supply just
this experience type of data. They have the advantage, when they
are not too large, of being able to control the conditions under
which their observations are made far better than these can be
1
See reference to this term on p. 86.
297
SOCIAL DIAGNOSIS
TABLE 5. SOCIAL AGENCIES (EXCLUSIVE OF HEALTH AND SCHOOL

AGENCIES) USED AS SOURCES BY 56 AGENCIES IN 2,800 CASES
Type of social agency

Plenty of evidence is at hand that, when case workers can see the asylum official
who knows their client, they get valuable data as to the client's personal habits.
The temporary homes utilized by children's agencies during a period of observation
(investigation by experiment) are also useful aids in diagnosis.
Children's institutions that are excellent witnesses as to their own experiences

with inmates have only the vaguest of extra-mural data about them.
may still
They may admit them, discharge them, send them home temporarily at vacation
time, and place them permanently with relatives or with strangers on knowledge
that would be regarded as inadequate by any humane person who was seeking a
home for a stray cat or dog. It follows, of course, that institutions of the type that
Miss Florence L. Lattimore describes in her study of Pittsburgh are not competent
witnesses as to family conditions either past or present. Nor is their investigation
of placing-out homes any better. In 1907, the date of Miss Lattimore's study, one
of the largest homes in Pittsburgh allowed children to be taken out "by any woman
of respectable appearance who applied at the institution, filled out a blank, and
l
waited for the child to be dressed."
Even in our estimate of an institution's intra-mural testimony

the point of view of the institution witness must be taken into
account. In fact, the personal point of view must be probed for
and allowed for everywhere. One amusing instance of this ap-
pears in a medical-social record:
A temporary home for working women was asked to report upon the conduct of a
certain girl. The home replied that she was troublesome, unruly, and hard to con-
"
trol. When asked for detailed examples of her behavior, they wrote as follows: We
told Mary that she could not crochet in this house on Sunday. We had to speak
a second time about this and send her to her room. Later, we found her disobeying
upstairs. We do not allow gaiety of any sort in this house on Sunday, not even
light music. You know we must keep up a certain standard."
A very different point of view one that is also based largely on

experience, but upon experience of a more flexible kind is that
supplied by the social settlement. The settlement thinks instinc-
tively in terms of neighborhood reactions. This is a type of evi-
dence so little known to numbers of case workers that they do not
consciously seek it, as they should, or recognize its absence. 2
A head worker in a settlement, who had formerly been for a year in a charity
organization society, writes, in reply to a question about changes in her point of
1 "
Pittsburgh as a Foster Mother," in the Pittsburgh District, Civic Frontage,
p. 348.
* For a
good illustration of the type of neighborhood evidence that a settlement
worker of experience is able to give, see the descriptions of foreign neighborhoods in
Boston in Robert A. Woods' Americans in Process. Boston, Houghton Mitrlin,
and Co., 1902.
299
SOCIAL DIAGNOSIS
view: "The is continually gauging cause and effect in neighbor-

settlement worker
hood and by continuous experimenting in lines of action tending toward
reactions,
a fuller citizenship comes to develop a sort of intuitive sense of the practicability
of plans. Because of this on the part of the settlement worker and the training in
analysis and deduction on the part of the charity organization society worker, the
two should work together closely far more closely than they do.
"
From the settlement I have gained that subtle, interpretative method of deal-
ing with facts which I believe can only come by steeping one's self in the standards,
manners, and customs of races, and by entering into the community life of a neigh-
borhood. By so doing one becomes sensitive to the varying tendencies of a district,
and hence one comes to interpret the lives of individuals with all the gradations of
shading which make fact true. Had entered as fully into the lives of the working
I
people when in charity organization work as I have the past two years, I know I
could have done much better in my charity organization contacts."
To another group of sources, to the churches, social case

still
workers may turn for personal experience more freely than for
objective data. The degree and variety of contact with parish-
ioners are very diverse, however, in the different religious denomina-
tions and in the churches for different nationalities. A pastor or
priest of the foreigncommunity an American city is often the
in
one to whom members of the community most naturally turn for
advice in temporal matters also for the interpreting of letters and
for a variety of other services, each of which gives him added
insight into the daily lives of his people. Parishes are sometimes
so large and their clergy so overburdened that this ceases to be
true, but in smaller communities it often holds true of both the
foreign and the native American clergy.
In court work, both clergymen and settlement workers hesitate
to give the testimony that they have to give, even when this would
substantially aid in assuring a much desired result. The ground
of their hesitation is the possibility of estrangement in future re-
lations with the families involved. Social workers who are eager
to bring about a certain beneficent result the protection of chil-
dren from neglect, the punishment of a deserter, etc. must learn
and to protect the parish and neigh-
to respect this point of view,
borhood representative from involvement, whenever this is possible.
Like the judge, the clergyman leans to a too great faith in con-
version on the spot. In fact, the latter often takes a deliberately
optimistic view which impairs his value as a witness in court and

out.
300
In churches which employ a pastor's assistant, deaconess, or

church visitor, this worker often knows more of the things that the
case worker seeks information about than the minister does.
2. To Supply the Results of Their Inquiries. There is a second
function of social agencies as witnesses; namely, to supply those ob-
jective data of a fundamental sort about clients which seldom
change. Gathered originally by a particular organization for its
own purposes, these facts may, if collected carefully in the first
place, serve equally well, and with substantial economy of time
and effort, the purposes of a second organization. A more im-
portant saving, even, is the wear and tear to the sensibilities of a
client who might otherwise be harassed by needless questioning. 1
It will help us to evaluate the evidence of social agencies more
justly if we can keep quite distinct in our own minds these two
functions of theirs as witnesses. In their testimony from personal
experience they are witnesses of their own knowledge; in testimony
based upon data that they have gathered they are often witnesses
to matters of hearsay. Even in this second capacity, they have
the advantage sometimes, though not always, of a certain skill in
the weighing and testing of evidence. If their items of outside
evidence have been recorded and duly credited to their sources

at the time that they were gathered with sufficient fullness and
accuracy to make them clear, and if the written record is always

consulted before reporting to another agency, the danger of error
is materially reduced. Danger of error in the original observation
remains, however, and no one agency is ever an equally good judge
of all kinds of data.Agencies that habitually neglect certain ob-
servations may be very keen about certain others. Such differ-
ences can be discovered by practical experience only. The par-
ticular type of social work engaged in, with its natural limitations,
isone guide; the history not only of the individual agency but of
the form of effort of which it is a part is another; the past relations
of the given agency to the one seeking information is still another;
but the most important factor of all is the native ability and pro-
fessional equipment of the individual case worker who made the
original observation or who represents the agency as witness, and

this is a changing factor.
1
See also the discussion of duplicate investigations on p. 3 1 1 .
301
SOCIAL DIAGNOSIS
A case worker who removes from one city to another must revise all his standards
of measure of social agency testimony.A charity organization society or associated
charities, for example, is usually an agency that thinks of and knows a family as
a whole. Relatively speaking, it has an unusually clear idea of the family histories
and background of its clients, is well grounded in the habit of conferring with rela-
tives,health agencies, former employers, schools, and the social agencies interested.
It isnot so strong in ability to gauge neighborhood influences; it too often neglects
to individualize each growing child in the family; it sometimes emphasizes health
and self-support at the expense of less measurable but very important social gains.
But in certain cities the societies bearing the name of charity organization society
or of associated charities are only rudderless, small-dole agencies, operating without
plan or purpose. Obviously, it is necessary to look beyond the name and the
avowed objects of a society in accepting its testimony.
A may have been well trained, but may be employed by an agency
case worker
under conditions that make it impossible for him to do trained work. These con-
ditions limit his Some public departments,
competence as a witness, of course.
with reference to the question of ability or inability
for instance, investigate chiefly
to reimburse the state, or with reference to legal settlement. Others have rules
that so many references three or four are to be consulted. Limitations of this
order must be known and allowed for.
A radical management in an agency often makes it necessary to note

change of
whether a particular investigation, together with the inferences and plan of treat-
ment drawn from it, was made before the change or after. One of the case readers
for this volume spent two months in a society to protect children from cruelty in
which there had been a change of management. After reading a large number of its
records, she wrote:
"
Even those cases in which only one or two or three interviews are thought to be
necessary show an absolutely new way of approach since the change. I think I
mentioned before that, under the old regime, unless the evidence of the investi-
gator's eyes, backed up, perhaps, by a policeman or a neighbor, showed obvious
neglect, the entry'Nothing for us to do' was by no means uncommon. I have not
found one case, under the new regime, where this sentiment is expressed in letter or
in spirit. There is always something for the S. P. C. C. to do, though this is not
always taking the case into court."
This last illustration might also point the moral that agencies
skilled in the gathering and recording of objective data are usually
the ones most likely to continue treatment long enough to gather
also a rich store of personal experiences. This is not always true,
however. Resourceless treatment, together with inability to
recognize the significance of reactions to treatment, may follow a
fairly good social diagnosis. It should be repeated, therefore,
that the two types of evidence as to actual, first-hand experiences

with clients, and as to objective data gathered outside about them
302
must be distinguished, and that from each social agency must

be had the type of witness that it is best able to give. Social
agencies are not what Francis H. McLean calls a "single-headed"
source. 1 They are so far from being this that they presented, in
the material studied for this book, examples of the very best and
of the very worst social reporting.
With the increasing activity of social organizations and with
theirmarked tendency toward specialization, has come a new need
of some systematic exchange of information. This has become a
prime necessity, if only to fix responsibility for social treatment,
though it has many other advantages. As we have seen in the
chapter on The First Interview, the first step, upon receipt of an
application from a new client, is to discover what other social
agencies, if any, are acquainted with him. This discovery is
facilitatedby the regular exchange of information among agencies,
by an exchange of the identifying data which will
or, better still,
lead us to sources of information. Very easily and conveniently
these identifying memoranda lead to an exchange of information
when it is needed and not otherwise.
II. THE CONFIDENTIAL EXCHANGE

Someyears ago the writer had occasion to consult an oculist
in a strange city. He proved very skilful, so that when she re-
moved her home from Philadelphia to New York and needed to
choose another regular oculist, she asked the advice of this one.
Upon her first visit to the New York practitioner thus selected,
she tried to give the history of former eye treatments, first in her
old home, then in the city only visited, and so on, making a sincere
effort todo this as accurately as she could. But the new doctor
received these communications with an air of skepticism. It
appeared that he had been supplied with more trustworthy data

already; the specialist who had recommended him had sent him a
detailed statement of the Philadelphia prescriptions, and of his
own findings and prescriptions. These were more truthful than
the oral witness of the patient for two reasons: they were taken
from memoranda made at the time, and, more important, they
were taken from memoranda made by expert reactionists.
1
See p. 175.
303
SOCIAL DIAGNOSIS
Such communication direct from practitioner to practitioner

greatly reduces the percentage of error in every profession, and
upon the need of some such direct interchange of experiences in
social work is based a system now widely adopted, especially in our
larger cities, and already referred to in these pages more than once.
It was known as the "registration bureau" and later as the
first
"confidential exchange," or the "social service exchange." Its
use brings other minor advantages, such as a checking of the ten-

dency (not confined to the clients of social agencies) to run around
from adviser to adviser. Doctors, lawyers, architects, and many
other professional men, probably, know the type of nervous in-
decision, of speculative fever, of which such running around is only
a symptom.
The Confidential Exchange was devised by the charity organi-
zation societies and is still financially supported or administered or
both by these societies in most places. Better diagnosis, better
treatment, better understandings among agencies, are its out-
standing achievements, but incidentally it has reduced duplica-
tion of effort, has increased the sense of responsibility of the social
agency definitely in charge of the individual case, and has been,

moreover, a real economy. Its advantages are not confined to the
processes of social diagnosis, for, long after treatment has begun,

an inquiry at the Exchange from another agency about one of our
clients may enable us to prevent unnecessary interference or may
assure much needed co-operation; but the present account of the
Exchange is limited to its uses in diagnosis.
Wherever there has been no Exchange and then one is estab-
soon vividly illustrated by such
lished, its possible usefulness is
instances as the following, taken from Miss Margaret F. Bying-
1
ton's pamphlet study of Exchanges:
In another city a Confidential Exchange is just being started, and the infant
mortality nurses and the tuberculosis nurses have not yet learned to use it. One
family was badly infected with tuberculosis, the father dying, and the mother in an
advanced stage of the disease. There were seven children, the youngest a nursing
baby. The tuberculosis nurse kept urging the mother to stop nursing the child,
but she refused to do so. Finally the tuberculosis nurse found that the infant
mortality nurse had been visiting the family and, not knowing that the mother had
1
The Confidential Exchange, p. 8.
304
tuberculosis, was insisting that she nurse the child. When the two nurses got to-
gether on the case, it was too late, for the baby died of tubercular meningitis.
Here was failure to consult owing to ignorance of the other

agency's relation, but our case reading shows many instances of
such failure where the other agency's relation was known. This
sense of self-sufficiency, this tendency to operate in a vacuum,
is worn down by the successfully administered Exchange. Not
all who have
the advantage of a local Exchange use it, as the case
just cited also shows, but a few such happenings as this one (and
oversights quite as serious are brought to light as soon as an Ex-
change is started) convey their own lesson.
The following brief description of Confidential Exchange ma-
chinery is Miss Byington's: 1
"The mechanism of the Exchange is an alphabetical index with
a card for each family or unattached person known to any of the
inquiring agencies. This card gives the 'identifying information'
the names, ages, and occupations of the members of the family
group, names and addresses of relatives, and the names of agencies
interested, with the date on which each inquired. No facts about
family history or treatment are included. When a co-operating
society becomes interested in a new family, or in any one of its
members, it inquires at once whether the Confidential Exchange
knows the family or person. This inquiry is made either by tele-
phone or by mail on printed slips furnished by the Exchange.
The Exchange looks up the family in the index, and then reports
to the inquiring agency the names of any societies that have been
previously interested and the dates on which they inquired. If the
information given by the inquirer is not sufficient to make identi-

fication possible, the
agency so notified, with the request that it
is
inform the Exchange when further facts are secured. 2 The Chil-
1
The
Confidential Exchange, p. 5 sq.
*
The
following on the subject of identifying information is part of a longer pas-
sage in Wigmore's Principles of Judicial Proof, pp. 64-65. "The process of con-
structing an inference of identification . . . consists usually in adding together
a number of circumstances, each of which by itself might be a feature of many ob-
jects, but all of which together can conceivably coexist in a single object only.
Each additional circumstance reduces the chances of there being more than one ob-
ject so associated. . . . It may be illustrated by the ordinary case of identifi-
cation by name. Suppose there existed a parent named John Smith, whose heirs
are sought; and there is also a claimant whose parent's name was John Smith.
The name John Smith is associated with so many persons that the chances of two
ao 305
SOCIAL DIAGNOSIS
dren's Aid Society, for example, inquires about Mrs. Mary Jones,
and informed that the North End Mission 'inquired' in January,
is
1910, the S. P. C. C. in December, 1910, and the Social Service
Department of the Massachusetts General Hospital in March,

1911. The
Children's Aid Society then calls up, or, better still,
personally interviews, all these agencies, and secures directly from
them what data they have about Mrs. Jones and the story of their
relations with her. Experience has indicated that it is wiser to
have no information in regard to the family pass through the office
of the Exchange; that it should give only the names of interested
societies."
It will be noted that agencies no longer "register" but "inquire,"
thus placing the emphasis on the more important part of the proc-
ess. No one not directly and disinterestedly concerned, no one
who cannot prove that social betterment is his aim, should be en-
titled to even the colorless data that the Exchange can supply.
Its facts should be carefully guarded from those who might put
them to other uses, such as installment collectors or other credi-

tors. Instead of invading privacy, the Exchange assures it. Where
there is no such aid to co-operation, or where agencies whose lines
may cross refuse to make systematic inquiry of an Exchange already

established, it becomes necessary, in order to be sure that effort is
not being duplicated and that useful insights are not lost, to in-
quire directly of each agency that might have known a given
client.Each such repetition of a client's name to an agency that
does notknow him is rendered unnecessary by the existence of an
Exchange in which all the social agencies are participants.
supposed persons of that name being different are too numerous to allow us to con-
sider the common mark as having appreciable probative value. But these chances
may be diminished by adding other common circumstances going to form the com-
mon mark. Add, for instance, another name circumstance, as that the name of
each supposed person was John
Barebpnes Bonaparte Smith; here the chances of
there being two persons of that name, in any district, however large, are instantly
reduced to a minimum. Or, add a circumstance of locality, for example, that
each of the supposed persons lived in a particular village, or in a particular block
of a certain street, or in a particular house; here, again, the chances are reduced
in varying degrees in each instance. Or, add a circumstance of family, for ex-
ample, that each of the persons had seven sons and five daughters, or that each had
a wife named Mary Elizabeth and three daughters named Flora, Delia, and Stella;
here the chances are again reduced in varying degrees, in proportion to the probable
number of persons who would possess this composite mark. In every instance, the
process depends upon the same principle the extent to which the common mark
is capable of being associated, in human experience, with more than one object."
3 06
In a small city where the Confidential Exchange is still a new thing, a worker in a
family agency reports that she must also call up the overseer of the poor about each
new application to her office, because he does not use the Exchange. She has found
itnecessary to communicate besides with a missionary who is often working in an
unrelated way with the same families. The confidential character of the work of
the family agency, the overseer, and the missionary would have been conserved if
all three had used the Exchange, for then no client's name need have been mentioned
to an agency not already acquainted with him.
The reason most often given by a social agency for refusing to use
the Exchange is that its relations with its clients are too confiden-
tial.
1
As just shown, this objectionbased upon a misappre-
is
hension. Nor does an agreement to make systematic inquiry

imply obligation to inquire in every single instance. There may
be exceptional cases in which no inquiry need be made or should
be made, though these exceptions will not be many after the true
nature and value of the Exchange have been made apparent by
itsfrequent use.
course be understood that the Exchange
It will of is not confined
to an indexing of the recipients of material relief. It is a key to
the knowledge and activities of those who have rendered or are
rendering social service in any form, and its usefulness is being
rapidly extended far beyond the boundaries of relief societies and
other charitable agencies.
Both of these objections that their work is confidential and
that it is not relief have heretofore held back many of the social
settlements from making inquiry. In so far as their work is with
a whole neighborhood, inquiry of the Exchange is not practicable,
of course, but case work of any kind social betterment work,
that is, with individuals is helped by the Exchange, whether it
radiates from a settlement, a church, or a private family as its

center. "To the casual onlooker," says Miss Byington, "the
Confidential Exchange, with its files of cards, must seem to em-
body the maximum of red tape with the minimum of 'charity.'
We must kindle his imagination, that he may see as we do that
behind the machinery is a constructive force; that the Exchange is
not a device for preventing overlapping of relief, that it is not a
benevolent detective agency, but that it does conserve and render
1
See The Confidential Exchange, p. 13.
307
SOCIAL DIAGNOSIS
more efficient our service to an important section of the com-

1
munity."
III. THE USE OF EXCHANGE DATA
The old adage about bringing a horse to water has been illus-
trated in the course of our case reading by the very perfunctory
use made of the Exchange by some of the agencies studied. It is
necessary to inquire of the Exchange before acting instead of after,
if the clues suggested by its reports are to be of any real service.
And there is no particular merit in consulting the Exchange, even

with great promptness, if the clues which it furnishes are not in-
telligently followed up.
It is true that, in a city in which the Exchange is well established
and widely used, the clues furnished are sometimes bewilderingly

many; some of them may yield little of value; and always the time
element makes necessary an intelligent choice of the order in which
social agency clues shall be consulted.
In the case of Boston, where so many agencies inquire of the
Exchange that this is particularly true, the writer has had the op-
portunity to examine a group of reports on the practice of a large
number of agencies using the Exchange. 2 Some send letters at
once to clues furnished by the Confidential Exchange, some
all
select for a consultation the agency most like their own, some
first
consult first the one that is most conveniently situated for a prompt
personal interview, some go first to those in whose methods they
have the most confidence, many consult at once the agency that
inquired last of the Exchange, and many others consult first the
Associated Charities, when its name appears in the list of clues,
consulting next the agency most like their own. These reports
cannot be taken as proof of the wisdom or unwisdom of any
definite principles of choice they were gathered too informally
but they are suggestive. The agencies that always consulted the
Boston Associated Charities first usually gave as their reason that
1
Miss Byington makes it clear that something more than good clerks and a sound
office system is needed in a successful Exchange. It must be administered by social
workers who are fully alive to its progressive case work possibilities. It must be
assured continuity of policy, and that policy social in the highest sense. The Con-
fidential Exchange, p. 22.
1
Contained in notes of two informal conferences held in April, 1915. by students
of the Boston School for Social Workers, for which the writer is indebted to Miss
Zilpha D. Smith.
3 08
agency studied the general family history very care-

this particular
fully, and always covered the clues furnished by the Exchange,

thus rendering first-hand consultations with each and every one
of these clues unnecessary. The agencies that invariably consulted
firstthe Exchange inquirer of latest date usually gave as their
reason that this source was most likely to know about the present
situation.
Here we have somewhat divergent tendencies, which recall the
principle of choice suggested in Chapter VIII, Outside Sources
in General, that sources rich in history only be sought before those
likely to prove rich in co-operation. It is to be expected that some
agencies will be most occupied with the present situation, and that
others, seeking a broader basis for what may prove a longer treat-
ment and one looking to more permanent results, are eager to get
a good family background for their diagnosis and prognosis. A
placing-out agency is unquestionably more likely to get the special
information that it needs from another placing-out agency, and,
more important still, it is more likely to find that some one capable
of taking full charge has already accepted the responsibility or
wishes to do so. There is much to be said for propinquity also.
For instance, an agency in a charities building on the next floor
but one can be seen at once, and the direct communication, with
its fair chance of seeing the particular worker in the agency who
knows the client best and its further chance of hearing him detail,
with case record in hand, the agency's information and experience,
has very definite advantages. 1 In theory, the agency that last
inquired has either left the case in charge of another willing to
assume or else has inquired of all the previous
full responsibility
inquirers, and a position to pass on their data; but with each

is in
remove such information tends to become diluted, so that the most
that can be hoped for from the best of social agency witnesses is a
hint as to what kind of information we are likely to find from the
other agencies reported by the Exchange. If we consult only those
whose methods of investigation we approve, a process of in-breed-
ing and of separation begins at once, which may have serious effects
upon our own work and upon community co-operation later.
1
For a discussion of the telephone as a medium of communication in the proc-
esses leading to diagnosis see the next chapter.
309
SOCIAL DIAGNOSIS
In summing upthese conferences, Miss Zilpha D. Smith gives,

as the purpose of calling up previous inquirers, "To find out
first
if any other organization holds itself responsible for the social
treatment of the family or person, or responsible for making a

plan. If so, to report how their affairs came to our notice and why.
Also, to help, need be, the family or person to co-operate with

if
the other organization." When no such responsibility has been

assumed and treatment therefore becomes necessary, the second
purpose is to profit by the experiences of the agencies reported as
having inquired, and to utilize any items of history that they may
have gathered.
After treatment of a case has ceased, the notifications that con-
tinue to come in from the Exchange that the former client has been
inquired about by successive agencies are often thrust aside or
destroyed. Even if no attention is paid to these notices at the
time, and sometimes they require attention, they should be saved
for future reference, for treatment may have to be resumed at a
later date.
to remind ourselves, in leaving this subject of the use of
It is well
Exchange data, that no system of indices can take the place of a

quick and resourceful summoning of concrete case experiences
into consciousness. Some social agencies would have been satis-
fied to return a prompt negative to the following inquiry:
A woman calling herself Sarah Collier Potter, who claimed that she was recently
widowed and penniless, applied to a child-protective agency. She had with her a
two-year-old boy named George and was soon to become a mother. As the in-
town addresses she gave were false, the agency wrote to the overseer of the poor in
a nearby town on the chance that Mrs. Potter might be known to him, at the same
time adding some descriptive details. The overseer replied that he knew of no
Sarah Collier Potter, but that some items in the story suggested that she might be
Bridget Karrigan, who had sometimes given the name of Collier, and who was an
unmarried woman now pregnant and mother of a boy of two named George. Then
followed a clear account of Bridget's occupations, application to court for support
of her child, etc. These cases were found to be identical. An index alone could
hardly have established the fact.
IV. SOME FURTHER DETAILS OF CO-OPERATION

Almost every aspect of theethics and technique of consultation
is involved in the right use of the confidential exchange. There
are, however, certain details of co-operative relations that require
310
separate treatment, such as the knotty problem of duplicate in-

vestigations, the advisability of investigation that probably will
be followed immediately by transfer to another agency, and certain
daily helps in the practical working out of co-operation as it relates
to diagnosis.
1. Duplicate Investigations. In the earliest stages of this in-
quiry into social diagnosis, a meeting of representatives from 31

local social agencies was held in one of our large cities. Again
and again, in the course of the frankly informal discussion of co-
operative relations with which the evening was filled, the topic of
duplicate investigations was returned to. Some present felt that
overlapping of investigation was quite as great an evil as the over-
lapping of relief an evil not traceable to any failure to use the
local confidential exchange, for all present inquired of it system-
atically, but due, rather, to unwillingness to accept the investiga-
tions and recommendations of others as a satisfactory basis for
action without supplementary inquiry.
Inquiries that cover the same ground needlessly and repeatedly
are undoubtedly not only a hardship to our clients but an injury to
them, for under the experience they can become as abnormally
self-consciousand self-pitying as are certain of the more well-to-do
who from doctor to doctor.
flit
At the same time, no general arrangement to pool our social

diagnoses will furnish a way out of the dilemma, so long as stan-
dards of investigation are so capriciously variable. One reason
why agencies cannot agree at present to accept the investigations
of others wholesale is that they cannot trust them to be good,
though they should be perfectly willing to take the facts of another

agency in so far as they can be assured that they really are facts.
The slow development of a sound technique in common is the only
sure way of overcoming the worst results of over-inquiry. Dupli-
cation will seem inexcusable in a community in which such a tech-
nique has been mastered by all case workers. If, however, by
duplicate investigation is meant any inquiry by more than one
agency, there is little doubt that, for the best interests of our
clients, such duplication must continue. The idea of one broadly
comprehensive inquiry, covering all the social aspects of a family's
life, made once only and then placed forever after at the service
SOCIAL DIAGNOSIS
of all social workers interested in any of the family's members as a

substitute for further investigation, is a doctrinaire conception
originating probably with the charity organization societies but

now for the most part outgrown by them. As a basis for social
inquiry the family point .of view is valuable beyond question, and
certain data so gathered will not need to be regathered, but there
will have to be reinquiry as circumstances change, as new ques-
tions arise, and as a new form of social service, requiring its separate
skill and separate data, is needed. The new agency called in
should utilize the older experience, of course, but it will not only
have to bring this experience up to date, but must seek besides
the particular insight into the situation and the personality which
isnecessary for the new task in hand. The oculist already re-
ferred to (p. 303) did not rest back upon the very satisfactory data
furnished, but made with those data in mind.
his re-examination
most of these difficulties were pre-
Practical illustrations of
sented at the meeting at which the elimination of inquiry by more
than one agency was urged. A medical-social worker to take an
extreme instance stated that, in certain cases, the most important
single item of her inquiry was to discover what a patient had had
for breakfast that morning a matter which obviously could not
be referred back to someone who was supposed to have a more
comprehensive knowledge of the patient. The after-care agent
of a girls' reformatory, whose cordial relations with the local
society to protect children were based upon many case work views
held in common, pointed out that written reports from the society
inevitably emphasized those aspects of a girl's history for which
the community held that particular society responsible, whereas a
visitto the agent of the society who had known the girl usually
brought out useful information that, for the original investigator's
purposes, had not seemed even worth recording. In addition to
these items, however, new questions had usually come up that
made reinvestigation necessary a new decision had to be made,
and its very nature suggested lines of inquiry not already covered,
such as further detailed characteristics of a certain relative now

willing to take the girl, the more recent physical and mental his-
tory of the girl herself, etc.

Neither confidential exchanges nor uniform record cards, nor
312
the businesslike agreements sometimes suggested by efficiency ex-

perts who know little or nothing about social case work, will suc-
ceed in eliminating supplementary investigation, but, with such
efficient aids as a thorough standard of diagnosis, re-enforced by
thorough use of the confidential exchange, the duplicate investi-

gation which really duplicates and to which, therefore, there can be
reasonable objection, will gradually disappear.
2. The Transfer to Another Agency for Treatment. When the
firststeps in our relations with a new client indicate that he is
probably in more need of the services of another agency than of
our own, how far should we go with our inquiry preliminary to
diagnosis before referring him, and what should our further rela-
tions be to him and to the agency after the transfer has been
effected? Evidence on the first of these two questions is very
conflicting. Some of it seems to indicate that the first agency
should go far enough at least to be quite sure that the transfer is a
justifiable one. Emphasis on this side could be defended, in part,
by the fact that under pressure of work most case workers tend to
accept quite readily any indication that a particular demand upon
their time and sympathy can, with decency, be set aside or passed
on to others. The unfortunate results of this tendency are ag-
gravated, sometimes, by another transfer, made for much the
same reason by the second agency, to a third. A further argu-
ment against the ill considered reference is that it is one of the
greatest bars to co-operation. Obviously, we cannot co-operate
with an agency the purposes and limitations of which we have
never concerned ourselves to discover; but however well we may
know these purposes and limitations, unless we know also some-
thing more than can be learned at an application desk of the
clients whom we refer to the agency, we shall continually be asking
it to do things not at all within its scope.
On the other hand, the social organization which tries to do
thorough work likes cases referred to it promptly. One of the
most cheering developments in connection with tasks formerly
undertaken only at the eleventh hour is that they are now develop-
ing a preventive side; but preventive measures seldom succeed
without the early reference. This is notably true of various forms
of what was formerly court work or nothing. The case records of
313
SOCIAL DIAGNOSIS
one society for the protection of children show a good deal of work
in co-operation with other agencies and with parents themselves,
in which, by timely treatment, court intervention was rendered
unnecessary. Dr. William Healy, working exclusively at first
with the Chicago Juvenile Court, was later often appealed to by
parents, clergymen, and teachers for an expert opinion on a difficult
child that had no court record. 1 We cannot always be sure, of
course, that our first reference will be the right one, and any ten-
dency to delay too long in seeking co-operation may make effective
treatment more difficult.
Another possible argument against investigation before transfer

is that a client who must be transferred goes more readily and
gives a second agency his confidence more freely if he has not been
visited, interviewed, questioned by the first agency just before
the transfer was made. The more complete the understanding
between the two agencies, the less will be the difficulty from this
last obstacle.
As with so many other questions raised in this book, there can
be no one conclusive answer. The matter of investigation before
transfer cannot be settled by a formula. We can be on guard,
however, against the very natural tendency to relieve ourselves of
trouble by hasty transfers, and we can be sure that no endeavor
put into strengthening the relations of our client to the agency to
which he is being transferred will be wasted.
Says a critic of a group of case records: The entry "disposed of through the
"
juvenile court," or "removed to (another city or town or some place in the
country), is a form of social bookkeeping entry that may indicate no real conclu-
sion of the social difficulty. All environmental changes need analysis, if we are
to be thorough.
There can be no two opinions, of course, about the folly of tak-

ing up the case of a transferred client anew, later on, without con-
sulting with the organization to which we transferred him.
A single woman in need of light work, for example, was referred to a family agency
by a medical-social department. The family agency provided convalescent care
and later found work for her. About a year and a half later she applied to the
hospital again for medical care and was visited by its social service department.
Following this second application, an auxiliary of the department provided sewing
1
The Individual Delinquent, p. 14.
314
for sixmonths and rendered other service without making any inquiry of, or at-
tempting to confer with, the family agency previously called in.
3. Additional Suggestions. Communication with other social

organizations should be direct and not through clients or any other
intermediaries. Statements and messages are often repeated in-
accurately in al! innocence, and sometimes they are colored by the
interest of the messenger.
A conference of representatives of several agencies of all
interested in some one case which happens to present special dif-
ficulties may save valuable time, promote good understanding,
and bring the solution appreciably nearer. A certain agency has
refused, perhaps, to accept the point of view of another. It is not
impressed with the reasons given and believes the diagnosis or the
prognosis or both to be mistaken. At the conference of all inter-
ested, however, it is impressed, or else the organization from which
it has differed is impressed, by the point of view of a third, or by
the new lightthrown upon the matter by a doctor or teacher who

is present. The outcome is not necessarily the one intended by
the agency calling the conference; a better policy may be adopted
than that originally favored by either of the two disputants.
Since co-operation is based upon trust, one final suggestion under
this head emphasize the importance of teaching co-operat-
may well
ing agencies that we are as good as our word always. If we have
said that we will do a thing, it should be known to be as good as

done.

1. The
process of arriving at a social diagnosis is a co-operative one. Properly
conducted, moreover, it often leads to the intelligent co-operation of relatives, em-
ployers, social agencies, etc., in the treatment which is to follow diagnosis.
2. As regards social agencies, the four stages of development from competition

to co-operation in their social work are (i) the competitive period, (2) the period of
co-operation in vacua, (3) the period of "joint traffic agreements," (4) the period of
co-operation in spirit.
3. As
outside sources, social agencies belong upon a different plane from all
others, and to their evidence somewhat different tests must be applied. They ful-
fill two distinct functions as witnesses: first,
they can supply their own social ex-
perience with a given client; second, they can often supply certain objective data
about him. Some agencies excel in the one kind of testimony, some in the other,
and a small group in both.
35
SOCIAL DIAGNOSIS
4. In evaluating its testimony, the point of view of the individual agency must be
considered and allowed for. Other things being equal, that type of social experience
which is least like our own is most valuable the agency developed on the neighbor-
hood unit helps most the one that regards the family as its unit of measure, etc.
If there has been a complete change of management in an agency, it is important
to know, in each instance, whether its case report refers to work done before or
after the change.
5. A systematic and confidential exchange of identifying information among

social agencies assures better diagnosisand treatment, promotes better understand-
ing between agencies, reduces duplication of effort, and increases the sense of in-
dividual responsibility for work undertaken.
6. Prompt consultation of the exchange is essential, however, and a prompt fol-
lowing up of the clues which it supplies.
7. The order in which the social agency clues so followed up should be consulted
depends upon a number of factors; but, in general, the first thing to seek is assurance
that the entrance of our own agency into a given case would not duplicate effort
or interfere with the treatment of some other agency; second, when this first point
has been settled, history useful in our own diagnosis; third, co-operation in treat-
ment.
8. Additional investigation is not necessarily a duplication of effort, but over-
inquiry will best be done away with by a high and widely accepted standard of
diagnosis.
9. Communication between social practitioners should be direct and not through

their clients or other intermediaries.
3 l6
CHAPTER XVII
LETTERS, TELEPHONE MESSAGES, ETC.

review of outside sources is ended, but before leaving
this part of our subject for an analysis of the last stage of

OUR all in the processes leading to diagnosis, there are certain
things to be said about the various means of communication with

outside sources and the relative uses to which these means may be
put. Of the statements procured by different means, which ones
(other things being equal) are most satisfactory those that are
(a) written replies to the questions on a form or schedule, (b) writ-
ten replies to letters, (c) telephone replies to questions asked by
telephone, (d) telegraphic replies to inquiries made through the
same medium or (e) replies by word of mouth secured in the course
of a personal interview? Many other combinations of these means
are possible, of course, but taking these five main forms of com-
munication without their variations, from which one, on the whole,
does the social case worker win the best results? The personal
interview has become his main reliance. There are exceptions to
this, but to an increasing degree it is true in most forms of case
work.
Oral testimony fails us when accuracy is vital, as in matters of
time, place, amount, etc., but so does written testimony, unless
we seek the original documents. 1 The distinguishing character-
istic of social evidence is not, however, its handling of objective
matters, but its ability to evaluate human relations. It is justified
as a separate type of evidence by possible usefulness in gauging

its
the interest, capacity, and whole atmosphere and spirit of the

individual witness, including his capacity to become more inter-
ested than he now is. In subjective matters such as these there is
no satisfactory substitute for the personal interview.
A policeman wrote from a small town to an associated charities secretary about

a family in which the husband was very abusive. After giving certain information,
1
See Chapter XIII, Documentary Sources.
3'7
SOCIAL DIAGNOSIS
"
he added, If I could see you, I could say many things which I think it would be just
as well not to write, for the reason that the explanation would take a lot of time and
paper and then perhaps would not be very satisfactory you know how it is."
A woman probation officer was asked to inquire into the story of a young girl
arrested for immoral conduct who gave the name of Emily Burton. The girl said
that she came from the town of G , about sixty miles away, and that her people
were French Canadians and Catholics. Her name seemed unmistakably Anglo-
Saxon, but she persisted that she had no other, so the probation officer decided to
go herself to G , and follow personally the very slender clues
that were in her
hand. First, she saw the police captain there, and interested him to assign an officer
to accompany her on her search, but the girl's parents could not be found at the
address given or anywhere in that street or neighborhood. School records revealed
nothing, nor could the parish priest identify the family from the description. The
mill in which the girl claimed to have worked was the next to the last clue, but it
yielded nothing. Returning to the captain of police, the probation officer told him
of a brother George who worked for a farmer (or so the girl claimed), but the only
George known at police headquarters who worked for a farmer was named Lodie,
and the probation officer did not even attempt to see him.
On the day of the trial, and just before it began, the girl begged hard for mercy,
but the probation officer was forced to point out in all kindness that she did not
even know who she was. Whereupon the girl said that her name was Lodie and that
she really did live in G . The identification of this one name more than justi-
fied what had seemed a futile journey, for it gave promise that there was further
truth in the girl's story. second visit to G
A brought to light five respectable
brothers and sisters, with four of whom the officer was able to consult. This led to
plans of co-operation with the girl's mother, to the return home of the wanderer,
who had been denied a welcome earlier and to plans for her continuous supervision
under suspended sentence.
Where such serious issues are involved as in the case just cited,
it is no unusual thing, now, for case workers to travel from one end
of a state to another or into other states to make an inquiry in
person. At one time this would have been regarded as a very
wasteful procedure, but much footless endeavor expensive in
time and money, and expensive in its results has been saved by
such journeys.
I. BLANK FORMS
Many charitable institutions still select their inmates on the
basis of statements filled out on application blanks, to which are

appended certain letters of endorsement. The formality of these
blanks believed to secure greater accuracy in the replies. Where
is
inaccurate replies are a statutory offense, punishable by fine or

imprisonment, there may be justification for this view, but such
318
powers seldom reside in social agencies, either public or private, and

where they do they are not always used. The logically arranged
and categorically framed questions of an application blank suggest
the answer that will lead to the decision desired by the applicant.
This is the chief objection; another is that no formal set of ques-
tions, however full, can cover all possible contingencies; a blank
may be carefully and accurately filled out by a witness and yet

omit important items. As regards the letters of endorsement
which usually accompany such applications, 1 written by merchants,
teachers, clergymen, doctors, and other presumably responsible
persons, these are too often found to be not worth the paper upon
which they are written, as some of the cases cited in this volume
show. 2
II. LETTERS OF INQUIRY
The author's examination of case records indicates greater
advances during the last decade in the art of conducting personal
interviews than in the art of letter writing. This is natural, per-
haps, for the attempt to make social diagnosis a more flexible and
understanding thing has been pushed forward under many dis-
advantages, of which time pressure, public impatience, and in-
adequate preparation are only a few. Under these handicaps the
substitution of visits for letters has diverted attention from the
possibilities of letters in those cases, still numerous, in which they
should be used. As a result, manyof the carbon copies of letters
found in case records have the air of having been written or dic-
tated in a most perfunctory and absent-minded way.
A case worker's letters, in so far as they relate to diagnosis, fall
into the two large groups of those that ask information about clients
and those that give information. Those that ask information may
be divided into letters that ask it of the witnesses direct and letters
that ask it of intermediaries who are requested to see the witnesses
or to communicate with them in some other way. Again, letters
that ask information direct may be divided into those that ask
it of persons near enough at hand to make a personal interview
with them later quite easy or at least possible, and those in which
1
Some institutions and agencies provide a form of recommendation requiring
nothing but the signature of the endorser.
1
See, for example, pp. 232 and 241.
319
SOCIAL DIAGNOSIS
the opportunity for such direct communication later is remote or

non-existent. Obviously, each one of these divisions and subdi-
visions demands from the letter writer a somewhat different method
of presentation, though attention will be given here almost exclu-
sively to letters of out-of-town inquiry and their replies.
In respect of letters of inquiry (to take this half of the subject
first) the question that precedes every other is (i) What other
means of communication, at command, would serve the purpose
better? This settled in favor of the letter, as the best available
means, the next question is (2) Have the preliminary inquiries that
would make the writing of this letter the logical next step all been
made? And Has the definite relation of the part of the inquiry
(3)
to be covered by the letter to the whole of diagnosis and treatment
been thought out by the inquirer as clearly as it can be at this
early stage? Only when this has been done can be found the an-
swer to the next question, which is (4) Has the best possible corre-
spondent been chosen for the particular information or the particu-
lar service desired? (5) If so, what method of presentation will
most interest him, and so win the information or the service? (6)
How, for instance, can the trouble to which he will be put by the
inquiry be justly measured, and every effort be made to anticipate
and give him the details that will help him to over-
his difficulties
come them? (7) If the correspondent is not personally known, as
often happens, what circumstances of his occupation, experience,

education, and of his relation to this particular problem should be
borne in mind and turned to account in the attempt to make the
significance and possibilities of the inquiry clear to him? Each of
these questions deserves amplification.
1. Should the Letter Be Written at All? The advantages of a
personal interview have been made clear. When letters are the
sole means communication with persons who do not understand
of
the case worker's point of view or whose attitude and character-
istics are unknown to him, his work is seriously handicapped from
the beginning. Some letters are merely preliminary to an inter-
view; others follow it, to secure in black and white data of a
technical or of a purely objective nature, 1 in which accuracy is
1
Many hospitals refuse to give a diagnosis unless written application is made
for it.
320
of the first importance. These present no difficulties, but less di-

rect means long distance telephone messages, telegraphic
letters,
dispatches must often be the only approach. In more than n

per cent of all the outside sources consulted in the 2,800 cases
included in our special study, the agencies and persons communi-

cated with were out of town. Letters to out-of-town sources tax
the case worker's ingenuity far more than does his other corre-
spondence, and except when otherwise specified this discussion
is limited to them.
2. Should the Letter Be Written Now? A favorite time for
writing letters of inquiry is just after the first interview has been
held. When no one living in or near the city in which the client
makes his application has had any but the most casual contacts
with him, letters to those at a distance who have known him well,
or to others who will visit these witnesses, are a necessary procedure
and such letters must be written at once. A safe general rule to
follow, nevertheless, Write no important letter to a place
is this:
at a distance which is not based upon and shaped by all the ob-
tainable evidence near at hand. Much of the growing dissatisfac-
tion among agencies which receive many out-of-town requests for
inquiry service notably among the charity organization societies

upon which thisdemand has fallen the heaviest may be traced to
the fact that many requests are made upon very inadequate data
when it is known that more data near at hand are readily obtain-
able. On the other hand, it must be conceded that there is real

danger in delaying out-of-town inquiry until after plans have been
made and the case treatment has actively been started.
A flagrant instance of the inquiry that should have been made,
and yet was made too soon, will be found on page 74, where the 1
public charities of a German city were asked to seek out relatives,

to interest them in a case of distress, to get their advice as to the
best method of treatment, and to obtain from them material assis-
tance. All of this was asked without providing them with any data
save the impressions of a first visit supplemented by the impres-
sions of the agency that referred the family for care. The family
had lived in the same American city for eleven years, yet no his-
tory was procured before setting in motion a process which, if un-

successful in its outcome the first time, could not easily be repeated.
21
321
SOCIAL DIAGNOSIS
The inquirer might well have reasoned as follows: The public

department of charities in a large German city has many inquiries
from America, probably. It has its own work besides. This
matter will receive only perfunctory attention unless I can show
that I know whereof I write. The relatives of this woman have
not seen her for many years, probably, and about her life in America
they know what she has told them. I must seek information
Covering this long period elsewhere, and out of the clues now in
my hand, must construct her past in this country as best I can.
Since I shall be fortunate if I get one
reply from my German corre-
spondent, I must make that one count for as much as possible in
shaping treatment aright by letting the inquiry overseas grow out
of the history nearer at hand. But the line of reasoning actually
followed would appear to have been this: It will take several
weeks to hear from Germany, so a letter must be written at once
the visits here can be delayed. Besides, there are no relatives over
here, or so the mother of the family says, and relatives are always
the best references.
3. What Relation Does This Particular Inquiry Bear to the
Whole Process? The need of asking this further question is
illustratedby the letter of inquiry just referred to. It is also illus-
trated by many letters to relatives, copies of which have been found
in the case records studied. Instead of showing that the inquirer
isthinking of his client's life as a whole, of the great gaps in his
understanding of that life, and of the kind of insight that the
relative would best be fitted to give, they show an almost auto-
matic drift into requests that the brother pay a month's rent, that
the grandfather furnish milk for the baby, that a home be supplied
for a family of six, etc. These are services all of which may be
appropriately undertaken by relatives under certain conditions,
but what is the purpose in paying the rent and furnishing the trans-
portation? Permanent betterment presumably, or at least some
better foothold, some more effective adjustment for the client or
for hiswhole family. The following inquiry shows this relating of
the simple question the question of willingness to receive a rela-
tive to some of the more important issues involved. The reply
is given on p. 324.
We are anxious to have a call made upon Mrs. Jane Seymour, who lives in Bed-
322
ford [a small town in the same state as that of the agency addressed]. Will you
be kind enough to forward this letter to your correspondent there? [The enclosure
read as follows:]
We have become very much interested Arthur Brown, a private in the United
in
States Artillery stationed at Fort He comes from Bedford,
in this harbor.
where his mother, stepfather, and brother have a farm. He has been in the army
nearly three years and has five more months to serve. Last summer he married a
girl in this city whom he is unable to support, as his pay is only $18 a month. Con-
sequently he has been running into debt ever since his marriage and owes about $40.
At the present time he has drawn a month's pay in advance. He tells us that his
mother, Mrs. Seymour, is very willing to take his wife and baby into her home. We
are afraid that Mrs. Brown is a difficult girl to get on with and for that reason are
particularly anxious to know whether Mrs. Seymour is a tactful and intelligent

woman.
Can you send someone to see Mrs. Seymour and can you find out anything about
the family? you are able to see Mrs. Seymour will you tell her that we are going
If
to help Mr. Brown to pay his wife's rent until we hear from her? If this address is
not accurate enough will you please let me know?
This letter was not addressed to Mrs. Seymour herself for reasons
that are evident; the inquirywas sent through two intermediaries
through a family agency in Mrs. Seymour's state, which found
a correspondent in her town of Bedford. It would have been easy
enough to write to Mrs. Seymour direct and ask, Will you take
your daughter-in-law and grandchild into your home? But it was
not possible to ask, Are you responsible enough and tactful enough
to care for a girl who needs especially good care? Which brings
us to our next question.
4.Has the Best Correspondent Been Chosen for the End in
View? The real end in view must be clearly grasped before this
query can be asked or answered. It must be confessed that the
very uneven development of social case work in different cities and
in different parts of the country often reduces the inquirer to
Hobson's choice in the matter of correspondents. It is not always
possible, for instance, to avoid direct communication by mail with
the Mrs. Seymours, and certain things that they cannot tell us
must remain unasked and unanswered. In choosing the method
of inquiry through an intermediary, moreover, there is always the
risk that a private matter may be made public, that the pride of
sensitive people may be wounded, owing to lack of tact and discre-
tion in the intermediary selected. Nevertheless, direct replies from
323
SOCIAL DIAGNOSIS
illiterate witnesses are often so unsatisfactory, and the observations

and estimates of an intermediary are so much needed that this risk
has frequently to be taken.
The correspondent found in Mrs. Seymour's town replied as
follows:
I have just received the report of the chairman of our investigating committee
of the case of Mrs. Jane Seymour, as requested in your communication of the i8th.
She reports Mrs. Seymour to be a quiet, modest woman of average intelligence and
fair education,who she judges could get along with her son's wife if she is at all
reasonable. Mrs. Seymour is a woman of few words, a good housekeeper, in com-
fortable circumstances, with plenty of room in her house for Mrs. Brown, and she is
quite willing to have her come so she can help her son in this way to get on his feet
She said she did not have money to send for Mrs.
after his enlistment expires.
Brown, but could and would take care of her until her son was able to take care of
her himself. I think the society need not hesitate to send Mrs. Brown to
Mrs. Seymour's. There will be plenty to eat, a good home, with wholesome sur-
roundings, and from all I can learn a thoughtful woman to live with and take care
of her.
This is not the report of a trained social worker it is not so

concrete as such a report should be but it contains a general
common-sense estimate by a kindly householder, and this estimate
makes the answer more satisfactory on the whole than direct corre-
spondence could have been. It cannot be denied, however, that
the choice between direct and indirect communication is a difficult
one to make, and one requiring tact and consideration. The letter
of inquiry (p. 323) speaks of Mrs. Brown as "a difficult girl to get
on with." This is a vague description, but it may have been pur-
posely so in view of the fact that the correspondent to be selected
was unknown to the writer.
One letter about the relatives of a skilled workman known to be drinking heavily
and to be despondent and destitute was sent to an overseer of the poor in a small
town. He promptly handed it to the man's brother and told him to answer it.
The kind of reply thus obtained could have been had as well or better by direct
correspondence. The intermediary had failed to grasp the purpose for which he had
been called in.
Local correspondents can be secured in a number of ways.

Through the use of the professional directories and the year books
described in the chapter on Documentary Sources a state or county
official, lawyer, teacher, physician, or clergyman may be found who
may prove a valuable intermediary in an important inquiry. When
324
we are seeking the kind of information likely to be known to a

local merchant or manufacturer, wholesale houses in our own city
may have correspondents in smaller places to whom they can give
us letters of introduction, and some such approach might be found
to the other out-of-town sources mentioned in this paragraph.
Miss M. L. Birtwell writes 1 as follows of clergymen as corre-
spondents:
In localities in which we have no regular correspondent we may use some local
clergyman, preferably of the same denomination as the family in regard to whom we

are inquiring. Often we use the Episcopal clergyman, as the organization of that
denomination on the parish system gives their clergymen a sense of responsibility
in regard to any need within parish boundaries. If the inquiry is to be made in a
locality ofwhich we are entirely ignorant, we have sometimes written to the post-
master, enclosing a letter which he is requested to give to the nearest or most in-
fluential local clergyman.
Our local Home for Destitute Children once asked us to investigate the applica-
tion of a widow for the admission of her two children to the home. Her husband,
she said, had been drowned some months before in Nova Scotia; she could find no
work there by which she could support herself, so had come to a sister
in Cambridge
in the hope that the latter would care for her children while she went out to work.
The sister had children of her own, however, and her husband would not consent to
the additional burden. The woman said she had a place at a restaurant at $5.00 a
week, which she would lose unless she could get her children cared for at once. We
found the woman with her sister in a neat, comfortable home with every appearance
of respectability, but she seemed unable to give references from her home town.
The owner of the mill where the husband worked had gone out of business, they
had lived too far out in the country to go to church, so knew no clergyman well
enough to give his name as reference, etc. We advised the Home against hasty
action and refused to make any recommendation till a thorough investigation could
be made. A letter was at once written to the local Episcopal clergyman, asking
him to look up the family history, the record of the man's death, and resources in
the way of work for the woman. A prompt reply was received saying that the man
was alive and well; that there had been a family jar, and the woman in a fit of
temper had gone to the States to visit her sister; that the man had told her to go if
she wanted to, but had said that she would have to get back as best she could. We
wrote the clergyman to stimulate a forgiving spirit in the man and urge him to
send at least part of the fare of the family, and promised to do what we could to
help the woman earn her share. We got her a place at service with one child, the
employer knowing it was a temporary arrangement, leaving the other child with her
sister. She saved her wages of $2.00 per week, and in a few weeks, with her hus-
band's help, the traveling expenses were met and the family reunion took place.
An exasperating practice of some social workers which is usually

1
325
SOCIAL DIAGNOSIS
without excuse is to write directly to a relative or other witness,

asking for advice and service, and at the same time to write to
another correspondent, asking that the person thus addressed be
seen, without mentioning to either that a letter has been sent to
the other. Presumably .the idea behind this procedure is that, if
either source fails, time will have been saved by duplicate inquiry.
There may be cases in which both letters should be written, but
in these circumstances both correspondents are entitled to an
explanation.
Sometimes a client will suggest that he himself do the writing
to relatives or others at a distance who know him, showing the
replies when received to the case worker. Usually this is not a
good plan. A letter of reply is of little value as evidence without
the contents of the letter to which it is an answer, and moreover
the client's failure (innocent failure often) to ask the right questions
may cause unnecessary delays.
The choice of foreign correspondents has always presented diffi-
culties, and these difficulties have been increased since August,
1914, though time will bring better adjustments, of course. The
following general suggestions about foreign letters are made by
the American Association of Societies for Organizing Charity:
Letters written in the language of the country to which they are going may be
addressed to the mayor of the town or to the parish priest; the consul in your city
who represents this country may be willing to forward a letter for you or write him-
self to some local official; inquiries may be sent to the American Consul in the city
nearest the town where the visit is to be made. While the department of state has
stated that thisis a logical service for the consuls to render, the societies have not
always received prompt or satisfactory replies from them. In France and Italy
the mayor of the town has proved to be the best source of information.
5. What Will Interest the Correspondent Selected? An intel-
ligent choice of out-of-town sources of information follows as far

as possible the line of their natural interests. kindly woman, A
herself a householder, can enter more fully than many another into
the deeper meanings of the request made of Mrs. Seymour (p. 322)
that she receive an unknown daughter-in-law into her home. A
clergyman is fulfilling one of the true functions of his pastorate
when he seeks to stimulate a forgiving spirit between husband and
wife (p. 325). This was not the first request made in this instance,
but family estrangement is suggested by the story of a woman
326
of apparent respectability who will give not a single clue to sources

of information in her home town. The looking up of records was
only preliminary to the real task developed by the facts of the case.
This longer view not only helps in the choice of correspondents,
but it enables us, in writing to them, to leave a window open, to
suggest a prospect beyond the immediate details about which we
are concerned. It is this prospect, this relating of small details to
helpful and constructive results in the near future, that will most
surely interest them in our request, and fire them with a desire to
have a share in this particular social undertaking. Not many
words will be necessary, but something of our real interest, some-
thing more than mere processes, must be suggested.
The avoidance of technical terms, a choice of words at once
direct and human, an ability to think imaginatively of our task
and to convey its large spirit of service to our correspondent
these are methods that emphasize the need of varied approach,
for no one form of approach will interest all correspondents equally.
It isworse than folly to write to the prosperous father of a way-
ward son to a father who might have been not only the most
valuable single source of information but the best of co-operators
"
and seek to interest him by saying, We are very anxious to obtain
the previous record of this young man." One such inquiry, to
which reference has been made earlier, brought no reply, and the
"
I am
following, also found in a case record, did not deserve one:
anxious to have your advice about your brother, John Smith, now
in this city." This was the entire letter, but extreme prolixity is
quite as bad. A letter that is practically a case record summary

and a chronological one at that may be serviceable as part of
another social agency's case record, but it will never interest a
correspondent.
Every little while someone proposes that, in order to systematize
out-of-town inquiries, they should all be centralized, should be
handled for each community by some one agency. The maximum
of interest will never be developed in this way, however, and it is
likely that order can be introduced into our inquiries by some other
plan not so liable to destroy their serviceableness.
6. What Presentation Will Save the Correspondent Unneces-
sary Trouble? Every witness from whom we seek co-operation

327
SOCIAL DIAGNOSIS
should be assumed to be socially minded and willing to do his fair

share until there is conclusive proof to the contrary. He is en-
titled, therefore, to protection from annoying publicity. Inquiries
should not be sent on post cards, and in small places, or in neigh-
borhoods in which our letters may be handled by gossiping fellow
tenants, they should have only a return address printed on the
outside instead of the full name of the social agency.
Whatever data will aid in the full identification of our client and
of the places or people locally involved in his story, whatever
details will make clearer the items to be verified or discovered, will
surely save time in the long run for the inquiring agency. But even
more important is the consideration that a clear setting forth of
these things in the original inquiry will save unnecessary annoy-
ance to the correspondent, will further excite his interest, and will
make him a more competent reporter, whether of his own first-
hand information or of the data obtained by visits made at our
request.
In writing to relatives, for instance, it is not enough to dwell upon
the specific things that we wish to know, or even to suggest the
future helpful uses to which their information will be put. Rela-
consumed with anxiety to know just what has been
tives are often
happening lately, and what are the present circumstances of one

from whom they have not heard in a long while. Our statements
should be specific rather than general, moreover, though they
should not be technical. This applies also to letters in which we
ask a correspondent to see relatives.
A family agency found a man ill in the almshouse hospital with tuberculosis, who
confessed to a prison term for forgery. Though he told thus much, he gave the
agency an assumed name and added a false address for his immediate family in a
distant city. A kindred agency there was asked to visit. They could not find the
man's family at the address given, but did find the firm of employers whose check
he said that he had forged. All knowledge of him or of the circumstances was
denied, however, by the clerk in charge at this establishment, until mention was
made of the fact that the man was now very ill. The clerk, who, it appears, was an
old chum, immediately became alarmed, told the sick man's real name, and took
the case worker making the inquiry to the family's right address. The visits made
in this case would have been of no avail without the mention of the client's present
condition contained in the letter of inquiry.
An associated charities was asked to see the relatives of a one-legged man who,
with his family, was destitute in a distant city. It replied that these relatives re-
328
fused to be interviewed or to give any information. The inquiring agency wrote

again, giving more and asking more specific questions, but with no better
details
result. When the agency protested to a referee later about what seemed to be
poor inquiry work on the part of its correspondent, the referee replied in part as
follows:
Without knowing anything more than the letter reveals, it seems to me possible
that the unwillingness of the Jacks family in Wickford to give any information, and
the unwillingness of the Wickford society to push an already exasperated relative
further at the present time may be due to the fact that, doubtless through hurry
or some oversight, you failed to ask any of the questions in your first letter that you
did ask in your second. The visitor of the Wickford Associated Charities had a
commission from you to find out whether the Wickford relatives would contribute
toward the purchase of a new leg. This was a perfectly concrete demand upon
them which seems to have brought an indignant response. In my own experience
it is a mistake to begin an approach to relatives with a demand for service on their
part. The initial demand should be for advice and any experience of theirs that will
increase your own insight. It is very clear that you realize some of this, or you
would not have written the questions contained in your second letter, but unfor-
tunately they came rather late and after the damage had been done. In ...
your first letter you do not even supply Jacks' first name, and, upon reading the
two letters side by side, think you will agree with me that your second would have
I
been a much better guide to anyone visiting the Wickford relatives for the first
time than your first letter was.
One "Will you kindly forward the following

letter of inquiry reads as follows:
information to your correspondent in Cranford? James Harvey, American, aged
thirty-three, came to us this morning to obtain work. His mother, Mrs. Kate
Harvey, lives at 20 Saunders Street, Cranford, with her married daughter. There
are several other brothers and sisters of Mr. Harvey, and we would like to find out
ifthey are able to give him some assistance.
"Will you also look up the following business references for Mr. Harvey? He
has worked for the Cranford Tunnel Company and for the Electric Works as wire-
man. During the past winter he says that he was ill in the Cranford Hospital with
hemorrhages of the stomach. Any information which you may obtain for us will
be greatly appreciated."
About which the case worker responsible for the inquiry in Cranford writes:
"There is no explanation here as to how Harvey came to the
society, what his plan
for himself is, how he
being cared for in fact nothing that has any human in-
is
terest. When the mother was interviewed, she began to ask questions which we
were unable to answer. The mother felt and expressed herself as unable to suggest
anything unless she had further information, and the interview was a failure from
every angle."
Another kindred agency out of town describes the present
letter of inquiry to a
situation of a family quite fully and then asks that visits be paid to a tax collector,
a minister, a trust company, a farmer, and to a Mrs. Carter on B Street. The
street is several miles long, and neither street number, first name of woman, nor rela-
329
SOCIAL DIAGNOSIS
tion to the family written about was indicated. In fact, the particular information
sought of each informant and his supposed relation to the case were not named in a
single instance.
The following is a better example than any given so far of the

type of inquiry which saves delay and trouble, and secures socially
valuable results. It was written by a state board of charity to a
child-protective agency in the same state.
I do not know whether you are the proper person to whom to address the follow-
ing inquiry, but if you are not, trust you will forward
I
my letter to the appropriate
society.
We are interested in a girl named Jessie Smith, who is at the State Institution at
Fairview. She was sent there by the House of the Good Shepherd of Preston for
confinement. She had been arrested in Knightsbridge and put on probation for a
year, the year to be spent at the House of the Good Shepherd. She entered Fair-
view on September 2, 1910, and her child was born about the middle of November.
Her year on probation will not be completed until the latter part of this month,
January, but the Sisters had no way of taking care of a woman with a baby, and so
would receive Jessie again only on condition that her child was taken from her first.
Neither of Jessie's two sisters nor her aunt will receive the mother and infant, or
even the baby without its mother.
The doctors at Fairview have had this girl under observation for some time. She
has a violent and ugly temper, provoked by trifles. They consider that it is quite
possible that she is insane, but they would like us to get more of her family history
to help them in their diagnosis. I am writing to ask whether you will not assist us
by getting some skilful visitor to make certain inquiries for us.

Jessie tells us that she was born in Franklin, West Virginia, August 5, 1887; that
she lived in that city with her father for fourteen years. Her mother died when she
was a At fourteen her father placed her in the Industrial School of that
little child.
state at Perry, and she remained there for seven years until she was twenty-one.
This school is a reform school. When twenty-one she was placed out in Jefferson,
near Perry, by the Industrial School. From there she was shortly taken by a Rev.
Mr. Baer of Clayton in this state. Mr. Baer had, as I understand, brought up her
sister Jane (Mrs. Albert Dawson, Exeter Street, in your town) and so was anxious
to take Jessie, Jane in the meantime having married. Jessie stayed with Mr.
Baer a year and then went to be with Mrs. Dawson. From there she came down to
Beaufort to stay with her aunt, and later returned to the eastern part of the state.
She worked as a waitress for a Mrs. Jenkins who runs a dining room for your girls'
seminary, and was also a waitress for a time at the Eastern Hospital.
Can you put on foot an inquiry of Mrs. Jenkins; of the Eastern Hospital; of
the police in Knightsbridge; and of the sister, Mrs. Dawson? We should be glad
to know how good a worker she is, why she left her places, and how she conducted
herself. And of the sister we should like to know whether there is anything in her
inheritance which would explain her possible insanity. She told me that her father
lives in California because of asthma, but she also said that he had had a cough for
330
many years. If there is any other taint in the family, such as alcoholism or epilepsy,
this or tuberculosis, according to the present opinion of doctors, might be a con-
tributing cause of mental disorder. Some uncle or aunt may show the taint, even
if her immediate forebears do not.
I fear that I am asking a great deal of you, but the information may be of the
greatest value to us. This girl is certainly not normal, and I know I don't need to
say to you how almost hopeless it is to try to get such a girl plus a baby estab-
lished respectably. For the sake of the child, and of future children that ought not
to be born, we want to do everything we can towards having this mother committed.
We shall ourselves, of course, get the information from Clayton and Beaufort.
7. WhatFacts relating to the Correspondent's Occupation,

Education, etc., Should Modify the Approach by Letter? Where
a correspondent is personally known to us, we have a definite
advantage in our choice of method of approach, but often our only
guides are a few stray facts as to his occupation, his educational
advantages, and his alleged relation to the client about whom we
write. We fall back upon these slender clues because we lack an
intermediary whose point of view is known, whose discretion can

be trusted, and whose face-to-face intercourse with the witness can
overcome our own handicaps.
Letters to business men should be as brief as is possible without
sacrificing defmiteness and clearness. Letters to former employers
of a client should give his name in full accurately, and state definite
dates and the exact kind of information sought, while at the same
time explaining the reason for the inquiry in such a way as to create
no unreasonable prejudice. Where the client's service has been of
a personal kind, involving direct daily contacts with the corre-
spondent, the letter can safely be more personal.
Inquiries of physicians have been considered in the chapter on
Medical Sources. It may be repeated here, however, that no letter
asking for a medical diagnosis should attempt to give one, that the
relation of medical diagnosis to the social treatment of which the
letter of inquiry is a part should be made clear, and that family
history and the specific circumstances, acts, etc., that might have
a bearing upon medical diagnosis should be stated. To say that
we think our client is mentally deranged is futile; to state the ob-
servations that have created this impression is a possible help.
A worker in a public agency for the blind whose work is statewide
takes for granted, in writing to priests about their parishioners,
SOCIAL DIAGNOSIS
that they have a deep interest in the things she is trying to accom-
plish. I n her experience, the interest already exists or is very easily
aroused, and her letters usually convey a recognition of this fact.
The following is a characteristic beginning:
"
You probably will be glad to know that, learning of a child in your parish who
has inflammation of the eyes, I went to see her and found the family willing to let
the child come to the city and attend the Eye Hospital." And this is a char-
"
acteristic letter ending: Remember me should you hear of one who is blind or in
of so. I should like not only to do what I can to help them, but,
danger becoming
in doing for your parishioners, to be able to serve you."
This same worker, in addressing the parents of a client, always

puts the names of both on the outside of the envelope as well as
on the enclosure, doing this in order to make both parents feel an
equal responsibility for answering her inquiries and for carrying
out her suggestions.
A case worker in a children's agency once said, after looking over
a group of letters addressed by workers in another agency to a
wayward girl, that they were so dignifiedly and elegantly expressed
as to make her hesitate to show her own. She was accustomed,
when writing to uneducated people personally known to her, to
address them in simple and familiar language, some of it almost
childish. It may be questioned whether letters of inquiry to simple
folk are always intelligible to them. Short words and sentences,
and an ability to see both the form and the content of the letter
through the eyes of the receiver would bring better results. Even
the form of the letter its typewriter script on official letter paper
may put a barrier between its writer and the least businesslike
of his correspondents; a letter written by hand on unofficial paper
sometimes makes a better beginning.
Sometimes, on the other hand, a formal rather than a familiar
tone is justified by the nature of the contents. This is true in the
following to a father from a child-protective agency:
"A complaint has come to this office that you are not properly providing for the
support of your wife and minor child, that most of your time you are idle, that your
wife is obliged to go out to work leaving your child in the care of your mother. I
your home yesterday

called at to talk this matter over with you, found the house
empty and the door unlocked. The outside appearance was very disorderly and
dirty. I would hear your side of the story and would be glad to have you
like to
call at this office Saturday morning at 10 o'clock." The recipient did not come, but
332
went to work the next day and, a month later, was found to be still working steadily
and doing better in every way.
In all of the foregoing, emphasis has been put upon letters to
those who are not themselves engaged in social work. When we
are writing to social agencies, our statements must be full enough
to enable them to co-operate intelligently. If we are writing about
a family, the names and ages of all its members, the wife's maiden
name, and the husband's full name (even though deceased) should
be given. In asking to have an employer visited, do not omit to
mention the approximate dates of employment, the kind of work
done, and, if a large firm, the department in which the worker was
employed, his work number, and the name of his foreman. When
marriages, births, or deaths are to be verified, always give the dates.
Dates should be given also for the period of residence when insti-
tutional connections are to be looked up or former addresses are
to be visited. When addresses are given us it is an easy matter,
before asking an out-of-town agency to visit, to discover whether
the addresses are at all possible by consulting the nearest file of
out-of-town city directories, or the nearest set of street guides for
other cities.
"When I have a name given me without the street address," writes a family
case worker, "and
want to ask another society to investigate for me, I have been
I
able to give the exact address by consulting the directory of that city, so I do not
often ask for investigations at addresses that do not exist. Recently had a client I
who said that his brother-in-law had a restaurant in Los Angeles, and he gave the
street address. Instead of writing to a Los Angeles social agency and waiting two
weeks for their reply, I went into our board of trade rooms and consulted the di-
rectory. I could not find either the brother-in-law's name or that of the street.
When my client found that I could not accept all of his first story, he told me the
true one." *
The time of social case workers in other cities is quite as valuable

as our own. More care in calling upon them for service, a clearer
realization of the uses to be made of that service, and a better
statement of our own case would greatly enhance the value of
information received from these sources.
III. LETTERS OF REPLY TO INQUIRIES

The quality of a letter of inquiry has much to do with the full-
ness and satisfactoriness of the reply. For this reason more space
1
For use of directories see also Chapter XIII, Documentary Sources.
333
SOCIAL DIAGNOSIS
has been given to this first half of letter writing. The second half,
which we must consider only in so far as it relates to the replies of
social case workers to the letters, that is, in which they send
information already at hand and those others in which they send
information secured especially for the inquirer need not detain
us long. The worst failings of such letters of report are traceable
to failings in the investigations themselves, but some few are due
to faults of the social diagnostician as correspondent.
In the first place, his letters, like those of other modern cor-
respondents, often contain internal evidence that they have been
written in reply to inquiries that have not been read, or, if read,
1
have not been It follows, in the second place
fully apprehended.
then, that his reply fails to cover all the points raised. When it is
impossible to cover them he could at least indicate the items not
supplied and the reasons for the omission. This precaution would
save the annoyance of further inquiries, further replies, apologies,
etc., with all their avoidable delays. In the third place, he gives
too often only the inferences drawn from information gathered,
whereas the information itself, with its source or sources and some
evaluation of the witnesses quoted, is needed. The inferences are
useful too, but they should be recognized and stated as such, thus
giving the inquirer a chance to use his own judgment. Statements

" "
such as, I am informed," I understand," without
saying by or
from whom, leave the mind confused and unsatisfied. What is
said elsewhere 2 about the use of general terms in case records
applies to letters also.

Letters of report to correspondents in the same city are easily
followed by director communication, which supplements or cor-
rects their deficiencies. There is something so tangible about a
letter,however, that an error may survive the correction and make
trouble a good deal later.
1 "
My dear old grandfather. taught me never to attempt to answer a letter
. .
without placing it before me and reviewing it scrupulously, paragraph by para-

graph. Hundreds of times have I devoutly blessed his memory for that lesson in
the common-sense of correspondence." Anonymous Contributor in the Atlantic
Monthly, June, 1913, pp. 856-7.
See p. 349-
334
IV. SOME TECHNICAL DETAILS

The foregoing sentence might seem to contain an argument for
destroying letters as soon as their immediate purpose had been
served. In one family agency a business men's committee recom-
mended that correspondence about any given case be destroyed
all
was "closed" this being the agency's technical

as soon as the case
term for the discontinuance of treatment. Medical men would
have seen by analogy the folly of this, but business men could not,
and the attempt to carry out the decision caused endless trouble.
It is important in case work to keep all letters received and copies
of all letters sent that have any bearing upon case diagnosis and
treatment. The originals of letters written by a client who, at the
time of writing or later, suffers from some form of mental disease
are sometimes important items in the diagnosis of the disease. This
is also true in the diagnosis of mental defect, but there are equally
important inferences to be drawn from the letters of the normal,

such as their fitness for certain work, their degree of education, etc.
It is often found wise to preserve copies of letters not addressed to
the case worker but shown by the client as having an important

bearing upon his affairs. One child-protective agency is accus-
tomed to have such letters copied at its office while the client waits.
Letters of inquiry or report should not be forwarded by the
client's own hand. One letter so sent to a hospital contains the
"
following sentence: No doubt you will notice at once upon talking
with her that she is not mentally normal." Apart from the danger
of suggesting a diagnosis, it was a mistake, of course, to send this
by a The report should have gone by mail, and only a

client.
short, unsealed note of introduction, referring to the letter, should

have gone by hand.
Letters addressed "to whom it may concern" should not be
written at all. The
worthlessness of such letters has already been
referred to (p. 1 77). Circular letters of inquiry are often used with
good results in cases involving the discovery of the whereabouts of
runaway boys or of adults who are mentally disturbed. These
forms should indicate that duplicates are being sent to a number
of places. They should contain a careful description of the person
sought and suggestions as to the kind of story that he is likely to

tell.
335
SOCIAL DIAGNOSIS
Another very useful device in establishing whereabouts and even
identity the
is registered letter. The special delivery letter is not
so good, because the post office authorities are not so careful to
demand, for its receipt, the signature of the addressee or of someone
holding his power of attorney. The registered letter receipt is used
as evidence in court. Here its signature can be disputed, of course,
in which case the handwriting expert may have to be called in.
One medical-social department tried to find the mother of a hospital patient, a

childwho was on the dangerous list. A letter addressed to her had just been re-
turned "not found." The post office authorities were consulted, with the practical
guarantee from them that a registered letter would reach her in two days' time. It
suburb several miles away from the original address.

did, in a
A
regulation of the post office department forbids letter carriers
to give information about addresses, but it is possible to get such
information higher up when satisfactory reasons can be given for
seeking it. In large cities application can be made to the division
superintendents, followed, when this fails, by appeal to the post-
master himself. supposed irregular use of the mails should be
Any
reported promptly to the post office inspectors, who are always
ready to investigate such complaints.
As has been said already, a letter is better evidence when accom-
panied by the inquiry to which it is a reply. A letter is somewhat
better evidence when accompanied by the addressed and post-
marked envelope in which it was received. In the case of letters
returned, the envelope marked "address not found" should be
saved. It is evidence that the attempt to find has been made.
V. COMMUNICATION BY TELEGRAPH
In a good many minor matters, where necessary details can be
stated briefly and where promptness rather than fullness of reply
is the important thing, communication by telegraph is more satis-
factory than by letter alone. A telegraphic dispatch should always

be followed by a letter the same day, and in cases in which this
procedure is not well understood and therefore taken for granted
by the recipient, the dispatch should state that a letter is on the
way. The follow-up letter should contain a copy of the dispatch,
which may have been mutilated in transmission. Sometimes, when
a letter alone would suffice if given prompt attention, the psycho-
336
logical effect of the dispatch is to assure prompter answer of the

"
letter. The night letter" form of dispatch, which carries 50 words
without extra charge, is often better than a letter alone, when a
correspondent is more than twenty-four hours' journey away.
A large group of social agencies (about 800 at the present
writing) use a telegraphic code in matters pertaining to the trans-
portation of their clients within the United States. The prelimi-
nary inquiries by telegraph that often precede the furnishing of
transportation are thus made at lower cost, and there is also a gen-
eralunderstanding among these agencies, which are all signers of
a "transportation agreement," that such inquiries shall take pre-
cedence of others and be answered with especial promptness. 1
VI. COMMUNICATION BY TELEPHONE

The question of whether, in a given case, the long distance tele-
phone would not be a better means of communication than the
telegraph is one that must be answered with a knowledge of all the
circumstances of each inquiry in mind. The possibility of a choice
should not be lost sight of, however. The mere existence of a tele-
graphic code, for instance, may lead the signers of the transporta-
tion agreement to use it when some other means of communication
would be better. For data already in the possession of the one
communicated with, the telephone response is prompter and fuller,
though it is not always accurately received. For information that
must be gathered, reply by telegraph, with all its shortcomings, is
better, therefore, and especially so for names, numbers, etc. All
such data should be repeated by letter, however, when originally
communicated either by telephone or by telegraph. The prompt-
ness of the long distance telephone in putting us in communi-
cation with those who already know is illustrated by the following
by Miss Alice Higgins (Mrs.
instances, the first supplied Wm. H.
Lothrop), and the second by Miss M. L. Birtwell:
A businessman asked us to send a young fellow to his father in a city 200 miles
distant, and thought us a bit fussy when we talked over a long distance telephone
to learn if such return would help the man. We learned the father was a chronic
drunkard and a most undesirable guardian, but that an uncle in an adjoining city
to our own would be a wise and interested adviser. Consultation with the uncle
1
See pamphlet, Passing On as a Method of Charitable Relief. Russell Sage
Foundation, New York, 19 1 1. (Now out of print.)
aa 337
SOCIAL DIAGNOSIS
resulted in a good position and a home for the nephew; and the business man then
appreciated that knowledge before action meant wiser action.
A man of fifty-three wandered into our office one morning at about 1 1 o'clock
and asked for work. He did not seem strong or intelligent and we felt that he was
hardly a promising subject for the labor market. We could get little out of him,
but on rather close questioning he mentioned Palmer as a recent place of residence.
Knowing that the State Hospital for Epileptics was located there, we telephoned
to the State Board of Insanity to inquire whether such a man had been a recent
inmate. The reply came that according to report from that hospital a man of that
name had left the institution two days before. A telephone message to Palmer,
eighty-four miles away, brought word from the superintendent that the man had
left against the advice of the authorities; that he was entirely unfitted to earn his
living out in the community, but that he could do some work about the institution;
and that they would like us to use our utmost efforts to persuade him to return.
He refused for a time and shed tears at the prospect; but after much kindly per-
suasion on the part of one of our workers, who shared her lunch with him, he con-
sented. He was put on the train in care of the conductor, the superintendent was
telephoned to that he was coming, and at half-past five in the afternoon he was in
safe hands again. He wrote us a day or two later that the doctor met him, that he
had a good bath and a good supper, and was back at his old job at the stable.
As a means of communication within the city, especially with
other social agencies, the telephone is very popular among case
workers and will probably continue to be so. Its dangers and
shortcomings are only beginning to be noted, and they deserve
enumeration for this reason. No one will use the telephone too
little, because it is so convenient, but the facts brought to light in
the course of our case reading should lead everyone to use it, in
diagnosis, with more caution.
It is comparatively easy to get in communication with even a
very busy person over the telephone, which still has the right of
way in household and office alike. But this very fact means that
the one telephoned to may have been interrupted, with the result
that he is somewhat irritated and has little conscience about put-
ting off the interrupter with an inadequate and hastily expressed
statement. Are the ordinary run of people as frank in their tele-
phone intercourse as they are in intercourse face to face? The
question is not without interest. When an
attempt is made to
answer it, this factor of interruption will have to be taken into
account. Another consideration will have to be the fact that the
one telephoned to cannot always be sure of the identity of the
person at the other end of the wire. How can he know that this
338
questioner is just what he claims to be? The one telephoning, on

the other hand, cannot know who is in the same room with his
informant, and the informant cannot always be sure, unless he has
a private wire, who else, besides the people in the room with him
and the questioner, may be listening to the conversation.
Two other elements increase the chances, not of suppression or
untruthfulness, but of error. Over the telephone, as we now know
it, proper names are very frequently and other words somewhat
lessfrequently misunderstood. In case work this is a serious draw-

back. In addition to this, case records seem to show that the eye
helps the ear in noting what is said, and that telephone conversa-
tions are less accurately reported on our records than are personal
interviews. The following comments and case items illustrate
these drawbacks:
A critic of case records writes of one as follows: I should say that the telephone
communication with the minister on September 16 had been ill advised. With a
minister who does not understand our methods one of two systems of approach is
generally advisable; first, and preferably, the personal conference; second, a
letter,possibly followed by a telephone call. Direct approach by telephone is
pretty risky unless we know our people.

The husband of a tuberculous wife asked a medical-social department to com-
municate with him by telephone, when necessary, at the factory where he worked.
But in this way the fact that his wife had tuberculosis became known there, and the
fear among his fellow employes that he might infect them made it so uncomfortable
for him that he was forced to leave.
A former newspaper reporter became the client of a certain social agency. Soon
after, the agency received a telephone message purporting to be from the night
editor of a daily paper asking that the reporter's application receive immediate
and careful attention, and that whatever inquiry was made be conducted without
inconvenience to him. Seen later the same day, the night editor denied all knowl-
edge of this message. Far from commending the reporter in any way, he con-
sidered him an adventurer and "hold-up man."
A family agency was asked by a society in another city to see the relatives of
one of its clients and his physician. The agency telephoned to the physician to find
was in his office at the time. While the treatment of the
that the client's brother
casewas not hampered by this fact, it made an additional difficulty for the brother,
who was extremely sensitive about the client's misfortunes.
A child-protective agency operating in a rural area reports that, in the small
country towns included in its district, half the town may be on one telephone line,
and that it is considered an innocent and legitimate diversion to lift the receiver and
hear all about one's neighbors. This is especially true if a particular neighbor is
known to have had a visit from the agency's case worker.
339
SOCIAL DIAGNOSIS
The one of the confidential exchanges reports that a hospital tele-

registrar of
phones each morning all the names about which it wishes to make inquiry, and that
a written report is sent to the hospital later in the day about each one, indicating
whether it is known or unknown. Usually a note comes from the hospital still
later to say that certain of the names previously telephoned were misunderstood,
and that the correct spelling is so and so. Thereupon the exchange often finds that
these names about which "no information" had been reported are really in the
exchange.
The use of the telephone to obtain medical data led to the following results in one
Polish family: (i) Dispensary reported by telephone after examination of the three
children that Dominic had been given a positive diagnosis of tuberculosis. (2)
Three days later a visit to the dispensary brought out the fact that this diagnosis
belonged not to Dominic but to Almena, his sister. (3) A year and four months
later,dispensary telephoned that the mother of the family had an advanced case of
tuberculosis. (4) Three weeks later, the doctor, when seen at the dispensary, said
that she had an early case.
A family was referred by a medical-social department to an associated charities

with certain data, including the statement of the man of the family that he was
earning $14 a week. The society visited the employer and reported over the tele-
phone to the medical agency after this visit (or was understood to have reported)
that the man was earning $173 week and had been doing so for the last six years.
As a matter of fact the record of the associated charities quotes the employer as
saying that the man had been earning $14 a week for six years but that his weekly
wage had just been increased to $17. The record of the medical-social department
did the man unintentional but serious injustice, as it suggested the inference that
he was not trustworthy. 1
Some case workers are so unwilling that their work should be

represented on the records of other organizations by someone's
recollection either of a telephone conversation or of one face to face
that they always offer, when information is requested, to send a
written summary of what they know instead. If inquirers are in
special haste, they make a brief statement at the time and send
the written summary for purposes of verification and for its fuller
and more carefully considered details. Such workers, in asking
information from others in following up the clues supplied by the
confidential exchange, for instance are careful to ask for written
summaries from those agencies which prove, when telephoned to,
to have some definite information to give. When supplemented
1
A critic points out that this same error in reporting or recording might
have hap-
pened in or after a personal interview, though there are more errors when the tele-
phone is used.
340
by the written summary, the telephone becomes a far safer means

of communication.

1. The best means of communication for most case work purposes is the personal
interview; the worst is the blank form.
2. The letter of inquiry is too often a matter of routine. The value of such a
letter may be tested by the following questions:
(1) Should the letter be written at all or would some other means of communica-
tion serve the purpose better?
(2) Should the letter be written now? Have the preliminary inquiries that
would make writing the logical next step all been made?
its
(3) What relation does this particular inquiry bear to the whole process?
(4) Has the best correspondent been chosen for the end in view?
(5) What will interestthe correspondent selected?

(6) What presentation will save him unnecessary trouble?
(7) What facts relating to this correspondent's occupation, education, etc.,
should modify the approach by letter?
3. The case worker's letter of reply to an inquiry should bear internal evidence
that the inquirer's letter has been read and its contents fully apprehended. When
it is impossible to cover all the points of an inquiry, a reply should name the items
not covered and give reasons for the omission.
4. A letter of reply to an inquiry should not confuse the inferences of the writer
with the information on which they are based. The letter should give both, but
it should be possible for its recipient to distinguish them.
5. A telegraphic dispatch should always be followed by a letter the same day;

this follow-up letter should contain a copy of the dispatch.
6. The telephone as a means of communication in case work is too convenient
to be abandoned, but its drawbacks are not always understood and guarded against.
There are good reasons why people are not so frank in their telephone intercourse
as they are face to face, nor do they understand what is said as well. The eye aids
the ear in getting names and numbers accurately; over the telephone these are fre-
quently misunderstood.
341
CHAPTER XVIII
COMPARISON AND INTERPRETATION

come now to the fourth and last of what for conve-
WE nience we have defined as the stages leading to diagnosis.

Workers will continue, in many cases, to find their way to
a correct and sufficiently amplified diagnosis without consciously
arranging the preliminary steps in groups, but in cases presenting
difficulties they will find this separation and the further analysis
attempted an aid to thinking. The processes already
in this chapter
described have been (i) the first full interview with a client, (2)
the early contacts with his immediate family, (3) the search for
further insight and for sources of needed co-operation outside his
immediate family.
To
emphasize the essential unity of these three processes, to
bring out a few of their salient features and to establish more clearly
the relation of these to the final process of Comparison and Inter-
pretation now to be described, it is necessary at this point to review
briefly a part of the ground that has already been covered. Since
each item of this restatement has been more fully developed in
earlier chapters, no more than a regrouping of the main ideas is
necessary.
I. CERTAIN ASPECTS OF EARLIER PROCESSES RESTATED

We (i) that certain methods and points of view are
have seen
common interviews, (2) that different types of interview call
to all
for changes of emphasis, (3) that discrimination in the choice of

outside sources of insight is an economy of time as well as an indi-
cation of skill, (4) that the risks involved in different types of evi-
dence and the nature of these types must be kept in mind in gather-
ing the facts and in weighing them, and (5) that the characteristics
of human beings as witnesses should be our constant study.
1. Methods Common to All Interviews. Our methods and point
of view are in many ways the same whether we are meeting a client
342
for the first time, visiting members of his immediate family, or

seeking insight from outside sources. In all these cases we should
(a) Strive to procure from each the evidence that each is best
able to give. Some facts come best from our client, some from our
observation of his home surroundings and neighborhood, some from
the testimony of employers and comrades, and some from docu-
mentary sources.
(b) Utilize any natural avenue of approach to a client presented

at the beginning of the interview, and as the interview develops
avoid the temptation to shape it in accordance with preconceived
ideas of its probable content. The same caution applies to any
questions that we may have to ask the way in which we put our
question should not suggest the answer.
(c) Give the person interviewed ample time, therefore, in which
to explain his own point of view, and give him also a sympa-
thetic hearing.
(d) Keep the goals of fuller knowledge of the client's problem

and of the future co-operation of relatives, employers, etc., in its
solution always in view. Our ability to show genuine interest will
play an important part in procuring both information and backing.
2. Changes of Emphasis in Interviewing. Generally speaking,
we are justified in narrowing our inquiry, somewhat, as we approach
the sources farthest away from our client's personal life, and in
broadening it in our talks with him and his family. As between the
client and his family group on the one hand and certain outside
sources on the other, this difference becomes a marked one. In
talking with our client, the whole man, for any diagnosis that de-
serves to be called social, must concern us. We
must be alert to
every possible clue to his personality, or, in other words, we must
note the current of events in his life as well as his social relation-
ships. What has been the main drift of that current? Who are
the people and what are the social institutions that have most
influenced him?
To win these insights as promptly as possible without endanger-
ing our future relations with him we must avoid, in our interviews,
all dictation, hurry, and overquestioning; we must give our client
a patient and fair hearing, merely guiding the trend of talk enough
to encourage a full development of his story.
343
SOCIAL DIAGNOSIS
This same painstaking method may be necessary with all the

members of the client's family group. Knowledge of the main
drift of thefamily life may be the key to a diagnosis of the client's
situation. In studying that drift it will be found useful to note the
difference between the power of cohesion in a united and in an
unstable family.
Passing to outside sources, we find some, more especially those
whose relations to our client have been personal and unbroken,
from whom we need guidance and help during the period of
shall
treatment. A of others, however, we shall see only, as a
number
rule, before our diagnosis is made, and thereafter not at all. With
these latter we can afford to save time by narrowing the inquiry to
the special information which this or that source is likely to supply,
though always with the possibility in mind that, at any moment,
the person interviewed may show himself able to throw unexpected
light on other aspects of the problem. We do not see even the least
important outside source merely for verification of items already
learned elsewhere; verification should be a by-product of more
fruitful intercourse. Success in the interviewing of outside sources
depends partly upon taking time to explain briefly to teacher, phy-
sician, church visitor, etc., the relation of the items of information
sought from him to the constructive work which is in process.

It is evident that the multiplication of interviews in which
inquiry is thus narrowed may be carried too far. If undertaken

heedlessly, without a clear conception of the weaknesses and
strengths of the evidence already gathered, they may add little to
our sum of knowledge. On the other hand, there is always a
degree of risk in omitting any source. One of the ways of econo-
mizing means is to strive to get from sources that are being con-
sulted sidelights upon the probable value of those that have not
yet been seen.

3. Discrimination in the Choice of Outside Sources. Economy
of means is a lesson still heeded by case workers. They
too little
should beware, it is true, of using in every case the same two or

three kinds of source and no more; but, in choosing varied sources
for varied cases, they should learn to seek the source of each kind
which is likely to yield the facts they want the most skilful phy-
sician, for example, the employer for whom a client worked longest,
344
the one forwhom he worked longest during the last five years, the
previous residence at which his family lived the longest during the
same period, the social agency that has had the least casual con-
tacts with his family, etc. It may even be that some social agency
has already assumed responsibility for treatment. This fact would
come out after consultation of the index at the confidential ex-
change or social service exchange, and would render unnecessary
further work with the client in question.
Every such discrimination gives a more assured and economical

use of sources. Thus
(a) Some sources are known, even before they have been seen,
to be rich in history they are familiar with our client's early life
from observation instead of hearsay. These witnesses may or
may not be so associated with the client's present as to be likely
to be rich also in co-operation. In choosing the order in which
sources should be seen, it has been found useful to see first those
who are likely to be rich in history only, in order that our first
conference with a possible co-operator may be conducted later,
when we can meet him on more equal terms as to a knowledge of
relevant facts in the client's history and therefore with greater
likelihood of achieving a social result.
(b) Another useful discrimination is that between clues to out-
side sources obtained from a client or his immediate family, and
such clues when obtained elsewhere. The latter are called sup-
plementary clues, and, since usually they have been revealed more
disinterestedly, are less liable to be prejudiced.
(c) A further discrimination divides social agencies as witnesses
into those agencies that have had a personal experience with our
client which has a bearing upon diagnosis, and those agencies that,
with or without such an experience, have gathered certain objective
and fundamental data with regard to the client data which are
not likely to change. Previous experience of the work of certain
social agencies may serve here to guide us to those that usually
gather carefully the facts of family and personal background.
(d) Still another discrimination is between the uses to which
documentary and personal sources can be put. The impersonal

document is more satisfactory for objective matters of fact, such
as events, dates, places, amounts; and individual testimony more
345
SOCIAL DIAGNOSIS
satisfactory for subjective matters, such as personal traits, in which

the motives and capacity of the witness, the atmosphere and spirit
of his statement, are all important.
4. Types of Evidence. There are discriminations to be made
not only in the types of source but in the types of evidence which
sources supply. Real evidence, it will be remembered, is the very
fact at issue presented to our senses. Testimonial evidence is the
assertions of human beings, to which must always be applied tests
of the competence and bias of the witnesses. Circumstantial
evidence is any indirect evidence whatsoever which tends to es-
tablish the point at issue. The tests applied to it have to vary,
because the subject matter is infinitely varied. Any fact in the ma-
terial universe or in the mind of man may become the basis from
which some other fact is inferred.
There is an important distinction in testimonial evidence be-
tween the assertions of those who say that they saw or heard the
supposed facts themselves and the assertions of those who have
the facts only from what others have told them. This latter is
hearsay evidence, and in all our interviewing we should discover
the extent to which the assertions of the interviewed are founded
on observations or on mere rumor.
5. Characteristics of Witnesses. The first, unrehearsed state-
ment of a witness is often the most trustworthy. This first state-
"
ment can be made less reliable, however, by a careless use of lead-
ing questions," which are a danger not only in the first interview
but everywhere. "Every one of us," says Gross, "has made the
frightful observation that by the end of an examination the wit-
ness has simply taken the point of view of the examiner, and the
worst thing about this is that the witness still thinks that he is
thinking in his own way."
1
A witness may be quite sincere also in thinking that he knows

more about an event or a person than he really does. His good
faith, therefore, is not the only thing to establish. His compe-
tence includes both his opportunity to know the facts and the way
in which he has used his opportunity. This latter is conditioned
by his powers of attention, memory, and suggestibility. What
ideas had he in stock, moreover, which would have made him a
1
Criminal Psychology, p. 163.
346
good or a bad observer? What reason had he for observing care-

fully?
Apart from his competence as a witness, what risk is there of
bias in his testimony? Biasbe racial, national, religious,
may
political, environmental, or some element of self-interest may
enter in. Important forms of environmental bias are those of a
man's occupation and of the particular habit group to which he
belongs.
Obviously it is not enough to add statement to statement, as a
phonograph would. The processes of inference, of comparison of
material, begin with the first interview and continue through all
the steps leading to diagnosis.
THE COMPARISON OF MATERIAL

II.
"
I am astonished/' says Dubois, " to see how many young phy-
sicians possessing all theworking machinery of diagnosis do not
know how to make a
diagnosis. It is because the art of diagnosis
does not consist merely in gathering together a great many facts,
but in co-ordinating those that one has been able to collect, in
order to reach a clear conception of the situation." 1 And we are
told that the historian first collects his material, then collates it,
and only after it has been collated attempts his final interpretation.
He weighs his evidence, of course, as we do, item by item when it
isgathered, but a reweighing of the total is necessary when all
the items are in. "After a student has learned to open his eyes
"
and sees," writes Dr. RichardCabot of clinical teaching, he must
learn to shut them and think." 2 So must we. Nevertheless, this
stage of assembling our material, of relating its parts and trying
to bring it up into consciousness as a whole, will not be easy to
illustrate, since it is the most neglected part of case work technique.
Speaking broadly, the social case worker of an earlier day did

little visiting of anyone except his client and so observed only
within those narrow limits. He was mentally sluggish, moreover,

and guilty of much thoughtless prescribing. The case worker of
today is more active physically sometimes doing too much run-
ning around, one is tempted to believe but his advance in useful-
1
The Psychic Treatment of Nervous Disorders, p. 277.
*Case Teaching in Medicine, Introduction, p. vii.
347
SOCIAL DIAGNOSIS
ness over earlier workers would be greater if he would oftener
"shut and think," if he would reduce the visible signs of

his eyes
his activity and assemble his forces in order the better to deliberate
upon his next move before he makes it. Case records often show
a well made investigation and a plan formulated and carried out,
but with no discoverable connection between them. Instead, at
the right moment, of shutting his eyes and thinking, the worker
seems to have shut his eyes and jumped. On the other hand, how-
ever carefully the inquiries are recorded and the diagnosis which
grew out of them indicated, however carefully a plan of action is
decided upon, etc., the processes by which the diagnosis is arrived
at what parts of the evidence have been accepted or rejected and
why, what inferences have been drawn from these accepted items
and how they have been tested can none of them be revealed
in a record.
Some case workers feel that their conscious assembling of ma-
terialcomes when they present a summary to the case committees
of volunteers who assist them in making the diagnosis and the plan
of treatment. This is any of the members of
especially true if
the committee have a social experience that has made them both
critical and just in their valuing of testimony. One worker
"
writes, Repeatedly, flaws in my investigation have not occurred
to me in reading over the record, but they have become only too
evident at the moment of presenting the case to my committee.
The standard in my mind of what the committee ought to know in
order to make a fair decision has then suddenly revealed weaknesses
to me before they were brought out in the discussion."
The same bracing influence comes from submitting findings at
this stage to a case supervisor who is responsible for the work of a
group of social case workers. Indeed, the process of comparison,

in so far as it can be studied at all at present, is found at its best
in the daily work of a few experienced supervisors. Unfortunately
they are usually persons who are much overburdened. Although
committees, at their worst, can be useless as critics, when well
chosen they have an advantage over any one referee in that they
bring not only less jaded minds but more varied experiences to
bear upon each problem. Either supervisors or committees have
the advantage over the worker who makes his analysis unaided,
348
that they do not know the client or his story, and that conse-
quently they are not already so impressed with any one part of the
story as to be unable to grasp the client's history as a whole.
1
1. Suggestions for Self-supervision. In the absence of a com-

petent supervisor or of a committee, the case worker will often
have to take the place of both by consciously setting aside some
time in which he will strive to look at his own work as if he were a
critical outsider. 2
(a) He can try to review each item of a case with all the others
in mind. When each particular piece of evidence came to him,
he judged it by what he then knew. How does he judge it now in
the light of all the evidence?
Gross suggests another way of testing our material which is
psychologically more difficult; namely, to consider a part of it
with other material deliberately excluded. 3
This what a probation officer had to do, probably, when a father lodged com-
is
plaint against his boy for stubbornness and for thieving from his older brothers.
The home seemed so satisfactory that she was inclined to seek the cause of the
trouble in outside influences that would have led the lad to take first small sums and
then much larger ones. When, however, the time came for planning, the explana-
1
A
case reader of wide experience suggests here that, in fields of work where no
committee is possible and no supervisor is at hand, someone with a keen mind be
introduced to case record reading and that current problems be "tried out on him."
Even where there is a committee it is important that someone on the committee
besides the case worker read the record before the case comes up for discussion.
*Any detailed discussion of the worker's case records must be reserved for a
separate book on that subject, though self-supervision might well include not only
the case work but its recording. Charles Kingsley warned a young writer that he
should never refer to anything as a "tree" if he could call it a "spruce" or a "pine."
If that lesson had been impressed upon the present generation of case recorders,
the task of writing this book would have been an easier one.
Among the general terms against which collectors of family histories for eugenic
study are warned by the Cold Spring Harbor Eugenics Record Office (see Eugenics
Record Office Bulletin No. 7, p. 91) are abscess, without cause or location; acci-
dent, decline, without naming the disease; cancer, without specifying organ first
affected; congestion, without naming organ affected; convulsions, without details
and period of life; fever; heart trouble and heart failure; insanity, without details;
kidney trouble; lung trouble; marasmus; stomach trouble.

The social case worker's Index Expurgatorius would have to cover a much wider
range of subjects; but some of the commonest substitutions are relative for the word
expressing the exact degree of relationship; Italian or Austrian or German for the
term descriptive of a native of the particular province or other political subdivi-
sion; day laborer or salesman or clerk for the particular occupation; and bad, dull,
unsanitary, shiftless, incompetent, unsatisfactory, good, bright, industrious, proud,
refined, and a host of such adjectives for the specific act or condition.
'Criminal Psychology, p. 12.
349
SOCIAL DIAGNOSIS
tion had not been found, and, having a mind that demanded specific data instead
of fallingback upon an unsupported theory, she began her search anew and ex-
cluding from her mind for the time being the favorable family appearances, found
two court records of the arrest of the father, one for buying junk from minors and
the other for peddling without a license. These may seem small offenses, but they
were serious enough in the father of a boy who was also developing a tendency to
lawlessness.
(b) Sometimes, as Gross suggests also, the grounding of a fact

has been so difficult, has taken so much time, that we slur over the
task of establishing its logical connection with the whole, or do that
part of our work "swiftly and wrongly."

1
Or sometimes the
slurring is due to the desire to make a definite report with prompt-
ness, as in the following case:
A charity organization society was asked in August by the state's attorney to
interest itself in a non-support case, in which the man of the family had been ar-
rested for not making weekly payments to his wife on the separate support order of
the court. A week later the society submitted a report of its inquiry upholding the
wife. In October, however, when the man made application to have his children
removed from the home, an exhaustive study of the case revealed bad conditions
there. A critic of this case record writes: " Before your first report to the state's
attorney was sent, contradictions in the evidence had developed that should have
made it clear to you that further investigation was needed. The sources of informa-
tion were at hand and the winter's rush was not upon you."
(c) As was the case in the foregoing example, a review of our

material will often reveal unsuspected contradictions in the evi-
dence. Where these contradictions cannot be reconciled we may
safely infer that further evidence is needed; where, though all the
evidence points one way, no explanation of the difficulty or guide
to its solution has been revealed, we must again look for additional
facts.
(d) The rhetorics tell us that the first and last paragraphs of an
essay are the two that make the deepest impression upon the reader.
It may be well to ask always, therefore, whether the story as told
by the first person seen, or the first theory adopted by the worker
has received undue consideration in shaping the final conclusion;

or whether the last statement made has been allowed this advan-
tage. Anyone who has had occasion to note the eagerness of each
of two complainants to tell his grievance first will appreciate that
1
Criminal Psychology, p. 143.
350
we have an intuition that first impressions are lasting. Where

there have been matters in dispute, however, the strategic posi-
tion second only in value to the first is the last. In short, we
must guard against the impression made by first and by last state-
ments in an investigation.
In all this analysis of data the suggestions made in Part I in the
discussion of inferences will be found useful. 1 What is there said
about the testing of inferences applies to their retesting by the
case worker, and is so fundamental that it has seemed best not to
restate in abbreviated form the conclusions of that chapter at the
beginning of this. There are, however, many of the details in the
later process ofcomparison in the process of examining critically,
thatis, the gathered testimony which are best summarized on the
assumption that someone besides the case worker himself is to re-
view a mass of evidence.
2. Suggestions for Comparisons Made by a Supervisor. What
should a supervisor look for in a case record in which the work has
reached the stage of evidence gathered but not yet compared or
interpreted? For convenience of reference the treatment of this
topic has been reduced to questionnaire form and added to the

series of questionnaires in Part III, 2 but every other questionnaire
in thisvolume should be understood to have a relation to super-
visory work and to the comparisons made in self-supervision.
The questionnaire for supervisors summarizes material scattered
throughout this volume and rearranges it under the heads of (a)
the case worker's relations with client, (b) with client's family,
(c) with outside sources, (d) the conduct of the inquiry as a whole,
and (e) wider aspects of the inquiry.
Good supervision must include this consideration of wider as-
pects. We have seen that the habit of keeping in mind the bearing
of each individual fact on general social conditions gives added sig-
nificance to the statements in a record. This habit may also open
broader avenues of usefulness. Every case worker has noticed how
a certain juxtaposition of facts often reappears in record after
record, and must have suspected that this recurring juxtaposition
indicates a hidden relation of cause and effect. Or else he must
have noted that some twist in the affairs of clients showed again
1 '
See p. 8 1 sq. See p. 449 sq.
351
SOCIAL DIAGNOSIS
and again a marked similarity of outline such as to suggest a com-

mon cause, thoughno rational explanation came to hand. It is
"
here that the notation of recurrence," as it is called, becomes a
duty of supervisor and case worker. Not only should these repe-
titions be noted but they should be compared carefully. Some
situations that seemed similar will be found upon examination to
be different in essence, but the remainder, if they are likely to
throw light on social conditions or on the characteristics of any
disadvantaged group, should be submitted to those specialists in
social reform who can make a critical and constructive use of them.
The getting at knowledge that will make the case work of another
generation more effective may be only a by-product of our own case
work, but it is an important by-product.
1
The wider significance
of case work data is illustrated incidentally in the analysis of the
Ames case, which follows:
3. The Ames Case. On page 84 will be found the face card of
a family record of the Ameses, begun in 1909, together with a dis-
cussion of some of the inferences drawn from it by a case worker
who had not read the record itself. This process of drawing in-
ferences from a face card and then testing them by the record or by
further inquiry will be found useful in review procedure.
Let us now see, without attempting to reproduce the Ames
record,
2
how a few
of the suggestions in this section may be ap-
plied to the story of that family:
1
Dr. Adolf Meyer, addressing a group of after-care committees for the insane,
"
just after having read some of their records, says, I had to
put a big black cross
in my mind over the town of Waterloo. There is a town which evidently contains
centers of infection, which the community cannot afford to tolerate, and which
can be attacked if one has sufficient material against them. . . . The authori-
ties and the good and bad people may not pay much attention to remonstrations
until sufficient material accumulates and is plunged at the right time, and then you
may be able to do something. These are difficult tasks, I know, but there is no
way of doing anything by keeping quiet or by making abstract complaints."
After-care and Prophylaxis, p. 16. Reprint of an article in the State Hospitals
Bulletin, March, 1909, authorized by the State Commission in Lunacy, Albany,
N. Y. Utica, N. Y., State Hospitals Press, 1909.
1
Study of the original case record would be more satisfactory, for case workers
will always disagree as to what is important and what is not in the making of a
summary. On the other hand, a social case record which is fully adequate for study
is such an identifiable thing that the writer has never been willing to publish one.
The few that have been privately printed for class study only have been excellent
teaching material, though even in the use of these few the danger of violating the
confidences of clients has not been completely avoided, and the problem of recon-
ciling their use with the highest case work ethics has been a puzzling one.
352
Thomas Ames is a tuberculous hatter of thirty-eight with a wife of twenty-eight

and two children, girls aged six and nearly two. Mrs. Ames' mother lives with
them. The family had been reported as in distress to a charitable woman, Miss
Delancey, when she happened to be visiting some of their neighbors. After one
visit to the Ameses, she sought, on May 10, the advice and aid of the nearest dis-
the charity organization society. One of the society's case workers

trict office of
held the interview in the home that same day, noting on the record that she
first
was obliged to interview Ames, his wife, and his mother-in-law together.
Mr. Ames gave at this time his story of work at Caldwell's hat factory ever since
his marriage, and stated that the tuberculosis dispensary had advised him to apply
for admission to the state sanatorium, but that he could not leave his family. He
was seeking work as an insurance solicitor, hoping in this way to become stronger.
The mother-in-law was not working for reasons unstated. The church had helped
but was too poor to continue, or so the family believed. Mrs. Ames had never been
strong since the younger child's birth. She showed some hesitation about having
any of her own or her husband's people seen. Mr. Ames, however, said that he
understood the case worker's desire to consult them and furnished the addresses
of his four brothers and sisters and of his wife's two sisters.
The outside visits were then made in the following order: Tuberculosis dis-
pensary, Mrs. Ames' two sisters, her doctor, the school principal of the older child,
one of Mr. Ames' brothers, and his two sisters, then the tuberculosis dispensary
twice again, followed by an interview with Mrs. Ames alone. Only after all these
visits had been made were the manager of the hat factory and the pastor of the
church seen.
What did these outside visits reveal? An unusually simple family history, which
for that reason is used here for illustration. The dispensary doctor was not found
from sending a quart of milk
until the third visit to the dispensary, which, aside
daily,had had no contact with the home. The medical record showed that Ames'
condition was grave, that he was running a high temperature and was unable to
work.
Mrs. Ames' two sisters spoke in high terms of Ames' industry and kindness to
his family. The older child was reported by the school principal to be quiet, well
trained, and diligent, but "by no means bright." Mrs. Ames' doctor had known
the family a long while, spoke well of them, but was vague about the wife's health,
describing her as "always frail," and did not state how long it had been since he
had last treated her.
Joseph Ames and his wife had not realized before the seriousness of the situation.
On learning it, they offered Mrs. Ames and her children a home if her husband would
go to the sanatorium. (The case worker said on the spot that she thought the plan
an excellent one, though the interview developed that both Joseph and his wife were
sure Mrs. Ames should go
to work and that she was "too high-toned.") Their sister,
Clara, seen on Maywas found to know the Ameses better than the other relatives
1
5,
of the husband. She dropped a hint that Ames was willing to go away, but that
his wife was holding him back and urging him to find other work.
The case worker had had no intimation of this, but it proved the key to all the
33
353
SOCIAL DIAGNOSIS
treatment that followed. A private interview was had with Mrs. Ames. She
could not believe at that her husband's condition was as grave as represented,
first
and moreover was worried as to what was to become of her home and her children.
It was Ames was a very sick man, and to reassure her
possible to convince her that
as to her household. The
explanation of Ames' attitude having been passed on to
the dispensary, the doctor there was able to persuade his patient to apply for ad-
mission to the sanatorium.
It had taken ten days to accomplish this. Thereafter followed quickly visits
to the two important sources of co-operation in the case the employer and the
church. Although Caldwell's had aided, the firm did not know that Ames had
was incapacitated for any work. They agreed, in the light of this
tuberculosis or
development, to pay $5.00 a week until Ames could be admitted to the sanatorium.
(The period of help was extended later to the date of Ames' return.) The pastor
of the church agreed to supply whatever food was needed.
During an interval of some months before Ames could be admitted, Miss De-
lancey served as a regular visitor to the family, with the immediate object of sug-
gesting the necessary precautions for the invalid. With a sleeping tent in the back
yard, Ames actually made some slight gains at home before his five months away.
This social diagnosis and treatment, which was successful in the promptness with
which it got at the heart of the difficulty a personal as well as an economic one
and rallied the outside sources to meet it, had some weaknesses which a competent
supervisor would quickly discover. Ames came back well enough to take and keep
more healthful work under his old employers. But just after he went to the sana-
torium in September, Mrs. Ames developed an incipient case of tuberculosis.
Fortunately the infection was discovered in time; but the fact is there had been
such concentration upon the problem of the sick man that preventive examinations
of wife and children a precaution more often neglected in 1909 than now, it is
true had not been made. And why was a woman described as frail left with no
more definite diagnosis for four months? The opinions of the relatives on both
sides of the house as to her health, her ability to work, etc., were set down in the
record, butno competent professional judgment was procured.
Then, before the inquiry had been completed, the offer from the Joseph Ameses
of a home with them for Mrs. Ames and the children had been accepted by the case
worker as a definite solution without weighing the arguments for and against.
Probably it was so received because it was the first concrete offer made. Its
abandonment later may have been because other resources became available, and
may have had no reference to the real objections to this solution on the score of
health, incompatibility, the difficulty of re-establishing the home once it had been
broken up, etc.
What does the school principal mean by her statement that Alice Ames is "a
diligent student, although by no means a bright child"?
Even
in so relatively simple a case as this one, a comparison of
the items of evidence, both by the case worker and by someone
all
who did not know the Ameses, would have saved motion in useless
354
directions and have started it in helpful ones.

supervisorA
skilled in the notation of recurrence, moreover, would have learned
from the study of other cases that not only in the hat factory where
Ames worked but in certain branches of the whole industry did
an unduly large proportion of tuberculosis cases have their origin.
This feature of the case noted, all available data should have been
placed at the service of students of occupational disease in its
legislative and other aspects. Not satisfied with search in this
one direction, the supervisor should have sought for possible
causal factors of Ames' disease in his family history and his home
sanitation.
At the same time it must be admitted that both case worker and
supervisor might have made all these comparisons painstakingly,

might have secured the necessary medical diagnoses of mother and
children, and the mental examination of the older child, might have
organized a committee to investigate the relation between hat
making and tuberculosis, and might still have failed utterly in the
social diagnosis and treatment of the Ameses. "They go through
all their paces," said a social worker of certain trained assistants,
"they attend to all the latest things listed in our modern social
programs, and then miss, far too often, the most significant point
in the whole case." This is another way of saying what Dubois
has said they possess all the working machinery of diagnosis
but do not know how to make a diagnosis. 1 Painstaking com-
parison of all the items of evidence aids and leads up to interpre-
tation, it often reveals the interpretation, but it cannot provide
the imaginative insight which can make interpretation more than
half of treatment.
III. THE INTERPRETATION OF MATERIAL

Ability to form a judgment is more important than ability to
suspend judgment. We
are between the horns of a dilemma here,
for the diagnosis too promptly made, even when not erroneous, may
be only the one-word diagnosis which roughly describes the general
type of difficulty, and leaves undefined every individualizing par-
ticular. The delayed diagnosis, on the other hand, may miss
the critical moment for effectiveness in treatment. With all the
1
See p. 347.
355
SOCIAL DIAGNOSIS
defects apparent in the social handling of the Ames case, it shows

ability to grasp promptly the significant factor in a human rela-
tion in this instance, the wife's unwillingness to have her husband
leave home, and the reason for it. It is this insight into human
relations that distinguishes social diagnosis from all other kinds.

The dispensary had known Ames for a number of weeks and had
diagnosed only the disease, his church and his employer had known
him for years and had observed only the distress, when a social
case worker, called in more or less by chance, found the true situa-
tion, simple as it was, still undefined and unanalyzed. Some fum-

bling followed. The social diagnosis might have been swamped
by the premature remedy proposed by the Joseph Ameses. The
check, however, was momentary, and five days after the original
application the key to the situation had been found. The highest
success, of course, would have been to find and hold to this main
theme without losing grasp upon the other and related matters
that were already in evidence. Miss Delancey was at hand and
eager for direction. Assuming the possibility of her success in
aiding the family to rearrange home conditions for the invalid
father, this could have been counted upon to make her all the more
influential in looking after the physical and mental health of the
two and the health of their mother. That these were not
little girls
included in the program from the very beginning was a waste of

time and opportunity.
Sometimes where there has been frequent change of social agency
or of worker in a case, every type of diagnostic habit will be found
in a single record the one-word diagnosis, the situation-of-the-
moment diagnosis, the painstaking but fumbling kind, the clear-
on-the-main-difficulty type, as well as the type which is both clear
and full.
Take, for example, the family of Braucher, the man with a South
American wife and two small children, whose story is told in part
in the chapter on Relatives. 1 The family, it will be remembered,
had been treated in four different districts of one charity organiza-
"
tion society. First, the situation was summarized as man unable
to work because of flat-foot; distress of family due to this cause."
Later, when Braucher had neglected the medical treatment offered,
1
See p. 188.
356
and when routine efforts to verify his story had failed, it was
summed up "family shows industry as beggars, but
in the phrase,
in no other way." A local charity in another city had offered, as a
definition of the characteristics of the man's relatives, who lived
there, the statement that they were people with "a discouraging
record." But the secretary in the fourth district, dissatisfied with
this report, had sought out Braucher's people and brought back
to him a message from them. The message appealed to an unsus-
pected side of the man's nature a fact which this fourth social
diagnostician, unprejudiced by earlier verdicts, was prompt to recog-
nize. The renewal of Braucher's relations with long estranged
kindred became the worker's starting point in the attempt to
develop his social and industrial ambitions, these ambitions be-
coming in turn the keynote in a long and successful treatment.
With all this, Mrs. Braucher's separate needs were not overlooked.
Social diagnosis should not limit itself to the naming of one cause or
one disability.
would be possible to maintain, of course, that the worker who
It
succeeded where three had failed had a stronger faith in human

nature or a more winning personality. Unquestionably these
were factors in the success. As has been said elsewhere, faith in
the possibilities of our clients and of social treatment is funda-
mental. But the turning point was the discovery of the relatives
by one who knew how to weigh evidence and to follow slight clues.
Success was due to technique and insight in combination.
1. Diagnosis Redefined. Social diagnosis, then, may be described
as the attempt to make as exact a definition as possible of the situa-
tion and personality of a human being in some social need of his
situation and personality, that is, in relation to the other human
beings upon whom he in any way depends or who depend upon
him, and in relation also to the social institutions of his community.
Medical diagnosis leans more and more to the inclusion of a
certain amount of social context; diagnoses of mental states will
in time do the same. Each, however, will continue to be based
a
upon body of experience which is not primarily social, which has
a different starting point and develops a different skill and em-
phasis. The fields overlap but are by no means coterminous.
As social diagnosis becomes more expert it will be, incidentally,
357
SOCIAL DIAGNOSIS
a serviceable adjunct of medicine and of psychology, and there is

no need to add that both of these will continue to furnish invalu-
able data to the social diagnostician.
Since this book is not addressed to the specialist in any one
branch of social case work, it cannot narrow its field to suggestions
which would not apply to all branches. With this limitation, it
willnot be possible to dogmatize about the content of a diagnosis,
about the making of diagnostic summaries, or even about the time
element in this part of case work; it will only be possible, in bring-
ing the discussion of this final stage to a close, to add under these
various heads a few general suggestions.
2. Diagnostic Content. A poor social diagnosis errs by being
too general, by being too detailed and therefore confused, or by
overlooking some of the important factors in a case though clear
on the main disability; whereas good social diagnosis includes all
the principal factors standing in the way of social reconstruc-
tion, with emphasis placed upon the features which indicate the
treatment to be followed. This emphasis the worker should allow
no predisposition toward some favorite causal factor to disturb.
A diagnosis may be mistaken. It is humiliating to find that a
case of mental disease or of tuberculosis can still be diagnosed by

a social agency as a case of unemployment due to laziness or in-
efficiency. On the other hand, it is exasperating to find that a
tuberculosis nurse can still tell a patient, upon her first visit, that
his is the worst case of overwork she has ever encountered, when
the facts are notorious that he has never supported himself and
his family, and that he has undermined his health by years of
dissipation. This absorption of the worker in the superficial

aspects of a case is responsible for many mistaken diagnoses.
A diagnosis may be a mere classification. It may be no better
than pigeon-holing. The one-word diagnosis, even when it names
the general type of difficulty with correctness, is not social. Jn
the days of disorganized social dosing, a woman with children and
no male head in her household might be recorded by different
agencies as a widow, a deserted wife, or an unmarried mother with-
out any of them having verified her civil condition. Although
the affixing of the correct label is an advance, no such label stand-
ing by itself has a practical bearing upon prognosis and treatment.
358
Widowhood, desertion, illegitimacy these are only isolated social

facts having no diagnostic significance until their context in the
particular instance is given. How varied that context may be is

partially indicated by the questionnaires bearing upon these three
disabilities in Part III.
A diagnosis may be too detailed. As the purpose of diagnosis is to
throw into high light the factors most influential in bringing a client
to his present pass, it follows that the including of details is apt
to spoil the perspective and so give either a distorted or a confused
picture of the situation. In other words, the defining of a client's
need calls upon the worker to distinguish in the evidence collected
what is from what
relatively important for successful treatment
isrelatively unimportant. A worker may
have gathered the evi-
dence in a case with care; he may have had his perceptions awak-
ened in many directions by the ablest books on the causes of
poverty; yet he may have failed to recognize the factors working
most mischief in the case under consideration. In short, his work
may be painstaking but without penetration. The remedy lies
in experience under skilful supervision, where this is possible,
as well as in a deepened sense of fellowship with one's clients.
A diagnosis may be partial, although clear on the main difficulty.
This was true in the Ames case; it is true today of much of the work
of case workers with method and experience above the average.
The saving strength in their work is that they are testing diagnosis
continually by that knowledge of the consequences of a given
treatment as applied to a given diagnosis which comes only from
long familiarity with social practice. The weakness in their work
isthat they are apt to note and to treat merely some one con-
spicuous need in a number of cases too large to allow of more
thorough work. True as it is that the results of treatment must
be the usual test of a diagnosis, practical experience in observing
these results will not save a worker who is under the pressure of
too many cases from getting but a partial view of their complexi-
ties and possibilities.
A diagnosis can be full without loss of clearness. It is wasteful
to gather ample evidence and then, in our eagerness for quick
results in dealing with some urgent need, lose sight of the facts
significant for a more searching treatment. A fuller diagnosis
359
SOCIAL DIAGNOSIS
would bring these into the picture of the case without obscuring
any immediate issue.

Thus emphasis has been placed upon the defining of the
far,
difficulty in the client's situation.We must, however, remember

that, while making a comprehensive diagnosis which is to be fol-
lowed by treatment, we must keep the clues to possible remedies
in view. The diagnosis itself should bring together those elements
in the situation which may become obstacles or aids in the treat-
ment. We have no word for this summing up of assets and lia-
bilities. Its inclusion in diagnosis is justified only on the ground
that the diagnostician, who must have had social treatment in
view from the very beginning, has been measuring at every stage
work the treatment value of each circumstance, each human
of his
and each personal characteristic. Here then is the place
relation,
to sum them up.
The diagnostic summary, or the diagnosis put in black and white,
should give the content of a diagnosis in orderly form, although
that form may have to be somewhat varied for different types of
social casework. Most types will have to include, in addition to a
general description of the difficulty, a statement of those peculi-
arities of circumstance and personality which differentiate the
case under review from all others. Then should come an enumera-
tion of the causal factors, so far as known, in the order of their
importance. a help to clearness of thinking to set them down

It is
though they must be understood, at this early stage of treatment,

to be only tentative. 1 And last should come the just mentioned
appraisal of the assets for reconstruction discovered in the course of
inquiry those within our client, within his immediate family,
and outside.The inquiry has had this for one of its chief objects.
Not only the assets but the special obstacles to be overcome and
guarded against in treatment should be included. All of this must

be dated and must stand, like a bill of lading, "errors and omis-
sions excepted." There would be few more dangerous things
1
This listing of factors recognized as causal in the individual case should not be
confused with the attempt to establish statistically the causes of poverty, crime, or
any other of society's outstanding failures. To any such generalizing other tests
must be applied. The two undertakings may be related or may become so some
day, but they cannot be assumed to be identical.
360
than a social diagnosis that was not subject to review in the light
of further facts.
How do these suggestions apply to the Ames case? The fol-
lowing summary attempts to embody the criticisms and review of
that case already given in this chapter:
DIAGNOSTIC SUMMARY
May 19, 1909
Ames, Thomas (38) and Jane (28), two girls, 6 and 2, and Mrs. Ames' mother
DIFFICULTIES DEFINED: Illness of breadwinner from tuberculosis, no savings.
Ames unwilling to take needed sanatorium treatment, wife seconds him. Mrs.
Ames described as "frail" (competent report needed). 1 Older child "not bright"
in school (mental examination needed?).
CAUSAL FACTORS: Of the tuberculosis, not definitely known. (Family history?

Housing? Conditions of man's work?) Of the refusal of sanatorium care, Mrs.
Ames' failure to realize man's condition, and her fears that home may be broken up.
Of Mice's school record, not known.
ASSETS AND LIABILITIES: Assets (i) Man's temperate habits and affection for
family. home standards of family. (3) Dispensary's willingness to

(2) Excellent
co-operate in persuading Ames to go away. (4) Miss Delancey's interest. (5)

Mrs. Freeman, the wife's sister, and Joseph Ames are able to help with relief; other
relief resources are Caldwell's and the church. Liabilities (i) Man not a skilled
worker, highest weekly earnings $12. (2) Needing immediate attention Mrs.
Ames' opposition to sanatorium care as above.
3. The Time Element. The omissions in the Ames record that

are indicated in the foregoing diagnostic summary could have been
accounted for, probably, by pressure of other work. Those who
know most about the well-nigh intolerable conditions under
which case work is done conditions, that is, of too many clients
and of continual hurry will make large allowance for short-
comings. Even in normal seasons the demand for good social
case work is so fitful that it cannot assure the conditions essential
to good work. In periods of industrial depression, of war, of
epidemic, or of other abnormal pressure, standards that have been
established laboriously are not only battered down by the stress
of the time but remain down long after the occasion has passed.
This is owing in part to the tendency to carry over into ordinary
times habits of work created by emergent periods.

In spite of these discouragements the case worker who depresses
1
Entries in parenthesis indicate omissions in the inquiry.
3 6l
SOCIAL DIAGNOSIS
himself and others by an attitude of skepticism toward progress

forgets that he is not alone in facing difficulties. Most of the
world's advances in skill have been made under pressure. They
have been made by the exceptional man or woman who has de-
veloped judgment in eliminating matters of lesser importance from
the work before him through sheer strength of desire to work out
his ideas. The exceptional teacher, physician, social worker has
repeatedly established and advanced standards in this way. And
one need not be unusually gifted to try two experiments in con-
nection with his own work which will have a steadying influence
upon standards.
The first experiment has just been suggested; namely, that as
soon as a period of special pressure is passed the worker should
set himself to overcome those lax methods and mental habits
which emergency conditions have forced upon him.
The second experiment is suggested by Dr. Adolf Meyer, pro-
fessor of psychiatry at Johns Hopkins. Dr. Meyer teaches stu-
dents specializing in mental diseases that there is a subjective
reaction toward better work in all their cases if they are careful
to get a complete picture in a minority of them. In social work,
also, experiment shows that the habit of covering the ground with
especial thoroughness in a few cases affects a worker's standards

with all. He may not be able to give any more time to the ma-
jority of his clients after this tonic exercise than before, but his
judgments about them will be more penetrating. This result is
so beneficent and far-reaching that every case worker should con-
trive to secure at some time during his crowded days a few undis-
turbed hours, a little center of quiet into which he may bring
selected tasks to be worked out studiously, and, if possible, to a
successful issue.
Such concentrated attention produces another reaction which
extends beyond the worker himself and his own achievement.
Good work creates a demand for more work of the same grade,
thus exerting an influence which tends, as it spreads, to change
for the better the conditions under which social work is done.
Boards of directors become awakened to the fact that thorough
work means results, and are then ready to do their part toward
supplying enough workers to maintain standards.
362
An after-care worker for a girls' reformatory found that the reformatory authori-
ties were satisfied with meager reports of the girls' previous histories. In special
instances at first instances in which the authorities could see at a glance the sig-
nificance of a fuller history she began to supply written data. The result was
that gradually the management came to demand and to make provision for obtaining
more detail for all inmates. By assuring a better understanding of each girl's
individual problems not only the after-care work but the treatment of inmates of
the institution was reshaped.
Diagnosis Not Always Possible. Last of all, full diag-

4. Full
nosis any correct diagnosis in fact is not always possible, even
when there is ample time. We are dealing with human factors
and we too are human. We cannot hope that the processes here
described will always bring the truth to light or reveal the possi-
bilities of treatment. Try we may, certain cases will remain
as
obscure. When this happens we must trust in part to further
acquaintance with our client and in part to temporary treatment
ofsome kind which will itself become a form of investigation.
Be it repeated, no diagnosis is final. Since later developments
in a case may clarify the social practitioner's insight into its causal
factors, there is a sense in which investigation continues as long as
does treatment.

1. First we our material, next
collect we compare each part with all the other
parts, and then we interpret it. This last is diagnosis.
2. Social diagnosis may be described as the attempt to make as exact a definition
as possible of the situation and personality of a human being in some social need
of his situation and personality, that is, in relation to the other human beings upon
whom he in any way depends or who depend upon him, and in relation also to the
social institutions of his community.
3. There has been too little relation, heretofore, between material gathered and
its interpretation. This is due to neglect of the process of critical comparison.
4. Comparison of data should include review of each item with all the others in
mind, and sometimes review of each with other items deliberately excluded.
all
It must guard against overemphasizing the fact established with difficulty, against
hidden contradictions, and against overemphasizing first and last statements and
hypotheses. It must retest carefully the inferences that have underlain the con-
duct of the inquiry so far. The questionnaire for Supervision and Review in Part
III gives detailed suggestions for the comparison of data.
5. It is possible to make
these comparisons painstakingly and arrive nowhere.
all
The "working machinery" of diagnosis does not assure results where imaginative
insight is lacking.
363
SOCIAL DIAGNOSIS
6. A good social diagnosis is at once full and clear, with emphasis placed upon the
features which indicate the social treatment to be followed.
7. The one-word diagnosis which is a mere classification is of little value, but a

detailed diagnosis can also be valueless ifmisses the very factors that are working
it
most mischief in the case under consideration.

8. Not only must a social diagnosis define clearly the difficulty or difficulties;
it must also bring together those elements in the situation which may become ob-
stacles or aids in the treatment.
9. The form of diagnostic summary may have to be varied for different types of
social case work, probably, but generally it will include (i) a definition of the diffi-
culties, (2) a listing of the causal factors, so far as known, that enter into these
difficulties, (3) an enumeration of the assets available and the liabilities to be reck-
oned with in treatment.
10. There are two experiments that may help to control, in part, the trouble-
some time element in diagnosis: (i) To watch for and check the tendency to carry
over emergency period habits into times that are not emergent. (2) To cover the
ground in a minority of cases with especial thoroughness.
11. Full diagnosis any correct diagnosis in fact is not always possible, and no
diagnosis is final.
,64
CHAPTER XIX
THE UNDERLYING PHILOSOPHY
THOUGH mention has been made more than once in
earlier chapters of theinterdependence of individual and
A" mass betterment, it will not be amiss, in bringing this long
discussion of the diagnostic process to a close, to re-enforce briefly
the position already taken that social reform and social case work
must of necessity progress together. We
have seen, for example,
that the diagnostic side of case work received a great impetus when
the plans of reformers began to be realized, and that social work
immediately had at its command more varied resources than it
could apply without further knowledge of the differences between

men. 1 To understand these differences and adapt its working
programs to them, account has had to be taken of men's social
relationships.
Less emphasis is placed in these pages upon the other side, upon
the number of social reforms that have been direct outgrowths of

case work, and the number that owe to this work either effective
amendment or successful administration. There are few adminis-
which do not have to utilize
trative tasks in the social field, in fact,
some form of and treatment. A new piece of social
social diagnosis
legislation may give case work a new direction, it almost always

modifies such work, and sometimes renders it unnecessary in a
given field. This last eventuality, however, is predicted many
times for once that it is realized.
When, for example, the restriction of child labor was made
possible, severalnew kinds of case work became necessary, one of
them involving greater skill in sifting the various evidences of age,
one involving the development of other family plans to take the
place of children's earnings, etc. The methods of many agencies
engaged in case work were modified by these child labor measures.
In some states, on the other hand, data supplied by the agencies
pointed the way for improvement in the new laws. Discussing this
subject of the relation of case work to social reform at a recent
1
See p. 32.
365
SOCIAL DIAGNOSIS
session of the National Conference of Charities and Correction, 1 the

writer ventured the opinion that workmen's compensation laws
belonged to the type of social legislation which rendered further case
work for one group unnecessary. But in the debate which followed
several people were on their feet at one time to bring forward in-
stances in which case workers had not only had to make adaptations
of the existing compensation laws to individual cases, but, in so do-
ing, had discovered points at which these laws should be amended.

In any consideration of the readjustments necessary from time
to time between social diagnosis and treatment on the one hand
and social research and prevention on the other, analogies drawn
from recent developments in medical science and practice are
inevitable. As between laboratory discovery and bedside prac-
tice, for instance, Dr. Lewellys F. Barker summed up the situation
a few years ago, 2 making among other points the following: Many
of the teachers and investigators in the purely laboratory branches
of medicine are men of limited clinical experience or none at all,
while the clinical branches themselves are becoming more highly
specialized. As everyone knows, there has been almost explosive
progress in the laboratory branches, but laymen are not so familiar
with the important fact emphasized by Dr. Barker that new
medical discoveries may, and often do, lie unapplied for long until
clinical medicine has been developed to a point where it can adapt
and apply them. "The Wassermann reaction maybe primarily
worked out in a non-clinical laboratory, but the determination of
its real significance for the diagnosis and treatment of disease de-
mands, subsequently, long years of clinical research." Scientific
clinical work will suffer loss, in Dr. Barker's opinion, "if the men
who are presumably cultivating the clinical sciences of diagnosis
and therapy overlook their own legitimate problems." These
problems are "tasks set patients themselves
by the . . .
these living patients are, primarily, the objects of study of the

clinical scientist." Meanwhile the air is thick with "applicable
"
facts, of the most diverse origin," and only the younger clinicians
1
See Proceedings of the National Conference of Charities and Correction for
1915 (Baltimore), p. 43 sq.
*
Presidential address before the Association of American Physicians. Science,
May 16, 1913.
366
have had opportunity for securing a training permitting of an

understanding of even a part of them."
It would be easy to push this analogy too far, to
urge too in-
sistently that applicable knowledge is not being applied in the
social field because we have failed to stimulate original and pro-
gressive work among social practitioners to the extent that we

should. The important fact for us
that, while readjustments are
is
clearly necessary, diagnosis and therapy do assuredly assume, with

each advance in social reform, each gain of scientific medicine, not
less but more importance in both fields. If, as we have seen, the
one-word diagnosis of our case work cannot be social, neither can

the single reform put forward to cure all the ills of society. There
is, in fact, more resemblance than either would admit between the
mental habits of the case worker who contentedly treats one in-
dividual after another, one family after another, without giving a
thought to the civic and industrial conditions that hedge them
about, and the mental habits of the reformer who is sure that the
adoption of his particular reform will render all social case work
unnecessary. Both ignore the complexity, the great diversity, of
the materials with which they are attempting to deal.
This diversity of man's life is made clearer on its mental side and
in its relation to our subject by certain concepts of modern psy-
chology. Two of these, in fact, may be said to constitute the
underlying philosophy of social case work; they explain the

necessity for its continuing survival in some form. The first
relates to the fact of individual differences, the second to the
theory of "the wider self."
I. INDIVIDUAL DIFFERENCES
Not that the resemblances among men are socially unimportant;
resemblances have made mass betterment possible, while individu-
ality has made adaptation a necessity. In the early stages of a
1
democracy, doing the same thing for everybody seems to be the

best that administrative skill is equal to, but later we learn to do
1
"Even if man's nature included only five traits, a, "b, c, d, and e, and even if
each of these existed in only five degrees, I, 2, 3, 4, and 5, there could be over three
thousand (3,125, to be exact) varieties of men. . . .
Hygiene, medicine, edu-
cation, and all social forces have to reckon with original differences in men."
E. L. Thorndike, Individuality, pp. 19 and 43.
367
SOCIAL DIAGNOSIS
different things for and with different people with social better-
ment clearly in view. Our public schools of a generation ago prided
themselves upon treating all alike whereas reports of recent school
investigations show that it is the differentiated treatment of the
school child which now possesses the minds of educational reformers. 1
Itseems unnecessary to illustrate further the truth of this first
concept, but that of the second one, relating to the wider self, is
not so obvious.
II. THE WIDER SELF

Individual differences must be reckoned with in every field of
endeavor, but the theory of the wider self, though it has of course
other implications, seems to lie at the base of social case work.
We have seen how slowly such work has abandoned its few general
classifications and tried instead to consider the whole man. Even
more slowly is it realizing that the mind of man (and in a very real
sense the mind is the man) can be described as the sum of his
social relationships.
Mrs. Helen Bosanquet expresses this for the layman more
clearly perhaps because she is a social worker than others who
have written about it. She says:
The soul literally is, or is built up of, all its experience; and such part of this
experience, or soul life, as is active at any given time or for any given purpose con-
stitutes the self at that time and for that purpose. We
know how the self enlarges
and expands as we enter upon new new interests, contract new ties
duties, acquire
of friendship; we know how it is mutilated when some sphere of activity is cut off,
or some near friend snatched away by death. It is literally, and not metaphorically,
a part of ourselves which we have lost. 2
1
For example, take the following by Leonard P. Ayres in the Proceedings of the
Fifty-second Annual Meeting of the National Education Association, 1914, p.
2jS: "In every school system there is greater difference in class room ability be-
tween different members of the same grade than there is between the abilities of the
average children in the lowest and the average children in the highest grades.
. . . This means that ... we must differentiate our courses because our
courses are made for our children, and our children are differentiated by nature."
Or the following by Paul H. Hanus in School Efficiency, A Constructive Study
Applied to New York City, p. 15: "Over and above the foregoing suggestions for
the improvement of the course of study in certain details is ...
the adjust-
ment of the entire course of study to individual and local needs throughout the
city. The differences in respect to individual and local needs in New York City
with its heterogeneous population are very great, and they are not now satisfac-
torily taken into the account." Yonkers, N. Y., World Book Co., 1913.
'Bosanquet, Mrs. Helen: The Standard of Life and Other Studies, p. 131,
London, Macmillan and Co., 1898.
368
That we may know a man by the company he keeps is a maxim

of which Polonius might have been the author. But it has a deeper
meaning than the conventional one. A man really is the company
he keeps plus the company that his ancestors kept. He is "co-
extensive with the scope of his conscious interests and affections."
These interests change inevitably. In fact, change is one of the
conditions of their continuing healthfulness, though change may
mean either contraction and loss or the widening of interests, the
1
strengthening of social ties.
Although the preliminary inquiries of social agencies are still
conducted from other motives, many of the more thoughtful case
workers of today are learning to study the relations of individual
men in the light of this concept of the wider self of the expanding
self, as they like to believe. In so doing, they are allying them-
selves with the things that "move, touch, teach"; for where dis-
orders within or without threaten a man's happiness, his social
relations must continue to be the chief means of his recovery.
Many years before these ideas were formulated by science they

1
This conception of the wider self is described in varying terms by different
psychologists. The twofollowing passages may be taken as representative:
James Mark Baldwin: The thought of self arises directly out of certain given
social relationships; indeed, it is the form which these actual relationships take on
in the organization of a new personal experience. The ego of which he thinks at
any time is not the isolated-and-in-his-body-alone-situated abstraction which our
theories of personality usually lead us to think. It is rather a sense of a network
of relationships among you, me, and the others, in which certain necessities of
pungent feeling, active life, and concrete thought require that I throw the emphasis
on one pole sometimes, calling it me; and on the other pole sometimes, calling it you
or him. Social and Ethical Interpretations in Mental Development, p. 508 sq.
Edward L. Thorndike: About fifteen years ago the point of view of students of
human nature showed the first clear signs of what has been a rather abrupt change
toward thinking of a man's mind as the sum total of connections between the
situations which life offers and the responses which the man makes. Up till then
the mind had been thought of primarily as a set of magical faculties or powers
attention, memory, inference, reasoning, choice, and the like or as a collection of
certain contents sensations, images, thoughts, volitions, and the like. Today the
progressives in psychology think of a man's mind as the organized system of con-
nections or bonds or associations wherby he responds or reacts by this or that
thought or feeling or act to each of the millions of situations or circumstances or
events that befall him. Their customary name for the mind is the connection-
system; their ideal of psychology is a science which can predict what any given
situation or stimulus will connect with or evoke in the way of thought, feeling,
word, or deed; their offering to education is an offering of knowledge of the laws
whereby connections in thought and behavior are made and broken, are preserved
and weakened, and are of help and hindrance one to another. The Foundations
of Educational Achievement, The Educational Review, December, 1914, pp. 487-8,
Vol. 48, No. 5.
24 369
SOCIAL DIAGNOSIS
were applied to housing reform, to neighborhood improvement,

and to case work by Miss Octavia Hill, whose relation to the be-
ginnings of social diagnosis has been described in the first chapter.

Hers was a conception so sound and so inspired that science came
later not to correct but to fulfill it.
It will still be necessary to do different things for and with
different people, and to study their differences, if the results of our
doing are to be more good than bad. It will still be necessary to
study the social relations of people, not only in order to under-

stand their differences but in order to find a remedy for the ills
that will continue to beset them. These ills will change their
form, some will be blotted out, and the whole level of life, as we
have a right to hope, will be lifted. Although the level upon which
the case worker operates will also be raised, case work will still be
needed; its adaptation of general principles to specific instances
willnot be automatic nor will good administration become so.
It may also be predicted that the forms of organization now re-
sponsible for case work will change, that its scope and skill will
advance far beyond the present-day practice described in this
study. The methods and processes here dwelt upon will sub-
ordinate themselves to a larger whole. It is only through devo-
tion to that whole not through any narrow insistence upon

technique alone that we can submit ourselves in the right spirit
to the task of analyzing individual situations. But we must come
under the law before we can rise above it.
370
PART III
VARIATIONS IN THE PROCESSES

CHAPTER XX
SOCIAL DISABILITIES AND THE QUESTIONNAIRE
PLAN OF PRESENTATION
the case worker has gone only a short distance
WHEN in his preliminary inquiries, or sometimes at a later

period, he discovers a certain disability or a combina-
tion of disabilities. What are the implications of his discovery?
How should it modify his method? By what means can a
large number of possible modifications be indicated and made
accessible for reference when needed? This, next to the discus-
sion of evidence, has been the most difficult problem with which the
present study has had to deal. Our discussion of the methods and
points of view common to all social diagnosis is ended, but there
remains to be treated this baffling topic of the variations in method
demanded by different tasks and by the presence of different
disabilities.
I. OBJECTS OF-THE QUESTIONNAIRES

1. Their Dangers. In determining to present in questionnaire
form most of the material gathered for this final division of the
subject, the writer is aware that the device is clumsy and that it
has its dangers. The purposes and limitations of these question-
naires are bound to be misunderstood by some who attempt to
use them, no matter how clearly it is set forth that none are sets
of questions to be asked of clients and that none are schedules
the answers to which are to be filled in by anyone. They are
merely long lists of queries which, when gone over by the social
case worker with a particular case in mind, may bring to his atten-
tion, out of the many presented, a possible four or five that may
contain suggestive leads.
Leading questions are dangerous things, as already indicated;
the questioner, ignorant of the true answer, suggests one never-
theless to the person who is being questioned. Here the case
373
SOCIAL DIAGNOSIS
worker is asking himself questions. He is merely doing more

formally, in fact, what he is forced to do all the time, for social
diagnosis moves forward by calling up mind one possible
before the
explanation after another, one alternative after another, before
putting each to the test. It is in the suggestion of alternative
situations and explanations that these questionnaires will, it is
hoped, prove of some help. Their very extent and elaboration
should make it evident that no one of them could apply in its en-
tirety to any one client or any one family. But it may be added
that they have no significance and will seem only a confused mass
of detail unless they are examined with a particular case in mind.
In a case in which the first interview has been held and certain
data have been gathered elsewhere, the choice of questionnaires to
be examined should not be difficult. The preliminary question-
naire regarding Any Family takes precedence (if there is a family)
of the questionnaires covering the particular disability or dis-
abilities.
2. Their Use Illustrated. Thus, the Angelinos are a family,

and that may justify taking the time to read over the first
fact
questionnaire in order to be sure that no important point which

seems to bear upon their present difficulties has been omitted.
Many of the questions are disposed of at once as not applying, as
applying but unimportant, or as already followed up, but a few of
those which remain may raise a doubt of the course that the in-
quiry has taken so far and suggest another way. The Angelinos
are not just a family, however, they are a family recently arrived
in this country. What does that fact suggest with regard to their
background and foreground? The Immigrant Family Question-
naire is necessarily general, but it may yield a few ideas. The
oldest girl is blind and has had no care. Unless the case worker
knows just where to turn for guidance in dealing with this dis-
ability on its social side, Miss Lucy Wright's carefully framed
questions, as given in Chapter XXV, may have something to teach
him. A good deal later Angelino leaves home without giving any
clue to his destination, or so his wife says. Possibly the Deserted
Family Questionnaire may throw some light on the first steps to be
taken. Neither in this case nor in any other, however, are these
questionnaires to be heavily leaned upon. Anyone who has had
374
THE QUESTIONNAIRES
the patience to follow the earlier discussions of this book will

realize that it does not put forward the treatment of separate
whole of social case work by any means. The
disabilities as the
Angelinos are not just an immigrant family or a deserted family,

and the case worker who knows them as well as their disabilities
is the one who will have most success in the diagnosis and treat-
ment of their social situation.
II. WHAT IS TRUE OF EVERYBODY?

Requests often came to us, in gathering our material, for a good,
comprehensive outline of the ground that should be covered in
any social diagnosis whatsoever. No single question of the out-
line thus asked for was to be unimportant, and all were to apply
quite universally to human situations. This was, in effect, a

demand for a short cut, and there are no short cuts in diagnosis.
Between a clear conception of the things that are true of everybody
and an equally clear conception of the things that are true of that
complex of human relations and experiences represented by an
individual client, anything might be important, and there are few
things that might not become in certain circumstances unimpor-
tant.
Studies yet to be made will undoubtedly give case work a more
solid basis of formulated and applicable experience, but such
studies, they are to be of value, cannot begin with uniform
if
schedules, filled out by different agencies and workers each

with a different notion of what social evidence means or with none
at all. When answers obtained in this way are added together to
make a total, the result is meaningless. A more fruitful method
of case work study, and one adaptations of which
probably will
be tried in the near future with different groups of cases, is that
already illustrated by Dr. Healy's Individual Delinquent and by
Dr. Cabot's Differential Diagnosis. The former gives the results
of diagnosis and treatment in 1000 cases of juvenile delinquency
selected on the basis of "repetition of offense plus sufficiency of
data"; the latter classifies 383 case histories of disease by what
its author calls their "presenting symptom" by the one, that is,
of which the patient was most acutely aware when he asked medical
"
aid, such as a backache, a chill, a headache, etc. Cases do not
375
SOCIAL DIAGNOSIS
"
often come
to us systematically arranged," says Dr. Cabot, like
the account of typhoid in a text-book of practice of medicine.
They are generally presented to us from an angle, and with one
symptom, generally a misleading one, in the foreground. From
this point of view we must reason our way back into the deeper
processes and more obscure causes which guide our therapeutic
endeavor." With Dr. Cabot "we" means the medical practi-
tioners, but it is illuminating to us as well as to them to see dis-
eases of the most diverse origins and degrees of curability thrust in
shoulder to shoulder, jostling one another, because their victims
allhappened to complain chiefly of a headache, for instance. As
a lesson in social diagnosis, the book carries two meanings its
obvious meaning, which is that the symptoms of physical disease

encountered daily in the course of social work need the most ex-
pert medical diagnosis, and its deeper meaning, that social diagnosis
"
must also be expert, must also reason its way back into the deeper
processes," and push beyond surface symptoms to their causes.
The socialworker needs for his daily task two kinds of equip-
ment. To be a good case worker, he must have a generous con-
ception, and one filled with concrete details, of the varied possi-
bilities of social service, and this conception must be a growing one.
It must grow with his growing experience and also with each year's
freight of social discovery. And quite as vividly, quite as pro-
gressively, he must have a conception of the possibilities of human
nature of the suggestibility, improvability, and supreme value of
folks. The former conception can be acquired; it comes in part
from sympathetic study of the constructive programs of service
already well represented in the literature of social work, in part
from the use of such technical material as has been compiled here,
and in part from practical work under progressive leadership.
But the latter conception is, in a sense, part of himself. What he
thinks of human nature is bounded by what he knows of human
nature, and what he knows, in this field, is bounded by what he is.
What are the things that are true of everybody? Or, to narrow
the question somewhat, What is true of everybody living under the
conditions which a modern civilization imposes? No two people
will answer this question in the same way, but the mere exercise
of trying to answer it will clear the mind, or will at least make it
376
THE QUESTIONNAIRES
impossible to continue to record as facts statements that cannot

possibly be true of anybody.
The writer used to give this question as an exercise to workers
in training with interesting results. What a case worker "think-
eth in his heart" about the life of the individual and about society's
responsibility for it is going to be a matter of commanding influence
in his daily work. The question is one which each worker must
answer for himself and in his own way, but the following rather
matter-of-fact answer is given here as being more or less in key with
the point of view of the present volume:
We all have a birthday and a place of birth, and have or have had two parents,
four grandparents, etc., with all that this implies by way of racial and national
characteristics, of family inheritance and tradition, and probably of family environ-
ment. Our place of birth (assuming here and elsewhere the conditions of a modern
civilization) was a house of some kind, and we have continued to live in this or in a
series of other houses ever since. The characteristics of these houses, their neigh-
borhood and atmosphere, have helped to make us what we are.
We all have bodies that need intelligent care if we are to keep them in good re-
pair. Their condition has influenced our minds and our characters, though it is
equally true that these, in turn, may have influenced profoundly our bodily health.
We have all had an education, whether through instruction in the schools and
in the churches, or through means less formal.
We have all had some means of subsistence, whether through gainful occupa-
tions of our own, through dependence upon the gainful occupations of others, or
through assistance public or private.

We all modify, and are in turn modified by, our material and our social environ-
ment. The body of social traditions, institutions, equipments of every sort that
man has built up has left a deep mark upon him. This implies, among other
things, an emotional responsiveness to the society of our fellows responsiveness
whether shown in marriage and the founding of a second home (in which case, of
course, all of the foregoing things are true also of the one married), or in other
associations of personal loyalty with our fellows, individually and in groups. These
attractions imply repulsions. We
are remoulded by the discords of the one, the
concords of the other.
We are all going somewhere and have not yet arrived. Our character is "not
cut in marble," but is the sum of our past experiences a sum which is to be
changed, inevitably, by our future experiences.
III. WHAT IS POSSIBLY TRUE OF ANY FAMILY?

As already most of the questionnaires that follow are
said,
applicable to a particular disability, and are confined to the diag-

nostic aspects of that disability. But the line between diagnosis
377
SOCIAL DIAGNOSIS
and treatment cannot be drawn strictly, so a few questions bearing

more especially upon treatment are included; and the first and the
last questionnaire do not treat of disabilities at all. The first
relates instead to the basic facts likely to be true of most families;
the last is framed for one who reviews the entries of a case record
before advising as to the next steps leading to diagnosis or as to
the diagnosis itself.
The family rather than the individual has been made the sub-
ject of this preliminary questionnaire, because the work to be
undertaken is social, and the individual in whose interest the lists
of questions will be consulted must be considered primarily
whatever his disabilities may be in his social relationships.
The questions of this preliminary list are not as a rule repeated
in later lists, though sometimes, where they have seemed especially
applicable, they have had to be repeated for emphasis. It is
assumed, however, that where a special questionnaire has to be

consulted this first one will also be included. The eleven lists
which follow it are not poured into any one mould. Their classi-
fication is not uniform nor is their treatment. It will be seen that
they are the product of different hands and that the subjects are
too diverse, moreover, to have made uniform treatment advisable.
QUESTIONNAIRE REGARDING ANY FAMILY

This is not a schedule to be filledout nor a set of queries to be answered by a
social agency's client or clients. For an explanation of the purpose of these question-
naires see p. 373 sq.
A star ( * ) indicates that the answer to the question may be found in, or confirmed
by, public records.
I General Social Data

1. Family's name? Wife's given and maiden name? Husband's given name?
Full names of children? Names of all other members of the household, and their
relation to the family?
2. What was the birthplace of husband, of wife, and of each child? Nationality of
each of the four grandparents?
3. What was the date of birth of husband, of wife, and of each child?*
4. What were the conditions, economic and moral, in the husband's childhood
home? The wife's? What was the effect of these conditions on his or her health,
character, and industrial status?
5. How long have they been in the city, the state, and the country? Reason for
each migration? Do they both speak English?
378
ANY FAMILY
6. What was the date and place of their marriage?*

7. What previous marriages had either contracted, if any?*
8. Has there been any divorce or legal separation and on what grounds?* Have
any of the children been placed under guardianship?* Adopted?*
9. What relatives outside of the household have husband and wife (including mar-
ried and unmarried children, and children by previous marriages)? What are
the circumstances of these relatives, their interest in the family, degree of influ-
ence with the family? Names, addresses, degrees of relationship?
10. What the point of view of such other natural sources of insight as friends,
is
former neighbors, former tradesmen and landlords, priests or pastors, fellow

workmen and lodge members, etc.?
11. Has the trend of the family life been upward or downward? What character-
husband or wife, or what circumstances of health, employment, etc., have
istics of
determined this trend? What were the family circumstances and characteristics
when the family was at its best? How do these compare with its present
standard?
12. What is the attitude of the members of the family toward one another? Do
they hang together through thick and thin or is there little cohesion?
13. Have the parents good control over the children? Have they their confidences?
Are the children taught consideration of the rights of others?
14. What are the children's aptitudes, chief interests, and achievements?
II Physical and Mental Conditions

15. Did the parents or other relatives of husband or wife have marked mental,
moral, or physical defects? Unusual gifts or abilities? What facts, if any, about
the husband or wife or their parents would indicate physical or mental dangers
to be guarded against or special capabilities to be developed in the children?
16. How many children have they had? Did wife have any miscarriages? How
many children have died? When and from what causes?
17. What attention is given to personal hygiene and health in the family? Are
there regular meal hours? Do the food expenditures give a sufficient and well
balanced diet? Is the importance of regular sleep, bathing, care of the teeth,
and regular action of the bowels appreciated?
1 8. If there is a baby, how is it fed, where does it sleep, how much is it in the open
air during the day? If the wife is pregnant, is she receiving good care?
19. What is the present physical condition of each member of the family, including
also bodily and mental defects?
20. What treatment has been and what is now being given the various members
by physicians and medical agencies, and with what results?
III Industrial History

21. What the business or employment, both previous and present, of each worker
is
in the family? What are the names and addresses of employers, previous and
present? Between what dates was worker employed by each? What were his
379
SOCIAL DIAGNOSIS
earnings, maximum and usual, when regularly employed? What was his work
record at these places for speed, accuracy, regularity, sobriety? What were his
reasons for leaving? To what trade union, if any, does he belong? Is he in
good standing?
22. At what age did each member of the family go to work, what was his training,
and what was his first occupation? Have his occupations since been, on the whole,
a good fit? If not, is he capable of developing greater skill at something else?
23. What was the occupation of the wife before marriage, if any, and wages then?
24. Is present occupation of each worker regular, seasonal, or occasional? Is there
any chance of advancement? If out of work, how long and why?
25. Are the conditions under which each member of the family works good? If
not, in what way bad?
IV Financial Situation (ezclusive of charitable relief)

26. Income. What are the present wages and earnings? What proportion, in each
case, goes into the family budget? proportion too large or too small?
Is this
Present income from other sources, including lodgers, boarders, pensions, bene-
fits, contributions from relatives, etc.? Is the present income adequate? Could
the present income be increased in any wise way?

27. Outgo. What are the monthly expenditures for food, rent, clothing, fuel, insur-
ance, carfare, recreation, sundries? What is the amount of debts, to whom, for
what? Are any articles in pawn, where, amount due? Are any articles being
purchased on the installment plan? Weekly payments? Amount still to be paid?
With what insurance company are members of family insured? What is the total
of weekly premiums? Are they paid up to date? Could the present expenditures
be decreased in any wise way? Should they be increased, and how?
28. Is thereany court record of inheritance, of property, of insurance, of damages
recovered?*Has the family, or did it ever have, savings? When, where, and
how much? Do any members belong to benefit organizations? Amount of dues,
possible benefits?
V Education
29. What was the education of parents? At what ages did they and the older
children leave school? Did the children have any vocational training? How
does the education of each member of the family compare with the standards of
the community in which each was reared?
30. What is the school and grade of each child of school age? His teacher's name?
School evidence as to scholarship, attendance, behavior, physical and mental
condition, and home care?
VI Religious Affiliations
31. What is the religion of each parent? Name of church? What signs are there
of its influence?
32. Do children receive religious instruction in Sunday schools, or otherwise?

Where and from whom? Where were they baptized?
380
ANY FAMILY
Vn Recreation
33. What social affiliations have the various members of the family? Do any of
them belong to clubs or societies
church, settlement, fraternal, political, or
other? What forms of recreation do the family enjoy together? What sepa-
rately? How does each member employ his leisure time?
VIII Environment
34. Does family occupy a whole house? If so, has it a yard? A garden? If not,
on what floor do they live? At front or rear? How many rooms? Name and
address of landlord or agent?
35. Are the rooms adequately lighted and ventilated? What are the toilet and
water facilities? The general sanitary condition of the house?
36. Are the rooms comfortably furnished? Are they clean, or sordid and dirty?
37. What the character of the neighborhood? Has it undesirable physical or

is
moral features? How many other families in the house? Their general char-
acter?
38. How long has family lived at present address? At what previous addresses
has family lived? When and how long? Character of each neighborhood and
house?
IX Relations, If Any, with Social Agencies

39. Have any social agencies or institutions had relations with the family? If so,
of what kind and with what results? If first contacts have been with the wife,
is the husband known also, or vice versa? To what extent has the family re-
ceived charitable aid, if at all?
X Basis for Treatment

40. What are the family's plans and ambitions for the future? What moral and
temperamental characteristics and what aptitudes of each member can be reck-
oned with as assets or must be recognized as liabilities in the shaping of that
future?
CHAPTER XXI
THE IMMIGRANT FAMILY
RECENT immigrant has been mentioned a number of
times in these chapters in connection with such topics as
THE the "funded thought" of peasant witnesses, the attitude
of the alientoward our social agencies, the search for data in foreign
birth records, in immigration records, etc. These comments will
not be repeated; they can be readily referred to with the aid of
the index. Passages in earlier pages bearing upon topics discussed
in the chapters which follow are made available in the same way.
In dealing with foreign clients, the case worker finds himself in
danger of falling into one of two errors: he may think of them as
members of a colony or of a nationality having such and such
fixed characteristics, or he may ignore national and racial char-
and try to apply to them the same standards of measure
acteristics
that he would apply to his fellow-countrymen. He is liable to
surprises if he adopts the latter course. Before long, he will
have learned that he cannot ignore national characteristics al-
together. But only extended experience will teach him to be as
discriminating in ascribing such characteristics to others as he
would wish his own adviser to be were he a stranger in a strange
land and in difficulties. Generalizations about Americans, ap-
plied to himself in such a case, might strike him as beside the
mark.
Let us suppose instead that he is suddenly transferred from ser-
vice in one of our city districts or in a town that happens to have
few foreign residents, to a crowded immigrant quarter where he is
made responsible for shaping the child-protective activities or the
family case work of the neighborhood. In addition to the obvious
duty of studying the quarter as he finds it, he will be confronted
with the further one of trying to acquaint himself with the old
world background of his neighbors not merely the characteristics
of their native country as a whole, but those of the different prov-
inces and localities from which they came.
382
I. STUDY OF THE GROUP

Only general suggestions are possible here as to how such a
study might be undertaken. Following the questionnaire plan
already adopted, a list of queries has been prepared relating to
the group background and another list relating to a family of recent
immigrants. The latter is given further on (p. 387) the former ;
follows here. questions should be understood to apply to native

I ts
country, province, and town. From this, a student of the subject

may be able, after omitting those questions that obviously do not
fit either the particular group in mind or his own individual needs,
to make a modified outline which will serve as a starting point
for his reading and thinking.
I Characteristics of the Inhabitants
1. Are they and industrious? Are they as a whole law abiding? What is
thrifty
their attitudetoward the courts? Does the character of the laws or the manner
of their enforcement explain any criminal tendencies in the community? Are
there any community customs which are popularly recognized as substitutes for
law? Where is the line drawn between fellow citizens and strangers?
2. Are the people stolid or excitable? Warlike or submissive? Jealous? Hot-

tempered? Given to intemperance? Superstitious? Suspicious? Are there
any superstitions which in any way affect their life in this country? Are family
relations affectionate? How deep a hold has religion?
3. If there are peculiar and striking characteristics which are puzzling to Ameri-
cans, is there anything in the history or traditions of the people to explain them?
II Occupations and Recreations

4. What are the chief occupations of the place? Agriculture? Manufacturing?
Fishing? What stage of development have industries reached? Are there
many skilled workmen? A large professional class? Is there only one means of
livelihood in the community? Is there any marked discrepancy between wages

and the cost of living?
5. Do women engage in wage-earning occupations? If so, what is their in-

the
Do they ordinarily work in the field? Do they carry on home
dustrial status?
manufacturing? What is their attitude toward domestic service?

6. What are the national songs and dances, the special holidays and ffite days?
What are the favorite recreations and sports of the community? Do they de-
velop the team spirit? Are games of chance prominent?
III Education and Culture
7. What opportunities for education are accessible to the peasant? What is the
percentage of illiteracy in the country? Among the peasants? Is education
secular or religious? Public or private? Is it given in the native language?

383
SOCIAL DIAGNOSIS
Is it compulsory? To what age? How many weeks comprise the school year?
Are there trade schools? Is there any legally established apprenticeship system
or other system of trade training? What training are the women given, at home
or at school, in sewing, knitting, weaving, lace-making, embroidery, etc.?
8. How do the attainments of the educated class compare with those of other
countries? Have there been notable literary achievements? What are the
national arts? To what extent do they form part of the life of all classes?
IV Religion
9. Is there a dominant church, politically? Is it a large factor in the social and
community life of the people? Does it figure chiefly in ceremonials or does it
influence the thought and life of the people?
V Family Life and Woman's Position

10. What is the relation of parents and children? Does the father have any patri-
archal authority over his family? Is the tie of kinship particularly strong or
weak? Does it extend beyond the immediate family? To relationships by
marriage? Is intermarriage of relatives common?
n. What is woman's position in the home? What is the customary age at mar-
riage? What amount of freedom do women have before marriage? After
marriage? How is the marriage arranged? What are the dowry customs?
12. What isthe general attitude toward irregular relationships formed by young
girls? By married women? Is betrothal equivalent merely to engagement, as
in the United States, or is it regarded as a sort of trial marriage?
VI Community Customs
13. What are the usual living conditions among the peasants as regards housing,
sanitation, cleanliness, etc.? What are the peculiar customs of dress, cooking,
etc.?
14. Is there a strong community feeling? If a family is in need, how is it usually

relieved? By relatives, friends, public assistance, private organizations? What
is the popular attitude toward medical agencies, toward institutional care, to-
ward outdoor relief and begging?
VII Laws and Government

15. Is the land held in large estates or small holdings?
16. Is the country (or was it until very recently) under a liberal government? An
oppressive government? Is taxation heavy? To what extent is the community
self-governing? Is national patriotism strong in the community? Local pa-
triotism? What are the government's requirements regarding military service?
17. How progressive and competent is the government in its handling of sanitary
and health matters?
1 8. What is the nature of the laws regulating labor wages, hours, equipment of
factories, etc.? Are there laws prohibiting child labor, and how well are they en-
forced?
384
19. What are the most important legal regulations relating to the family? What
legal rights do women have? Are both civil and religious marriage ceremonies
required? Is divorce or separation permitted? What is the legal status of the
illegitimate child? What are the laws of inheritance of wife and children? Of
trusts for minor children?
20. What governmental provision is there for old age, unemployment, sickness,
accident? For dependents, for delinquents, for defectives?
VIII Emigration
21. Has the emigration from this community been a recent development? What
causes have led to it racial, religious, economic (necessity or experimentation),
political? Has the desire to escape military service contributed? Is exile used
as a substitute for imprisonment?
22. Has emigration been unduly large? Has it drained the community of the able-
bodied? What effect has emigration had on standards of living and wages in
the community? Do members of the community receive much money from
America? Has the emigration been mainly directed toward one destination?
If so, what?
Answers to these questions will not be found in any one place.

Some will be in books, some can be learned from people, and a
few of the most important of those remaining unanswered will
come gradually in the course of one's daily work. No one way of
proceeding can be urged, but if the writer found herself suddenly
responsible for social work among a foreign group, she would be
eager to get well in mind the history of their nation in the last
hundred years. During that period there have been momentous
politicalchanges the world over, and it would be necessary to
understand those that had most closely touched the particular
group with which she was dealing. Sometimes the clearest under-
standing may be had from the "life and times" of a great national
figure. No one who has read Thayer's Life of Cavour, 1 for ex-
ample, can ever forget the strikingly dissimilar characteristics of
the natives of the different Italian provinces, or forget the back-
ground of oppression and anarchy that is only half a century away
from the Neapolitan or the Sicilian of our own day. Another
view of a given foreign group may be had from whatever native
poetry and legend best illustrate folk ways. Some of their modern
fiction too would be illuminating, though much of it would be of no
1
Thayer, William Roscoe: Life and Times of Cavour. Boston, Houghton
Mifflin and Company, 1911.
25 385
SOCIAL DIAGNOSIS
use whatever. Books of travel help, unless written by men of
one determined to prove their point.

idea,
The
history of the coming to this country of the immigrant group
which is being studied, and the sum of its achievements and failures
here, are often matters of record. If, of the people under consider-
ation, such an admirable study has been made as Miss Emily Greene
Balch gives us in Our Slavic Fellow Citizens, this part of the inquiry
will be made easy. The social settlements in America have done
a great service to their country by interpreting immigrant life in
to a preoccupied public.
its cities From the appearance of Hull
House Maps and Papers 1 in 1895 to the present time, they have
labored unceasingly and with rare discernment in this particular
field. The various stages of Americanization are made clear, for
example, in a book mentioned earlier in Robert A. Woods' Ameri-
cans in Process.
Advice upon the right books to read may well be sought of some
of the settlement leaders, especially where there is a settlement in
the foreign quarter which a worker is studying, or where there is one
in another quarter of the city of like character. Advice may be
sought of this leader not only upon books but upon the people who
can help upon representative men and women of the colony, and
educated fellow-countrymen in the city. Some of the latter hold
themselves aloof, however, taking an unsympathetic attitude
toward the struggles of their less sophisticated compatriots. The
case worker who reads the language can get many insights from
the newspapers and periodicals which are printed in it in this
country.
II. STUDY OF THE INDIVIDUAL
As already our questions will not be fully answered by
said,
any or all of these means. It should also be repeated that in-

dividuals and families cannot be treated merely as recent immi-
grants exhibiting certain racial and national characteristics. They
are human beings first of all. Even the detailed questions which
follow, outlining not only their early history and their migration
to this country but the period of attempted adjustment here, do
not necessarily bear upon the most important part of the client's
story in every case.
1
Hull House Maps and Papers. New York, T. Y. Crowell and Company, 1895.
386
IMMIGRANT FAMILY QUESTIONNAIRE 1
This not a schedule to be

is out nor a set of queries to be answered by a
filled
social agency's client or clients. For an explanation of the purpose of these ques-
tionnaires see p. 373 sq.
A
star (*) indicates that the answer to the question may be found in, or con-
firmed by, public records.
The questionnaire regarding Any Family (p. 378) precedes this one. Its more
general questions are repeated here only in rare instances, when it has seemed
necessary to give them special emphasis.
I Parents and Early Home in Old Country

1. In what country, province, and town were the husband and wife born and
brought up? Was birthplace (or early home, if different) in highland or lowland
country? Inland or a seaport? Isolated from foreign influences? In country,
town, or city?
2. Was the family home comfortable? How many rooms were there? Of what,
in general, did the family's food consist? Was it meager in quantity or variety?
Was it limited by custom or by economic conditions? Was the income of the
family sufficient for family needs?
3. Did the father work in the field, factory, shop, or at a profession? Did he work
on share or by the day? Did he hold any government position? Did the mother
work as well? At what?
4. Did the family belong to a dominant or a subject race? What was the standing
of the family in the community? Was the standard of living in any respect
above or below the general level? If so, how and why? Did the father own
property? What was its nature and value? Has this property deteriorated
in value? Has it been sold?
5. Was the family a united one? Had the father patriarchal authority over the
children? What was the attitude of the family toward the mother? Were
religious influences strong in the home? Is any history of religious persecution
involved? What was the family's attitude toward the government under which
it lived?
6. Was there any family history of insanity, feeble-mindedness, tuberculosis, deaf

mutism, eye disease, goitre, or syphilis?
7. Had either parent, or any members of their families, a criminal record?* A

record of unusual immorality?
8. How many brothers and sisters have the husband and wife had? How many
are now in this country, how many abroad? What name, address, age, occu-
is
pation, social and economic status of each? Influence with these clients of each?
9. Ifparents or brothers or sisters have died, what was age and cause of death in
each case?*
1
This questionnaire is for a family in which the parents came to this country
as adults, after marriage. If they came as children or young people, some of the
questions and their grouping would have to be modified; the questionnaire might
in that case be regarded as applying in part to the parents belonging to the preced-
ing generation.
387
SOCIAL DIAGNOSIS
II Individual History prior to Marriage

10. What type of school public or private, church or secular did the two heads
of the present family attend? Did they learn to read and write their own
language or any other? At what age did each leave school?
1 1. What was the age of each at beginning work? Was it for the father, or was
he or she apprenticed, or put to work for a regular wage? What was the nature
of the work? Was it too hard for his or her years? Did the man ever serve in
the army or navy?* How long?* Was service compulsory?
12. When did each first break away from home ties, and why?
13. Had either been married before the present marriage? If so, what were the
circumstances, time, and place?* Did the former wife or husband die? If so,
when and where?* Under what circumstances? Did he or she leave any prop-
erty* or insurance? If still living, has a divorce been secured? If so, when,
where, and for what cause?*
14. Was the earlier marriage a happy one? What period elapsed before remar-
riage? Was
remarriage for economic reasons? Were there any illegal relation-
ships before the present marriage?

III Marriage and Family Life
15. Are husband and wife from the same community and class? Are they related?
In what degree? Are they of different races, religions, or nationalities? Of
widely different ages?
16. What was the period of acquaintance before marriage? Was the marriage
negotiated by the respective families? If so, what were the guiding principles
of the choice?
17. When and where did marriage take place?* Was there both civil and church
ceremony? Have they a certificate? Who were the witnesses?*
1 8. When (exact date) and where was each child bora?* Christened? Who were
its sponsors?
19. What is the relation of parents and children? Does the father have any pa-
triarchal authority over his family? What is the mother's position in the home?
Is the tie of kinship particularly strong or is it weak? Does the tie extend be-
yond the immediate family?
20. Has the marriage been a happy one? If not, did the trouble begin before emi-
gration? When and how? Was there any evidence of unfaithfulness?

21. Did the home, after marriage, compare favorably with those that the husband
and wife had known before? Did the husband support the family to the best of
his ability?
IV Circumstances Pertaining to Emigration

22. Had there been any change in the family's circumstances which made emi-
gration desirable? Did they come to earn the necessities or the comforts of life,
or was it to accumulate savings to take home? Was it to escape justice? To
avoid military service? Was it because of racial or religious persecution? Be-
cause of domestic difficulties or infelicities?
23. Did the husband have regular work at the time of emigration? What was he
doing at that time?
24. Had relatives or friends preceded them? Did the impetus come from a steam-
ship agent, or from printed matter sent out by steamship companies? Was work
promised by an employment agency or a steamship company?
25. How were the necessary funds secured? From savings, from selling or mort-
gaging property, by borrowing from relatives or friends, from a steamship agent,
from a banker? For how long a period were they planning and saving for the
journey? What was the destination on embarking? Why had the emigrant
chosen that particular town or city?
26. If money was borrowed, how much, and what were the terms of payment?
What household belongings, if any, did they bring with them?
27. Did the husband leave his family behind? If so, what provision did he make
for their support?Did he send money? Did relatives care for them? Did they
have income from property? Did the wife work? How long before the family
joined him? How was the money secured?
28. From what port did he (and his family) embark?* Name of steamship?*
Did he follow route ordinarily taken from his town? If not, why?
29. What was the port of entry, date of landing (and other items on passport)?*
Had husband (or family) received instructions regarding answers at port?
What, why, from whom? Was he (or were they) detained?* Why, how long,
how released?* Were there any reasons why any member of the family could
not be admitted?* What was done?* Who befriended and who took advantage
of the family? To whom were they assigned?* Did they go first to a relative or
friend? What address?
V Industrial Adjustment in This Country

30. How much money did the husband have on landing? Was it his own? Did it
last until he was able to earn his way? If not, how did he manage?
31. What work did he expect to do in this country, and why? If he had been
promised a job before coming, what was it, and by whom promised? Did he get
it? How long before he went to work? How did he get his first job? What
was the nature of work? Was he fitted for it by previous training or experience?
What were his wages?
32. How did this occupation compare with work formerly done by him in the old
country as regards skill or strength, healthfulness, remuneration, hours, and
chances for future development? Was he handicapped by not speaking English?
Was he at an advantage or disadvantage over Americans in the same industry?
Were others of his countrymen employed with or over him? How long did he
keep this job and what were his reasons for leaving it? Was his next job an
advance over his first?
33. If work was of a different nature from that to which he was accustomed, what
effortwas made to procure work of his own kind? Has he ever procured such work
since? When and how? What were the difficulties in keeping it?
389
SOCIAL DIAGNOSIS
34. Was he a member of a trade union in the old country, and if so, why has he not
joined one in America? Is he eligible for membership here?
35. How many had in this country? Has he been frequently out of
places has he
work? Because of hard times, lack of knowledge of English, or for what
illness,
other cause? How long idle? How did he secure work again? Has his work
been seasonal? Irregular? Either of these by his own choice? Has it been
casual? Regular? What changes in nature of work? Has his work necessi-
tated changes in habits of living and in his recreations?
36. Has he ever been exploited by any employment agency, broker, padrone?
Compelled to pay lump sums to secure a job, or to share earnings with foremen or
others? Sent to jobs which proved to be non-existent? Discharged after brief
employment to make way for new employes? Has there been exploi-
periods of
and of the colony of which it is a part by a ring composed of
tation of this family
the employment agent, a banker, grocer, steamship agent, or the like?
37. If debts were contracted, either before or after arrival, did he pay them off?
How long did this take? Did he or does he send money to the old country? In
payment of debts, as an investment, or to support members of his family? How
much? How frequently? Through whom?
38. Has he ever returned to the old country? If so, how was the money procured?
39. Has the wife ever worked outside the home? At what? Has she done home
work? Of what nature? Has she worked whenever she could find work to do,
or has she resorted to such work only in times of special emergency? What pro-
vision was made for the children during her absence?
40. If there are children of working age, at what age did they leave school, and
what has been the industrial history of each? Have they frequently shifted
from one job to another? Have they been shunted into "dead-end" occupa-
tions? Have they shown any ambition? Any special abilities?
VI Social Adjustment in This Country

41. Has the family lived here in a colony (or colonies) of its own nationality? Is
this colony largeenough to have business and interests of its own which are inde-
pendent of the rest of the community? Does the colony maintain a newspaper
(daily or weekly) in its own language? What characteristics does the colony
ascribe to Americans in general and to American women in particular? Has
there been any friction between this colony and the rest of the community?
What contact has there been, by the man and the woman, with Americans or
with those of any nationality other than their own?
42. In what way has the family's home life in this country differed from that in
Europe? What customs had to be changed?
43. Has there been evidenced a persistent clinging to the old, or a willingness to
try the new? What is the general community feeling in this respect? Has this
family been particularly slow in making this adjustment?
44. How far have the husband and wife progressed in learning the English language?
Has either attended night school?
390
45. Has it been the plan of the family to return to Europe for final settlement or to
remain permanently in this country?
46. What steps, if any, has the husband taken toward naturalization?* What
preparation, any, has he had for naturalization?
if If he has taken no steps,
what is his reason? If he has been denied his certificate of naturalization, on
what ground did the court base its action?*
47. Has he shown any interest in politics? Frequented any club where public
matters are discussed? Shown enthusiasm for democratic ideals?
48. there been changes in standard of living, in food, in number of rooms,

Have
during the period of residence in this country? What and why? Has this
etc.,
change been for the better or for the worse? If the mother has been accus-
tomed to do any work for pay, what effect has it had upon the family standards?
49. Have their church affiliations been vital or Has the hold of
merely nominal?
the church on them been strengthened or weakened by immigration? Have they
contributed regularly to the support of the church?
50. Have the children attended public* or parochial school? Or both? Have their
teachers been of foreign birth? Have they been taught chiefly or entirely in a
foreign language? Have they mingled with native American children or chil-
dren of other nationalities? Has their school progress been normal for their
ages? has there been anything in the family history or home life to ac-
If not,
count for the retardation? Has it been due to lack of adjustment to American
conditions? Have the children been truants? Have the parents kept them out
of school to work?
51. What use, if any, have the children made of night schools, special classes or
clubs, the libraries?
52. Have the children grown away from parental influence? In what way was
this first noticed? How early did estrangement begin? Has it reached a serious
stage? Has the tendency of some teachers and social workers to disregard the
parents and deal with the family only through the children been a factor in
breaking down the children's respect for their parents?
53.Have the children introduced any changes into the family customs and routine?
What? Are they contemptuous of all old world customs, without discrimina-
tion? Are they extravagant in matters of dress and amusement? Is there un-
necessary friction or is the family willing to make the adjustment? Does the
family appreciate the danger?
54. What forms of amusement have the family been accustomed to enjoy together?
What forms separately? How do the various members of the family spend their
Sundays and evenings?
55. Has there been any deterioration in character, or in moral or physical stamina,
in any member of the family? Have any members suffered from serious or pro-
longed illnesses?
56. If any of the children have died, when and from what causes?*
391
SOCIAL DIAGNOSIS
57. Have there been emergencies in which the family has sought or accepted aid?
Have relatives or friends assisted at such times? How long after arrival in Amer-
ica was first application for relief (if any) made to a public* or private agency?
What was the occasion? What were the results? What has been the effect on
the family, on relatives and friends? Is there evidence of growing dependence?
VII Housing at Present

58. How long has the family lived in its present home? How does home compare
with previous ones in this country in respect to neighborhood, number of rooms,
lighting, ventilation, sanitation, and furnishings? Is the landlord one of their
own nationality? Is he a fellow townsman? Does he live in the same house?
Is he paying for the house and therefore unwilling to put money into repairs?
Do these facts affect the rental? How does rent compare with that for similar
accommodations in other parts of the city? What determined the family in its
choice of this location nearness to work, presence of compatriots, any other
factors?
59. How many persons sleep in a single room? Is the number a menace to the
physical or moral welfare of the family? How many rooms are there for general
use (not sleeping rooms)? How do these conditions compare with those in the
old world, and with their previous quarters in this country?
Lodgers
60. Are there any lodgers? How many? Men or women? On what terms are
they kept? Does housewife cook their food? Does food left over go to the
family? Do they share a room with any members of the family? Are they
relatives, fellow townsmen? Have they but recently arrived in America?
61. Is the presence of lodgers rendered necessary by the family budget? Are they
kept to swell a savings account, or to make payments on property possible? Are

they kept from motives of friendship? Are the lodgers kept only occasionally,
or is it a custom? Is the family anxious to dispense with them?
62. Are the lodgers also boarders? On what terms? Are they an added burden to
the family when out of work? Does the family ever borrow money of the lodg-
ers? Are their habits or physical condition such as to be a menace to the family
in any way?
IX Health
63. What is the physical and mental condition of each member of the family?
His fitness for his work? Is a cause of ill health to be found in housing or living
conditions, in hours or conditions of work, or in lack of adjustment to conditions
of life in America?
64. What is the attitude of the heads of the family toward medical agencies, dis-
pensaries, hospitals? Is this attitude, if unfriendly, accounted for by exploita-
tion in this country or abroad, at the hands of medical quacks or fake institu-
tions? Is it an attitude characteristic of the people in the family's home town in
the old country?
392
X Occupations
1
65. What is the present occupation of each member of the family? Hours of work,
habitual and overtime?
XI Needs and Resources 1

66. If the family is unable to speak English, who is the person who has been acting as
interpreter? Are his general intelligence, his knowledge of English and of the foreign
language he claims to know, and his disinterestedness such as to make the informa-
tion about needs, resources, and other matters obtained through him quite reliable?
67. If the family is in need, what circumstances are responsible? How does the
if there is one, differ from any that have
present emergency, previously arisen?
Have relatives, friends, fellow townsmen assisted? Is their aid less than on pre-
vious occasions? Why?

68. Does either the husband or wife belong to any lodge or benefit society? If so,
what are the dues? If they do not, what is their reason? If they have dropped
out, when was it and why? What are the chances of reinstatement? Who are
the officers, the doctor? Are some of the members fellow townsmen? Is it a
religious organization?
69. Has the organization aided them by the payment of sickness or of death benefits?
When? To what extent? What are the rulings as to this? Do they ever make volun-
tary collections in addition to the regular aid? Through whom is the money paid?
Do they carry members on their books who are temporarily unable to pay dues?
70. What are the death benefits of the organization? Is it a fixed amount, or pro-
portional to membership? How long after death is the amount paid to bene-
ficiaries? Is the undertaker paid first? Does the society itself make the ar-
rangements with the undertaker?
71. Has the family within recent years received any inheritance,* damages,* or in-
surance money? Has it, or did it recently have, savings? Does it, or did it
recently, own any property?*
72. What
prospect does there seem to be that this family will retain or regain eco-
nomic independence? That they will make a satisfactory social adjustment in this
country? If these prospects are slight, would it be possible and desirable to
deport them? Are they deportable on any of the grounds specified in the Im-
migration Law?1 for example, as mentally deficient, insane, or epileptic; as
For Income and Outgo and further questions relating to Occupations, see ques-
1
tionnaire regarding Any Family, questions 26 and 27 and 21 to 35.

* It should be borne in mind that an
alien, to be deportable, must (with certain
exceptions) have been "at the time of entry . . . a member of one or more of
the classes excluded by law/' or must have become "within five years after entry
. . . a public charge from causes not affirmatively shown to have arisen subse-
quent to landing." The Immigration Law of 1917, especially in sections 3 and 19,
together with the Immigration Act of 1924, especially section 14, and the Act ap-
of the Act approved
proved June 24, 1929, amending subdivision (a) of section
i
March 4, 1929 (Public Law Numbered 1018, Seventieth Congress), contain a

number of important departures from previous laws as, for example, in regard to
the period after landing during which deportation is possible, and inability ever to
return to the United States after deportation. Consult immigration authorities as
to interpretation and conditions of the enforcement of these acts.
393
SOCIAL DIAGNOSIS
paupers, beggars, or vagrants; as chronic alcoholics; as tuberculous or afflicted

with any loathsome or dangerous contagious disease; as criminals; as prostitutes
or persons who profit by prostitution; as anarchists or persons who advocate or
teach the unlawful destruction of property; as contract laborers; as illiterates?
If they are not deportable, would it be possible to arrange for their return to the
old country by consular ticket? Are there relatives there who would assume
responsibility?
394
CHAPTER XXII
DESERTION AND WIDOWHOOD
situation of the mother whose children have been
deserted by their father and that of the widowed mother
THE with children present some superficial resemblances. An
early stage in the development of social treatment one domi-
nated by emergencies and by surface symptoms usually leaves
the two situations undifferentiated. That they present different
problems shown by the two questionnaires which follow.
is
State laws relating to the apprehension and punishment of de-

serters are so varied that no questions are included with regard
to extradition, trial, suspension of sentence, probation, reimburse-
ment of family during imprisonment, etc. It is assumed here that
the social worker knows the state law or city ordinance bearing
upon desertion and intends to confer with the public officials or
private agencies most interested in its enforcement.
For re-enforcement of the position frequently taken in these
pages that single disabilities cannot be treated as ultimate causes,
and that they cannot be understood even in one case without
reference to the factors behind and those entering into their mani-
festations, attention may be called to the desertion case summar-
ized on page 140. Even the finding of a deserter, which is the first
step in his treatment, of course, can be expedited by the attempt,
from such data as are at hand, to understand him.
DESERTED FAMILY QUESTIONNAIRE

filled
Astar (*) indicates that the answer to the question may be found in, or con-
firmed by, public records.
general questions are repeated here only in rare instances, when it has seemed neces-
sary to give them special emphasis.
I. What steps, if any, have been taken to make sure that the husband is not in the
immediate neighborhood and in communication with his family? That he is
not in some hospital unidentified? That he has not been arrested and sent to
395
SOCIAL DIAGNOSIS
the house of correction or some other institution? Or that he has not gone away
to seek work with the knowledge and approval of his wife? What is the wife's
reputation for trustworthiness?
2. If clear that the desertion is genuine, what steps have been taken to trace
it is
him? Has his picture been obtained for purposes of identification? Have out-
of-town and in-town relatives and friends been consulted? Or his last foreman,
his fellow workmen, etc., or his neighborhood cronies, and the keeper of the
saloon, if he frequented one? Or any benefit societies and trade union to which
he may have belonged? Have army and navy enlistments been consulted, or the
police?
I Circumstances of Present Desertion

3. When did the husband last desert? What steps on her own initiative has his
wife taken to find him? What steps with the help of others, and of whom?
4. What is the wife's statement as to the immediate cause of his departure? As to

her knowledge or inference with regard to his intention? As to his present
whereabouts?
5. Has he ever been Has he ever expressed a desire to

in other cities? Which?
visit any special place? that forwarding of mail to him has been
Is it likely
arranged for at the post office?* Does he speak so little English that he would
probably be found in the foreign colony in whatever city he went to? What
languages does he speak?
6. If husband's whereabouts is known, what is his statement of the cause of his
desertion?
7. What do relatives on each side, friends, fellow employes, and other references
give as probable causes of his desertion? What bias have these different wit-
nesses?
8. Was wife pregnant at time of desertion?

9. What was husband's employment at time of desertion? If none, causes of un-
employment? How long had he been out of work?
10. Have any facts that explain the desertion come to light? Was there a special
burden of debt, including installment purchases? Or was husband in danger of
arrest for some dishonesty? Are any earlier criminal acts on record?* Is there
any evidence that he is mentally abnormal or nervously unstable?
1 1. Did he take money (if so, how much) or clothing with him? Did he have sav-
ings? Where
did he get the money to go with? Did he leave any personal or
real property or money in bank? Has the wife any property?
12. Since he left, has he sent money or other supplies to his family? How much?
Date of last remittance? Date and postmark of last letter?
13. If his whereabouts is known, is he at work? What are his earnings? Is he

living with another woman?
14. Has the wife sworn out a warrant for his arrest?* (In some places a warrant
cannot be had until the husband's whereabouts is known.) What is her attitude
396
THE DESERTED FAMILY
toward jail sentence, probation, separate support, or reconciliation, and is this

attitude likely to be a stable one? What other plans has she for the immediate
future?
n Past Desertions
15. How many times has husband deserted his present wife before? How long after
marriage did he first desert? Length of each period of desertion? Intervals
between desertions? What events led up to each? Is there any long interval
between births of the children next to each other in age that may be due to pro-
longed separation of parents?

1 6.Where did he go on previous desertions? How did he go by freight, tramping,
or paying hisway? Did he get work elsewhere? Did he send money home?
How much?
17. In each desertion, what action, if any, was taken by the wife, by the courts,*
by public* or private charity, and with what results? How was the wife sup-
ported in his absence? What effort was made to develop his sense of responsi-
bility for his family after his return?
18. Have there been any arrests for non-support?* If so, with what results?*
19. What were the circumstances of each return? When persuaded to take her
husband back, what outside influences, if any, led to the wife's action?
Ill The Husband's Early Life

20. What were the general conditions of the husband's early home life? What
was his home training? Was he indulged or unduly repressed? Did his father
and mother fulfill their responsibilities? Did either show evidence of physical
or mental defect? Did his father ever desert or fail to provide for his family?
21. Did the husband have any institutional training as a boy? Of what nature?
For how long?
22. Did he earn before leaving school, either by selling papers, doing errands, or
otherwise? Any truancy or other signs of a roving disposition during school life?
23. What was
his age and in what grade was he when he left school? Did he go
to work immediately and work regularly? If not, was it because he preferred to
loaf? How often did these loafing periods come and how long did they last?
Did he show a tendency to wander from home then?
24. What were his amusements in childhood and youth?
25. What employment or employments did he choose? What opportunity for de-
velopment did they offer?
26. Did he, before marriage, turn over his wages to the family?
27. When did he leave his parents' home? Why?
28. Did he ever serve in army or navy?*
29. Was he ever married before? Was it a legal marriage?* Was he then a de-
serter or arrested for non-support?* Has he children by another marriage?
What are the relations between these children and their stepmother?
397
SOCIAL DIAGNOSIS
IV The Wife's Early Life

30. What were the wife's early home life, education, and training? (For details
that apply, see The Husband's Early Life, 20 to 29.) On what terms is she now
with her own people?
31. Did she have any training at home or school to prepare her for making a home?
32. Did she work before marriage? If so, at what and under what conditions?
33. Had she been previously married?* If so, what children had she by that
marriage and what have been the relations between them and their stepfather?
V Their Married Life

34. How did husband and wife meet? What was age of each at present marriage?*
35. When (exact date), where, and under what circumstances were couple married?*
36. Is marriage legal? If married by religious ceremony in the old country, is it

legal here? Has either a husband or wife living from whom no divorce has been
obtained? (In the treatment of desertion cases it is especially important to
have some legal proof of the marriage.)
37. Did marriage take place because wife was pregnant? If so, was marriage
forced upon husband? Were there any other unusual circumstances?
38. At time of marriage, did either husband or wife have any money saved? How
was it spent? Did they buy furniture on the installment plan? What was their
income when first married? Rent? Character of neighborhood in which they
began married life? Was the home better or worse than either had been accus-
tomed to before marriage?
39. Have they ever lived in furnished rooms?
40. Have they ever lived with their relatives? Have any of their relatives ever
lived with them? Have they interfered in the home? What are the character-
istics of the relatives who have been most closely associated with the family?
41. Have the family taken lodgers or have any other outsiders lived with them?
Men or women? What have been their relations with the husband? With the
wife?
42. If foreign born, did man precede his family in coming to this country? How
long? Have differences in degree of Americanization influenced the home life?
(See Immigrant Family Questionnaire, p. 387.)
43. What striking differences, if any, between husband and wife in age, race, na-
tionality, religion, education, or personal habits? Have these differences led to
disagreements and family dissension?
44. What was husband's occupation when living with his family, and his average
wage? Was it enough to maintain a decent standard of living? How did his
wage in the last position held compare with his maximum wage? If lower, what
was reason? How did work done compare with that done at his best?
45. Was his work seasonal or otherwise irregular? Did he always work when he
could get work?
398
THE DESERTED FAMILY
46.What proportion of his wages did he give family when working full time?
When working part time?
47. Has wife worked since marriage? At what and for what wage? What has
been on her health, effect on man as a wage-earner, on home and children?
effect
What arrangement was made for the care of the children in her absence? Did
she consider work a hardship, or prefer it to confinement to home duties? What
are her capabilities as a possible wage-earner?
48. What is the health record of husband? Of wife? Has either any physical or
mental defects? Has either deteriorated markedly since marriage? Has either
been intemperate or given to the use of drugs? (See Inebriety Questionnaire,
P. 430.)
49. Has either husband or wife been immoral? Given to gambling, betting, or
any form of dishonesty?
50. What are husband's personal characteristics? Has he seemed fond of home?
Of children? Or has he, for example, been lazy, sullen, penurious, jealous, or
cruel to family? What is his employer's estimate of him? What were his re-
lations with his fellow employes? If there were marked signs of bad temper at
home or in his relations with shop mates, has the possibility of mental disease
ever been considered?
51. What are wife's personal characteristics? Has she, for instance, a difficult or
nagging disposition? Is she a good housekeeper? A good mother?
52. What signs are there that there has been or still is any real affection on the
part of either husband or wife? How have they influenced one another? Or is
estrangement due in large part to external things and not to their own disposi-
tions?
53. What active affiliation with church, with clubs, etc., has either had? What
usual recreations? Did family ever go on trips or enjoy other recreations to-
gether?
54. Are the children attractive and generally well cared for and well behaved?
55. What is the attitude of the older children toward their father? Toward their
mother? Toward assuming support of family?
56. What is the attitude of any and all relatives toward husband? Toward wife?
Toward helping in support of family or other solution? Do his brothers or sis-
ters or his parents condone his desertion? Are any of them harboring him?
57. the present home detached, or is

Is it a tenement?Are the rooms pleasant
and well furnished? Well cared for? Are any lodgers or other outsiders now
living with family?
58. What is the character of the neighborhood? How long have the family lived
in this neighborhood? If they have recently come here, what was the character
of their former home and neighborhood?
VI Financial Situation
59. What is the financial standing of husband's father? Has he contributed to
support of his grandchildren? Has he been prosecuted for failure to do so?
399
SOCIAL DIAGNOSIS
60. Had family been dependent before husband's desertion? To what extent,
how long, and for what causes?
61. Was relief given from public sources,* from private charities, or from relatives?
Or had they received free transportation? What had been effect of aid on the
husband? On the wife?
62. Is family now dependent? On whom? To what extent? What is the atti-
tude toward the present situation of those who have assumed any part of the
financial burden?
63. What is the total family income? Family expenditures? (See questionnaire
regarding Any Family, Financial Situation, 26, 27, p. 380.)
64. Are the wage-earning members of family all employed at maximum earning
capacity?
QUESTIONNAIRE REGARDING A WIDOW WITH CHILDREN

This is not a schedule to be out nor a set of queries to be answered by a
filled
A
star (*) indicates that the answer to the question may be found in, or confirmed
by, public records.
general questions are repeated here only in rare instances, when it has seemed
necessary to give them special emphasis.
I Circumstances of Husband's Death

1. When (exact date) and where did husband die?* Who was the undertaker?
2. What was the cause of his death?* (Give exact medical diagnosis.)
3. Were the conditions of his work responsible for it? If so, what action has been
taken to secure compensation? What state law is applicable to the situation?
4. Had he been physically weakened by overwork? By excessive drinking, bad

living conditions, or other causes?
5. How long was he ill? What medical care did he receive? Name and address
of physician who attended him?
6. Is there anything important to be noted in the inheritance physical, mental,
or moral of the husband? Was there in his family tuberculosis, inebriety, in-
sanity, feeble-mindedness, or epilepsy?
7. How was family supported during his illness? Were wages continued in full or
in part by his employers? What were the sources of support relatives, savings,
sick benefits, wages of woman, of children, relief, other sources? Approximate
amount from each source?
8. What was the amount of insurance, legal compensation, or death benefits?
Amount collected by fellow workmen, contributed by employer, etc.? Cost of
funeral? Amount of debts? Balance left for widow? What disposition was
made of this money, and how long did it last?
400
THE WIDOW WITH CHILDREN
1 Early Life of Widow
9. What of the family inheritance of the mother (see question 6)?
10. What was the occupation of her father? Did he work steadily and fulfill his
obligations to his family? Was her home a normally constituted one? If not,
in what particulars abnormal?
1 1. Did she before her marriage live in the city or country? Did she ever have in-
stitutional care? Where? For how long? How far did she go in school? Why
and at what age did she leave?
12. Did she work before marriage? Nature of occupation? Wages? Length of
time employed in each place? Wages at time of marriage?
13. If before marriage she lived in another country, has she worked since coming to
America? Nature of occupation? Wages?
UI Married Life
14. When (exact date), where, and under what circumstances did marriage take
place?*
15. At time of marriage, did either husband or wife have any money saved? How
was it spent? What was income when first married? Character of neighbor-
hood in which they began married life? Was the home better or worse than
either had been accustomed to before marriage? Were they near to relatives?
16. Did they ever live with relatives? In furnished rooms? Were they separated
at any time? If so, how long and for what reason?
17. Did the wife work between the time of her marriage and her husband's death?
Occupation? Length of time employed? Occasion for her going to work?
18. What was the husband's occupation? Maximum wage? Was he regularly,
seasonally, or occasionally employed? What were his weekly earnings just
before he was taken ill? Did he pay a regular amount weekly to his wife, or turn
over his pay envelope to her untouched? Was he industrially efficient? Who
was his last employer? How long was he employed there? Is employer inter-
ested in the family?
19. Did the family or any member of it have relief or institutional care before
husband's last illness? When? Source, occasion, kind, and approximate
amount?
20. Did the character of husband or of wife change materiallyafter marriage?
Was he intemperate, vicious, or lazy? When did these characteristics begin to
be manifested? Do any events explain them? What was his influence on the
children?
21. Did he ever desert, or had he a court record?*

22. When did the family reach its high-water mark? What was the standard of
living at that time?
23. Was this standard lowered before husband's last illness? Why? In what
particulars?
26
401
SOCIAL DIAGNOSIS
IV The Transition Period

24. Have any changes in standard been made since the husband's death? Re-
moval to cheaper rent? Children taken from school? Children put in institu-
tions? Supply of food or clothing reduced? Lodgers or boarders taken?
Have these changes been a menace to the home life and to the future of the chil-
dren?
25. How long after husband's death was the first application, if any, for relief
made? To what agency? Treatment by that agency and by any others that
may have been called on to aid this family? Total (approximate) amount of
relief given by all agencies to date?
26. How was the family supported in the interval preceding application? In-
surance, relatives, savings, sick benefits, wages of widow, of children, other
sources?
V Present Surroundings
27. What is the character of the neighborhood? The house? The apartment?
(For detailed questions, see questionnaire regarding Any Family, 34-38, p. 381.)
28. How near are they to schools, settlements, libraries, parks, other opportunities
for recreation? Where do the children play? Does the family have any recrea-
tion in common?
VI Present Family Problems in General
29. What is the widow's general health? Has she any physical or mental disabili-
ties or defects? What is the physical and mental condition of each member of the
household? If the husband died of tuberculosis, have all members of the family
been examined?
30. Have any of them had, in the past, treatment by physician, hospital, or dis-
pensary? With what results? What was the attitude of the patient, willing-
ness to follow advice, etc.?
31. If the mother or any of the children need medical care, what is the diagnosis
of physician, hospital, dispensary? What treatment or special care is recom-
mended?
32. Is it likely that any members of the family would be benefited by removal to
the country? Is there anything to indicate that the family would be adapted to
country life?
33. What is the widow's character and ability? Is she moral? Temperate? Is
there indication of strength of character? What resourcefulness, if any? What
is her attitude toward relief, both public and private?
34. In is her home and the children's clothing?

what condition Is she a thrifty
housekeeper? Does she know how to select and prepare nourishing food? Is
she an affectionate mother? Does she maintain discipline, especially over her
boys?
35. Are the children obedient, well behaved, helpful, of good habits? Have they
attended school regularly? Whatthe teacher's report concerning them?
is
Are they up to the normal grade in school? What arrangement has been made
402
THE WIDOW WITH CHILDREN
for receiving reports regarding attendance, etc., from week to week? Have
they ever been under the care of a truant officer?* Have any of them been before
the children's court?* If so, under what circumstances and with what results?
36. Do any of the family take advantage of clubs or social activities in schools,
settlements, etc.? What is the testimony of the directors of such activities in
regard to them?
37. If the family is foreign, what is the degree of Americanization? Does the
mother speak English? What influence have differences in custom on her rela-
tions with the children? (See also Immigrant Family Questionnaire, p. 387.)
38. Are there other members of the household? Boarders and lodgers? What is
the effect of their presence on the family life? Are any of these male adults?
Are they related to the widow?
39. Does the mother plan to put any of the children in institutions? If so, what are
her reasons? Or what other plans has she in detail for herself and for each of
her children?
VII Present Work Problems

40. If the widow
is not working, is her constant presence with the children needed?
Is itgood for them, or would they both gain by periods of absence? How does
she spend her time? What are the work standards of women in the neighbor-
hood who have working husbands? How much and what kind of work, if any,
should she be expected to do? Would she be helped in ways other than financial
by further training?
41. If employed, what is What are her weekly

the nature of her occupation?
earnings? Working and total hours per day? Does she go out to work?
hours,
If so, how many days per week and for what specific hours of the day (A. M. and
P. M.) is she away from home? If she is working early and late hours, how much
sleep does she get?
42. If the mother works away from home, where is each of the children under
working age in her absence? Who cooks their meals? Do they get food enough
and of the right kind? Who cares for them? If a neighbor does, what is her
character and influence? What provision is made for care of school children
out of school hours?
43. Do the children of school age help their mother at home? Do they sell papers,
run errands, or do any work outside the home? If so, what are the days and
hours of work and amount earned? Is the child labor law being violated?
44. What are the conditions, moral and physical, under which widow and children
work? If she works at home, do conditions comply with regulations of factory
inspectors?
45. Are the children of working age at work and earning maximum possible wages?
Will their present occupation lead to advancement? Have they special talents
to be cultivated? What are their earnings?
46. What is their attitude toward assuming family responsibility? Do they give
mother full wage? Does she allow them money for clothes and spending money?
403
SOCIAL DIAGNOSIS
47. Is any effort being made, as younger children approach working age, to secure
for them work suited to their preferences or abilities that will train them for fu-
ture efficiency? What is the mother's attitude toward their further education?
VIII Income and Outgo

48. What, in detail, is the present income of the family? The present outgo? (See
questionnaire regarding Any Family, 26, 27, p. 380.)
49. What does careful analysis show to be the necessary expenditure for food, rent,
fuel, clothing, insurance, carfare, lunches, other items?
IX Possible Sources of Advice and Help

50. Are there relatives near at hand? Are they friendly? What plan for the
widow's future do they advise? What material help can they give in carrying it
out? What helps that are not material? What is their moral standing? Is
their influence desirable? they live in another community in the United States
If
or in the old country, could the family go to live with them? Are any of them
known to any social agency? If the husband was a member of a lodge or benefit
society, is the man who stood sponsor for him an old friend whose advice might
prove valuable?
51. Has the family attended church or Sunday school regularly? Is there any
religious instruction athome? What help can the church give, either material
or by supervision, encouragement, etc.?
52. Are any charities or other social agencies interested? If so, what plan do they
advise?
53. Are there any other sources of information and advice as to future plans?
Any other sources of material help? Friends? Previous employers? Trade
unions?
404
CHAPTER XXIII
THE NEGLECTED CHILD

SEEMED best to Dr. Catherine Brannick, who prepared
the questionnaire regarding a Neglected Child which follows,
IT to classify nearly half of her material on the basis of the par-
ticular forms of neglect recognized in many of our states as statu-
tory offenses. This was done to facilitate reference, but it has

involved repeating under each form listed questions that apply to
several forms. The court side only one aspect of this important
is
problem, but it is a side with which social workers have to make

themselves familiar.
QUESTIONNAIRE REGARDING A NEGLECTED CHILD*

This not a schedule to be filled out nor a set of queries to be answered by a
is
Astar (*) indicates that the answer to the question may be found in, or confirmed
by, public records.
general questions are repeated here only in rare instances, when it has seemed neces-
I The Child's Father

1. Is there any criminal tendency in his family? Any record of drunkenness,
chronic dependence, unusual degree of immorality, physical degeneracy?
2. Were any members of his family insane, feeble-minded, or epileptic?
3. Was he born out of wedlock?
4. Were there elements of neglect or cruelty in his own childhood? Was he a

spoiled or unrestrained child?
5. Was he country or city bred? What was the character of the community in
which he was reared?
6. Was he brought up to attend any church? What was his religious education?
7. What was his school training? His record at school? Was he considered in
any degree mentally defective? Did he show signs of unusual temper, inherent
cruelty, moral degeneracy? Age and grade on leaving school? Reason for
leaving school? Did he have any special training?
Prepared for this volume by Dr. Catherine Brannick.

1
405
SOCIAL DIAGNOSIS
8. Did he have any record of juvenile delinquency?* What, in detail?
9. Was he ever an inmate of a children's home or institution? If so, under what

circumstances? For how long? If he was in an institution or otherwise a public
charge, at what age did supervision cease?* What was his reputation?
10. If foreign born, at what age and under what circumstances did he begin life
in the United States?

n. At what age did he begin work? What kind of work was it? Was it of such
nature as to have a bad effect on him physically or otherwise? (i. e., was it a
dangerous trade, a seasonal trade, irregular work, etc.?)
12. What was toward his parents? Did he show neglect of filial duties
his attitude
in withholding wages, etc.? Was he actively abusive?
13. Did he work whenever possible, or did he show a tendency to loaf?
14. What in general were his habits? What were his recreations?
15. Is there record in lower or superior court of any charge or conviction? For
what offense?*
H The Child's Mother

1 6. What were the characteristics and standing of the mother's parents and of her
immediate family? The circumstances of her early home life? Was she her-
self a neglected child? What was her schooling? Was she regarded as a dull
or difficult child? What work did she take up after leaving school? Did she
ever have any training in her home or elsewhere to fit her for domestic life?
What kind of associates did she choose? Was she ever committed to an indus-
trial or reform school?* Was she known as a girl of "loose habits"? (For de-
tails that apply, see The Child's Father, i to 15.)
HI The Family Life

17. Has either the father or the mother ever been married before?* If so, is former
wife or husband living? If divorced, where and on what ground was divorce
obtained?*
18. Has any children by a former marriage or any illegitimate chil-
either parent
dren? If so, how many
are there, what are their ages and sexes, where are they,
and what are their relations with their parents and stepparents? If any such
children have died, what was the cause of death?* If any are living with the
family, is marked partiality shown by stepparent to his or her own children?
19. Are the father and mother legally married? When, where, and by whom was
the ceremony performed?* What were the circumstances of the marriage?
Was it a forced one? How old were the parents at the time? How long had
they known each other?
20. Are there any mental or physical defects in either parent that should have
barred marriage?
21. Are there family difficulties between husband and wife due to racial or reli-
gious differences? To unwise interference by relatives? Are differences so serious
that they are not likely ever to be overcome?
406
THE NEGLECTED CHILD
22. How many children have been born of this marriage? How many have died,
and from what causes?*
23. What was the father's occupation at the time of marriage? Since? Was he
then and has he since been earning enough to support a family? Has he given
his family normal support? When did family reach its high-water mark and
what were the conditions?
now working, what are his wages? What proportion of his
24. If the father is
income does he give to his family? What is his employer's estimate of
total
him? What is his attitude toward his fellow employes?
25. How does wage compare with that which he is capable of earning
his present
his maximum wage? What
is reason for lower wage? How does present type
of work compare with work done at his best?
26. How does the home now provided by him compare with that which he is able to
provide?
27. If he is not working, what is the reason? How long has he been out of work?
member
28. Is he a of a trade union? What is his reputation in the union? Is he
a member of any fraternal organization? Affiliated with any anti-social organi-
zation?
29. Is he, or has he ever been, a satisfactory husband and father? Fond of home
life? Of his children? Or does he regard children as merely a means of support
for himself, now or later?
30. If satisfactory at one time and now given to abuse or neglect, when did change
take place? Wasapparently due to development of inherent bad qualities?
it
To "easy disposition," bad companionship and surroundings? To discourage-

ment over lack of work, long illness in family, debt, characteristics of wife as a
homemaker?
31. What is the attitude of the children toward their father and mother? Have
they real affection for them? Are they afraid of either of them? Are they con-
trolled by either or both? How? By fear or otherwise?
32. Is the wife, or has she ever been, a good mother or satisfactory housekeeper?
If her home standards were fair at one time and have since become low, what
causes have contributed to lower them? Her own or her husband's habits?
Her own illness or other illness in the family? Overwork? Too many children?
Extreme poverty?
33. Is she obliged, or has she in the past been obliged, to contribute to the family
support? To what extent? Has she had the burden of regular work away from
home? Is this responsible for much of the neglect?
34. or has either parent ever been affiliated with any church?
Is What is present
relation to the church and clergy?
35. What are the habits of father and mother as affecting their family life? Does
either drink to excess? (See Inebriety Questionnaire, p. 430.) In the home, or
away from it? Does drinking bring dissolute companions into the home? Has
either parent ever signed the pledge or has either any respect for it? Does
407
SOCIAL DIAGNOSIS
either use drugs? immoral? Obscene in language or action before

Is either
the children? Is Does mother neglect her household duties,

father a loafer?
spend much time away from home or in association with criminal or immoral
persons? Has either an ugly or dangerous temper? Does either beat or otherwise
abuse the children? Is either given to gambling? Dishonest? Quarrelsome?
36. Is either parent suffering from a disease that constitutes a menace to the
family? Is there reliable evidence of this condition in hospital records or with
a competent private physician? What is the date of this record?
37. Does the bad example of either parent show in the conduct of any of the chil-
dren? Do they imitate parental vices?

38. Is either parent known to the police of the district, and what is his or her repu-
tation with them?
39. Has either a court record?* Has the father been accused or convicted of of-
fenses against his family of desertion, non-support, assault, cruelty, criminal
abuse?* Has the mother?*
40. Is either parent by reason of mental or physical defects, disposition, or habits
unfit to have the care of children? On what grounds? Is there medical author-
ity for this? Has either ever been pronounced mentally irresponsible? Would
mental examination now be likely to result in such a decision?
IV Particular Form of the "Neglect"
(a) Desertion or failure to provide for home
41. Have the parents, or either of them, deserted? How long ago? Under what
circumstances? Is this the first desertion? If not, what is history of previous
desertions? (For other questions on desertion, see Deserted Family Question-
naire, p. 395.)
42. How many rooms in the home? Is there overcrowding beyond that which the
law or decency allows?
43. Is the home furnished sufficiently for decent living and privacy?
44.What are the sleeping arrangements? Is there a decent supply of bedding?

How many sleep in each bed? Are children forced to sleep with parents, adult
members of family, or lodgers? Do children sleep in a dark room?
45. Are the children decently clothed? How does their clothing compare with
that of other children of the neighborhood?
46. Have the children sufficient food? How is it prepared and served? What
did the children actually have to eat at certain meals? If there is an infant, how
is it fed?
47. What is the testimony of the teacher or school nurse in regard to these facts?
48. How long has this condition of neglect existed?
(b) Neglect to provide medical care

49. Are any of the children suffering from physical defects or diseases such as
deformities, rickets, persistent cough, chorea or other nervous affection, anemia,
408
THE NEGLECTED CHILD
malnutrition, adenoids, skin disease, carious teeth, pediculosis, defective eye-

sight which can be remedied by proper medical care which the parents have
been able but have failed to provide?
50. Has any one of the children syphilis or gonorrhea? What was the probable
source of infection? Is he receiving treatment for this? Is his condition a
menace to other children? Is there past history of these diseases?
51. Is either parent or any frequenter of the home

suffering from venereal or other
contagious disease? Is there medical authority for this? Of what date? Are
conditions such that the children are inevitably exposed to contagion from this?
52. Is there record of the physical ills of the children with the school nurse or doc-
nurse or physician, hospital or competent private physician?
tor, district With
the board of health?*
53. What efforts have been made through other agencies to persuade the parents
to secure proper medical care for the children? With what results?
54. What is the testimony of these agencies? Is further effort by them likely to
be successful?
55. Has the school physician power to act in the matter?
56. Is the neglect of such nature that the board of health has power to act?
57. Was the diagnosis of the neglected condition specified in the complaint made by
a recognized medical authority whose word would be taken in court?
58. Is it likely that any other recognized medical authority would disagree with the
first?
59. Have any children of the family died? When and from what causes?* Do
the deaths show probable medical neglect? Were such children insured?
(c) Lack of control

60. Is there lack of ordinary parental guidance? Are the parents able or do they
try to control the children?
61. Do the difficulties of a new country press upon the parents? Do the children
take advantage of this?
62. What is the school record of the children, especially as to attendance and be-
havior? Are they truant? In their language or habits at school do they show
the lack of salutary control?
63. Are the children constantly on the streets and late at night? Do they frequent
low picture shows, visit saloons or other places likely to lead to an idle and dis-
solute life?
64. Has the lack of salutary control reached the point where wrong-doing is a habit
and the child is delinquent? Is there record of habitual truancy? Theft?
Immoral conduct or association with immoral persons? Frequenting houses of
ill repute? Street walking? Begging or vagrancy? Use of vile language?
Relative incorrigibility?
65. Have any of the children any juvenile or other court record?*
409
SOCIAL DIAGNOSIS
66. Have any of the delinquent children been pronounced defective? If so, has cus-
todial care been refused by the parents or not been provided by the community?
(d) Exploitation
67. Are the children overworked in home duties?
68. Are they illegally employed? Before the legal age or at illegal hours?
69. Are they made to contribute to the family support by sweatshop work in the
home? By unreasonable help in the business of their parents?
70. Are they sent upon the streets to beg? Are they sent out ostensibly to sell
on the street, but really to use this as a means of begging?

articles
71. Is there deliberate exploitation of the children for immoral purposes?
(e) Cruelty, physical injury, or abuse

72. Is parental discipline rigid to the point of cruelty? Is punishment given by
parent when in anger, or is self-control exercised? Is punishment frequent,
oversevere, of unnatural or cruel form, dictated by perverted religious ideas, etc.?
Is there abusive treatment not associated with the idea of punishment?
73. Are the older children permitted to punish or abuse the younger?
74. Do the children show evidence of such abuse or punishments?
(f) Moral neglect
75. the neighborhood of bad reputation? Are there people of bad reputation
Is
in the same house? Are the sleeping arrangements of the home such that decent
privacy is impossible?
76. Are the children exposed to lead an idle and dissolute life by the drinking of the
parents? By liquor selling in the home? Have the police knowledge of liquor
selling? Are the children exposed to moral contagion by the immorality of the
parents? By obscene acts and language of the parents in presence of the chil-
dren? By the presence of lodgers or others admitted to the home?
77. Are the children known as "young street walkers"? Have the parents been
aware of such practice or have they deliberately encouraged it?
78. Are the children of bad moral reputation in the neighborhood? In the school?
evidence of unnatural relations between parents and children?
Is there Between
the children?
79. Is there reliable record of physical examination of any of the children showing
venereal disease or evidence of immoral relations?
(g) Inducement of chronic dependence

80. Are the parents now or have they been frequently in receipt of charitable aid
either public or private for which their neglect is responsible?
81. Have the parents or children ever been inmates of public institutions?* Under
what circumstances?
82. Is there record of dependency in the case of grandparents, uncles, aunts?
83. What is the testimony of public relief-giving agencies regarding family?
84. What is the attitude of parents and children toward relief?
410
THE NEGLECTED CHILD
85. Has family been aided by many private relief agencies? Have parents
"
"worked these agencies? What is testimony of these private agencies in regard
to the effect on the children?
86. Are parents known to beg?
87. Are the children permitted or compelled by parents to ask for relief at offices of
public or private relief agencies?

88. Do children show tendency to dependency in their habits? Are they known to
beg with or without knowledge of their parents? What is the testimony of the
school in regard to this?
V General Aspects of the "Neglect"

89. Is the neglect more truly destitution? Is it the direct result of half orphanage,
the parents, lack of work, or other unfortunate circumstances for which
illness of
the parents are not responsible? Are the children more truly dependent than
neglected?
90. If present condition has elements of dependency rather than neglect, is it the
result of neglect and vice at an earlier period of the family life?
91. Is condition due in any part to racial habits or characteristics? Does the stan-
dard of the family compare favorably enough with the standards of the particular
race or social group?
92. Is the condition one of all-round neglect which has reached the point where it
isnot sufficiently bad for court interference and yet too bad for any hope from
constructive work? Is the only possible thing to wait (though with continued
close supervision) for conditions to become worse?

93. Is neglect of such degree or character that remedy may be reached by prosecu-
tion of parents leading to probation?
94. Is the father so nearly wholly responsible for the neglect that action against
him would be more just than the more general charge of neglect, which involves
the mother? non-support the main factor? Frequent desertion? Can the
Is
mother be persuaded to testify to this or to bring the charge herself?
95. Has the home ever before been broken up? By reason of the (temporary)
home? By court action?* How was the
inability of the parents to provide a
home re-established? Have the children ever been inmates of a home or institu-
tion and under what circumstances?
96. Are the conditions of neglect recent or of long standing? What is the critical
point in the neglect which led to the complaint?
97. Is the complainant a reliable person? Is the complainant possibly irrespon-

sible, biased, or vindictive? Is he willing to testify if necessary to the conditions
of which he has made complaint?

98. Is there first-hand evidence of the conditions of neglect? By the complainant?
By the police? By reliable neighbors? By unbiased relatives? By the worker

himself? Can specific instances be cited? Have night visits been made to as-
certain exact sleeping conditions or presence of undesirables in the household?
411
SOCIAL DIAGNOSIS
99. Is any of the evidence likely to be attacked as prejudiced?

100. Can the parents themselves be persuaded to admit the charges of neglect?
101. If evidence of any one of the children seems necessary or desirable, has the re-
liability of the child been investigated through the school, Sunday school, or
other responsible source?
102. What is the attitude of the police toward the specific form of neglect? Of
the court? Of the community?
103. Are there responsible relatives? Have these relatives in the past made any
attempt to build up the family life? Can they be depended upon to take charge
of the family without appeal to the court?
104. Is it best to make the appeal to the court first, for the purpose of working out
plans with relatives under the court's direction or with its co-operation?
105. Is more satisfactory disposition possible without court action? If warrant

for neglect is not advisable or possible, is informal summons and warning by court
possible?
1 06. If the state laws are such that the charge of neglect is made against the child,
and the law provides for prosecution of the parent by an independent action, have
plans been made for such action?
VI Work of Other Agencies
107. Has family been known to other social agencies? If so, what is the testimony
of these agencies regarding it, what has been their experience in attempts at con-
structive work, and what do they advise?
108. Has probation been tried in the case of either parent? With what success?
109. Is constructive work of any one of these or other agencies likely to succeed
if strengthened by action on the part of the social agency charged with responsi-
bility of protecting children from neglect? Is any one agency, by reason of pres-
tige or standing with family, more peculiarly fitted to undertake such work?
1 10. Is the consensus of opinion of these agencies that further effort at constructive
work with the family is useless?
412
CHAPTER XXIV
THE UNMARRIED MOTHER
HAVE seen earlier that the affixing of a label even of
WE has no practical bearing upon prognosis

a correct label
and treatment, and that a classification of this sort is not
a social diagnosis. This truth has been illustrated in the dealings of
social agencies with the mother of an illegitimate child. There
are few tasks requiring more individualization, and there are few
in which there has been so little.
Mrs. Sheffield, in the questionnaire regarding an Unmarried
Mother which follows, aims to bring out first, under the captions
The Mother and The Father, certain facts of environment and
early influence together with the outstanding traits of these two
people which may throw light on their standards of conduct and
habits of thought. Although, in our treatment of an unmarried
woman or girl we are liable to overlook her father,
in this situation,
it is obvious that his characteristics and what went to mould them
are quite as significant socially as those of her mother. The in-
formation may point the way not only to effective treatment in the
particular case, but also to measures for mass betterment in the
community.
The part of the questionnaire calls for the more immediate
last
explanation of the girl's or woman's situation and for facts bearing

on the identity and responsibility of the man. For various reasons
the child's father only too frequently escapes responsibility. Evi-
dence of paternity may not be convincing, the man may dis-
appear, or the social agency occupied with many other tasks
may feel that the small amount which the mother would be likely
to receive does not warrant the labor of establishing the man's
whereabouts and of bringing him to trial. The question has other
aspects, however. Even small sums, if required whenever pa-
ternity can be established, will have an influence in modifying
413
SOCIAL DIAGNOSIS
public opinion, will lead it to hold a man as well as a woman

answerable for the support of offspring.
In making arrangements for mother and child, their physi-
final
cal welfare, including the mother's fitness for giving the baby
proper care, is of course of primary concern. The need of facts that
bear on the choice of work and surroundings for the mother herself
is indicated by earlier questions. And it should not be necessary
to emphasize an unmarried mother's need for wise supervision
whether she keeps her infant with her or not.
QUESTIONNAIRE REGARDING AN UNMARRIED MOTHER'

This is not a schedule to be out nor a set of queries to be answered by a
filled
A star (*) indicates that the answer to the question may be found in, or confirmed
by, public records.
The preliminary social questions regarding the husband and wife contained in
the questionnaire regarding Any Family, p. 378 those regarding names, ages,
nationality, religion, language spoken, length of residence in city, state, and
country may be assumed to apply to the Unmarried Mother, and (in cases in
which she is sure who he is) to the father of her child.
I The Mother
Her family and borne
1. Did or does she live with her own parents? Is she legitimate? Adopted?
Did she ever live in an institution, and if so, when, how long, and why? What
is the standing of parents in the community? Are they self-supporting, self-
respecting people? Is the home clean and respectable looking? Was her par-
ents' marriage forced? Did her mother or sisters have illegitimate children?
Were these children kept with their mothers, or what became of them?
2. Are (or were) parents fond of children? Even-tempered or irritable? Faithful
to church? Earnest or indifferent as to moral standards? Lax or firm in con-
they conscientious in overseeing their daughters' recrea-

trol (for instance, are
tions; did the mother teach her daughters housework, instruct them in sex
hygiene)? Or oversevere (for instance, are they reasonable in allowing pleasures

and part of earnings)?
Her community
3. What is the character of the city quarter or town in which the girl or woman
grew up in size, race, religion, general moral standards, faithfulness to church,
predominating occupation, if any, recreations and social life? Is it a factory
town, farming region, or what is its industrial character? Has it distinct foreign
colonies?
Prepared for this volume by Mrs. Ada Eliot

1
Sheffield.
414
4. If shecame from a small town or village is it within easy distance of a large city?
Do her companions have local amusements or do they go to the city for them?
Are their pleasures supervised?
5. Are the schools good from academic, vocational, and social standpoints?
6. Are the local police alert towards loose behavior on the streets? Are saloons,
dance halls, etc., regulated well? Are they numerous in proportion to the popu-
lation? Is the judge in the local police court interested in the welfare of boys
and girls?
7. What the proportion of illegitimate births in the girl's or woman's native

is
town or country?* Does custom there treat the offense as a slight one, or is
ostracism relentless? Do pregnant girls frequently leave to hide their condition
and dispose of the child elsewhere? Is this region equipped to care for such
girls? If not, why? If it is, what co-operative understanding has been estab-
lished with local agencies?
8. Are the local doctors and clergymen (if a small community) awake to the prob-
lem? What attitude do they take in regard to young unmarried mothers keep-
ing their babies?
The mother herself

9. What was her health as a child? At what age did she mature? Has she any
physical peculiarity or deformity? Is there any evidence that she is mentally
deficient or abnormal?
10. Did her parents say that she was troublesome as a child? If so, how? Did
she disobey her parents, fail to heed their advice, was she disrespectful to them?
Did she frequent candy, ice cream, or fruit stores for diversion? What sort of
associates did she have while she was growing up? How have they turned out?
Can her parents throw light on the reasons for her behavior, if loose? Of what
sort are her present girl or women friends?
11. When her parents learned she was pregnant, what, if any, plans did they make
for her?
12. What grade in school did she reach? What do the teachers who knew her
best think of her? In what studies did she excel? What vocational training, if
any, did she receive?
13. her employers say of her work? How long has she held her positions?
What do
Ifshe was employed in a factory, how much judgment did her work call for?
Was it mechanical? If as a domestic, what are the things that she does well,
what ill? For instance, can she make good bread, season vegetables? Is she
neat and clean about her person and her work? Can she wash and iron? Does
she wait on table smoothly and quietly? Has she done ordering for her mistress?
How much did she know when her mistress took her? Does she improve rap-
idly or slowly? Does she remember directions, or do they have to be repeated?
What does she do best, heavy worker light? Is she good with children? Is she
capable enough to hold a place with her child?

415
SOCIAL DIAGNOSIS
14. What do her employers say of her character? Is she honest, of a good dis-
position, industrious? If a domestic, has she been discreet with tradesmen who
come to the house? Has she had men callers, one or many? Have they been
accustomed to go at a proper hour? Has she been given to staying out very
late? Does she dress conspicuously?
15. When did or woman's sexual experience begin? Under what circum-
girl's
stances with a relative, an employer, an older man, a school boy? Has
was it
she accepted money from any man or men for unchastity, or has she received
only a good time theaters, dinners, etc. or board? Has she lived for any
period as the wife of any man or men? Has she supplemented her income through
men, or has she made her whole livelihood in this way? If so, for how long and
when? Has she been a common prostitute, has she had a succession of "friends,"
or has she been intimate with but the one man? Has she a court record?* From
what she, her relatives, friends, and employers say, does she seem to seek wrong-
doing, or does she merely yield when evil approaches her?
16. Has she had another child or other children by a different man or men? When
were the children born and where? How
long did she nurse them? If they did
not live, at what age and of what disease did they die? If they are alive, where
are they with her, with her family, with the man's family, boarded out, or
adopted? If the latter, through whom was the adoption brought about? What
does she know of the character and circumstances of the adoptive parents of her
child or children? Has she any child in charge of a society or institution? Was
itplaced out in a family? How often has its mother seen it? Is it under super-
vision? If she separated from her child, what has seemed to be the effect upon
her character? If she kept it with her, what?
17. Has she ever been under treatment for syphilis or gonorrhea? When and by
whom?
II The Father1
His family
18. What is or was the standing of the man's parents in the community? Did the
father instruct his sons in sex hygiene? Did his influence in this direction tend
towards high-mindedness, towards cautiousness in pleasure, or towards un-
abashed laxity in morals? Did the mother and sisters take a double standard
for granted? (See in addition same topic under The Mother for questions that
apply.)
His community
19. What is the character of the community in which the man grew up? (See
same topic under The Mother for questions that apply.)
The man himself

20. Was he troublesome to his parents as a boy? Respectful and obedient, or the
reverse? What sort of associates did he have while he was growing up? How
have they turned out morally? Have any of them got girls into trouble? If so.
1
To be used only in cases where the mother is sure who is the father of her child.
416
do they boast of it, or have they the average moral scruples? Where do th< ,
draw the line as to the things "a fellow can't do"?

21. Did he spend any part of his childhood in an institution? If so, how long was
he there, at what age, and why? What was his record while there?
22.What grade in school did he reach? Why did he leave, and at what age?
What have his teachers to say of his character and ability? In what studies did
he excel? Has he attended a trade school or a night school?
23. Is he single or married? Is he still living at home? If not, at what age and
for what reason did he leave? How has he lived since? What type of associates
has he chosen?
24. At what age did he first go to work? With what employer and at what occupa-
tion has he worked longest? Where is he now working and how long has he held
this place? What do his employers say of the quality of his work? How much
judgment does it call for?
25. Does he drink to the point of intemperance? Use drugs? Gamble? Is
there any evidence that he has been dishonest?

26. What is his record as to sexual morality? Has he been known as a loose liver?
Involved in scandals? Or has he, on the other hand, borne a good reputation, and
is this the first affair with a woman in which he has been involved?
27. Has he ever been arrested? At what age and for what offense? If imprisoned,
for how long? What was his record at reform school or prison?*
28. Is he of the same social status as the mother of his child?
in The Situation, Past and Present

Man and woman
29. What is the girl's or woman's explanation of her going wrong? Was she en-
gaged to the man? Was she in love with him? If not, was it loneliness, drink,
ignorance, force, that led to her shame? Where and when did she meet the man?
Was she living at home at the time? With relatives, friends, in a lodging house,
or at service? Had she known the man steadily or was he a passing acquaint-
ance? Did she live with him for any time as his wife? Did he promise mar-
riage? Do her family or friends know of his seeing her often at about the time
of conception? Had they been expecting that he would marry her? Has she
lettersfrom him that go to show his probable paternity? Has the man known
her family, called at her home? Does she know his family?
30. Does the man acknowledge paternity? Does he acknowledge having had rela-
tions with her? Does he claim that others had also? If so, who? Did she live
in a lodging house, or were there men lodgers in the same house or tenement?
Is there any evidence that she was intimate with any other man at about the time
of conception? Any evidence (such as that of the physician who confined her,
regarding earlier abortions, miscarriages, or births) to prove her previous un-
chastity?
27 417
SOCIAL DIAGNOSIS
31. What the man's opinion of the girl's character? What suggestions, if any,
is
has he made
to her regarding her plans? Did he suggest her consulting any
illegal practitioner? Did she follow his advice? Name of the practitioner?
32. Do man and the girl wish to marry? If so, why have they not done it
the
before? Are they both such human material as to make marriage advisable?
What are the man's health and habits? Has he had a medical examination?
By whom? Was it clinical only or with laboratory tests? Does marriage in the
mother's home state legitimize a child, or must its parents adopt it?
33. Have the couple lived together for several years and had more than one child?
(Consult, as circumstances of the case demand, the questionnaires regarding
Any Family, a Deserted Family, or a Neglected Child, pp. 378, 395, and 405.)
34. If the man is married, does his wife know of his relations with the girl or woman?
Has he legitimate children to support? If unmarried, has he relatives whom he
must help?
35. Has the man property? Has he a steady place? What is his income? Would
his employers bring pressure on him to help his baby, or would they abet him in
eluding his responsibility? Is he a man who would readily leave for another
state if
prosecuted? (See Deserted Family Questionnaire, p. 395.) How much
should he pay?
36. Is there evidence beyond a reasonable doubt as to man's paternity? Has he a

lawyer? who? Will the man settle out of court? Is it desirable that he
If so,
do so? Why? Can he get bonds? If not, is he likely to keep up weekly pay-
ments, or is he so unreliable that a lump sum is wiser? Would his family do any-
thing for the baby? Has his father property?
37. Has the mother a lawyer? If so, who? Has she taken out a warrant, started
or completed proceedings? If the latter, what was the settlement?* Has the
man paid her anything towards the expenses of confinement, etc.? Did she sign
a release paper? Is it legally valid? If she has taken no steps against the man,
does she wish to prosecute? If not, is this a case in which it is advisable for an
outside party to bring suit, supposing state law permits?
38. Is it better that the man pay the money to the girl, or to a trustee who would
hold it for the child? In your opinion, the purpose of payment in this case to
is
punish the man, to help the girl, or to provide for the baby's future?
Mother and child

39. If this is the girl's or woman's first child, does she appreciate the seriousness of
her act and of its Did she leave her home to hide her shame?
consequences?
To give her baby to strangers so that her misconduct might remain unsuspected
at home? Does she love her baby? Does she want to keep it?
40. What preparations did she make for the child? How long before confinement
did she stop work? What sort of work was she doing during the previous
months? What was her physical condition at this time? Did she have instruc-
tion in prenatal care and did she follow it?
418
41. Was she confined

in a hospital? How long did she stay? Did she receive after-
care? not confined in a hospital, where? Was she attended by a physician
If
or by a midwife? (Name and address of either.) How soon after confinement

did she go to work?
42. Is the child's birth correctly recorded?* Has the child been baptized?
43. Have the mother and her baby been examined by a physician? What is his
name and address? How soon after confinement did the examination take
place? Was it clinical only or was it accompanied by laboratory tests? Is the
mother or her child under treatment? What is the physician's report of her
health and of the child's, and what is his advice?
44. Does she nurse the baby? If not, is it by a doctor's ad vice? Can she get pure
milk? Does she understand the preparation of food? Has she had instruction
in the general care of an infant? Is she capable of profiting by such instruction?
Can she easily get a nurse's visits, or take the baby to a clinic?
45. Do her parents know of her situation? Are they so circumstanced that they
can help her by taking her home with the baby, by tending the baby while she
goes to work, by adopting the child, or by showing their sense of responsibility
in any other way? Do they feel that their younger children should be kept in
ignorance of her story?
;,6.
What are the unmarried mother's plans for herself and child?
419
CHAPTER XXV
THE BLIND
social worker may happen upon cases in which blind-
ness the dominant cause of the present situation, or he
THE
may
is
happen upon any of the forms of disability outlined in

other questionnaires, complicated by the factor of blindness. In
the latter case, sets of questions like that regarding a Neglected
Child, or a Child Possibly Feeble-minded, may be even more help-
ful than one on blindness. There are, however, five captions under
which special consideration of the causes and results of blindness
may be of service. In making the questionnaire regarding a
Blind Person given in this chapter, Miss Lucy Wright has arranged
her material under these heads prevention of blindness and con-
servation of eyesight, special education, special employment, spe-
cial relief, and recreation.
Failure to be of practical service to the individual in cases of
blindness is usually due to one of two dangers the Scylla and
Charybdis of work for the blind. The one is the danger of over-
estimating the chances for an individual by considering the factor
of blindness alone. Other handicaps mental, moral, physical
are of even greater significance in the struggle of the blind individ-
ual than in the case of the sighted. On the other hand, the failure
may be due to underestimating the chances for the individual
because, through inexperience, insufficient trust is placed in the
truly great possibilities of practical accomplishment, manual and
through the use of other senses. In some instances
intellectual,
mental and moral force seems to gain strength under what appears
the great disadvantage of working in physical darkness. As
Norman Duncan makes Tom Tulk, the blind skipper, say, "A man,
with the best of a bad job to make . . . will learn many sur-
prisin' things ... by means of all the little voices in the

world, says he, which speak to a man without eyes."
420
THE BLIND
QUESTIONNAIRE REGARDING A BLIND PERSON*

is filledout nor a set of queries to be answered by a
A
by, public records.
I Prevention of Blindness and Conservation of Eyesight

1. Has a physician, expert in eye diseases, been consulted?
2. Has the vision of each eye been recorded separately, with degree of vision, cause
of blindness, and age at occurrence of blindness for each eye?
3. Does your case record distinguish clearly between patient's understanding of

cause and physician's statement of cause of blindness?
4. Was the cause of blindness congenital disease or defect, acquired disease, or

accident?
5. If a local eye defect, can it be helped by eye glasses, operation, or continuous

treatment?
6. If congenital or acquired disease, is it due to general disintegrating trouble
which need continuous treatment or result in other complications?
may Are
there chances of improvement in sight if general treatment is followed?
7. If accident, was the accident the fault of the individual, the occupation, or the
community? Is there anything to be done about it for the future safety of

others? If industrial accident, has compensation been allowed the individual?
8. Are there chances of retaining the remaining degree of vision if the right occupa-
tion is followed? If anxiety about support of self or family is relieved? If
healthful life is made possible?
9. Are there other cases of blindness or eye defect in family?
10. Is the disease of a kind which may in active stages menace other members of
family or fellow workers?
11. Although not blind, has the patient seriously defective eyesight, even with the
aid of the best glasses obtainable? When was he first given glasses, and where?
Subsequent glasses given by whom, and where? Which glasses, if any, is he wear-
ing now? Of what value have glasses proved? How recently has he had a physi-
cian's advice about his eyes?
II Appearance and Amount of Useful Vision

12. Does the patient need to wear smoked glasses for appearance's sake? Would
this make a difference about his getting work?
13. Is the patient totally blind or at most, does he see light only?
14. Has he sufficient sight to avoid running into objects?
Prepared for this volume by Miss Lucy Wright, General Superintendent of

1
the Massachusetts Commission for the Blind.
421
SOCIAL DIAGNOSIS
15. Is he able to distinguish color and see to play cards but not able to read?
1 6. Is he able to see to read, but forbidden to use his sight long enough for that
purpose?
17. Is his limitation of vision or of use to which it can be put sufficient to interfere
with ordinary schooling or occupation?
IK Special Education Children

1 8. What is the developmental history of the child? (See questionnaire regarding
a Child Possibly Feeble-minded, p. 441.)
19. Does the child appear to be mentally deficient? May this appearance be due
to neglect superadded to the physical defect? Because of the effect of such
neglect, should not the child's special education, whether at home, at a nursery,
or at school, begin at once or at an earlier age than that at which it would be
necessary to begin the education of a normal child? If the child has not learned
to walk, do his parents realize that, while he may walk as early as a sighted child,
he probably needs special incentives because he cannot see and imitate? If he
has "habit motions," putting fingers in eyes or the like, do the parents realize
that he may be cured of them if taken in hand early enough? Do they realize
that his future depends upon good use of hands, and that it will help him to learn
early to dress and feed himself?
20. If hisparents refuse at first to let him go away from home to school and there
is no compulsory education law which is effective in the case of the physically
handicapped, can they be persuaded to visit the special school themselves to see
itsadvantages? Can a blind graduate be found to persuade them? If there is
no special school, can public school training with sighted children be supple-
mented by special teaching from some trained blind person in the neighborhood?
Is there a kindergarten (worthy of being attended) which can be made use of
for him?
21. If the child isat a special school, is every effort being made to keep the family
and friends in touch with the child and the school in order that a recognized place
of usefulness may be ready for him when he leaves school?
22. If the blind child is at home, is he being spoiled with kindness by family, neigh-
bors, and sighted school mates, or is he having his chance to find out about life
as it is? Does he do his share of errands, fill the wood-box, etc.?
23. Does the blind child have his share of play and contribute to pleasure of others,
read aloud (from some form of Braille) as well as be read to?
IV Special Education Adults

24. If there are no travelling home teachers for adults nor any special school, can
some teacher (preferably blind) be found who will instruct and encourage the
newly blind person, so that he may gain confidence in other senses learn to
move about freely, be independent by use of some one of the forms of Braille,
the typewriter, etc.?
422
THE BLIND
25. Has he established his own confidence in the sense of touch and hearing by fol-
lowing normal activities? If an able-bodied man dependent on his wife's earn-

ings, do he and she realize that he can help with housework, saw wood, etc., while
he is waiting for the chance to learn a new trade?
26. Can he any part of his occupation as a sighted man which he came in-
recall
stinctively todo by touch or in which his hearing aided him? Is there any part
of the process which he could still do?
27. Has he sufficient executive ability to carry out a small venture of his own, like
a news-stand, or does he need to work for someone else?
28. Could he compete without further aid if his chances with sighted workers are
equalized by his learning a new trade, such as broom-making; if adequate pro-
vision is made for a guide; if provision is made for transcribing his music into
Braille; if he has aid in marketing products; if any other extra expenses incident
to his blindness are provided for?
29. If he cannot work in competition with the sighted, either in a shop or in an in-
dependent enterprise, is he strong enough nervously for a full day's work in a sub-
sidized shop? For a heavy day's work such as broom-making or other occupa-
tion entails?
30. Had he any important hobbies, such as chicken raising, cabinet work, or bas-
ketry, before loss of sight? Does he know this hobby well enough to pursue it
under handicap, effectively and with courage? Can he be given supplementary
training in this direction? Can you consult some blind person who has worked
out an occupation for himself under similar circumstances?
31. If home industry is possible, can adequate supervision be provided?
32. Have you,before trying to market products, considered that great as is sym-
pathy for the blind, when it comes to business, their goods must be not only "as
good as" but "better than" like products of the sighted? Does the blind worker
poor work means a forced, temporary market, good work a steady,
realize that
permanent market?
V Special Relief for Blind as Such

33. Is the blindness in any way the fault of the community, i. e., industrial acci-
dent, industrial disease? Or is it, as with many other troubles, the fault of
nature, disease, or accident not preventable with knowledge as it stands today?
Or the fault of the individual, needlessly acquired disease, or accident through
carelessness?
34. Has the blind individual contributed to his family and to society in proportion
to his ability? Before his blindness? How? Since his blindness? How?
35. If the blind individual is dependent, in what proportion is his dependence due
to lack of natural endowments other than sight? To lack of preparation for

competition; that is, no special education, or lack of other resources for blind?
To presence of social and industrial obstacles common to others than the blind?
423
SOCIAL DIAGNOSIS
is it for the protection of the blind individual, for

36. If institutional care is asked,
the protection of the community, or for the convenience or saving of expense to
relatives?
37. Should the blind individual's economic situation be considered alone or in re-
lation to that of his near relatives? How near are these relatives? What is
their ability, financial or other, to care for him?
38. If special forms of relief are sought or needed differing from or in excess of
relief received by citizens otherwise handicapped, what shall be required of
him in return for such relief? Work? Reasonable standards of living and
conduct?
39. Did the individual become blind after sixty? Had he been successful or had he
failed while in possession of his sight? Is his problem really a problem of blind-
ness?
VI Recreation
40. Are there not resources for recreation for sighted persons that this blind person
could make use of? is not using them, what stands in the way and how
If he
may the difficulty be overcome? Is it lack of a guide? Is it inability to provide
for double expense of carfares, etc.? Or lack of encouragement from family?

Or needless sensitiveness?
41. Can the family or friends be led to encourage him to all possible normal activi-
ties, walks, church, music, theater?
42. If he minds being done for, can you not arrange for him to do something for
somebody else, read aloud from Braille, etc., at least do things with others?
43. Does he realize that bowling, dancing, swimming, football, and gardening are
parts of the training and play at schools for the blind? Can any opportunity for
him to practice any of these exercises or games, or others that will take their
place, be developed?
44. Can a friendly visitor (sighted) be found who will call and converse (be talked
to as well as talk)? Does this visitor realize that automobile rides, carriage rides,
street car rides, or a walk will give respite to the family of a blind invalid as well
as prove a tonic to the invalid himself?
424
CHAPTER XXVI
THE HOMELESS MAN THE INEBRIATE
these two subjects overlap at one point, their juxta-
position here is entirely arbitrary. The inebriate is a pa-
THOUGH tient of the physician, or should be; the homeless man is a
client of the socialagency often in need of medical care, it is
true, but presenting no one medical problem. Inebriety is an
important topic for the case worker because the inebriate is often
in need not only of medical but of social treatment, and for the
further reason that he is often given a type of social treatment
which ignores altogether the obvious need of medical co-operation.
I. THE HOMELESS MAN

The under this one caption many
fact of homelessness brings
different sorts of men and
boys, from the lad seeking adventure
and the seasonal laborer to the homeless aged and the confirmed
wanderer or tramp. Mrs. Alice Willard Solenberger has described
them all in One Thousand Homeless Men, so that it is unnecessary
to do more here than to refer case workers to that book, by which
some of the questions that follow were suggested.
HOMELESS MAN QUESTIONNAIRE

filled
social agency's client or clients For an explanation of the purpose of these ques-
A
by, public records.
I Present Situation
1. How long has the man been in this country, state, city? If foreign born, is he
thoroughly Americanized? Is he a citizen?
2. Why did he come to this city? From what place did he last come? What was
his address there? How did he get here? Did he "beat" his way? Was
transportation furnished by a charitable society, an individual, an employer, or
employment agency?
425
SOCIAL DIAGNOSIS
3. If a foreigner, has he been exploited by any employment agent, foreign banker,

or padrone? Sent to this city or state on false promises of work, or discharged
after brief service contrary to contract or oral agreement? Do the ascertainable
facts in the case furnish a basis for prosecution under any state or federal law?
4. Where and under what conditions is he now living with friends, in a common
lodging house, a furnished room, or how? How has he maintained himself since
coming to the city? What is his present income, if any? Has he money in his
possession or due him? Does he receive money periodically: if so, how much
and from what sources? Or is he entirely without resources?
5. Has he had a home? Where? Has he been away from it long? What have
been his wanderings? In what places has he stayed? Length of stay, address,
manner of life in each? Has he a legal residence anywhere?
II Home Life
6. What were the conditions of his early home life? Were his parents physically
and mentally normal? Did they fulfill their responsibilities? What was his
home training? Was he indulged or unduly repressed?
7. Until what age did he go to school? Did he make normal progress? If not,
why? In what grade was he when he left? Why did he leave? Did he play
truant or show signs of a roving disposition while at school? Did he like school?
What studies, if any, did he enjoy or excel in? What was his religious educa-
tion?
8. Did he spend any part of his childhood in an institution? What institution?

Between what dates was he there? Why was he placed in the institution and
what led to his discharge? What sort of record had he there?
9. What were his amusements in childhood and youth? What sort of associates
had he?
10. After he began to work did he turn over his wages to his family? What allow-
ance or spending money did he receive?
n. If he is married, what are the facts about his wife and children? How old
was he when he married? How old was his wife? What was he earning at time
of marriage? What at the time of leaving home? What sort of home had he?
Were he and his wife happy? Was he fond of the children? What reason does
he give for having left home? If he has deserted, is this the first time? Has he
apparently broken away for good or is this a temporary desertion? What is the
date of his last letter from his family? (See Deserted Family Questionnaire,
P 395-)
12. If he is widowed, when did his wife die?* How have the children been provided
for since? When did he last see them? Did he begin his wanderings at time of
wife's death?
13. If separated or divorced, when and for what reasons?* What provision was
made for the children?
14. If single, what kind of home had he? In city or country? Were its condi-
tions good or bad? Were both parents still living? Were they living together?
426
THE HOMELESS MAN
How old was he when he left home? Why did he leave? How has he lived
since leaving home? What is his attitude toward his parents and other mem-
bers of his immediate family? (If a runaway boy, a frank story of his home
conditions and of the incidents which led to his running
away should be sought.)
15. Has your agency or any other communicated with parents, other relatives, or
friends in his home town? What do they give as his reason for leaving home?
m Work History
16. At what age did he begin work? Was he ever a newsboy or messenger? What
was the nature and wage of first occupation?
17. Did he learn a trade? If so, why did he give it up?
18. Does he, or did he ever, belong to a trade union?
If his membership has lapsed
how did this happen? Does he attribute later failure to such a lapse, or feel that
to become a union member would put him on his feet? Have any union officials
been consulted in regard to his past record or possible reinstatement, or in regard
to obtaining membership?
19. Did he ever serve in the army or navy? Between what dates? What were the
circumstances of his discharge and his record in the service?*
20. What have been his various occupations, the length of time each was held, the
wage, reasons for giving it up? Have his former employers been communicated
with to verify these statements and to learn their view of the reasons for his in-
dustrial failure?
21. What occupation did he like best, and why? What one of his employers did
he like best, and why?
22. What was the longest time he ever held a job? Which job was it? What was
the highest wage he ever received?
23. What was his last occupation? How long ago? Wage? How did he lose it?
Is his work casual, irregular, or seasonal by nature? How has he previously
lived between jobs?
24.Was his chief occupation too strenuous? Did he have to work too long hours?
What proof is there that he was not physically equal to it?
25. Has he ever been in business? What was it? Did he ever succeed? Reason
for failure?
26. Could he now go back to any of his old jobs?
27. What effort has he made to get work where he is? With what success?
28. If prevented by physical handicaps from doing the work that he is accustomed
to do, what else is he, or can he be, fitted to do?
IV Physical and Mental Condition

29. What is his present physical and mental condition? Has this been verified by
medical examination?
30. physically handicapped, what is the nature of handicap?

If Its cause? Is
recovery possible? Will any special treatment, appliance, or course of training

help to put him on his feet?
427
SOCIAL DIAGNOSIS
31. If the handicap is due to accident, when did accident occur? Where? Under
what circumstances? If it was an industrial accident, who was his employer?
What settlement, if any, was made?
32. If he is ill. what are causes of illness? What medical care is necessary? Is he
in a condition that is a menace to those with whom he works, lives, or associates?
33. If epileptic, feeble-minded, or insane, has he ever had any institutional care?
Where? When? Has the institution been asked for an account of him? Is he
eligible for any institution?
34. If aged, or feeble, what is his attitude toward almshouse care? Or (if his case
is suitable) toward care in a private institution?
V Moral and Intellectual Status

35. What vices, if any, has he? Is he a gambler or given to betting? Does he
drink moderately or to excess? When did he begin to drink, while very young or
after reachingmanhood? Does he use tobacco in any form to excess? Drugs?
Has he ever taken any drug or liquor cure? Has he ever been in any institution
for the care of inebriates? (See Inebriety Questionnaire, p. 430.)
36. Has he ever been arrested? For what offense?* What was the sentence?*
If imprisoned, what were the dates of commitment and release?* Has the prison
or reform school been asked for an account of him?
37. Has he, or has he ever had, any religious affiliation? Has his family? What
is his attitude toward religion?
38. Is he discouraged? What is the thing that especially discourages him?
39. Is there anything in his temperament which explains his past failures?
40. Does he really desire a chance to get on his own feet and turn his back on his
present way of living?
41. Does he read much and what does he prefer to read?

42. What are his ideas about education, about politics, about capital and labor,
about social conditions? Does he believe in a democracy, and under what form
of government would he prefer to live?
VI Plans for the Future

43. What relatives has he? What is their ability to help or advise?
44. What
other possible sources of assistance former employers, charities inter-
ested, etc. are there?
45. What are his own plans for the future? What is his attitude toward work?
Toward institutional care?
46. If he has a home town with normal environment and influences, is he willing
to return to it? If so, would anyone there take an interest in him?
47. What
does he look back upon as his best period? What marks of it still re-
main, such as personal cleanliness, for example? Can its conditions be won back?
428
THE INEBRIATE
II. THE INEBRIATE

This word has come to have a more definite meaning than for-
merly. It has never applied to all who drink, nor does it apply now
to all who get drunk; it does apply, however, to all who, owing to
a constitutional peculiarity or defect, are habitually overcome by
alcohol and unable to take it at all without taking it to excess.
Inebriety is a disease. It requires skilful medical diagnosis a
diagnosis which includes both a general physical examination and
a mental examination of the patient. The disease is not curable
in the sense that one who has once suffered from it can ever trust
himself even to taste alcohol without danger of a relapse. An
important further fact for the social worker to know is that both
the medical and the social treatment of the disease achieve a far
larger measure of success if the malady is dealt with when its
manifestations first appear. "Other things being equal," says
R. W. Branthwaite, "the success or failure of treatment depends
1
largely upon the early application of remedial measures." If
possible, prompt resort should be had to a physician specially

skilled in dealing with this particular disability, and in distinguish-
ing it from the alcoholic excess of those who still have the power of
remain sober if they choose to exercise it. Alcoholic excess
will to
may be due, moreover, to some removable physical cause, or it

may be an outcropping of mental disease or of mental defect.
We now say the "patient" and not the culprit, be it noted.
The earliest draft of this questionnaire referred to the inebriate
as desiring to reform, as having reformed, or as possibly being
helped to do so by a "reformed drunkard." This is not the
language that we can use or the position that we can take in the
light of recent scientific discovery. It is true that no improve-
ment is possible until some personal

in the inebriate's condition
influence orsome new set of circumstances has made a sufficient
impression upon his mind to give him a strong desire to win the
necessary self-control. In varying degree, success in the treat-
ment and of a dozen other diseases depends upon
of tuberculosis
the patient's co-operation, but individualization and long con-
tinued personal interest seem to be peculiarly needed with this
1
Report of the Inspector under the Inebriates Act, 1909.
429
SOCIAL DIAGNOSIS
disability. Hence social work has an important part to play, first

in gathering the pertinent social data, and later in rallying to the
patient's aid every tonic influence which can supplement the medi-
cal means employed. Social work must be continued too during
the long period of after-care which is usually necessary.
The writer is indebted for valuable suggestions in the preparation
of the following questionnaire to Dr. Irwin H. Neff, of the Norfolk
State Hospital in Massachusetts, and for the point of view ex-
pressed in these introductory paragraphs to Dr. Neff and to the
remarkable report of Inspector Branthwaite already quoted.
INEBRIETY QUESTIONNAIRE
filled
A
by, public records.
general questions are repeated here only in rare instances when it has seemed neces-
I Heredity
1. What were the habits of the parents, grandparents, and great-grandparents in
respect to alcohol and habit-forming drugs (opium, morphine, cocaine, ether,
chloral, patent medicines, headache powders, etc.)? What are the habits, in these
respects, of uncles and aunts, of brothers and sisters? Wherever any relative
mentioned used alcohol, (i) Was his use of it strictly moderate? (2) Was he a
free drinker who occasionally got drunk? Or (3) was he unable to take alcohol
at all without being overcome by it? If either parent of the present patient
was an alcoholic (2) or an inebriate (3), did these habits develop before the birth
of the patient?
2. Is there any history of mental or of nervous trouble in the family? Were any
of the ancestors and relatives mentioned above insane? Did any commit suicide?
Were any feeble-minded? Epileptic? Did any have "nervous prostration,"
or "fits"? Did any have marked eccentricities, violent temper, periods of ex-
treme depression?
II Duration
3. How long has patient been addicted to the excessive use of alcohol? How long
has he noticed that he has been unable to use alcohol socially or drink in modera-
tion?
4. Longest period of abstinence previous to two years ago? Longest period of

abstinence during last two years?
430
THE INEBRIATE
III Causal Factors

5. What is the patient's own analysis of the cause or causes of his drinking? What
are his reasons for relapses or for the continuance of drinking periods?
6. Is he nervously unstable? What evidence does he give of such nervous instabil-

ity? Has this condition developed recently or has it been present since child-
hood? Is there reason to suspect that he is mentally deficient? (See question-
naire regarding a Child Possibly Feeble-minded, p. 441.)
7. Are the home conditions such as to incline him to seek the saloon as more cheer-
ful? Is the homesituated in the vicinity of saloons? Is it squalid and in dis-
order? Does he take his meals at home? If so, are they well cooked?
8. Has he been unfortunate in business or family affairs? Has he suffered from any
painful disease or been in ill health? Has he suffered any severe shock or loss
which unsettled him and caused him to turn to drink? Is he happily married?
wife of a nagging disposition, or has she any bad habits that make trouble
Is his
between them? Has he children, and if so are they of good health and habits?
9. Is his employment such as to expose him unduly to the temptation to drink

(brewery worker, teamster, hack-driver, bartender, butler, waiter, longshore-
man, etc.)? Does he work long hours in extremes of temperature? Under
trying conditions of dust, humidity, or bad ventilation? Does he get drunk
only when unemployed?
10. (For a woman) Has she been in the habit of using alcoholic liquors every month
when unwell? Has she had frequent pregnancies? Has she used alcohol to
give her an increased supply of milk for nursing?
IV Drinking Habits
11. Does the patient have something to drink every day or every week? Are
there periods of weeks or months during which he will not touch alcohol, which
alternate with periods of complete intoxication?
12. Does he do most of In the home? With other

his drinking in the saloon?
members Does he take alcohol in the morning before taking food?
of the family?
Is he a solitary drinker; that is, does he drink only when off by himself? If in
the saloon, does he buy his drinks or is he treated?
13. Has he any drug habit in addition to his alcoholism? Was the alcohol habit
acquired as a substitute for any drug habit? Have drugs been used to promote
or encourage "sobering up" from drinking?
14. Does he desire to be rid of his alcohol habit? Is he indifferent about it? Is his
attitude antagonistic on this subject? If the first, is his desire due to a mental
antagonism to his habit, of which he is ashamed, or is it dependent upon the need

of treatment for some physical disease which may or may not be due directly to
alcoholic poisoning?
V Physical Condition and Medical Treatment

15. Has he ever been under medical treatment for the alcohol habit? If so, what
was the nature of the treatment? Was he treated at a hospital? How long?
SOCIAL DIAGNOSIS
Did he leave on the advice and with the consent of the physician? Did he co-
operate after leaving in any medical after-care? Did he undergo treatment at
home?
1 6. With regard to the present, has patient lost weight? Does he crave food regu-
larly and is his appetite good? Does he sleep well? Has he any physical in-
firmity?
17. Has he been examined recently by a physician? If so, what was his report?
18. no physician has been consulted about patient's habit, are not medical advice
If
and treatment needed either before or at the same time that social treatment
begins? Is it possible to secure these from a physician who is especially inter-
ested in the diagnosis and treatment of inebriety on both the physical and the
mental side? Does this physician advise a general medical examination also?
VI Social Conditions
19. Patient's exact statement in detail as to feeling of inefficiency due to alcohol?
Has the drink habit led to loss of work? Has unemployment from this cause
been occasional? Frequent? Habitual? Time lost from work during last
year? Financial loss to patient and family during this period? During his last
three drinking bouts?
20. Is the patient and are his family reduced to poverty because of his drink habit?
21. Does his wife have to work to help support the family? Are the children
obliged to work also?
22. If his work is steady, is he paid off regularly on Saturday? Does he, as a rule,
turn over part of his wages to his wife or family? If so, what proportion of his
wages?
23. Does he obtain money from his wife or children to buy drink? Does he ever
pawn household articles with this object in view?
24. Does he abuse other members of the family when drunk? When sober?
25. any evidence that he has criminal tendencies? Do these criminal

Is there
tendencies antedate his drunkenness or do they occur only during the periods of
intoxication?
VII Social Treatment

26. Has there ever been an attempt, apparently successful, to make the patient a
total abstainer, and under what circumstances?
27. Has he ever been

arrested for drunkenness?* If so, was he fined?* Impris-
oned?* Released on probation?* Has he been repeatedly arrested for this
offense?* Was he ever sent to a hospital for treatment as a condition of proba-
tion or suspended sentence?*
28. Can any new adjustment be made in the home which will help him to recovery?
What will win the co-operation of his family and make his surroundings more
livable?
432
THE INEBRIATE
29. Is complete change of environment desirable and possible, either as a tempo-

rary measure for a period of special treatment or permanently? Has he formed
harmful associations with which his connection should be broken? Are there
helpful associationswhich could be formed as with a church or settlement club
or with an individual volunteer? Could anyone formerly a drunkard but now
an abstainer be brought to take an active personal interest in him?
30. Has he, or has he ever had, any religious affiliations? Has he shown himself
susceptible to religious influences? Has he had contact with churches, missions,
etc.? What is his attitude toward religion?
433
CHAPTER XXVII
THE INSANE THE FEEBLE-MINDED
two disabilities, of insanity and of feeble-mindedness,
carry us still farther than that of inebriety into the territory
THESE where medical and social data are not easily separated. It
cannot be too emphatically stated, however, that the question-
naires here given can in no sense enable a social worker to make a
medical diagnosis; the diagnosis of mental disease and of mental
defectmust be regarded always as primarily medical, though social
data of the right kind can suggest the need of a physician in the
first place and may be serviceable to him later in making an in-
clusive examination of his patient.
Insanity is a term describing a legal rather than a medical con-

cept. It is loosely applied to mental disorders differing widely in
their originsand in their manifestations. Obviously no one ques-
tionnaire would be equally applicable to persons suffering from
senile mental reduction, those exhibiting undue pressure of men-
tal and physical activity, and those in whom slow distortions of
mental life are taking place. From the alienist's point of view,
the present outline merely suggests general lines of inquiry; for
the social worker, however, its questions are not routine questions
and must not be so understood.
The worker without medical training is sometimes ill
social
fitted to facethe ugly facts of defect and disease. To keep his
sense of values keen and true, his must be a spirit of sane help-
fulness. No one has described the right attitude better than Dr.
Adolf Meyer, who, five years ago, sent the writer the following
comments, among others, in criticising a discouraging record of
social work with a family of defective mentality.
We meet here a very difficult problem. As far as I can see, the social worker
like the physicianmust learn to accept human nature and human doings as they are
before rushing in with the superior knowledge of how they ought to be. The first
need is to know what they are. . . . The motto of every social worker and in-
434
THE INSANE
must be that of Terence's Heauton Timorumenos: Homo sum, bumani

vestigator
nibil a me alienum puto. One who investigates must be ... ready to
. . .
accept .
anything human beings think, feel, or do as not altogether strange
. .
"
in human nature: I am but human and I do not consider
anything human foreign
to me"; it is at least worthy of human consideration.
He was convinced that there was no way of stating the facts
effectively "except by stating them

directly and concisely in terms
of actions and perhaps also in terms of motives and prevailing
desires and tendencies taken from the person's point of view rather
than from that of the critic or helper." Such general terms in the
record submitted to him as "incorrigible," "immoral," "serious
trouble," "not very well," "troublesome" all containing a judg-
ment were unfortunate, in his opinion, because they did not give
the facts which would have enabled anyone else to judge for
himself.
The questionnaire given later in this chapter on the Child Pos-
sibly Feeble-minded (the possibly defective adult must be under-
stood to be included in this title) was prepared by Mrs. Hilbert F.
Day. Mrs. Day also made the first draft of the questionnaire
here given on the Patient Possibly Insane. This has been revised
and added to by Dr. Thomas W. Salmon, Medical Director of the
National Committee for Mental Hygiene, to whom the writer is
also indebted for the following suggestions to be observed in using it :
Great stress must be laid upon changes in mood, mental proc-

esses, activities, and social reactions. It must be remembered
too that the apparent mental status of the patient varies, in its
external manifestations, at different times of the same day for
example, the nocturnal restlessness and cloudiness of toxic and
of senile cases. Special effort should be made to ascertain whether
abnormal manifestations are increasing or diminishing in number
and in intensity, as this often has a practical bearing upon the
management of the case. It might be suggested, as a good general
guide, that weight be given to the apparent reasonableness of all

activities. There could be unfavorable answers to many of the
following questions when the social worker's client was a normal
subject; nevertheless, the reasonableness of this or that activity or
this or that reaction under the circumstances which actually existed
is the significant point.
435
SOCIAL DIAGNOSIS
QUESTIONNAIRE REGARDING A PATIENT POSSIBLY INSANE

should be repeated here that nothing in the following questionnaire must be
It
interpreted to mean that a social worker is ever able to make a medical diagnosis.
This is not a schedule to be filled out nor a set of queries to be answered by a social
agency's client or clients. For an explanation of the purpose of these question-
naires see p. 373 sq.
A
by, public records.
I History of Parents
Social
1. Were parents of patient related? In what degree?
2. Are both parents living? If dead, what was the cause of death?* Age at
death?*
3. What has been their general standing in the community? Have they been self-
supporting, self-respecting people?
4. Has either parent been wholly or partially dependent? Had institutional care?
Which one? What institutional or other care? When?
5. What have been their occupations? Have they been successful in them? If
not, to what cause was lack of success due?

Physical, mental, and moral characteristics or disabilities
6. Is (or was) either parent deaf, dumb, blind, or deformed?
7. Have they been considered normal mentally? If not, in what way abnormal?
8. Did either show sexual perversions? Did either lead a dissolute life?
9. Did either have extraordinary gifts? One-sided talents? Vacillating inter-

ests? Eccentricities? Was either absorbed in "causes" (for example, anti-
Catholic, litigious)? Was either irritable?
10. Were quarrels frequent in the family? Did parents "take sides" regarding
the discipline of the children? Was either parent too lenient or too severe and
to what extent?
11. Nervous and menial disorders. Was either excessively nervous? How was
nervousness shown?
12. Did either parent have epilepsy?
13. Did either have periodical headaches? Attacks of nervous prostration? Of

what nature?
14. Was either ever insane? When? For how long? At what age? How long
before or after patient was born? To what causes were the attacks attributed?
Were they cared for in a hospital?
15. Did either have any other disorders? St. Vitus's dance? Paralysis? Apoplexy?
16. Did either have constitutional diseases? Syphilis? Tuberculosis?
17. Alcobol. Was either addicted to the use of alcohol or habit-forming drugs?
Ifthey used alcohol, was its use moderate, excessive? Occasional, habitual?
How long was it taken? Years? With what results? Delirium tremens?
436
THE INSANE
Crime and suicide

18. Did either attempt or commit suicide? Under what circumstances?
19. Has either a criminal record? What?*
(The same points of history should be considered, where the situation warrants
it, for children of patient, brothers and sisters of patient, maternal and paternal
grandparents, uncles, aunts, and cousins.)
II Patient's Early History

20. Prenatal. Within the year before this patient was born, was either parent
(which parent) under great worry or strain? Was patient legitimate? Was
either parent using alcohol or drugs excessively? Engaged in particularly ex-
hausting occupations? 111? With what disease?
21 . Gestation. What was

the condition of the mother during pregnancy, with re-
gard to her general physical condition? Conditions of work? Nourishment?

Mental condition?
22. Birth. Was patient born at full term? If not, at what month? Was patient
born after prolonged labor? With instrumental delivery? Was more than one
child born at this time? What was patient's weight at birth?
Physical history of infancy and early childhood
23. Did patient have convulsions? How old was patient when these began?
How many years did they continue? How frequently did they occur? How
long was each seizure? What was their character, in detail? (For example, was
there loss of consciousness, local or general, and if so, how brought on?)
24. Did patient have rickets?
25. What other diseases did patient have? When and with what results?
26. When did patient learn to walk? To talk? To control urine day and night?
27. At what age did patient reach puberty? By what symptoms was it accom-
panied? Were there any abnormal changes noticed in the disposition, character,
or instincts at this time? What, in detail?
Schooling
28. When did patient first go to school? Until what age did he remain in school?
29. Did patient like school? Why did he leave? Grade on leaving?
30. What special difficulties did patient have with lessons? Pupils? Teachers?
Was he a truant?
31. What special abilities did patient manifest?
in Injuries, Diseases, and Habits of Later Life
32. Injuries and diseases. Has patient had any injuries, especially head injuries?
How was patient affected? By loss of consciousness? With convulsions?
33. Has patient had gonorrhea? Syphilis? When? What treatment for the
latter and with what result?
34. What other diseases has patient had? What were the after-effects?
437
SOCIAL DIAGNOSIS
35. Alcobol. Has patient taken alcohol in any form? Beer? Wine? Whiskey?
Tonic? Medicine? How
long has he been taking alcohol? Has its use been
moderate, excessive, occasional, habitual? Has he ever had delirium tremens?
36. What is the effect on his disposition? Does the alcohol make him pleasant or
disagreeable?
37. Oiler babits. Has the patient taken drugs cocaine, morphine, opium, or any
others for long periods of time?
38. Occupations. What is patient's present occupation? How long has he been
engaged in it?
39. Does he like it? Is he doing well in it? What difficulty has patient had with
employes or employers?
40. What previous occupations has patient had? Highest earnings? Average
during last five years? How long did he retain each position, how successful was
he in each, and why did he leave each?
41. Has patient worked by fits or with regularity?
42. Sex life. What were earliest sex experiences? With same or opposite sex?
Did patient make advances or vice versa? Any sexual attacks in childhood by
older relatives (father, uncles, cousins)?
43. To what extent has patient masturbated? Before puberty? Afterwards?

Has he sought advice on this subject?
44. What suggestions have there been of perverted tendencies (homosexuality, ex-
hibitionism, "peeping," etc.)?
IV Marriage and Children

45. Is or has the patient been married? When was he married? Is the wife (hus-
band) still living? How many times has he been married? What judgment
has been shown in marriage? Has the married life been happy? If not, why
not?
46. Has the patient (or wife) had any gynecological or menstrual difficulties? When
did catamenia begin? Has it been regular? When did catamenia end?
47. Has the patient (or wife) had abortions or miscarriages? Still-births? (Give
the details.) How often? When? How were they brought about?
48. Does husband (or wife) complain of patient's making perverse sexual demands?
What ones?
49. How many children has patient had? What is the sex and age of each? From
what nervous and mental diseases, if any, have they suffered?
V Character, Temperament, Disposition, and Social Instincts

50. Was patient thought peculiar in childhood? In maturity? In what way?
5 i . Does patient indulge in uncontrolled fits of temper? Has patient ever done so?
52. Is patient excitable? Active? Happy? Does patient belong to the "shut-
in" type, being unduly quiet, sad, and moody? Given to day-dreaming?
438
THE INSANE
53. Is patient free and confiding or reticent and seclusive?
54. Is patient self-confident? Diffident? Any difference in this respect when with
opposite sex?
55. Is patient introspective? Does patient indulge in self-reproach? Brood over

disappointments and incapacity?
56. child, did patient show any markedly lazy traits?
As a Refuse to do errands?
Want to sleep a great deal? Stay in bed for long periods? Was patient easily
frightened and subject to bad dreams?
57. Is religion a vital part of patient's life? Is patient over-religious? Has

patient shown special interest in revivalism? Clairvoyancy? Spiritualism?
Hypnotism?
58. Did patient play normally with other children as a child, getting on well with
them and entering fully into their games and good times? Was he inclined to
assume an air of superiority?
59. What is patient's attitude toward people? Friendly and responsive or the re-
verse?
60. Does patient enjoy companionship or prefer being alone in his work? In his
recreation? At home?
61. Is patient prone to passionate attachments?
62. Is patient attached to home, friends, and family, or indifferent to the natural
bonds of affection? Attitude toward father? Mother? Marked preference?
Any change at puberty?
63. Previous attacks.Has the patient had similar attacks before? What were the
symptoms? How long did the condition last? Did he go to a hospital for ner-
vous and mental diseases? When? Where? For how long? Why discharged?
64. If he has not had any similar attacks, has he ever had periods of depression or
of exaltation? How long have these lasted? What was done during these
attacks?
VI History and Description of the Present Illness
Cause and onset

65. Did the present illness seem to come on as the result of an accident or disease?
What, in detail?
66. Did the patient have a physical or mental shock? What, in detail?
67. Has he been under extraordinary strain for some time?

68. Is the present attack thought to be due to excess of any sort? Nature of excess?
69. Did the attack come on gradually or suddenly? Its history in detail?
Characteristics of attacks
70. General physicaland mental changes. Has there been a change of character in
the patient mentally? Morally? Socially? Has he been agreeable or disagree-
able to his wife (husband) and children? To friends and neighbors? Have
they considered his conduct peculiar or remarkable? In what respects?
439
SOCIAL DIAGNOSIS
71. Has he appeared to be dazed, or quiet, or restless? Has he been excited? Has
he temporary attacks of these conditions? Day or night?
72. Has he been tidy in eating and in his other habits, or has there been a distinct
change in his personal habits of cleanliness and order?
73. Has he slept well? How many hours has he slept each night? Has he slept
regularly?
74.Has he eaten well, or little? Has he had a perverse or abnormal appetite?

Has he taken his meals regularly? Does he give any explanation for his poor
appetite or his refusal to eat?
75. What was the patient's weight before the illness began? Has there been any
change in his weight? What other changes in the physical condition of the pa-
tient have been noted since the beginning of the illness? Any change in sex life?
Perversions (see questions 42 to 44)? Has he been tremulous in hands or in
speech? Slurring in speech? Has he become bald or has his hair whitened?
76. Movements. Are there abnormal movements of the body? Of the head?
Of the face? Are there rhythmic quiverings of the mouth? Are there wrinklings
of the forehead? Are there stereotyped movements? Are his movements stiff
and constrained?
77. Emotional condition, especially changes. Has the patient been depressed, or
unduly joyful, or apathetic?
78. Has he been passionate, or inclined to anger, or threatening? Has he become

specially sensitive and suspicious?
79. Hallucinations and delusions. Has he heard imaginary voices? What have
they said? Have they been abusive? Accusatory? Has he had visions?
Dreams so realistic that they seemed reality? Are they pleasant or unpleasant?
80. Did he go through the house looking under the beds and the furniture and in
the cupboards? Did he listen in corners or at the walls? Did he look at definite
points for some time?
81. Has he had ideas of persecution or of grandeur? Does he think he is being
unduly influenced, watched, or poisoned? Do things seem unreal to him? Does
he see indirect references to himself in newspapers, casual allusions, literature,
the Bible? Are there "undercurrents" against him? Has he any special terms?
What murder, poisoning, insanity, abduction? Has he ideas of sin, unworthi-
ness, impending punishment?
82. Suicide and bomicide. Has he made attempts at suicide? At homicide?
What were the exciting causes? Were the attempts serious?
83. Intellectualand memory defects. (Note especially beginning and duration of

changes in these.) Has he shown any intellectual defect? Has he been able to
carry on his business in the proper manner? Has he made peculiar or ill advised
purchases? Other errors in judgment? Has he lost his way in familiar places?
Does he remember his telephone number? Children's birthdays and birthplaces?
Is there a marked difference between memory for recent and for remote events?
440
THE FEEBLE-MINDED
84. Has he shown any other defect in memory? Has he remembered his business
engagements? Resorted to memoranda and devices for reminding?
85. Does he recognize his friends or relatives? Does he mistake persons?

86. Has he kept track of the days of the week and of the month?
87. Has he known where he has been?
88. Moral and legal laxness. Has the patient offended against the law? Against
morality? How did he so offend and with what result? Has he made threats?
Written to prominent persons? Has he become immodest in dress and attitude?
Garrulous as to family and personal affairs?
89. Insight. Has he understood that he has been mentally different from what he
is normally? Does he appreciate the nature of his disorder?
Description of patient
90. Does the patient look sad? Apprehensive? Furtive? Gay? Hostile? Sus-
picious? Visionary? Expressionless? Intent? Arrogant? Sleepy?
91. How does he carry his hands?

Is his hair tidy or unkempt? Nails? Teeth?
How about bathing? clothing well kept?
Is his Does he show that he has been
untidy in eating and in drinking? Any attempts at unusual dress or decoration?
Is he fully dressed, half dressed, or naked?
92. Does the patient walk straight and to some purpose? Does he walk irregu-
larly or go from one thing to another? Does he go slowly or quickly?
93. Does he voluntarily complain of ill-being, or ill treatment, or speak of his de-
lusions, or his feelings?
94. Is he coherent? Has he flight of ideas?
95. What spontaneous account does he give of the whole situation?
QUESTIONNAIRE REGARDING A CHILD POSSIBLY FEEBLE-MINDED 1
Many of the following questions apply also to an adult in years who is not an
adult in mind. It should be repeated that nothing in the following questionnaire
must be interpreted to mean that a social worker is ever able to make a medical
diagnosis. This is not a schedule to be filled out nor a set of queries to be answered
by a social agency's client or clients. For an explanation of the purpose of these
questionnaires see p. 373 sq.
A star (*) indicates that the answer to the question may be found in. or confirmed
by, public records.
Corrective Defects, Physical and Environmental *

1. Is child well nourished? If not, to what cause is under-nourishment due? To
poor appetite? Abnormal appetite? Insufficient food? Condition of the teeth?
2. Has he been pulled down by rheumatism or any of the childhood infectious dis-
eases?
1
Prepared for this volume by Mrs. Hilbert F. Day.
*
Before anyone can decide that the child is feeble-minded, due consideration
must be given to defects needing correction.
441
SOCIAL DIAGNOSIS
3. Has he grown rapidly? At the appearance of permanent teeth? At puberty?

4. Has he had a general physical examination? When? By whom and with what
results? Have nose and throat been examined? With what result? Were
tonsils enlarged? Were adenoids found? Were they removed? By whom?
When? Has vision been tested? By whom? With what result? Does child
wear glasses? When was last examination? Has hearing been examined? By
whom? When? With what result? What is the condition of the teeth?
5. Is there a history of lack of proper sleep?
6. Have there been too many or too few outside interests? Has child had any
emotional distress due to death or illness of loved ones? Has his home been un-
happy? Neglected? How? From what causes?
7. Is there any marked lack of sympathy between the school teacher and child?
Does the position of his desk admit of good light and opportunity for observa-
tion?
I Etiology
Heredity
8. What was the age of each parent when this child was born? Were the parents
related before marriage? In what degree? Were the grandparents on either
side related before marriage? Which ones? In what degree?
9. Are both parents living? If either is dead, what was the cause of death? At
what age did it occur?* Place of death?* Date?* If the grandparents are
deceased, of what disease and at what age did each die?*
10. Are there deceased brothers and sisters? If so, what was the order of their
and the cause,

birth, their sex, age, place, and date of their death?* Were their
mental and physical powers normal?
11. What have been the father's occupations? The mother's? At what age did
each begin work?
12. Did father or mother or any of their relatives show signs of or tendency towards
the following:
Feeble-mindedness
Imbecility
Idiocy
Deafness
Blindness
Being dwarfed
Being crippled
Being deformed
THE FEEBLE-MINDED
13. What members of the immediate family and what relatives, if any, on either
side, have been wholly or partially dependent? What institutional or other
care have they received? When?
14. Has child's mother had any still-births? How many and when? Any mis-
carriages? How many and when? Due to what causes? At what month of
pregnancy did they occur? What is the order of child's birth is he first-born?
second-born?
15. Within the year before this child was conceived, was either parent (which
parent) seriously ill? Under great worry or strain? Under mental excitement?
Using alcohol excessively? Using drugs, such as opium, etc.?
Gestation
16. Was there anything peculiar to be noted at time of conception? Were there
any abnormal conditions of the mother during pregnancy? Any attempts at
abortion? Did mother work during pregnancy? How steadily? To what
period? At what occupations? Did mother have sufficient nourishment?
Did she retain it?
17. While child was being carried, was there on the part of the mother any disease
that had begun before this time? Any disease begun during this time? What
disease? Was any abuse of alcohol or drugs? Any worry or anxiety?
there
Any fright or Any peculiar symptoms? Anything special to make an
shock?
impression on her mind?
18. Was this child born at full term? If not, at what month? Was more than one
child born at this time?
At time of birth
19. How long was the labor? Was it hard? Were anesthetics used? How long?
Were instruments used? What was the child's weight? Did child suffer from
difficult animation, breathing, or crying? Cyanosis, injury, deformity, paraly-
sis, inability to suckle?
II Physical History
Pathological
20. Was child nursed by his mother? How long? How was he fed when weaned?
21. Was he poorly developed in any way? How did he show it? Was he a strong
or sickly baby? If sickly, how did he show it?
22. Has he ever had any severe shock, fall, or fright? Any injury to the head?
When? What were the circumstances and apparent results?
23. Has had convulsions, fits, or spells? At what age did they begin?
child ever
To what cause did they appear to be due? What was their character? How
often did they occur? When was the last one? What treatment had been
given and with what results?
24. Has child ever had epilepsy? Rickets? Paralysis? Character and history
of attacks?
443
SOCIAL DIAGNOSIS
25. Has he ever had measles, whooping cough, scarlet fever, diphtheria, cerebro-
spinal meningitis, varioloid, or small-pox? At what age and how severely?
26. Has child ever had sore eyes, or any skin or scalp disease? Character and
history of trouble?
27. Has he ever had any disease of lungs or bowels? What?

28. Has he ever been pronounced insane? By whom? When? Character and
history of attacks that led to this diagnosis?
29. Has he ever had St. Vitus's dance? When?

30. What other diseases, if any, has he had? When?
Development
31. When did child teeth? Recognize persons? Sit alone? Use spoon? Walk?
Talk? did he advance in weight and height? How did he compare in
How
these respects with other children in family? Is he of average height and weight
for his age?
32. At what age did child reach puberty?
33. When were first signs of abnormal development noticed? Nature?
Peculiarities
34. How is child's circulation? Are his hands and feet often cold? Has he been
known to blush?
35. How does he sleep? Well? Restless? Noisy? Dream? Any night terrors?
36. Is he sensitive or callous to cold? Heat? Pain? Thunder storms?

37. Is appetite quick or abnormal in any way? What is the state of his taste?
Is he particular about what he eats? Does he swallow things without regard to
taste? Is he gluttonous? Will he eat garbage?
Appearance
38. What the general balance of child's body? Are shoulders equal?
is Is back
bent? there asymmetry of posture? Are there any abnormalities in the

Is
size and shape of the head? Does head loll to one side or droop forward?
39. Are there any variations from the normal in the size, shape, and relative posi-
tion of the features? Is there any marked coarseness of features? Do the eyes
roll? Shift? Are they wanting in changefulness? Is child cross-eyed? Are
ears large, outstanding, or dissimilar? Is the lower jaw protruding? Is mouth
usually open? Are there any abnormalities in the form, structure, and situation
of the teeth?
40. What is the expression of the face? Vacant? Gaze fixed? Has the child the
normal comeliness of youth? Does the skin show extreme pallor? Any other
peculiarities?
41. Are there any peculiarities of speech? What, in detail?
42. Does the child show any signs of nervousness? Automatic motions of the
features, hands, fingers, or limbs? Chronic frowning? Repeated grinning?
444
THE FEEBLE-MINDED
III Character
Temperament and disposition

43. Is child dull, listless, restless, or excitable? Is he active and vigorous? Does
he run about and notice things, or is he indolent?
44. Is he affectionate? Reclusive? Vindictive? Passionate? Conceited?

Boastful? Ungenerous? Ungrateful?
45. Is he often wilful, disobedient, and liable to attacks of stubbornness and bad
temper? Has he shown himself responsive to discipline or is he ready to risk
punishment for slight objects? Is he easily managed? Docile? Incorrigible?
46. Is child quarrelsome? Does he organize rebellion? Is he fond of stirring up

trouble and tale bearing? Cunning in attaining his own ends? Easily influenced?
47. Does he learn by experience? Is he heedless of danger?
48. Has he sympathy with distress or suffering? Is he dangerous to himself or
others during temper? Does he show embarrassment or shame when detected
in wrong-doing? Does he show remorse after wrong-doing?
Morality
49. Does child know the difference between right and wrong? Is he truthful?
Does he tell senseless lies? Is he trustworthy? Wantonly dishonest? Does he
indulge in purposeless and needless offenses? Will he pilfer?
50. Is child sexually precocious? Does he show any sexual perversion in practice?
By telling vulgar stories?
51. Does he drink or use drugs or tobacco? To what extent?
52. Has he a court record?*
Social relationships
53. What is child's attitude toward parents? Brothers? Sisters? Strangers?

"
Playthings? Is he violent toward playmates or an easy mark "? Is he cruel or
kind to animals? To children?
54. What sort of associates does he select? Are they below him socially? In-
tellectually? Are they younger, weaker physically? Is he fond of other chil-
dren? Does he help in the care of other children?
55. Does he show any excitement when in the presence of the opposite sex? At
what age was this first noticed?
56. How does he bear himself in public places?
Habits
57. What are child's habits in regard to personal appearance? Is he tidy? Un-
clean? Careless? Vain in dress? Is there a marked difference in these respects
between this child and the other members of the family? Does he wet or soil
clothing? Bedding?
58. Is he given to self-abuse? Has he ever been?
59. Will he hide, break, or destroy things? Clothing? Furniture?
445
SOCIAL DIAGNOSIS
60. Is he dangerous with fire?
61. Does child show tendency to run away from home? From school? From
work?
62. Has he any unfortunate habits not mentioned?
Peculiarities
63. Does child laugh or cry without cause? Quarrel without cause? Talk over-
intimately about himself? Is he prejudiced against anyone without reason?
Is he liable to uncontrollable anger for trifling cause?
change or alternation? Are there any strik-

64. Is the character subject to abrupt
ing contradictions in character? tender and cruel?
Is child Ingenuous and
crafty? Phlegmatic and nervous? Unfeeling and affectionate? Frank and
secretive? Artless and shy? Deceitful and truthful?
65. Are there periods of uncontrollable fear, of being impelled to violence, intoxica-
tion, or to immoral or criminal action? Have there been any periods of religious
enthusiasm?
IV Capacity
Intellectual
66. What schools has child attended? How old was he when he left? Why did
he leave? What grade did he reach in school? What is his history as to pro-
motion? Has he been held in one grade more than two years with regular atten-
dance? Has he ever attended a special class, been regarded as subnormal, or
been studied by a child-study department?
67. In school is child attentive? Easily fatigued by mental effort? Can he hold
his interest inone subject continuously? Does he lose interest quickly? Does
he need careful and close supervision? In what does he do his best work? His
poorest?
68. Does he recognize form? Which by name? Does he recognize color? Which
by name? Can he count? How many? Can he read? How much? Can he
add? Subtract? Multiply? Divide? Is he fond of music? What is his
musical capacity? Does he delight in acting? What is his power of memory?
Does he commit to memory easily? How long does it take him to learn, say, four
lines? Does he soon forget what he has learned? Can he speak a piece?
Recreational
69. How does child amuse himself? Can he entertain himself while alone? Does
he show any initiative or spontaneity in games? Does he show any imagination
in play?
70. In what stories is he interested? Vulgar? Blood and thunder? Gruesome?

How long will child play at any one thing? What, for example?
Co-ordination of faculties
71. What is child's power of imitation?

446
THE FEEBLE-MINDED
72. How does he respond to acommand? Is he slow? Will he respond incorrectly
though trying to obey? Can he do an errand?

73. Is he right-handed? Left-handed? Ambidextrous? Is the left hand more
dextrous and stronger than the right? Is his grip weak?
74. Can child use knife and fork? Does he masticate properly?
75. Can he throw a ball? Catch a ball? Can he button clothes? Tie a knot?
Lace shoes? Put on overshoes?
76. Can
child write, draw, sew? In drawing, writing, sewing, and manual training,
is co-ordination of hands and fingers labored? How does he write, from right to
left? In writing, is there a conspicuous number of i's undotted or t's uncrossed,
a lack of capitals? Can he take a simple dictation?
77. Can he handle tools? What can he make?
Industrial
78. Can child do any kind of work? What work has he done? When did he begin
work? he thorough in it? Can he work without supervision?
Is Does he keep
his positions? Can he support himself?
V Home
79. Is home in a crowded or a suburban district? Any grounds? What is the
character of the neighborhood, physical and moral? Single house or flat?
Number and size of rooms? Number used for sleeping? Ventilation? Light
or dark? Orderly or disorderly? Clean or dirty? Character of furnishings?
Condition and location of toilets?
80. What is the size of family? Are parents living together, or are they divorced
or separated? Of what members is immediate family group composed? Sex,
ages, and occupations? Are there any other members of the household? What
is their relation to the family?
Attitude of household toward child

81. Do family consider child abnormal? To what cause do they assign his condi-
tion? Inheritance? Accident? Acute sickness? Any other reason?
82. Do the parents have patience with child? Have they a strong attachment for
him?
83. What is with other children in the household? Do they abuse or
his relation
tease him? he repulsive, and does his appearance have a bad effect on the
Is
other children? Is he a source of terror, or is he the butt of the household?
84.Who is responsible How continuous is the supervision?

for the child's care?
How often is he left alone or with an irresponsible member of the household?
What degree of watchfulness and intelligent care can be expected for him at
home?
85. What is the nature of the home training? Is he neglected? Unduly repressed,
abused, or overindulged? Do parents or guardian control child? How? By
fear ot corporal punishment? By affection and reason?
447
SOCIAL DIAGNOSIS
Personal hygiene
86. Is his bedroom large or small? How many windows has it? Are the windows
kept open? Does he sleep alone? With whom? In a single or double bed?
What time does he go to bed and get up? Does he drink tea, coffee, milk, or
cocoa? How much? Usual food, breakfast, dinner, supper? Bathing, how
often? What kind? Does he use a toothbrush? Are his bowels regular?
VI Plan
87. Would parents be willing to have child placed in an institution? What is the
opinion of teachers, relatives, and physicians as to the wisdom of such a step?
448
CHAPTER XXVIII
SUPERVISION AND REVIEW
foregoing analyses of the diagnostic side of a few social
disabilities areonly a beginning. Should the plan followed
THE prove helpful in actual practice, other disabilities can be ana-
lyzed in the same way.
The questionnaire of this closing chapter turns from disabilities,
which are not always the most important consideration in social
work, to the other diagnostic topics likely to be of service to a case
work supervisor. When inquiry into a client's situation has
reached the stage of evidence gathered but not yet compared or
interpreted, and the record comes to a supervisor, or when, in
the absence of supervision, the case worker must review the evi-
dence without assistance, what are the things to look for? This
final list of questions is an attempt to answer the query. Needless
to say, it does not indicate a routine to be followed; some ques-
tions will apply to the given case but many will not.
The writer has had helpful suggestions for this list of queries
from former students, especially from members of the 1916 Charity
Organization Institute. Page numbers after questions indicate
where fuller discussion of the subject may be found in this book.
SUPERVISION AND REVIEW QUESTIONNAIRE
I Relations with Client
1. Does the record of the first interview indicate that the client has had a fair and
patient hearing, and that a sympathetic understanding, or at least a good basis
for further intercourse, was established at this early stage? (p. 1 14) 1
2. Are there indications that advice has been given prematurely, or that promises
have? (p. 129) Or has the client been put off with such artificial reasons for
delay or inaction as "my committee," "we never pay rent," "this is contrary
to the rules of the institution," etc.? Have there been too many ultimatums?
Have "no-thoroughfare" situations developed between case worker and client
due to these, due to Are there signs that the
failure to sift contradictions, etc.?
worker's lack of grasp of the situation has developed the scolding habit?
1 All page references are to other parts of this volume.
29 449
SOCIAL DIAGNOSIS
3. Were good clues to outside sources of insight and co-operation procured in the
first interview? (p. 120) What by the story, seem to
clues, indicated as possible
have been neglected? Do these belong to a group which this case worker often
finds it difficult to get, or usually overlooks?
4. the possible signs of physical or mental disease or breakdown noted early,

Were
and were medical examination and care procured immediately thereafter? (p.
21 1) If the assumption that the client was lazy, indifferent, or incorrigible was
made, was it possibly due to neglect of these precautions?
5. Has the worker who has conducted the first interview and seen the client's fam-
ily alsoseen the important outside sources, or were these parts of the inquiry
entrusted to someone else? (p. 176) Does the information procured from out-
side sources suggest that the inquirer had a sense of the relation of the part to
the whole?
6. Were any confessions, especially those that were damaging to the client who made
them, accepted as necessarily true? (p. 71) Has the client been protected from
misrepresentation of any kind?
II Relations with Client's Family
7. Does the record give its reader a sense of the main current of the lives of the
people recorded, or does it detail unrelated episodes and incidents only? (p. 138)
8. Have the relations of the members of the family to one another been noted?
Have any crises been noted that tested the family power of cohesion? (p. 139)
9. Does the record reveal whether the family has or has not shown good judgment,
on the whole, in its economic choices? Have expenditures been the expression
of an innate craving, have they been due to imitation, or are they indicative of
little judgment?
10. Are characteristic
disabilities belonging to the racial or economic group all
charged against the individual family?

1 1 . Have the children of the family, especially the growing children, been individual-
ized? (p. 153) Is there any clear picture of both their home and school life?
If the problem a family one, have the older children, those
is who are grown and
at work, been consulted? (p. 155)
12. Has the man of the family been seen? Were he and his wife seen separately?
(P- 143)
III Use of Outside Sources

13. Was
the confidential exchange consulted promptly? (p. 303) Was the identi-
fying information there procured promptly followed by consultations with the
agencies named? (p. 308) Were any inquiries that had already been made by
these agencies unnecessarily duplicated? (p. 311) Were the different agencies
each consulted about the kind of fact that each was best able to give? (p. 297)
Has any transfer of the case to another agency for treatment been preceded by
sufficient inquiry to justify the reference? (p. 313)
450
14. If not all the clues to outside sources were followed up, does an intelligent
made? For example, were some relatives on both sides
choice seem to have been
of the house seen, some former employers, etc.? (p. 175) Was the order in
which the sources were consulted wisely chosen? (p. 170) Were any of the
sources consulted found through supplementary clues clues revealed casually,
that is? (p. 174)
15. Have statements been sought, as far as possible, at first hand and not through
intermediaries from doctors, for example, rather than from patients, where
medical facts were in question, etc.? (p. 172) Or has hearsay evidence been
accepted without challenge? (p. 58) In evaluating the testimony of witnesses,
has their personal bias been allowed for? (p. 73)
16. Has the worker expressed opinions, in the letters attached to the record or else-
where, on matters about which he is not informed? Have the outside sources
been consulted about possible plans of action, or have they merely been per-
suaded to agree to plans proposed by the case worker? (p. 293)
17. In first contacts with relatives, have questions of the material assistance pro-
curable from them obscured more important matters? (p. 195)
18. Are the medical diagnoses from which social inferences have been drawn up-to-
date? (p. 216) Has discrimination been shown in seeking medical advice, and
has the needless multiplication of medical advisers been avoided? (p. 213)
19. Are the school reports quoted merely formal ones, or have the individualized
observations of teachers been sought? (p. 223)
20. Have the work records been entered perfunctorily, or do they cover the points
that would be of value in procuring new work, reinstatement, or advancement?
(See list of suggestions on page 239.) Has underpaid or unwholesome work that
tended to disintegrate the familylife (such as the twelve hour shift, supplemen-
tary earning by the homemaker away from home, sweatshop work, or premature
withdrawal of children from school) been noted?
21. Isany inexactness in the data at hand due to failure to consult original docu-
ments of birth, marriage, baptism, death, property, immigration, or court pro-
ceedings? (p. 255) Or to failure to consult out-of-town directories? (p. 265)
Or newspaper files? (p. 269)
22. Were interviews with present neighbors limited quite strictly to procuring
needed court evidence? (p. 274) Have the characteristics of the neighborhood
been kept in mind, and have experienced neighborhood social workers been con-
sulted about them? (p. 299)
IV Conduct of the Inquiry as a Whole

23. Have all the assets for reconstruction revealed by the client's history been care-
fully and sympathetically noted? Have they been summed up in black and
white? Or are there signs, on the other hand, of a tendency to overemphasize
the discouraging things? (pp. 157, 357, and 360)
24. What indications are there of the case worker's habits as a questioner? Have
leading questions been asked with full knowledge of their danger, and with good
451
SOCIAL DIAGNOSIS
reason for taking the risk? (p. 71) Have any marked personal prejudices of
the case worker's been allowed to warp the account? (pp. 94 and 97)
25. Is there evidence of a tendency to substitute such formulae as "maladjustment,"

"underfeeding," "chronic laziness," "hopelessly shiftless," "drink the sole cause,"
"large family," "insufficient wages," for the specific fact or facts? Are there
indications that the worker is hampered by some professional habit useful
under other conditions but not here? (p. 96) Are there signs of automatism,
of following a routine unthinkingly?
26. Has the worker been careful to clear up unfavorable items of evidence instead of
leaving them neither proved nor disproved?

27. Has the worker been hurried into hasty and ill considered action by a tendency
to cross bridges before they are reached, to regard situations as "emergent"
that are not really so? Has some picturesque minor incident of the story de-
moralized the inquiry? (p. 139)
28. Is there a tendency to "make out a case" at all hazards by overemphasizing

one side? Has the worker "held a brief" for or against or has he dealt even?
Are first theories promptly abandoned when the facts tend to disprove them?
(P- 98)
29. What hypotheses and inferences of the worker and of others have been accepted
without the necessary testing? (p. 87) Have any popular explanations of
things been accepted without challenge?
30. With regard to the record itself, does it develop an individual and colorful
picture, or are the main issues obscured by repetition and by unverified im-
pressions? Does it show skill in what is omitted? Is the present situation, for
example, described in such detail as to throw the more permanent aspects of the
story out of perspective? Are the words used as specific as they might be?
(P- 349)Are general terms avoided? Are acts described instead of qualities?
(P- 435) Are the statements of the record merely added or are they weighed?
Are there brief entries that help the supervisor to understand the relation of an
unknown witness to the matter about which he is quoted and to measure, in
some degree, his disinterestedness and his personal characteristics? (p. 278)
31. Are there signs of wasting time, of doing relatively unimportant things under
the impression that there is no time for the important ones? Does the investi-
gation center round and round some one point in the story, or does it lose itself
in aimless visits, many times repeated, to the client or his family? Are there,
on the other hand, signs of "economy of means," of achieving results, that is,
with the fewest possible motions and the smallest possible friction?
32. Has the inquiry, as it has developed, supplied a reasonable explanation for the
present situation? Does the investigation, that is, lay bare the personalities of
the chief actors plus the factors external to themselves that have brought them
to their present pass? Does it look back to their highest achievement in the past,
and give any sense of their possible resources in the joint task of reinstatement
or development which is still ahead? How far does the inquiry suggest not only
the diagnosis of the difficulty, but plans for its constructive treatment? (p. 360)
452
33. If needed evidence has not been procurable, and only partial or temporary
diagnosis can be made, what modifications in treatment could be devised in
order that a part of its necessary services might become also a means of pushing
the investigation forward? (pp. 86 and 236)
V Wider Aspects of the Inquiry
34. Is the record one in which this case worker has tried to make an especially
thorough and skilful inquiry? If not, are thereany such records? (p. 362)
35. Does it contain an instance of effort to push further into an unsolved problem
by presenting it, in this concrete form, to specialists in the national social reform
associations or elsewhere who might be able to suggest a solution? (Examples:
the possible relations between occupation and disease in a given case; the prob-
lem of the energetic boy who wishes to sell papers out of school hours; the
chances of recovery for tuberculous patients returned to their own country when,
for instance, a case committee suggests sending back such a one to Messina, etc.)
36. If there is no adequate provision for the feeble-minded, or no legal redress when
housing conditions threaten health (to give only two instances), what attitude
does the record reveal toward these evils? Is the situation accepted, or is a dis-
position manifest to push hard in some helpful direction? Is the evidence bear-
ing upon the matter accurately enough stated in the record to make it part of
the data needed for community action?
37. Are there any hopeful signs of breaking through routine, of getting a result by
new or unusual methods? What new outside sources, for example, have been
brought to light? (See list of outside sources in Appendix II, Table A, p. 467.)
Have any such new methods been noted and placed at the service of other case
workers?
38. If anyone has made an inquiry, supplied information, or aided at this stage of
the case in any way if a teacher has shown interest, for example will that
interest be remembered and will it be strengthened? Has any note been made,
looking to that end, to report later upon the further developments of the case,
especially upon any really significant ones?
453
APPENDICES
APPENDIX I
FIRST INTERVIEWS
three analyses of First Interviews which follow have been selected
THE from a larger number submitted in response to the questions given on p.

120. The first is with a patient in a medical-social department, the second
with a deserted wife in the office of an associated charities, and the third was held
in thehome of a young wife, a colored woman, who had just lost a child. Care has
been taken to change these interviews in minor details, which leave unchanged their
value as interviews but perhaps make the identification of the persons interviewed
less possible.
1. ANALYSIS OF INITIAL INTERVIEWS WITH A PSYCHONEUROTIC

PATIENT
Patient is brought into Social Service De-
partment by doctor from Male Medical Clinic,
who tells worker that the case is clearly one of
apprehension. Boy, sixteen years old, is phys-
ically sound. He lost his mother when very
young, is unhappy, and has given up his
work, because he became afraid he was sick.
What he needs is a friend, somebody who
will care and who will get him started.
During this conversation patient is sitting

on the bench. He is a handsome boy, with a
very attractive smile, looks a little embar-
rassed,but gets up with a friendly smile
when doctor introduces worker to him. Is j t j s very helpful to have doctor
greeted cordially, worker shakes hands and introduce patient to worker. He

asks him to wait a few moments while she t husshows patient that he trusts
a conversation with another patient.
finishes worker an d that he believes in her
Boy has evidently a real admiration for the power to help patient,
doctor. Worker can confidence
inspire
in patientby her manner, which
should always be cheerful and at
ease.
In a short time patient is invited to sit by
worker's desk. Worker explains to him that
the doctor has not time enough to go into
457
SOCIAL DIAGNOSIS
all the details of his case, but wishes a study This puts the emphasis upon the
of itmade, and that she and he will study it objective point of view and makes
together. Patient assents. patient a little less self-conscious.
then explained to patient that he must

It is Again manner plays an impor-
be prepared to answer a great many questions tant part. This is said as if worker
and to tell everything he can think of about and patient were about to begin
himself and his family. Is told that if an interesting game. This re-
worker had known him all his life she would lieves patient's embarrassment if
know how many brothers and sisters he had, he feels any.
and where he had been to school, but that
now he has come to her out of clear sky. He
is like a figure standing in front of a white
screen. He has no background. As no-
body in real life stands in front of a white
screen, patient must paint in the details.

He understands and says he will be glad to
help and will answer every question.
As it is late in the morning patient is in- Patient is evidently amused and

vited to come in again next day and is told interested and says he will be glad
that the necessary study may take several to come again.
interviews.
When patient comes in again record is Worker helps patient to con-

begun by asking him where he has been pre- centrate his attention upon this
viously treated. He had never had a doctor "study" by the businesslike way
until the year before when his brother's doc- of writing down his answers to
tor saw him a few times. questions, or the narrative he gives
unassisted. This places social
record on same plane as medical
record in his mind (a part of his
treatment), since it is taken in

same manner, and shows him that
doctor considers it all important.
This rule is broken only when in a
more confidential part of the story
patient needs the help of an en-
couraging look, or undivided at-
tention from worker.
After initial record is made,
taking notes is usually unneces-
sary, though worker never hesi-
tates to take them if anything
important is told. It keeps in
patient's mind the fact that doc-
tor is in touch with case.
458
FIRST INTERVIEWS
It is then explained to patient that the

study of his case necessitates his telling all
he can remember about his family. He is
asked about his grandparents. The only While at first puzzled to know
one he knows anything about (the others what is wanted, patient very is
having died in Austria) is his father's father, responsive. Fatigue in attention is

who is alive and in this country. Patient avoided by the many interruptions
has apparently no affection for him, and says which come to worker. Though
he is "cross and quick-tempered" and hard these interrupt narrative they
to get along with; does not stay long with have their uses.
Patient shows little interest in
any of his children. Is pretty well physi-
ancestry.
cally.
His father is a teacher. Does not seem

to know how to describe him until worker
"
asks several questions. Then says, He is a Great care is taken to ask ques-
good-natured man, sometimes gets his tem- tions which describe opposing
per up," but is good to his children. Came traits so that patient may not
to the U. S. eighteen years ago; has lived in have answers to questions sug-
D ever since; was married when he was gested to him.
seventeen. Is honest; much thought of
among his fellow-countrymen, but earns a
very small salary. In Austria his position

was very different. Is unable to help his
sons much.
Mother died when patient was only three. Patient unconsciously finds in
He can remember nothing about her. This this loss excuse formany of his
fact seems to have taken a certain hold upon weaknesses.
his imagination.
Patient has three brothers and a sister and

there is evidently much affection among
them. They are all older than he and while After patient understood what
his sister was at home she looked out for sort of description was necessary
him. He tells of their education, occupa- in his father's case he described the
tions, and marriage with very little question- others quite easily.
ing.
About five years ago his father married
again and patient has not been happy with
his stepmother. Just at present he is living
with a sister of his mother.
As patient complains of pain in his side,

he is told what a habit pain is a vicious
circle, "attention creates sensation, sensa-
459
SOCIAL DIAGNOSIS
tion causes fear, fear increases attention,"

which must be broken through at the point
of fear, because patient is afraid the pain
means something serious. As the doctor has
pronounced him physically sound, patient is
His responsibility toward others
urged to rest his faith in this statement. He
is reminded of his relations to other people is suggested to him from the be-
and the possible effect of his discouraged ginning.
attitude upon them. He is going out of
town to visit one of his brothers for a few
days, but will come again on his return. He This is intended to keep his
is asked to write down anything he can re- interest in the study alive. This
member of his life. leisurelyway of taking the record
is designed to suggest to patient
that he must not expect to over-
come his bad habits at once.
Thoroughness is much more im-

portant than speed.
Immediate effect is seen in a postal re-

A patient is very apt to respond
ceived from patient the next day in which quickly, but when he feels his old
he writes, "I am feeling fine."
sensations come again, discourage-
ment follows.
Five days later patient comes again. Had

felt perfectly well"yesterday when the
till
old pain had appeared again," and he is
feeling a bit discouraged. He brings a

written statement of some facts in his life
his proneness to stay by himself, his industry Document is read and patient
at school, his lack of all intellectual interests isencouraged to write more, and
outside of his school work.Family are very more fully and freely. This is to
increase his interest in
poor and patient does not get on well with personal
his stepmother, though he stayed at home study and gives him opportunity
after all the others went away, because he to express his own views without
wanted to get an education. chance of suggestion from worker.
Record is taken up again and family his-
tory is continued. Patient tells of his

father'sand mother's relatives; then of
what he had done since school; his habits
how he spends his time, what he eats, etc.
His not having earned anything for four
months is not a real source of worry to him, These facts make rough sketch
as his family are all good to him. of patient's background.
460
FIRST INTERVIEWS
He is evidently of a retiring disposition, Question of finances not taken

though not unfriendly. up, unless pressing, until later.
Record is here interrupted by a long talk

on habit and patient's future plans. His
former ambitions seem to be suspended by
his fears about his health. Worker suggests Patient's interest is still further
that she will visit patient's oldest brother. aroused by this personal interest.
Brother lives 30 miles away.
On the following day patient comes to

continue record. This part of record is the Worker tries in words and man-
most intimate as it relates to his earliest ner to impress patient with her
recollections, the people and things which interest. This part is the test of
have most affected him. He tells of his her power to convince patient of
school life, of the principles which govern his her real sympathy. She also learns
conduct, of his troubles and of his chief almost as much from what he does
difficulty, which has been deciding things. not say as from what he tells. His
manner is illuminating.
The next is to visit the patient's This not only helps worker very
step
brother. He
devoted to patient and is a
is
much in her knowledge of patient's
kind and sensible man. Future plans for surroundings and family, but gives
patient are discussed and brother's co-opera- patient a common interest with
tion fully won. worker.
The following day patient comes in with a

longer written statement than the first. The
initial interview is completed with his ac-
count of the cause and duration of his illness. It impressed upon patient
is
He is much interested to hear about worker's that this only the opening wedge
is
visit to brother. It is decided he is to go to in his recovery. Care is taken not

this brother very soon. He is encouraged to urge future plans upon patient
to read ten minutes every day and to think as it is deemed wiser to encourage
about his reading. He is asked to report more healthful habits of thought

about it to worker. He is also advised to and let his ambitions come to life
learn some good poetry. He is promised a slowly. He is so young.
list of books to read; is urged to decide some It best to avoid permitting
is
little thing every day and to stick to his de- patient to depend too much upon
cision. worker's will power.
461
SOCIAL DIAGNOSIS
2. AN OFFICE INTERVIEW WITH A DESERTED WIFE

On the of May, a woman aged twenty-
first
two and two children, two and a half and

one year old, are brought to the office by an
officer who gives this information:
The woman was deserted by her husband

three weeks before. She has since been liv-
ing with her parents, but was turned out two

days ago because she made slighting remarks
about her sister's fianc6. The sister and
mother whipped her. The officer had hoped
that her family would take her back, but her
father was seen this morning and refused.
Both the mother and this daughter have
violent tempers.
The interview begins with questions re-
garding the name and age of husband and These are direct questions, the
wife. When was she married? idea being to find whether the hus-
"Three years ago by a Lutheran minister." band ran away because he was too
"Are you Scandinavian then?" young for his responsibilities.
"No, mostly mixed, I guess."
"Tell me about your married life, have you This gives a chance for a ram-
had trouble like this before?"
bling story which follows.
She launches into her story, saying that

they were getting along very nicely in Mill-
bank. Her husband was not drinking much
and was supporting her. Then he sent her
here on a visit and came himself and now he
has left.
"When were you in Millbank?"

Maybe by returning to Mill-
"Since last August."
bank, if man is found, life could
"What was work there?"
his
be made happier.
"Switching. That is what he was doing
here. He showed me a pass just before he
left but I have forgotten where it was to."
"Had you just quarrelled or had you any Trying to find the cause.
trouble that would make him go away?"
In reply to this she tells of a previous time

when he deserted after selling some things
which did not belong to him while working
for an installment house. Her people did
not like this any more than they liked his
getting her in trouble before her marriage.
462
FIRST INTERVIEWS
She is asked, "Was he willing to marry A forced marriage might ex-

you or did he do it against his will?" plain his dishonesty, recklessness,
She says he was not unwilling, though not and desertion.
anxious. He made no objection, however,
when her father insisted. But ten days
after their marriage he was arrested for try-
ing to steal a bicycle while he was intoxi-

cated. Another time he spent two months
in the Parktown workhouse for defrauding
grocers.
She is asked, Did she know he drank and
was dishonest before marriage.
She says not, but that his responsibilities
seemed to him too heavy as a man of family.
He was good only while in Millbank.
"
Did he like the children?"
"While in Millbank he seemed to like them
all right."
The woman is then asked about her own With a view to solving the ques-
health and what work she did before mar- tion of how she is to live till he is
riage. found, or perhaps permanently.

Her health is good. She was a mangle
girl in a laundry.
Did she begin work early?
When she was sixteen years old. Her
father did not wish any of his girls to work,
but they all did because they wanted more
clothes than he could furnish them.
A day nursery is suggested.

She does not like this idea as she says the
baby keeps her up a good deal at night.

She would rather put the children in a home
and work in a laundry.
She is shown that thus she would have to
leave the children to the care of others and
is urged to consider the nursery plan.
Meanwhile, has she anywhere to go?
She mentions two relatives of hers, one of
whom is telephoned to. This relative will The possession of a telephone
not have her and does not wish to become suggests that her people are better
involved. able to help than are many.
The client then remembers her husband's A note is madeto look up this
half-sister, who is telephoned to. The sister sister-in-law and hold a private
says she will give temporary shelter but conversation with her face to face.
463
SOCIAL DIAGNOSIS
regrets that the client did not take her ad-

vice before marriage. The nursery plan is
explained to her and she thinks it good.
The woman is then told that an effort will II not thought wise to insist
be made to find her husband and to call later on da y' s work or an X Plan
until she
to talk over plans. She is sent to her sister- begins to recover her courage,
in-law's.
3. A FIRST INTERVIEW IN THE HOME

A young colored couple was referred on account of the death of one of their
children, for whom

they wished burial clothing and assistance toward the funeral
expenses, because the man was unemployed. The secretary had been warned
that Mrs. Reynolds (to give her another name) was in a very hysterical state, and
that would probably be impossible to get any information at all.
it
On
approaching the old wooden shanty, where Mrs. Reynolds lived, the writer
heard a series of moans and groans. She found the mother sitting on a tumbled
bed, rocking her body to and fro. Her eyes were tearless, but the moaning con-
tinued. The visitor laid her hand on the woman's shoulder and the latter, quiet
for an instant, looked
up inquiringly.
"Howdo you do, Mrs. Reynolds? I am so glad I found you in, because Mrs.
Miller would have been so disappointed if I had not."
"Oh, do you know Mrs. Miller?" asked the woman, immediately brightening,
"Ain't she a fine woman?"
"Indeed she is," answered the visitor, and allowed the colored woman to run on
for a few moments eulogizing Mrs. Miller, for whom she worked two days a week,
as it seemed to take her mind off of her loss and to calm her. She explained that
Mrs. Miller had known her husband and herself when they were first married, and
had been very friendly to them ever since. By immediately following this lead, it
was possible to learn where they were married, what her husband did for a living at
that time, and the kind of employment he now wanted. In this way were also
learned some of the places at which he had worked and the addresses at which the
family had lived at the time.
"
Did you have two children when you were down on North Street?" asked the
secretary, knowing that a direct question about the names and ages of the children
would probably start a fresh outbreak of grief.
"No, I just had Willie. He was two then, and after we moved up here in 1910,
Jessie came and poor Margaret would be two next month if she ." Here the
visitor interrupted quickly, "I imagine the children are very bright in school,
aren't they, Mrs. Reynolds? Do they go to public school No. 2?"
"Yes," answered the mother, "and they bring home such fine grades."
"Of course you send them to Sunday school, probably to the Colored Mission
around the corner," continued the visitor.
"Yes, we all go there," answered Mrs. Reynolds. "The funeral is going to be
from there tomorrow afternoon."
"Is the church going to help toward the expenses?"
"No, but Dobson is very reasonable. He is only going to charge $38."
464
FIRST INTERVIEWS
"Well, perhaps the relatives will all contribute a little."

"I haven't any relatives," was the conventional reply.
"Won't you get a little insurance perhaps?" was the next suggestion.
"No, the Metropolitan lapsed three weeks ago."
"
Do you get two carriages for the amount you are paying the undertaker, or
just one?" inquired the visitor further.
"Oh, we get two."
"That's good," said the visitor, "because your own little family can go in one
and then you can fill the other with just your nearest relatives, not people
carriage,
who come out of curiosity, but your own kin."
"
Yes, we have asked my sister and her husband to go and also Amos' brother
John, with his wife and child," continued Mrs. Reynolds.

"You are fortunate to have your own people living right near you. All of us are
not that lucky."
"
I reckon we are, and they are pretty good to us. Of course we see more of my
sister, Judy, for she lives just two doors from the corner. But Amos' brother lives
down on East so he does not get up so often."
St.,
In another two minutes the secretary was able to get not only the names and
addresses of these relatives, but a general idea of the status of their families.
Finally the question of burial clothes for the child had to be approached and,
sobbing hysterically, Mrs. Reynolds showed the child's ragged little wardrobe, so
that her visitor might judge what was needed. The office card was left in the
mother's hands, and she promised to come there the next morning at nine o'clock,
when the secretary was to accompany her to the department store where they could
buy the necessary articles. After a few last words of warm sympathy and encour-
agement, the visit was over.
The chief point in this case (continues its reporter) is the importance of the first
contact. It shows that, when one finds an applicant in an abnormal state of mind,
the key to the situation is to introduceupon entrance a topic that will be of im-
mediate and real personal interest, and at the same time to touch lightly upon the
subject preying upon his mind.
The problem is to keep the client from gravitating to the source of his
real
trouble until one is ready to have him do so; this is achieved by keeping up a rapid
interchange of firm but kind questions and answers, allowing no time for lapses of
attention on the part of the person interviewed. One would find it difficult to get
a good first statement in a case like the foregoing, if the order were reversed; if
the client were encouraged to speak of his trouble first in the interview, that is,
before the background had been secured.

Then another important thing illustrated is the necessity of having a legitimate
introduction. In this case it was through a mutual acquaintance, Mrs. Miller.
If the visitor had come in some mysterious, undefined way, she would have found it
difficult to gain Mrs. Reynolds' confidence. In this type of case, moreover, it is
especially important that the client get it firmly established in his mind that the
visitor's attitude is one of sympathy and of determination to help in every way
possible. With this impression left from the interview, the next contact will be
frank and friendly.
30 465
APPENDIX II
STATISTICS OF OUTSIDE SOURCES

FORM USED
. AGENCY 1. CITY
SOURCES OF INFORMATION USED AS A BASIS OF TREATMENT
o- *-,
TABLE A. SOURCES OF INFORMATION CONSULTED IN THREE CITIES,

AS SHOWN BY THE RECORDS EXAMINED
SOCIAL DIAGNOSIS
TABLE SOURCES OF INFORMATION CONSULTED IN THREE CITIES,
A.
AS SHOWN BY THE RECORDS EXAMINED. (Continued)
Source
TABLE A. SOURCES OF INFORMATION CONSULTED IN THREE CITIES,

AS SHOWN BY THE RECORDS EXAMINED. (Continued)
Source
SOCIAL DIAGNOSIS
TABLE B. SOURCES OF INFORMATION CONSULTED IN THE FIRST

CITY, BY AGENCIES ENGAGED IN SPECIFIED TYPES OF WORK

Agencies engaged in
APPENDIX III
SPECIMEN VARIABLE SPELLINGS 1
RECORDED INTHE SOCIAL SERVICE EXCHANGE, NEW YORK. (SEE

REFERENCE TO THEIR USE ON P. 270 SQ.)
Abbott Anderson Barry
Abad Andersen Barrie
Abbette Andresen Bary
Abbot Andreson Berry
Abbotte
Bailey
De Barry
Adams Bailie Bauer
Aadam Bailly Baier
Adam Baillie Bauers
Addams Baily Baur
McAdam Baley Bour
McAdams Bayley Bower
Aiello Baylie Bowers
Aeillo Bain
Berger
Aello Baine
Barger
Ahello Bane
Bergher
Aillo Bayen Bergor
Ailo Bayne Borger
Aiola Bean
Burger
Aiullo Beane
Bisella
See also PneUa, Basil*,
D AlclI Baldwyn BusbeU, Buccolo
Allen Balwin Barsila
Alan Boldwin Basila
Allan Barber Basil!
Allyn Barbour Basilia
1
It should be understood that the exchange in any city, however small, would
include (i) a vastly greater number of real names than are given here, and (2) a
very large number of misspellings (among foreign names especially) due to un-
familiarity with the clients' language on the part of the social workers, clerks,
or others, who interview and enquire about them. Those responsible for developing
an exchange will find that an important part of their work is the recording of such
misspellings, since it is never safe to assume that any variation from the real
spelling, however wild, may not be repeated.
472
SPECIMEN VARIABLE SPELLINGS
Bisella (Continued)
SOCIAL DIAGNOSIS
Donegan Fitzsimmons Kalisky

Doneghan Fitzimmons Kelinski
Donigan Fitzimons Koblinsky

Donnegan Fitzsimons Kolinski
Donnigan Flannigan Kolinsky

Donogan Flanagan Kolisky
Dunigan Flanigan Gardner
Dunnigan Flannagan Gardener
Flannegan Gardiner
Donohue
O' Flanagan Gartner
Donaghue
Donahue Flynn Gertner
Donnahue Flinn
Gerrity
Donoghue Fox
Garaty
O' Donahue Fuchs
Garety
Frank Garity
Donnelly Franc Garrety
Donelly
Franck Garrity
Donley
Francke Gearity
Donnally Franke Geraghty
Donnely
Franks Gereghty
Donnelly
Fraser Gerraghty
Dougherty Fraiser Gerraty
Daugherty Frasier Gerrighty
Docherty Frazer
Giorlando
Doherty Frazier
Gerlando
Dorrity Freizer
Giolando
Gablinsky
Dufify Gordon
Duffee
Gabelisky
Gordan
Gablonsky
Duffey Gorden
Duffie
Gabolensky
Gorton
Galinsky
Eckardt Galiski Gould
Echardt Galitzky Gold
Eckert Galizky Golde
Eckhart Gallinski Goldt
Ehhardt Gapalinsky Goold
Gobilinski
Evans Gray
Goliensky
Evan Graye
Golinsky
Evens Grey
Golitzky
Evins
Kabalinsky Green
Ivans
Kalensky Greene
Fisher Kalinsky Grun
Fischer Kaliski Grunn
474
Griffin Heinz
Greffin
Griff en
Griffins
Guarantano
Garantano
Garatano
Garetano
Garetona
Garratano
Guarnera
Guamero
Guaneri
Guarmieri
Guarnaro
Guarneri
Haggerty
Hagarty
Hagerty
Haggarty
Hegarty
Heggerty
Hogarty
Hart
Hardt
Harte
Hartt
Hartz
Harz
Heart
Herz
Hertz
Hayes
Hay
Haye
Hays
Healy
Healey
Heally
Hines
Heins
Heinse
SOCIAL DIAGNOSIS
Lane Levey Mackie

Laine Levi McCay
Lanes Lewis McKee
Layne Louis Me Key
Lehn Luis McKeon
McKean
Laughlin Lowery
Loughlin Laurie Me Keen
O' Laughlin McKeown
Lawery
Loughry Madison
Lawlor
Lowerie See also Mattbewson
Laulor
Lowrie Maddison
Lawlar
Lowry Madsen
Lawler
Matheson
Lawrence
Lynn
Matison
Lenne
Laurance Matsen
Linn
Laurence Matsin
Linne
Laurens Matson
Laurents McCarthy Mattison
Lorence MacCarthy Mattson
Lorens McCarthey
Maher
Lorentz McCartey
See also Meyer
Lorenz McCartie
Mahar
Lee McCarty
Mahr
Lea McCormick
Marr
Leigh
MacCormick
Meagher
McCormack
Lenahan Mahoney
McCormic
Lanahan Mahony
Lenehan
McCue
Mohoney
Lenihan MacCue
Mohony
Linahan McHugh O' Mahoney
Linehan McDonald Malloy
Leonard
Mac Donald Melloy
McDonell
Leighnard Molloy
McDonnell
Lenart Maloney
McDonnold
Lenhart Malaney
Leonhard McEvoy Malony
Leonhardt McAvoy Malloney
Lienhart McVoy Moloney
Linhard McGuire Mulaney
Linhardt MacGuire Mullaney
Linhart Maguire Meehan
Levy McKay Mahon
Leavey Mackay Meehen
Leavy Mackey Mehan
476
Meyer
SOCIAL DIAGNOSIS
Reilly Sproviro Vogel

O'Reilley Sprufera Fogel
O'Reilly
Van Vogel
Stevens
Reilley Vogele
Stefan
Reily Vogle
Steffens
Rielly
-
Stephan Walsh
Riley
Stephen Walsch
Robinson Stephens Welch
Roberson Welsch
Stewart
Robertson Welsh
Stuart
Robeson
Robison Thompson Webber
Robson Thomsen Weber
Thomson Weiber
Rogers
Rodger Tierney
Wilson
Rodgers Tarney
Willison
Schaefer Tearney
Willson
Schaeffer Teirney
Wilsen
Schafer Terney
Schaffer Tirney
Wolf
Scheaffer Trainor Wolfe
Schiefer Traynor Wolff
Schiffer Treanor Woolf
Shaefer Wulff
Ulrich
Shaffer
Uhlrich
Schneider Uhrich Worth
Schnider Ulrick Werth
Schnyder Wierth
Sneider Vano Wirth
Vaina Wuerth
Snyder
Vanna
Shea Vanni
Wishnofsky
Schey Vanyi Wasnicky
Shay Vena
Wasnisky
Sheay Viamio
Wischnefsky
Smith Viana
Wischnewsky
Schmidt Viane
Wishnefsky
Schmitt Viani
Wishnewsky
Schmitz Viania
Wishnosky
Smyth Viano
Wisneskey
Vierno Wisnewska
Sprovieri
Vaughan Wisnowski
Sprofera
Vaughn Wiszhnefsky
Sprovira
478
Wynn Zack Ziegler

Whyne Zach Seigler
Winn Zacks Siegler
Wynne Zaich Zeigler
Zak Ziegeler
Young
Zeak
Younge
Youngs
Yung
479
BIBLIOGRAPHY
BIBLIOGRAPHY
I. SOURCES
As explained in the Preface (p. 7), there have been two main sources of this study:
First, a large number of social case histories have been examined. Second, indi-
vidual case workers in different social agencies and different cities have been inter-
viewed.
II. REFERENCES
There no bibliography of the subject of investigation. The following titles
is
are selected from the references made throughout this book, as being the ones most
closely related to its theme:
Balch, Emily Greene (Associate Professor of Economics in Wellesley College).

Our Slavic Fellow Citizens. 536 p. New York, Charities Publication Com-
mittee, 1910.
Baldwin, James Mark, Ph.D., D. Sc. Oxon., LL.D. Glasgow (Professor in Prince-
ton University, Co-editor of Tbe Psychological Review). Social and Ethical
Interpretations in Mental Development; a study in social psychology. 606 p.
New York, The Macmillan Company, 1902.
Baldwin, Roger N., joint author, see Flexner, Bernard, and Baldwin, R. N.
Birtwell, Mary L. Investigation. Pamphlet published by the Boston Associated
Charities (No. 61), 1895.
Bosanquet, Helen. The Family. 344 p. London, Macmillan and Company

1906.
Bosanquet, Helen. The Standard of Life and Other Studies. 219 p. Lon-
don, Macmillan and Company, 1898.
Branthwaite, R. W. Report of the Inspector under the Inebriates Acts, 1879-
1900, for the Year 1909. Introduction, Habitual Drunkenness and its Treat-
ment, p. 4-10. London, The Home Office, 1911.
Byington, Margaret F. The Confidential Exchange; a form of social co-opera-
tion. 30 p. New York, Charity Organization Department Publication (No.
28), Russell Sage Foundation, 1912.
Cabot, Richard C., M.D. Case Teaching in Medicine. 214 p. Boston, D. C.
Heath and Company, 1906.
Cabot, Richard C., M.D. Differential Diagnosis; presented through an analysis
of 383 cases. 753 Philadelphia, W. B. Saunders Company, 1911.
p.
Cabot, Richard C., M.D. Report of the Chairman of the Committee on Health.
In Proceedings of the National Conference of Charities and Correction for 1915
(Baltimore), p. 224.
Cannon, Ida M., R.N. Social Work in Hospitals; a contribution to progressive
medicine. 257 p. New York, Russell Sage Foundation Publication, Survey
Associates, 1913.
483
BIBLIOGRAPHY
Chalmers, Thomas. Chalmers on Charity; a selection of passages and scenes

work of Thomas Chalmers, D.D.,
to illustrate the social teaching and practical
arranged and edited by N. Masterman, M.A. 414 p. Westminster, Archibald
Constable and Company, 1900.
Charity Organization Society, London. Occasional Papers of the, 1896. "How
to Take Down a Case," by W. G. Martley, p. 209-220.
Dubois, Paul, M.D. (Professor of Neuropathology in the University of Berne).
The Psychic Treatment of Nervous Disorders (The Psychoneuroses and their
Moral Treatment). 466 p. Translated and edited by S. E. Jelliffe, M.D.,
Ph.D., and W. A. White, M.D. New York, Funk and Wagnalls Company, 1907.
Flexner, Bernard, and Baldwin, Roger N. Juvenile Courts and Probation. 308 p.
New York, The Century Company, 1914.
Greenleaf, Simon, LL.D. Treatise on the Law of Evidence. Sixteenth edition,
revised, enlarged, and annotated by John Henry Wigmore, Professor of the Law
of Evidence in the Law School of Northwestern University. 993 p. Boston,
Little. Brown, and Company, 1899.
Gross, Hans, J.U.D. (Professor of Criminal Law in the University of Graz, Aus-
tria. Formerly Magistrate of the Criminal Court of Czernovitz, Austria).
Criminal Psychology; a manual for judges, practitioners, and students. Trans-
lated from the fourth German edition by Horace M. Kallen, Ph.D. 514 p.
Boston, Little, Brown, and Company, 1911.
Healy, Mary Tenney, and Healy, M. T.
B.L., joint author, see Healy, William,
Healy, William, M.D. Honesty; a study of the causes and treatment of dis-
honesty among children. 220 p. Indianapolis, The Bobbs-Merrill Company,
1915
Healy, William, M.D. The Individual Delinquent; a text-book of diagnosis and
prognosis for all concerned in understanding offenders. 830 p. Boston, Little,
Brown, and Company, 1915.
Healy, William, M.D., and Healy, Mary Tenney, B.L. Pathological Lying,
Accusation, and Swindling; a study in forensic psychology. 286 p. Boston,
Little, Brown, and Company, 1915.
Hill, Octavia. Life of Octavia Hill; as told in her letters. Edited by C. Ed-
mund Maurice. 591 p. London, Macmillan and Company, 1913.
Langlois, Charles V., and Seignobos, Charles (of the Sorbonne). Introduction
to the Study of History. Translated by G. G. Berry. 349 p. London, Duck-
worth and Company, 1898.
Lattimore, Florence L. "Pittsburgh as a Foster Mother." In The Pittsburgh
District, Civic Frontage, p. 337-449. New York, Russell Sage Foundation Pub-
lication, Survey Associates, 1914.
Lawton, Ruth W., and Murphy, J. Prentice. "A Study of Results of a Child-
placing Society." In Proceedings of the National Conference of Charities and
Correction for 1915 (Baltimore), p. 164-174.
Lee, Porter R. "The Culture of Family Life." In Proceedings of the National
Conference of Charities and Correction for 1914 (Memphis), p. 92-98.
Martley, W. G., see Charity Organization Society, London.
484
BIBLIOGRAPHY
Masterman, N., M.A., see Chalmers, Thomas.

Maurice, C. E., see Hill, Octavia.
McLean, Francis H. The Charities of Springfield, Illinois; a survey under the
direction of the American Association of Societies for Organizing Charity. 185 p.
The Springfield Survey, Charities Section. New York, Department of Surveys
and Exhibits, Russell Sage Foundation, December, 1915.
Meltzer, S. J., M.D., LL.D. "Ideas and Ideals in Medicine." Journal of ibe
American Medical Association, L: 1577-83, May 16, 1908.
Meyer, Adolf, M.D. "What Do Histories of Cases of Insanity Teach Us con-
cerning Preventive Mental Hygiene during the Years of School Life?" The
Psychological Clinic, II: 89-101, June 15, 1908.
Mitchell, S. Weir, M.D., LL.D. Doctor and Patient. Third edition, 177 p.
Philadelphia, J. B. Lippincott Company, 1898.
Murphy, J. Prentice, joint author, see Lawton, Ruth W., and Murphy, J. P.
Putnam, James Jackson, M.D. "The Treatment of Psychasthenia from the
Standpoint of the Social Consciousness." American Journal of the Medical
Sciences, CXXX: 77-94, January, 1908.
Sears, Amelia. The Charity Visitor; a handbook for beginners. 76 p. De-
partment of Social Investigation, Chicago School of Civics and Philanthropy, 1913.
Seignobos, Charles (of the Sorbonne), joint author, see Langlois, Charles V., and
Seignobos, C.
Sidgwick, Alfred. The Application of Logic. 321 p. London, Macmillan and
Company, 1910.
Solenberger, Alice Willard. One Thousand Homeless Men; a study of origi-
nal records. 374 p. New York, Russell Sage Foundation Publication, Charities
Publication Committee, 1911.
Summary of State Laws relating to the Dependent Classes. 1913. Department

of Commerce, Bureau of the Census, Washington, Government Printing Office,
1914.
Thayer, James Bradley, LL.D. (Weld Professor of Law in Harvard University).
A Preliminary Treatise on Evidence at the Common Law. 636 p. Boston,
Little, Brown, and Company, 1898.
Thorndike, Edward L. Individuality. 55 p. Boston, Hough ton, Mifflin, and

Company, 1911.
Turner, C. J. Ribton-. Suggestions for Systematic Inquiry into the Cases of
Applicants for Relief. 120 p. London, Knight and Company, 1872.
Wigmore, John Henry (Professor of the Law of Evidence in Northwestern Uni-
versity). The Principles of Judicial Proof as Given by Logic, Psychology, and
General Experience, and Illustrated by Judicial Trials. 1 179 p. Boston, Little,
Brown, and Company, 1913.
485
INDEX
INDEX
ACCIDENT CASES: dealings with employers APPEARANCE: queries regarding, for a blind
in, 247-248 person, 421; for a patient possibly in-
sane, 441; for a child possibly feeble-
ACCOUNTS, HOUSEHOLD: problem of dealing
with housewife who cannot keep, 148, minded, /]/]/|
149; wilful inaccuracies in keeping, how "APPLICANT:" substitution of "client" for,

shown, 150 in this book, 38; former methods of in-
ACCURACY IN WITNESSES: tests of, summar- terviewing, 127
64
ized, APPLICATION BLANKS: untrustworthy wit-
ADDRESSES: of employers, use of city direc- ness of, 177, 318-319. See also Blank
Forms
tory in making more accurate, 246; ways
of getting information about, through Application of Logic: by Alfred Sidgwick, 87,
postal authorities, 336 97
ADVICE: premature, in first interview, 129- APPLICATION, ORIGIN OF: as affecting method
130; queries regarding sources of, for a of first interview, 106
widow's family, 404 APPROACH IN FIRST INTERVIEW: mode of,
AFFIDAVITS, PERSONAL: not satisfactory evi- quotation from Dr. Adolf Meyer bearing
dence of age, 257 upon, 115
"After-care and Prophylaxis:" by Adolf Aran Islands: by John Synge, 185
Meyer, M.D., 352 ART: experiences of fellow practitioners of
AGE: a matter of public record, 123; of chil- value to practitioner of an, 103
dren, reasons for knowing exactly, 154- ASSESSORS, CITY: consultations with, by
155; ways of determining, 256-258 social agencies, 287
AGENTS FOR LANDLORDS: as sources of in- ASSETS FOR RECONSTRUCTION: should be
formation, 281 noted, 157; place of, in diagnostic sum-
ALCOHOL: excessive use of, and inebriety, mary, 360-361
429; queries regarding use of, for an ASSOCIATED CHARITIES. See Charity Organ-
inebriate, 430, 431; for a patient pos- ization Societies
sibly insane, 438 ASSOCIATED CHARITIES, BOSTON: consulta-
ALCOHOLIC: employer's interest in case of an, tion with, by users of the confidential
242 exchange, 308
ALCOHOLISM. See Inebriety ASSOCIATION: as an aid to memory, 68
AMERICAN ASSOCIATION OF SOCIETIES FOR ASSUMPTIONS: of social worker, risks arising
ORGANIZING CHARITY: suggestions about
from, 95-96; based on method of proba-
foreign correspondents made by, 326 bilities, 97
AMERICAN STATESMAN who "dealt with the Atlantic Monthly: anonymous contributor to,
facts" criticised by N. Y. Evening Post, quoted, 334
55
ATTENDANCE: school evidence regarding,
AMERICANIZATION: stages in, made clear in
225-226
Woods' Americans in Process, 386
ATTENDANCE OFFICERS: need of reorgania-
Americans in Process: by Robert A. Woods, tion of task of, 225
299, 386 ATTENTION: on the part of a witness, as
AMES CASE: inferences drawn from face card affecting his testimony, 66-68
of, 83, 85; face card of, reproduced, 84;
illustration of use of analogies drawn
AUSTIN, MARY, 96
from, 91 illustrations of mistaken causal
;
AVERAGES: habit of thinking in, 06; mean
relation suggested by, 92, 93; summary little in work with individuals, 163
of, used as basis for criticism of diag- AVER'S annual list of newspapers published
nostic processes, 352-356, 361 in U.S.. 269
AMSDEN, MRS. H. S., 10 AYRES, LEONARD P., 202, 368
ANALOGY, MISTAKEN: as source of error in AYRES, PHILIP W., 31
reasoning, 87, 91-92
ANALYSES OF FIRST INTERVIEWS: made by
BAKER, HARVEY H., 33
caseworkers, 120, 121,457-465
BALCH, EMILY G., 74, 75, 386
ANY FAMILY, QUESTIONNAIRE REGARDING: to
precede all other questionnaires, 374, BALDWIN, JAMES MARK, 369
378-381 BALDWIN, R. N., 44, 45. 143
489
INDEX
BANK ACCOUNTS: consultation of, 264 BOSTON ASSOCIATED CHARITIES: consulta-

tion with, by users of confidential ex-
BANKS, FOREIGN: as means of establishing
whereabouts, 261 change, 308
BAPTISM CERTIFICATES: use of, in establish-
BOSTON CHILDREN'S AID SOCIETY: interested
in probation, 33
ing age, 256; named in New York's child
labor law, 257 BOSTON MUNICIPAL COURT: separate hear-
BAPTISM RECORDS: consultation of, inthree ings of children's cases in, 33
cities,255; as source of name and ad- BOSTON SCHOOL FOR SOCIAL WORKERS: help
dress of child's godparents, 262 in gathering material for this book ren-
dered by, 10 notes on conferences of
BAR MIZVAH CERTIFICATES: as" evidence of ;
students of, on uses of confidential ex-

age, 257
change data, 308-310
BARKER. LEWBLLYS F., M.D., 366 BOSWORTH, MARION, 88
BEDFORD, CAROLINE L., 10 Boviker's Index to Dales of Current Events, 269
BEHAVIOR: school evidence as to, 226
BRANNICK, CATHERINE, M.D., 405
BENEFIT SOCIETIES: as one-headed sources,
175; uses of, in social diagnosis, 290
BRANTHWAITB, R. W., 429, 430
BETTERMENT, INDIVIDUAL AND MASS: inter-
BRAUCHER CASE: as illustrating insight
gained from relatives, 188-189; series of
dependence of, 25, 365, 366
diagnoses in, 356-357
BIAS: risks due to, in testimonial evidence,
59, 60; an historian's tests of, summar-
BREED, MARY I., 194, 195
ized, 64; racial or national, 73-7S; class, BROOKLYN Daily Eagle: index to, 269
among peasants, 74; environmental, 75- BROOKS, PHILLIPS, 10
76; of self-interest. 76-78; of self-esteem, BROTHERS: legal responsibility of, for sup-
79; of employers, 241
port, in different states, 195
BIBLE, FAMILY: as a birth record, 256, 257 BUDGET: family, wife authority on, 147, 149
BIBLIOGRAPHY: for this volume, plan fol- food, basis for, 150
lowed in making, 1 1
BURDEN OF PROOF: with regard to unfavor-
BINET-SIMON MEASURING SCALE, 34 able testimony about a client, 59, 61, 62
BIRTH: queries regarding, for a patient pos- BURROWS, SARAH F., 282
sibly insane, 437; for a child possibly BUSINESS MEN: letters to, 331
feeble-minded, 443 BUSINESS SOURCES: uses of, in social diag-
BIRTH CERTIFICATES: in New York
City, nosis, 288-290
content of, 256; named in N. Y. child
labor law, 257; foreign, how to obtain, BYINGTON, MARGARET F., 10, 149, 304, 305.
307. 308
257
BIRTH RECORDS: failure to consult. In one
city, 164; consultation of, in three cities,
255; present use of, illustrated, 256-257, CABOT, RICHARD C., M.D., 35, 49. 208, 212,
259; as means of discovering where- 214,218,347.375.376
abouts, 260; dates to be searched in CANNON, IDA M., 35
looking up, 271
CARSTENS, C. C., 251
BIRTWELL, MARY L., 31, 107, 268, 293, 325, CASE COMMITTEES: as critics, 348; case
337 workers' summaries to, 348
BLANK FORMS: use of, in early stages of in-
vestigation, 127; use made of, by three CASE HISTORIES: mental attitude essential
medical-social workers, 128-129; of in- to making of valuable, 09
quiry, addressed to dispensary doctors, CASE READERS: studies made for this volume
criticism of, 208; unsatisfactorincsa of, by. 7
318-319. See also A p plication Blanks CASE SUMMARIES: as an aid in obtaining
BLIND PERSON, QUESTIONNAIRE REGARDING medical co-operation, 218
A, 420-424 Case Teaching in Medicine: by Richard C.
BLIND, WORKER FOR THE: letters to priests Cabot, M.D.. 347
and parents by, 331-332
CASE WORK: dear thinking essential to, 99
BLINDNESS: mistake of considering fact of,
alone, 420; queries regarding prevention CASE WORK AGENCY: point of view of a,
of, 421 regarding evidence, contrasted with that
of S. P. C. C. and court, 41-43
BOARDERS: immigrant households, com-
in
plicate study of food problem, 149; in- CASE WORK STUDY: fruitful and unfruitful
fluence of, should be considered in deser- methods of, 375-376. See also Social
tion cases, 157. See also Lodgers Case Work
BOIES, HENRY M., 285 CASE WORKERS. See Social Workers
BOSANQUET, HELEN, 139. 152. 368 CAUSAL FACTORS: in a diagnostic summary,
BOSTON: influence of Octavia Hill in, 30; 360-361; hi case of an inebriate, queries
medical-social work in, 36; use of con- regarding, 431
fidential exchange data by agencies in, CAUSAL RELATION, MISTAKEN: as source of
308-310 error in reasoning, 87, 92-93
490
INDEX
CAUSES OK POVERTY. CRIME, BTC.: distin- in the matter of enforcing support from
guished from causal factors In the indi- relatives, 196; unwise approach to rela-
vidual case, 360 tives, 198; conflicting medical prognoses,
206, 207; helpful report of diagnosis and
CAVOUR: Thayer's Life of, 385
prognosis from a physician, 209; help-
CEMETERY RECORDS: use of, 261 ful report of social history to a physician,
209; acceptance of hearsay medical evi-
CHALMERS, THOMAS, 28, 29, 105 dence, 215; danger of medical opinions
CHAPIN, R. C., 128 from non-medical workers, 216; uses of
school evidence, 221, 222; school evi-
CHARACTER: queries regarding, for a person
dence on scholarship, 224; unreliable
possibly insane, 438-439; for a child
employer testimony, 241; testimony
possibly feeble-minded, 445 from an employer, 243; co-operation
CHARACTER EVIDENCE: change in type of, from a present employer, 243; securing
sought by social workers, 61, 62 information about an Italian laborer's
CHARACTERISTICS OF INHABITANTS: of native employment, 249; need of search for
province, etc., of immigrant groups, evidence of marriage, 258-259; con-
queries regarding, 383 sultation of a court record, 262; use of a
" hospital record to establish whereabouts,
''
CHA RAC TEROLOGY : understanding of,
262; concealment of property, 263-264;
needed in social work, 56 use of directories, 266-268; use of pres-
Charities of Springfield: by F. H. McLean, 221 ent neighborhood sources, 275, 276; use
CHARITY OFFICE: apology of man for not of insurance agents as a source of in-
Bending wife to, 143 formation, 289; unexpected results from
CHARITY ORGANIZATION CAMPAIGNS: for consulting an undertaker, 290; hasty
better housing and for prevention of reporting, 350; handling of a case by
four districts, 356-357
tuberculosis, influence upon case work of,
32 Charity Visitor, The: by Amelia Sears, 81, 88,
CHARITY ORGANIZATION MOVEMENT: contri- 89, 90, 155, 241, 249
bution to social diagnosis made by, 27,
28-33 CHESLEY, ANNIE L., 108, 190, 192, 197
CHARITY ORGANIZATION SOCIETIES: no meth- CHICAGO JUVENILE COURT: applied psychol-
ods or aims peculiar to, 5 case work op-
; ogy utilized in, 33-34
portunities offered to students by, 32; CHICAGO SCHOOL OF Civics AND PHILAN-
workers in, said by S. P. C. C. worker to
THROPY: help in gathering material for
need_ training in weighing evidence, 39; this book tendered by, 10
possible assumptions of workers in, 96;
experience of a worker in one of, com- CHILD-HELPING AGENCIES: possible assump-
pared with her later experience as agent tions of workers in, 95, 965 public and
of state department for care of children, private, included in statistical study of
105; opinion of worker in one of, as to outside sources, 161; illustration of non-
place of first interview, 108; conditions social attitude on part of a hospital fur-
of first interviews in, contrasted with nished by, 205; illustration of teacher's
those in medical-social work, 109; direc- part in diagnosis of feeble-mindedness
tion to "take no notes" given by, 127; furnished by, 229; instance of variable
included in statistical study of outside spellings furnished by, 271
sources, 161; criticism of case records by
CHILD LABOR COMMITTEE: use of school cen-
secretary of one of, 178; statistics of sus records reported by, 262
relatives consulted by two, 180; and
other agencies, division of territory be- CHILD LABOR LEGISLATION: effect on case
tween, 296; training of workers in, com- work of, 32, 365. See also New York
pared with that of settlement workers, Child Labor Law
300; character of some agencies which
bear name of, 302; relations to confi- CHILD, NEGLECTED, QUESTIONNAIRE REGARD-
dential exchange of, 304; conception of
ING A, 405-412
one investigation to stand for all time CHILD-PLACING AGENCIES: observations of,
outgrown by, 312; reasons for dissatis- as evidence regarding feeble-mindedness,
faction of, with out-of-town inquiries 43; possible assumptions of workers in,
received, 321; inadequate letter of in- 96; need of knowing family histories in
quiry to, cited, 328-329; analysis of an work of, 135; public and private, in-
interview with a deserted wife by worker cluded in statistical study of outside
in, 462-464 sources, 16 1 ; consultations with relatives
CHARITY ORGANIZATION WORK, ILLUSTRA- by, 180; illustration of hearsay medical
TIONS FROM, ON: need of developing evidence obtained by, 215; consultations
diagnostic skill in court work, 45; bias with present neighbors by, 273; special
due to family pride, 78; first interviews, value of evidence that one may give
117, 121 ; experiences in dealing with another, 309
South Italians through Interpreters, 118, CHILD-PROTECTIVE AGENCIES. See Society to
119; relations with family group, 140- Protect Children from Cruelly
142; handling of an illegitimacy case,
CHILD-SAVING: a commonplace of. 153. See
145; treatment of two young couples,
also Child-helping Agencies
145; failure of relatives to understand,
183; insight gained from relatives, 188- CHILD STUDY: the approach to social diag-
189; a public institution's carelessness nosis by way of, 33
491
INDEX
CHILDREN: excessive suggestibility of, 70; CLASS: a client should not be thought of as
experience in a first interview cited by one of a, 97
worker with, 109; causes of trouble be- CLASS BIAS: among peasants, 74
tween parents and, 140, 153, 153; habit
of some workers of dealing with family CLERGYMEN: as witnesses, 300; as corre-
through, 153; importance of confidences spondents, Miss Birtwell quoted on, 325,
between parents and, 153; failure of some 326
family agencies to individualize, 153-154; CLIENTS: term defined and explained, 38;
reasons for knowing ages of, exactly, 154- affairs of,not necessarily known to one
I55i possible explanations of long periods referring them to a social agency, nor to
between, 155; older, points to be kept in relatives, 65; first, unrehearsed state-
mind in dealing with, 155-156; grown, ments of, most reliable, 69; use of lead-
importance of interviews with, illus- ing questions in dealing with, 7i~73;
trated, 156; value to, of comradeship of should not be thought of as one of a
grandparents, 157; outside sources of class, 97; manner of application of, as
information most used in work with, 168 . affecting first interview, 106; attitude of,
169; tendency to turn over to care of as influencing choice of place of first
relatives, 185-186; legal responsibility of, interview, 107, 109, no; importance of
for support, 195; proof of marriage as knowing recorded experience with, before
bearing upon protection of, 259; queries first interview, no, in; importance of
regarding lack of control of, 409-410; giving a fair and patient hearing to, 112,
blind, queries regarding special educa- 113, 114; establishment of good under-
tion of, 421 ; of a person possibly insane, standing with, in first interview, 112, 113,
queries regarding, 438 114; suggestions from physicians bearing
CHILDREN, PUBLIC DEPARTMENT FOR CARE upon mode of approach to, 115, 1 16; need
of grasping personality of, in first inter-
OF: experience of agent for, compared
with her earlier experience in a C. O. S., view, 126; courtesy toward, should de-
termine note-taking, 127; attitude of,
105; opinion of agent for, as to place of toward blank form, as influencing its use
first interview, 108; account of first in-
terview by agent for, 115; consultation by medical-social workers, 128; ignor-
ance of family history of, as cause of un-
of relatives by, 180; experience of, with
successful treatment, 134, 135; inter-
relatives, cited, 184; illustration of co-
views with, alone and in presence of mem-
operation from a present employer re- bers of family, 136, 137; present situa-
ported by, 245; note on consultation of tion of. unduly dwelt upon by many
birth records by, 256; use of present
agencies, 169; sources of information
neighbors by, 273 nearest to, likely to prove most valuable,
CHILDREN'S AGENCY: illustration showing in- 170; objections of, to having relatives
fluence of visitor of, 70; ways of dealing seen, 180; relatives' failure to under-
with unmarried or deserting fathers illus- stand, illustrated, 183-186; one type of,
trated by notes from, 144; consultations compared to Aran Islanders, 185; reasons
with school sources by, 221; use of a for studying work records of, 236-238;
former residence as a source of informa- statements of, to be compared with those
tion by, 279; letters of a worker in, 332 of employer, 239; mis-statements as to
wages by, illustrated, 246; confidence of,
CHILDREN'S COURTS: contributions to social in the written word, 254; consultation of
diagnosis made by, 27, 33-34; supple- records to secure rights of, 264; impor-
ment legal evidence by social, 44. See tance of social worker's relations to other
also Juvenile Court
agencies and to, compared, 294; how in-
CHILDREN'S INSTITUTIO_NS: testimony of one, terests of, are conserved by confidential
regarding defects in teachers' evidence, exchange, 306-307; injury to, by dupli-
232: records of, as evidence of age, 257; cate investigations, 311: effect upon, of
in Pittsburgh, investigations by, 299; transfers, 314; letters of inquiry by, 326;
valuable data obtainable from, 299 letters shown by, copies of, 335; letters
regarding, should not be sent by hand of,
Choosing a Vocation: by Frank Parsons, 46 335; original letters of, as evidence of
Christian and Civic
Economy of Large Towns: mentality, education, etc., 335; queries
by Thomas Chalmers, 28 regarding a social worker's relations with,
449. See also Immigrants
CHURCHES: as sources of information in three
cities,167; as one-headed sources, 175;
CLINICAL TEACHING IN MEDICINE: Dr. Cabot
records of birth in, 256; consulted, in quoted on, 347
2,800 cases examined, 297, 298; social "CLUE BLINDNESS:" a remedy for, 254
evidence of, 300-301. See also Religious CLUES: to outside information, importance of
Affiliations obtaining, in first interview, 112, 113, 114;
CIRCUMCISION RECORDS: as evidence of age, those most needed in first interview, 124;
257 obtaining of, in emergency interviews.
131-132; supplementary, special value of,
CIRCUMSTANTIAL EVIDENCE: distinguished
from other types of evidence, 56, 59, 60; 174-175; supplementary, to former em-
ployers, 242; furnished by death records,
direct and indirect, trustworthiness and!
258; supplementary, furnished by former
value of, 60
neighbors, 279, 280
CITY SOLICITOR: consultations with, by social CODMAN, JULIAN: 66
agencies, 287
COFFEE, OVERUSE OF: Dr. Healy's findings
CIVIL LISTS: as sources of information, 266 regarding, 150
492
INDEX
COLONIES, FOREIGN: contact of parishioners good as one's word an important part of,
and clergy in, 300; value of advice of 315
leaders in, 386 CORRECTIVE DEFECTS: in a child possibly
COMMUNICATION WITH OUTSIDE SOURCES: feeble-minded, 441-442
various means of, 317 CORRESPONDENCE ON CLOSED CASES: mistake
COMMUNION RECORDS, FIRST: as evidence of of destroying, 335
age, 257 CORRESPONDENT: choice of the best, in writ-
COMMUNITY: of an unmarried mother, ing letters of inquiry, 323-326; selected
queries regarding, 414; of the father of for out-of-town inquiry, what will in-
her child, queries regarding, 416 terest? 326-327; what sort of letter of
COMMUNITY CUSTOMS: in native country of Inquiry will save unnecessary trouble to?
immigrant groups, queries regarding, 384 327-331; what facts relating to, should
modify approach by letter? 331-333
COMPARISON OF MATERIAL: suggestions for
the, 347-355 CORROBORATION OF INFERENCES, 85-87
COMPENSATION. See Workmen's Compensa- COUPLE, YOUNG MARRIED special problems
:
tion connected with, 145

COMPETENCE: and bias, in testimonial evi- COURT, LAW: point of view of, regarding evi-
dence, 59, 60; historians' tests of, sum- dence, contrasted with that of a case
marized, 64; lack of, illustrated, 65, 66,
work agency, 41-43; early English,
67,68 "vouching" in, 52; rejection of hearsay
evidence by, 57. See also Children's
COMPETITIVE STAGE of Social Work, 293 Courts and Domestic Relations Court
CONDUCT: teachers' evidence as to, 226; uses COURT OFFICIALS: consultation of present
of records of, 265
neighbors by, 275, 276, 277
CONFERENCES of representatives of agencies COURT RECORDS: consultation of, in three
on difficult cases, 315 cities, 255; as evidence of age, 257; il-
CONFESSIONS: mistaken, 71 lustration of use of, in establishing where-
CONFIDENTIAL EXCHANGE: importance of abouts, 262; types of work hampered by
condition of, 265
communicating with, before and after
firstinterview, in; beginnings of, 294; COURTIS, STUART A., 46
need of, illustrated, 303-304; history and "Courtis Tests in Arithmetic:" by Stuart A.
uses of, in diagnosis, 304; mechanism of,
Courtis, 46
described by Miss Byington, 305-306;
ensures privacy of clients by limiting CRIME: on part of parents of a person pos-
those who may use, 306-307; not a sibly insane, 437
benevolent detective agency, 307; use of Criminal Investigation: by Hans Gross, 9
data furnished by, 308-310; misunder- CRIMINAL JURISPRUDENCE: contributions to,
standings over the telephone reported by used in this study, 49
the registrar of, 340
Criminal Psychology: by Hans Gross, 67, 68,
Confidential Exchange, The: by Margaret F. 116, 346, 349. 350
Byington, 304, 305, 307, 308
CRUELTY, PHYSICAL INJURY OR ABUSE:
CONFIRMATION RECORDS: as evidence of age, queries regarding, 410
257
CULTURE: in native country of immigrant
CONSULS, FOREIGN illustrations of use of 288
: ,
group, queries regarding, 383-384
CONSULS, U. S.: consultations with, by social CUTLER, RUTH, 88
agencies, 288; use of, as correspondents
about foreign clients, 326
CONTAGIOUS DISEASE RECORDS: consulta- DAMPNESS: among housing defects that social
tion of, in one city, 255 workers should note, 151
CONTRADICTIONS: between witnesses should DAY, MRS. HILBERT F., 10, 435, 441
lead to further inquiry, 175-176; in evi- DAY NURSERIES: included in statistical study
dence, importance of looking for, 350 of outside sources, 161; consultations
CONTROL OF CHILDREN, LACK OF: queries
with relatives by one, 180; records of, as
evidence of age, 257
regarding, 409-410
CONTROLLER, STATE: consultation with, by DEACONESSES: as sources of information, 301
social agencies, 287 DEATH RECORDS: consultation of, in one city,
COOLEY, CHARLES MORTON. 4 255; use of, 258; as revealing where-
abouts, 260
CO-OPERATION: principles that should govern
seeking of sources rich in, 170-172, 309; DEBTS: inference regarding payment of, 8a,
from relatives, illustrated, 189-194: of 90, 91
employers, illustrations of, 242-246; from DEFINITIONS: of diagnosis, 5 T ; of references,
unions and fellow workmen, instances of, 52; of witnesses, 52; of fact, 53; of evi-
250; in social work, and diagnosis, 292- dence, 55; of inference. 55; of proof, 55
293; four stages in development of, in DELAND, LORIN F., 284
U.S., 293; third stage of, 294-295; high-
est form of, 295-296; promoted by con- DELUSIONS: of a patient possibly insane,
fidential exchange, 304-310; duplicate queries regarding, 440
investigations and, 311-313; and trans- DEMOCRACY: individual and mass activities
fer to another agency, 313-314; being as in a, 367-368
493
INDEX
DENISON, EDWARD, 37 Investigations and, 3"-3i3; fourth

DEPENDENCE: inducement of chronic, queries stage leading to, 342; certain aspects of
three first stages in, restated, 342-347;
regarding, 410-411
processes by which arrived at, not re-
DEPORTATION: resources of home country as vealed in case records, 348; haste and
bearing upon, 288; provisions regarding, delay in, 350, 355; processes of, illus-
in Immigration Law of 1917, 393 trated by the Ames case, 3S2-356, 361;
DEPORTMENT: teachers' evidence as to, 226 imaginative insight essential to success in,
DESERTED FAMILY: case of a, reported by 355, 356; redefined, 357; as an adjunct
Mrs. Chesley. 190-192 to medicine and psychology, 358; con-
tent of a, 358; may be mistaken or a
DESERTED FAMILY QUESTIONNAIRE, 395-400 mere classification, 358; may be too de-
DESERTED WIFE: analysis of interview with tailed, or partial, 359; may be full with-
a, 462-464 out loss of clearness, 359-360; ways of
DESERTER: C. O. S. record of, comments on, advancing standards in, 361, 362; time
element in, 361-363; not always possible
140-142; a children's society's dealings to make, and never final, 363; need of,
with, 144; who was living at home, case
in administrative tasks, 365; assumes
of. reported by a C. O. S., 188; connec-
tions often maintained by. with former
more importance with advances in social
surroundings, 251; queries regarding, reform, 367 requests for outline to cover
;
396-399 any, 375; lessons in, to be drawn from

Dr. Cabot's Differential Diagnosis, 376
DESERTION: method of study of cases of,
146; influence of relatives, lodgers, and
DIAGNOSTIC SUMMARY: content of, 360; of
boarders should be considered in cases of, the Ames case, 361
157; effect of throwing responsibility DIAGNOSTICIAN, SOCIAL: two
essentials of,
upon man's people in cases of, 199; as 98; personality of, in first interview, 104.
modifying outline of a work record, 239- See also Social Worker
240; proof of marriage in cases of, 259; DIETITIAN: experience with Polish woman
and widowhood, formerly confused, 358- related by, 149; methods employed with
3S9, 395 state laws regarding, 395 pres-
; ;
mothers receiving pensions reported by
ent and past, queries regarding, 396-397;
ISO
as a form of child neglect, queries regard-
ing, 408 Differential Diagnosis: by Richard C. Cabot,
M.D..37S
DETECTIVE MANNER: to be avoided, 72
DIRECTORIES: types of, 265-266; business,
DEVELOPMENTAL HISTORY: of a child pos-
use of, 266; city, uses of, 126, 246, 265-
sibly feeble-minded, 444 268, 333: of social agencies, etc., as
DBVINE, EDWARD T., 25, 31 sources of information, 266; professional,
as sources of information, 266 telephone,
DIAGNOSIS, MEDICAL: beginning to show in- ;
fluence of social evidence, 44; waiters on, use of, 266; trade, as sources of informa-
cited in this book, 49; conflicting, illus- tion, 266
trated, 206; early, importance of and DISABILITIES: and the questionnaire plan, 8,
social responsibility for, 211; written, 9; important part played by case work-
advisability of seeking, 215; should be ers' knowledge of and attitude toward,
dated, 216; mistake of suggesting, when HI: the questionnaire as a device for
writing to a physician, 331, illustrated, studying. 373-375, 377-378; not to be
335 ; Dubois quoted on, 347; inclusion treated as ultimate causes, 395; com-
of social context in, 357; of insanity or plicating blindness, 420
feeble-mindedness, social worker should DISCHARGE PAPERS OF SAILORS: evidence
not attempt to make, 434 contained in, 249
DIAGNOSIS, SOCIAL: elements of, common to DISEASE, MEDICAL HISTORIES OF: Dr. Cabot's
all types of case work, 5; wider useful- method of presenting, in Differential
ness of 6; advantages in use of term. 26;
,
Diagnosis, 375
uses of, 26, 27; contributions to, by the
DISEASES: in which early medical diagnosis
charity organization movement, 27, 28- is of especial importance, 211; of a per-
33; contributions to, by the children's son possibly insane, queries regarding,
court movement, 27, 33-34; contribu-
tions to, by the medical-social movement, 437-438
27, 34-36; denned, 51, 52; would be DISPATCH, TELEGRAPHIC: uses of, 336-337
strengthened by habit of distinguishing DISPOSITION: of a person possibly insane,
hearsay evidence, 57; should shun small queries regarding, 438-439; of a child
subterfuges, 72; application of processes possibly feeble-minded, queries regard-
of reasoning to, 81-98; sound reasoning ing, 445
fundamental in, 09; four processes lead- DISTRICT ATTORNEY: consultations with, by
ing to, 103; shaped by social philosophy social agencies, 287
of case worker, in; importance of
prom ptness in making, 112; importance to, DIVORCE RECORDS: consultation of, in one
of consultation with outside sources, 160; city, 255; need of consulting, illustrated,
division of labor in, 176; an axiom of, 259
178; reasoning in early stages leading to, Doctor and Patient: by S. Weir Mitchell,
178; two purposes of, developed in con- M.D., 170
sultations with employers, 238; and
DOCTOR TO DOCTOR is more frank, 216
co-operation, 292-293; confidential ex-
change promotes better, 304; duplicate DOCTORS. See Physicians
494
INDEX
DOCUMENTARY EVIDENCE: type* and uses of, worker consult, 88; better witnesses than
61; which a student of social work would his family to a man's habits, 123; obtain-
find to exist regarding himself, 253 ing information regarding, in first inter-
DOCUMENTS: two classes of. 253;in which view, 126; as sources of information in
events are recorded at the time of occur- three cities, 167; health sources consulted
rence, more reliable than memory, 254;
more frequently than, 204; reasons for
when most, and when least, satisfactory, unsatisfactory results of consultations
254; consultation of, in 2,800 cases with, 235; statements of, to be compared
studied, 255; possibility of delegating
with those of clients, 239; testimony of,
task of consulting, 255; method in con- value and certain failures of, 240-241;
sulting, 269-271 method of approach to, 246-247; deal-
ings with, in cases of accident, 247-248;
DOMESTIC RELATIONS COURT: relations of,
substitution of a developing for a static
with social work, 45
program in dealing with, 251. See also
DOYLE, ANDREW, 28 Employers, Former, Present, and Prospec-
DOYLE CASE: comments on, 140-142 tive
DRINKING HABITS: of an inebriate, queries EMPLOYERS, FORMER: reasons for consulting,

regarding, 431. See also Alcohol 238; co-operation of, illustrated, 242-
244; letters to, 331
DRUGGIST: aa a witness, 275, 282
EMPLOYERS, PRESENT: reasons for consult-
DRUGS: queries regarding use of, by aa in-
ing, 238; dangers involved in consulting,
ebriate, 43 1 ; by parents of a patient pos-
244; co-operation of, illustrated, 245
sibly insane, 436; by possibly insane pa-
tient himself, 438 EMPLOYERS, PROSPECTIVE: may create con-
ditions for investigation by experiment,
DRUNKARD, REFORMED: no longer correct to 236, 245; relations of social workers
speak of, 429 with, 238; circumstances under which
DUBOIS, PAUL, M.D., 49, 116, 136, 347, 355 they must be seen, and dangers in seeing,
DUNCAN, NORMAN, 420 246
DUPLICATE INQUIRY: letters of social workers EMPLOYMENT BUREAUS, STATE: consulta-
making, 326 tions with, by social agencies, 287
EMPLOYMENT CERTIFICATES. See Working
Papers
EARNINGS: evidence regarding, 241; in-
ENGLAND: beginnings of social diagnosis in,
stances of mis-statements regarding, by 28
clients, 246; inaccurate statements re- ENLISTMENT RECORDS, ARMY AND NAVY: use
garding, made in good faith, 247. See of, as means of locating men, 260
also Financial Situation
ENVIRONMENT: bias due to, 75-76; queries
ECONOMIC and more comprehensive approach regarding, for any family, 381; for a
to social diagnosis, 28 widow's family, 402
ECONOMIC INDEPENDENCE: possible assump- ETHICS: personal as contrasted with social
tions regarding, 96 standard of, 76
ECONOMIC STATUS: inferences as to, based on ETIOLOGY: of a child possibly feeble-minded,
part of house occupied, 89 queries regarding, 442
EDUCATION: social diagnosis to become an
_ EUGENIC DATA: obtaining of, from relatives,
adjunct in, 26; bias due to special, 75;
queries regarding, for any family, 380;
186-187
in native country of immigrant group, EUGENICS RECORD OFFICE: general terms use
383-384; queries regarding, for the blind, of which is warned against by, 349
422-423; for a homeless man, 426; for EUGENICS WORK: use of cemetery records in,
a patient possibly insane, 437 261
EDUCATORS recognizing need of social his- EVERYBODY: what is true of, 375-377
tories of pupils, 45
ELBERFBLD: poor relief system in, 28 EVIDENCE: denned, 55; types of, 56-62;
direct and indirect, trustworthiness of,
ELIOT, ADA. See Sheffield, Mrs. Ada Eliot 60; indirect, cumulative effect of itemg
ELLIS ISLAND: records at, likely to under- of, 60; gathered to corroborate or dis-
state children's ages, 257 prove a theory, value of, 87; importance
of ability to weigh risks involved in
EMERGENCY INTERVIEWS: illustrations of,
different types of, 98; items of, time for
131-132
considering as a whole, 98; total of, that
EMIGRATION: from native country, province, reveals no plan of action, shows need of
and town of immigrant group, queries further inquiry, 176; review of each item
regarding, 385; of an immigrant family, of, with others in mind and excluded,
queries regarding, 388-389
349-35p; importance of looking for con-
EMOTIONAL CONDITION: of a patient possibly tradictions in, 350. See also Real, Testi-
insane, queries regarding, 440 monial, Hearsay, Circumstantial, Docu-
EMPLOYERS: not competent witnesses as to mentary, Expert, and Character Efidtntt,
an employe's home conditions, 65-66; and Oral Testimony
personal as contrasted with social stan- EVIDENCE, LEGAL: social evidence differen-
dard of ethics on part of, 76; inference tiated from, 39-43; supplemented by
drawn from man's unwillingness to have social evidence in children's courts, 44
495
INDEX
EVIDENCE, SOCIAL: wider usefulness of, 6, FAMILY LIFE: main drift of, important to
43-So; presentation of subject of, in grasp, 138-139; in native country of
this book, 9; differentiated from other immigrant groups, queries regarding,
kinds, 38-43; may include facts of slight 384; queries regarding, for an immigrant
probative value, 39; need of social family, 388; of parents of a neglected
workers for training in use of, 39; defini- child, queries regarding, 406-408
tions bearing upon, 51; that reveals no
FAMILY PRIDE: collective self-esteem as, 78
plan of action, 176; different forms of,
177; distinguishing characteristic of, 317 FAMILY PROBLEMS: of a widow, queries re-
"EMs and by Mrs. garding, 402-403
of Investigation Relief;"
J. S. Lowell. 31 FAMILY RELATIONSHIPS: re-establishment of,
EXCHANGE, CONFIDENTIAL. See Confidential as result of social work, 194-195
Exchange FAMILY SOLIDARITY: possible assumptions re-
EXPERIENCE, RECORDED: as a starting point garding, 96; placing of children away
in a first interview, no destroys their sense of, 153
EXPERIMENT: importance of, in social work, FAMILY WORK: what should be learned hi first
284. See also Investigation by Experi- interview in, 126; outside sources of in-
ment formation most used in, 168, 169
EXPERT EVIDENCE: advantage and disad- FATHER: unmarried, ways of dealing with,
vantage of, 6 1 illustrated by case notes, 144-145; un-
EXPRESSMEN: as witnesses, 289 married, queries regarding, 416. See
also Parents
EXTRADITION OF DESERTERS: state laws re-
garding, 395 FEEBLE-MINDED CHILD, QUESTIONNAIRE RE-
EYESIGHT: conservation of, queries regarding, GARDING A POSSIBLY, 441-448
421 FEEBLE-MIND EDNESS: evidence regarding,
furnished by social agencies, 43, 44;
school evidence regarding, 228-229;
social worker should not attempt to make
FACE CARD experiment of drawing inferences
:
diagnosis of, 434
from, 83, 85; of Ames family, repro-
duced, 84; mistake of letting first inter-
FELLOW PUPILS: consultation of, 233
view be shaped by, 122; use made of, by FERNALD, W.
E., M.D., 43, 44
three medical-social workers, 128 FICTION: of native country of immigrant
FACTS: and unverified statements, confusion groups, as an aid to study of them, 385
between, illustrated, 53; defined, 53; FINANCIAL SITUATION: queries regarding, for
and inferences, confusion between, illus-
any family, 380; for a deserted fam-
trated, 54; difficulties in way of gather-
ilyt 3997400; for a widow's family, 404;
ing, 54; dealing with, a delicate process for a blind person, 423-424; for a home-
according to the N. Y. Evening Post, 55; less man, 426; for an inebriate, 432
importance of ability to discriminate be-
tween inference and, 98 FIRST IMPRESSIONS: lasting, hence need of
guarding against, 350-351
FACULTIES, CO-ORDINATION OF: in a child
"FIXED ORDER" type of first interview, 121,
possibly feeble-minded, queries regard- 122
ing, 446-447
FAMILY: shifting, inference regarding, 81, 90: FLEXNER, BERNARD, 44, 45, 143
discussion of organization of, no part of Flock, The: by Mary Austin, 96
plan of this book, 134; need of adjusting FOLK WAYS: of native country of immigrant
interests of individual to interests of,
groups, poetry and legend illustrating,
136, 137; the united and the unstable,
385
139; causes of estrangement in, 140; of
a young able-bodied man, interference FOOD: inference regarding minimum amount
with, 145; food habits of, 148-150; a family can live on, 82, 86; habits of
housing of, important points to look for family regarding, importance of, and
in, 151; what is possibly true of any, ways of getting at, 148-150
377-381. See also Any Family, Ques- FOOTNOTES: in this volume, why cut in cer-
tionnaire regarding tain cases, ii
Family, The: by Helen Bosanquet, 139, 152 FOREIGN CORRESPONDENTS: choice of, 326
FAMILY AGENCIES: possible assumptions of FOREIGN DRAFTS: as means of establishing
workers in. 95; changes in policy of, as whereabouts, 261
to place of first interview, 106; failure FOREIGN LANGUAGE PRESS: insights to be
of, to individualize children, 153; con-
gained from, 386
sultations with school sources by, 221;
use of present neighbors by, 273, 276 FOREIGN NEIGHBORHOODS: value of advice
of leaders in, 282, 386; in American
FAMILY GROUP: need of taking into account cities, contact of parishioners and clergy
plans and ideals of, 126; need of taking In, 300
into account, in all forms of social work,
134-137; important points to be con- FOREIGNERS: workers among, sometime! as-
sidered regarding children in, 152-156; sume that immigration is a menace, 95.
influence of relatives and others who are See also Immigrants and Immigration
members of, 156-158; queries regarding FOREMEN: value of , as sources of information,
social worker's relations with, 430 247
496
INDEX
FOREWOMEN: opportunity of, to do social 204; queries regarding, for any family,
work, 247 379; for an immigrant family, 392-393;
FORM: used in gathering statistics of outside for a deserted family, 399; for a widow's
sources, 466. See also Blank Forms family, 402; for an unmarried mother,
412; for a blind person, 421-422; for a
"Foundations of Educational Achievement:" homeless man, 427-428; for an inebriate,
by E. L. Thorndike, 369 432; for a patient possibly insane, 439-
FOUNDLING: references of a, 163 440; for a child possibly feeble-minded,
FRATERNAL ORDERS: as sources of informa- 443-444. See also Mental Conditions
tion, 290-291 HEALTH AGENCIES: possible assumptions of
Friendly Visiting among the Poor: by M. E.
workers in, 96; information regarding,
Richmond, 147 easily obtained in first interview, 125-
126; as sources of information in three
FRIENDS: as sources of information in three cities, 167
cities, 167
HEALTH DEPARTMENT, NEW YORK CITY:
FROST, ROBERT, 296 service from, reported by N. Y. C. O. S.,
FUNDED THOUGHT: denned and illustrated, 210; evidence of age accepted and re-
66-68 jected by, 257-258
HEALTH WORKERS. See Medical-social Work
and Workers
GALICIAN FARMERS: illiteracy among, 89
HEALY, WILLIAM, M.D., 34, 117, 129, 136,
GESTATION: of a patient possibly insane, 437 ;
137. ISO, 153. 314, 375
of a child possibly feeble-minded, 443
HEARSAY EVIDENCE: illustrations of, 53, 58,
GIRLS' REFORMATORY WORKER: on need of
77. 173-174. 215. 279; in social work and
new investigations in certain cases, 312; in the law, 57; employers' testimony on
how standards were advanced by, 363 certain matters merely, 240-241; social
GIRLS, SOCIETY FOR CARE OF: illustration of workers too likely to accept, regarding
obtaining medical instructions through property, 262
a physician furnished by, 217-218
HENDERSON, CHARLES R., 28
GODDARD, HENRY H., 34 HEREDITY: need of studying, in cases of
GODPARENTS: in certain foreign groups, 194; suspected insanity, 187; queries regard-
names and addresses of, on baptismal ing, for an inebriate, 430; for a patient
records, 262 possibly insane, 436-437 for ;
a child pos-
GOOD FAITH: tests of, in witnesses, summar- sibly feeble-minded, 442-443
ized, 64 HIGGINS, ALICE. See Lolhrop, Mrs. William H.
GOVERNMENT: immi-
in native country of HILL, OCTAVIA, 29, 30, 34, 147, 370
grant group, queries regarding, 384
HIPPOCRATIC OATH, 216-217
GRADE: evidence of teachers regarding, 223
GRADUATION CERTIFICATES: named in N. Y. HISTORIANS: what the social worker can learn
child labor law as evidence of age, 257 from, 40, 49, 62; summary of tests of
bias and competence formulated by, 64;
GRANDPARENTS AND GRANDCHILDREN: com- attitude of, toward hearsay evidence, 57
radeship between, 157; legal responsi-
bility of, for support, in different states,
HISTORY: importance of seeking early sources
rich in, 170-172, 3 09; need of, illustrated
IPS
by one unfortunate case, 173-174; indi-
GREENLHAF, SIMON, 72 vidual and family, relatives as sources of,
GROCER: as a witness, 282 186-187; of native country of immi-
GROSS, HANS, 4, 9, 49, 66, 68, 116, 393, 346, grant groups, study of, advised, 385; of
349. 350 immigrant family, prior to immigration,
queries regarding, 388; of a patient pos-
GUARDIANSHIP RECORDS: consultation of, in sibly insane, queries regarding, 436, 437.
one city, 255 See also Industrial History
GURTEEN, S. H.. 30 HOME: advantages and disadvantages of
holding first interview in,106-110; need
HABITS: of thought of social workers, that of inquiring into conditions of, in work
interfere with correct inference, 96-98;
with children, 135; analysis of a first
interview in, 464-465; school evidence
queries regarding, for a person possibly
insane, 437-438; for a child possibly regarding care given in, 220-230; early,
of immigrant family, queries regarding,
feeble-minded, 445
387; failure to provide for, queries re-
HALLUCINATIONS: of a patient possibly in- garding, 408; of an unmarried mother,
sane, 440 queries regarding, 414; former life in,
Handbook of Charily Organitation: by S. H. of a homeless man, queries regarding,
Gurteen, 30 426; of a child possibly feeble-minded,
HANDICAPS. See Disabilities queries regarding, 447
HANUS, PAUL H., 368 HOME AND SCHOOL VISITORS: included In

HARVARD MEDICAL STUDENTS: statistical study of outside sources, 161;
course in case of a school girl with St. Vitus's dance
medical-social work for, 36
reported by, 227; case of home malad-
HEALTH: and food consumption, 149, 150 justment reported by, 230; utilization of
shifting of interest from occupation! to, experience of, 333
3* 497
INDEX
HOMBLKSS MAN QUESTIONNAIRE, 425-428 IMMIGRANTS: silence of peasant, 68 69: class

HOMELESSNESS as modifying outline of a
:
bias among peasant, 74; maps and pic-
work record, 239-240 tures helpful in first interviews with, 1 18;
difficulties in holding interviews with,
HOMEMAKING: physical aspects of 148-150,
118, 119; conditions affecting family co-
Homes of the London Poor: by O. Hill, 30 hesion among, 140; presence of boarders
Homestead: by M. F. Byington, 149 in families of, complicates study of food
problems, 149; godparents in certain
HOMICIDE: attempted, on the part of a pa- groups of, 194; lodge doctor, as a source
tient possibly insane, 440 of information regarding, 219; how to
Honesty: by William Healy, M,D.. 34, 150, obtain birth certificates of, 257; diffi-
153 culty of obtaining property data, in cer-
tain groups of, 263; spokesmen of groups
HOSPITALS: advantages ana disadvantages
of social work connected with, 105, 106; of, 282; deportation of, considerations
non-medical facts recorded by, 219; bearing upon, 288; place of pastors and
records of, as evidence of age, 257; rec- priests among, 300; errors that case
ords of. In establishing whereabouts, 261. workers may fall into regarding, 382;
See also Medical-social Departments and suggestions regarding study of groups of,
Medical-social Workers 383-386; mistake of treating merely as
immigrants, 386. See also Workmen,
HOUSEKEEPERS, PRESENT: comments on in-
Foreign, and Italians
formation gathered from. 277
IMMIGRATION: sometimes assumed by city
HOUSES: unfit for occupation, persuading workers to be a menace, 95 as a compli-
;
tenants to move from, 152 cating factor in consultations with rela-

HOUSEWIFE'S SKILL: an asset to be included tives, 202; of groups of immigrants, im-
in family resources, 149 portance of history of, 386
HOUSING: of the family, important points to IMMIGRATION LAW OF 1917: provisions re-
look for in, 151; of an immigrant family, garding deportation in, 393
queries regarding, 392. See also Environ- IMMIGRATION OFFICIALS: consultations with,
ment by social agencies, 288
How to Obtain Foreign Birth Certificates, 257 IMMIGRATION RECORDS: consultation of, in
"How to Take Down a Case: " by W. G. Mart- three cities, 255; children's ages aa
ley, 31 stated in, 257; information contained in
Hull House Maps and Papers, 386 and ways of consulting, 264, 265
IMMORALITY: as a justification for consulting
HULL, IDA, 73, 118 See
present neighbors, 275, 276, 277.
HUSBAND: and wife, common causes of also Morality
trouble between, 140, 182; place of inter-
view with, 143-144; queries regarding INCOME: and outgo, wife authority on, 148;
early life of, for desertion cases, 397; queries regarding, for any family, 380;
for a widow's family, 404
queries regarding death of, for use in a
widow's family, 400 INDEX EXPURGATORTUS: of the social worker,
HUTSINPILLAR, FLORENCE W., 247, 248, 250 349
HYGIENE, PERSONAL: of a child possibly INDEX TO THIS VOLUME: uses of, suggested, 383
feeble-minded, 448 INDIVIDUAL: interests of the, need of adjust-
HYPOTHESES: use of, in investigation, 83, 85, ing to interests of family as well as of
86, 87, 09; confirmation of, by experi- society, 136, 137
ment, 86, 87; resulting from use of INDIVIDUAL BETTERMENT: and mass better-
method of probabilities, 97; danger of ment interdependent, 25, 365, 366
becoming attached to a particular one, Individual Delinquent: by William Healy,
98; formed during two first interviews, M.D., 34. 117. 129. 136. 314. 375
120, 121
INDIVIDUAL DIFFERENCES: psychological con-
cept of, and social progress, 367-368
Individuality: by E. L. Thorndike, 367
"Ideas and Ideals in Medicine:" by S. J. INDIVIDUALIZATION: of the inebriate, impor-
Meltzer, M.D., 54 tant, 147; of children by family agencies,
ILLITERACY: inference regarding relation be- often omitted, 153-154
tween mental ability and, 89 INDUSTRIAL CAPACITY: social acquaintances
ILLITERATES: communication by letter with, as witnesses regarding, 66; of a child
324 possibly feeble-minded, queries regard-
ILLNESS: queries regarding, in case of a per- ing, 447
son possibly insane, 439 INDUSTRIAL ESTABLISHMENTS: personal visits
IMAGINATION: importance of. in social work, to, as compared with letters or telephone
284 messages, 247
Imagination in Business: by Lorin F. Deland, INDUSTRIAL HISTORY: queries regarding, for
284 any family, 379-380; for an immigrant
family, 389-390; for a deserted family,
"Imbecile with Criminal Instincts:" by W. E.
398-399; for a widow's family, 401: for
Fernald. M.D.. 44 an unmarried mother, 415, 417; for a
IMMIGRANT FAMILY QUESTIONNAIRE. 387- homeless man, 427; for a patient pos-
394 sibly insane, 438
498
INDEX
INDUSTRIAL LEGISLATION: influence upon INSURANCE RECORDS: consultation of ,in one

case work of, 32 city, 255
INDUSTRIAL PROBLEMS: of a widow's family, INTELLECTUAL CAPACITY: of a child possibly
queries regarding, 403-404 feeble-minded, 446
INDUSTRIAL SCHOOL AT SHIRLEY: suggesti- INTELLECTUAL DEFECTS : of a patient possibly
bility of boys at, 70 insane, 440-441
INDUSTRY: social diagnosis to become an ad- INTELLECTUAL STATUS: of a homeless man,
junct in, 27; varying conditions in same, queries regarding, 428
as bearing upon case treatment, 237-238
INEBRIATE: should be a patient, 425. 429; INTERMEDIARIES: letters of inquiry addressed
success in treatment of, 429 to, and answers from, 323-326
INEBRIETY: approach to study of problem of, INTERPRETATION: defined, 103; of material

in diagnosis, 355-363
146, 147; as modifying outline of a work
record, 239, 240; denned 429 INTERPRETERS: difficulties in using, illus-
INEBRIETY QUESTIONNAIRE, 430-433 trated, 75; Italian, Miss Ida Hull quoted
INFERENCES: danger of confusing with facts, on use of, 118-119
54; importance of, in diagnosis, 55; de- INTERVIEW, FIRST: part of diagnostician's
nned. 81; how made, 81-85; drawn from task in which personality counts for most,
face card of Ames family, 83, 85: how 104; as modified by the nature of the
corroborated, 85-87; often miscalled in- task, 104; as modified by the origin of
tuitions, 86; errors in, due to mistaken the application, 106; as modified by the
general rule, 88-90; errors in, due to place of the interview, 106-1 10; as modi-
mistaken particular case, 90-91; errors
in, due to mistaken analogy, 91-92; er-
rors in, due to mistaken causal relation,
fied by the recorded experience available
as a starting point, no; scope of,
114; objects of, 114; the approach in,
m
92-93 errors in, due to thinker's predis-
; 115-119; illustrations of successful, 116,
positions, 94; errors in, due to thinker's 117; clues and questions in the, 120-126;
assumptions, 95-96; errors in, due to analyses of, by case workers, 120, 121,
mental habits of thinker, 96-98; impor- 457-465; two types of, 121, 122, 123;
tance of ability to discriminate between taking notes in, 126-129; premature ad-
fact and, 98; illustrations of, furnished vice and promises in, 120-130; tests of
by two first interviews, 120, 121; illus- success of, 130; bringing to a close, 130-
tration of invalid, due to desire of worker 131: emergency, 131-132; report from a
to secure prompt action, 350 medical-social department of a, 135-136
INJURIES: to a person possibly insane, queries INTERVIEWS: best method of approach, 177;
regarding, 437-438 with outside sources, essentials of method
INQUIRY: narrowing and broadening of, in in, 178; with employers, as compared
different types of interview, 343; wider with letters and telephone messages, 247;
aspects of, 351-352, 453; as a whole, main reliance of social worker, 317-318;
queries regarding, 451-453 advances in art of conducting, 319;
INSANE PERSON: terms in which activities of,
methods common to all, restated, 342-
should be described, 435 343; changes of emphasis in different
types of, 343-344
INSANE, QUESTIONNAIRE REGARDING A PA-
Introduction to the Study of History: by Lang-
TIENT POSSIBLY, 436-441
lois and Seignobos, 49, 57, 64, 68, 69
INSANITY: as a justification for the consulting INTUITIONS: mistake in applying term to
of present neighbors, 275, 276, 277; so-
rapid inferences, 86
cial worker should not attempt to make
diagnosis of, 434; previous attacks of, INVESTIGATION: and social diagnosis, 26, 51,
in case of a patient possibly insane, 439. 52; first attempts to introduce, 28, 29;
See also Mental Disease described as repressive, 30; not to be
regarded as an end in itself, 3 1 inference;
INSANITY COMMITMENT RECORDS: consulta- passes through various degrees of cer-

tion of, in one city, 255 tainty during, 83; drawing inferences
INSANITY, STATE BOARD OF: consultations from face card approximates mental
with, by social agencies, 287 processes in, 83; methods that make for
success in, 112, 113; use of interpreters
INSIGHT: relatives as sources of, 188 in, 119; early methods of, 127; Le Play
INSTITUTION WORKER: possible assumptions quoted as to his method of, 128; object
of. 96 of, 130; by visiting present neighbors,
justification of, 274, 276; quality of.
INSTITUTIONAL WORK FOR CHILDREN: need where co-operation lacking, 292; dupli-
of inquiry into home conditions in, 135
cate, and co-operation, 311; before trans-
INSTITUTIONS: public, carelessness of, in en- fer to another agency, extent of, 313-314;
forcing responsibility upon relatives, 195- and plan, lack of connection between,
196; ability of, to supply experience data 348; flaws in, revealed by summaries to
regarding inmates, 297; bias to be al- case committees, 348; need of guarding
lowed for in testimony of, 299 against effect of first and last statements
INSURANCE AGENTS : as a source of informa- in, 350-351
tion, 289 INVESTIGATION BY EXPERIMENT, 86, 87, 236,

INSURANCE POLICIES: as evidence of a child's 245. 297. 299
" "
age, 257 Investigation: by M. L. Birtwell, 31. 107
499
INDEX
INVESTIGATORS: who prided themselves on Layman's Handbook of Medicine: by Richard

catching client tripping. 72; Dr. Adolf C. Cabot, M.D., 212
Meyer's advice to, quoted, 434-435 LEADING QUESTIONS: dangers and uses of,
IRISHMAN, UNNA TOTALIZED: inferences as to explained and illustrated, 71-73; in first
an, 86, 98 interviews, 123
ITALIANS: traits of a group of, 73, 74; diffi- LEE, JOSEPH, 292
culty in testing willingness to work of, LEE, PORTER R., 136
86; use of interpreters with, 118-119;
wives of, often known by maiden name, LEGAL AID SOCIETY: case illustrating need of
search for marriage record reported by,
147; ways of getting information about
employment of, 249; illustrations of con- 259
cealment of property among, 263-264; LEGENDS: of native country of immigrant
concealment of relatives by, 289. See groups, as an aid to study of them, 385
also Immigrants LEGISLATION, HOUSING: reporting defects in
relation to, 151
JANITRESSES: comments on witness of, 277
LEGISLATION, SOCIAL: effect of, upon case
JOINT TRAFFIC AGREEMENTS: In social work, work, 365, 366
294 LEGITIMACY: proof of marriage as bearing
JOWBTT, BENJAMIN, 138 upon questions of, 259
JUDGMENT: ability to form and to suspend, LE PLAY, P. G. F., 128, 139
355 LETTER CARRIERS: forbidden to give infor-
JURISPRUDENCE: social diagnosis to become mation about addresses, 336
an adjunct in, 26
LETTERS: as evidence, 177; compared with
JUVENILE COURT: consultations with rela- other means of communication with em-
tives by, 180; estrangement from chil- ployers, 247 of endorsement accompany-
;
dren caused by parents' complaints to, ing blank forms, 319; "to whom it may
152; intervention of, rendered unneces- concern," 335; about client, mistake of
sary by other measures in certain cases, sending by him, 335; shown by client,
314. See also Children's Court, Chicago preservation of copies of, 335; on closed
Juvenile Court cases, mistake of destroying, 335; origi-
JUVENILE COURT LAW in Chicago secured, 33 nals of, as an evidence of mental disease,
Jtnenile Courts and Probation: education, etc., 335; registered, as a de-
by Flexnerand vice for establishing whereabouts, 336.
Baldwin, 45, 143 See also Letters of Inquiry and Letters
JUVENILE DELINQUENTS: Dr. Healy on of Reply to Inquiries
method of interviewing, 117, 129; con-
fidences between elders and children in LETTERS OF INQUIRY: example of one written
relation to, 153; Dr. Healy's method in prematurely, 174, 321-322; two classes
study of. 375 of, 319; questions that case worker
should ask himself before writing, 320;
should they be written at all? 320;
KINGSLEY, CHARLES, 349 should they be written now? 321-322;
what relation does the particular inquiry
LABOR: signs of change in methods of dealing bear to the whole process? 322; choice
with, 235-236 of the best correspondent for the end in
LABOR, STATE DEPARTMENT OF: consultation view, 323-326; what will interest cor-
with, by social agencies, 287 respondent selected? 326-327; examples
of unfortunate, 327; presentation that
LABOR UNION. See Trade Union will save correspondent unnecessary
LABORERS, DAY: ways of getting information trouble, 327-331; examples of poor. 329;
about, 249 example of good, 330; what facts re-
La Methode Sociale: by Le Play, 128 lating to correspondence should modify?
LANDLORDS: direct appeals to, sometimes
331-333; circular, uses of, 335
effective in remedying abuses, 152 LETTERS OF REPLY TO INQUIRIES: faults of
LANDLORDS, FORMER AND PRESENT: use of, 333-334
in three cities, 273; uses of, and dangers LEVIN, L. H., 58, 262
in consulting, 280-282 LIABILITIES: place of, in diagnostic sum-
LANCLOIS, CHARLES V., 49, 57, 64, 68, 69, 79, mary, 360, 361
173 LIBRARIANS: of children's rooms, 233; as a
LATTIMORE, FLORENCE L., 135, 194. 299 possible source of information, 287
LAW: social case work should profit by ex-
Life and Times ofCavour: by Wm. R. Thayer,
perience of, 40. See also Court
385
LAW SCHOOL GRADUATE: criticism of case LITHUANIAN PEASANTS: silence of, 69
records made by a, 59
LODGE DOCTOR: as a source of information
LAWRENCE, K. L., 124 about foreign families, 219
LAWS: in native country of immigrant group,
LODGERS: influence of, should be considered
queries regarding, 384
in desertion cases, 157; queries regard-
LAWTON, RUTH W., 135 ing, for an immigrant family, 392: for
LAWYER: what the social worker can learn a deserted family, 398, 399 for a widow's
i
from the, 62 family, 403
$OO
INDEX
LOGIC: books on, of use in thia study, 49; MEDICAL REPORT: of diagnosis and prog-
application of, in experimentation, 87. nosis, example of helpful, 209
See also Reasoning
MEDICAL SCIENCE AND PRACTICE: parallel
LONDON: work of Octavia Hill in, 30 between social work and, 366
LONDON CHARITY ORGANIZATION SOCIETY: MEDICAL-SOCIAL DEPARTMENT: illustration
early tendencies in, 29; Occasional Papers of use of leading question by worker in,
of the, 31 72; illustration of employer's biased testi-
LOTHROP, MRS. WILLIAM H., 262, 337 mony given by, 76; report from, regard-
ing a first interview where plan made
LOWELL, MRS. JOSEPHINE SHAW, 27, 31 without seeing man, 135; included in
statistical study of outside sources, 161;
outside sources of information most
MACK, JULIAN W., 34 used in work of, 168, 169; consultations
with relatives by. 180; conflicting diag-
MAIDEN NAME: importance of knowing noses in a case under care of, 206; illus-
wife's, 147; Italian wives sometimes tration of complementary nature of
known by, 14? medical and social data furnished by,
MAN OF FAMILY: should be seen, 143 208; example of better diagnosis ob-
tained through a physician as inter-
MANIFEST SHEETS: as evidence of age, 257 mediary, furnished by, 217; a teacher's
MAPS: value of, in first interviews with im- evidence regarding an hysterical child
migrants, 118 reported by, 227; instances of co-opera-
tion from unions reported by, 250; use
MARRIAGE: inference drawn from unreadi-
of voting list reported by, 260; instance
ness to give date and place of, 88; under of use of present neighbors in an insanity
an assumed name, case of, 259; queries case by, 277; use of sporting editor of a
regarding, for an immigrant family, 388;
for a person possibly insane, 438
paper as a source of information reported
by, 290: experience with masonic lodge
MARRIAGE RECORDS: failure to consult, a reported by, 291; instance of biased
sign of weakness in technique, 164; con- testimony of an institution supplied by,
sultation of, in three cities, 255; points 299; failure of, to consult agency to
to be kept in mind regarding, 258-259; which client had been transferred, 314:
as revealing whereabouts, 260; illustra- use of registered letter to find mother of
tion of use of one, to establish where- patient by, 336; report of, regarding
abouts, 262; dates to be searched in unfortunate results of use of telephone,
looking up, 271 339; misunderstanding over the tele-
MARRIED LIFE: queries regarding, for de-
phone reported by, 340; analysis of in-
terviews with patient in, 457-461. See
sertion cases, 398-399; for a widow with
also Medical-social Workers
children, 401
MASONIC FRATERNITY: relations to social MEDICAL-SOCIAL MOVEMENT: contributions
workers to social diagnosis made by, 27, 34-36
of, 290-291
MASS, CONDITION OF: social workers often MEDICAL-SOCIAL WORKERS: quotations from,
as to place of first interview, 108, 109;
oppressed by, 97 different methods of two, in first inter-
MASS BETTERMENT: and individual better- views, 123; differing use of blank forms
ment interdependent, 25, 363 by, 128-129; thinking of family as a
MASSACHUSETTS: state visiting agency in- whole important for, 136; way of getting
terested in probation, 33 insight into relations between members
of family reported by, 153; instructions
MASSACHUSETTS COMMISSION ON MINIMUM of, to new assistants, 216; importance
WAGE BOARDS, 237 of obtaining evidence of marriage illus-
MASSACHUSETTS GENERAL HOSPITAL: origin trated by. 259; cited on need of new in-
of social service department of, 35; course vestigations in certain cases, 312
in medical-social work for medical stu- MEDICAL SOURCES: frequency of consulta-
dents at, 36 tion with, 204; kinds of, most often con-
MASSACHUSETTS P. C. C.: reasons for
S. sulted, 205; importance of asking for
knowing exact ages of children stated prognosis when consulting, 213; economy
by secretary of, 153 of resources in consulting, 213-215; need
of consulting at first hand, 215; summa-
MAURICE, C. E., 30 ries and reports as means of strengthen-
MCLEAN, FRANCIS H., 6, 10, 175. 221, 280, ing relations with, 218; miscellaneous
282, 302 suggestions as to consulting, 219
MEDICAL AND SOCIAL DATA: complementary MEDICAL TREATMENT: of an inebriate,
nature of, 207-211 queries regarding, 431
MEDICAL CARE, NEGLECT TO PROVIDE: MEDICINE: diagnosjs to become an
social
queries regarding, 408-409 adjunct in, contributions of social
26;
work Dr. Cabot's handbook of,
to, 44;
MEDICAL EVIDENCE: failures in, due to non- for laymen, 212; social diagnosis aa an
social attitude, 205; failures in, due to
adjunct to, 358
conflicting diagnoses and prognoses, 206,
207 MELTZER, S. J., M.D., 49, 54, 55
MEDICAL RECORDS: faults of, 207 MEMOIRS, PERSONAL: weakness of, 68
501
INDEX
MEMORY: as affecting the competence of wit- fused with widow and deserted wife, 358-
nesses 68-69; importance of training of,
, 359. See also Questionnaire regarding an
in interviewing without taking notes, Unmarried Mother
127; documents of original entry, as cor- MOTHERS. See also Parents, Wife, and Widow
rectives for, 254; queries regarding de-
fects of, in a patient possibly insane, 440- MOTHERS' PENSIONS: methods employed by
a dietitian administering, 150
441
MENTAL ABILITY: inference as to relation be- MOVING VAN NUMBER: as a clue in discover-
tween ing whereabouts, 289
illiteracy and, 89
MENTAL CONDITIONS: school -evidence re- MURPHY, J. PRENTICE, 135
garding, 227-229; queries regarding, for
any family, 379; for a widow's family, NATIONAL OR RACIAL BIAS of witnesses, 73-75
402; for a homeless man, 427 for parents ;
of a patient possibly insane, 436; for the NATiys COUNTRY OF IMMIGRANTS: sugges-
tions regarding study of, 383-386
patient himself, 439, 440
MENTAL DEFECT: inferences from illiteracy NATURALIZATION: failure to seek as basis for
and retardation as to, 89. See also Feeble- inference, 86
mindedness NATURALIZATION PAPERS: father's, as evi-
MENTAL DISEASE: dence of a child's age, 257
unfamiliarity of unedu-
cated witnesses with symptoms of, 67; NAVAL TRAINING STATION, U. S.: circular
need of studying family history in cases letter to parents of apprentice seamen by,
of suspected, 187; letters as an evidence 198
of, 335; diagnosed as unemployment due NAVY DEPARTMENT: consultations with, by
to laziness, 358; social worker's contri- social agencies, 288
bution to study of, 434. See also Insanity
NEEDS: of an immigrant family, queries re-
MENTAL HISTORY: of men written in their garding, 393
social relations, 136
NEFF, IRWIN H., M.D., 147, 430
MENTAL HYGIENE MOVEMENT: influence
upon case work of, 32
NEGLECT OF CHILDREN: points of view of
case work agency and court as to evi-
MENTAL STATES: inclusion of social context dence regarding, 41-43; school evidence
in diagnosis of, 357
regarding, 222, 229-230; queries regard-
METHOD OF PROBABILITIES: Sidgwick quoted ing particular form of, 408-411; queries
on, 97 regarding general aspects of, 411-412
METHODS: used in this study, 6-9; of social NEGLECTED CHILD, QUESTIONNAIRE REGARD-
worker that mean narrowed resourceful- ING A, 405-412
ness, 96; in first interview, 104, 112-113, NEIGHBORHOOD EVIDENCE: compared with
115-132; of investigation employed by other types, 273
Le Play, 128; in visiting outside sources
of information, 176178; of approach to NEIGHBORHOODS: previous, obtaining infor-
relatives, 198, 200-202; of consulting mation regarding, hi first interviews, 126:
medical sources, 213-219; of consulting present, significance of frequent use of
school sources, 232-233; of approach to sources belonging to, 164, 167
employers, 246-249; in consultation of NEIGHBORS: former, use of, in three cities,
documents, 260-271; common to all in- 273! present, use of, in three cities, 273;
terviews, 342-344; of case work study, present, dangers and uses of, 274-278;
fruitful and unfruitful, 375-376 former, dangers and uses of, as witnesses,
MEYER, ADOLF, M.D., 114. 131, 218, 352, 278-280
362, 434 NERVOUS DISORDERS: of parents of a patient
MrowivES' RECORDS of births, 256 possibly insane, queries regarding, 436
MINISTER. See Clergymen NEW YORK CHARITY ORGANIZATION SOCIETY:
work of committee to prevent tubercu-
Minority Report of English Poor Law Com- 35 service rendered by N. Y. C.
losis of, ;
mission, Part II, 237 Department of Health to, 210; speci-

MITCHELL, S. WEIR, M.D., 49, 170 mens of variable spellings in social service
MONEY: economies increased out- exchange of, 270, 472-479
in, call for
and work, 149
lay in skill NEW YORK CHILD LABOR LAW: documentary
evidence of age named in, 257
MONTESSORI, MARIE, 45 NEW YORK CITY: social workers in, 25;
MORALITY: queries regarding, for a deserted items covered by birth certificates in, 256
family, 399; for family of a neglected NEW YORK CITY BUREAU OF RECORDS: pho-
child, 408, 409, 410; for an unmarried
mother and the father of her child, 415, tographic copies of records made by, 270
416, 417, 418; for a homeless man, 428- NEW YORK CITY DEATH CERTIFICATE: data
429; for the parents of a patient possibly called for by, 258
insane, 436; for the patient himself, 441; NEW YORK CITY HEALTH DEPARTMENT: ser-
for a child possibly feeble-minded, 445 vices of, reported by N. Y. C. O. S., 210;
MOTHER, UNMARRIED: of second child, for- evidence of age accepted and rejected by,
merly assumed to be hopelessly degraded, 257-258
95 mistake to communicate with father
; NEW YORK Evening Post: quoted in criticism
of child through, 144; case of, reported of a statesman who "dealt with the
by Mrs. Chesley, 190-192; formerly con- facts," 55
502
INDEX
NEW YORK HOSPITALS: non-medical facti OUT-OF-TOWN INQUIRIES: reasons for dissat-
recorded by, 219 isfaction with, 321 ; plans for centralized
NEW YORK PUBLIC LIBRARY: news indices on handling of, 327
shelves of, listed, 269 OVERCROWDING: inference regarding, 8r, 86;
NEW YORK SCHOOL OF PHILANTHROPY: data points regarding, which social workers
should have in mind, 151
prepared for this volume used by author
when Kennedy lecturer of, 10; pamphlet OVERSEER OF THE POOR: good reporting by
of, cited, 25; organization 31 of, an, 310; failure to grasp role of interme-
NBW YORK STATE CHARITIES An> ASSOCIA- diary by an, 324
TION, 30
NEW YORK STATE FACTORY INVESTIGATING PARENTS: legal responsibility of, for support
COMMISSION, Fourth Report, 237 of children, 195 queries regarding, for an
;
NEW YORK Times: index to, 269 immigrant family, 387; for a patient pos-
NEW YORK Tribune: index to, 269 sibly insane, 436
NEWS INDICES: list of, 269 PARSONS, FRANK, 46

PARTICULAR CASE, MISTAKEN: as source of
NEWSBOYS, CITY SUPERINTENDENT OF: con- error in reasoning, 87, 90-91
sultations with, by social agencies, 287
PASSING ON: as a method of charitable relief,
NEWSPAPER FILES: made accessible by cer-
337
tain indices, 269
PASSPORTS: use of, in three cities, 255; ai
NEWSPAPERS, FOREIGN LANGUAGE: insights evidence of age, 256 named in New York
;
to be gained from, 386 child labor law, 257; data needed for
identification of immigrant upon, 265
NON-SUPPORT CASES: importance of present
employer testimony in, 244 PATHOLOGICAL HISTORY: of a child possibly
feeble-minded, 443-444
North of Boston: by Robert Frost, 296
PATHOLOGICAL LYING: need of co-operation
NOTATION OF RECURRENCE: a duty of case in the home when treating, 137
worker and supervisor, 352
Pathological Lying, Accusation, and Swin-
NOTE-TAKING in the first interview, 126-129 by William Healy, M.D., 137
dling:
NO-THOROUGHFARE SITUATIONS: call for fur- PATROLMEN. See Police
ther inquiry, 176 PEASANTS: silence of, 68, 69; class bias
NURSES: habit of some, of dealing with fami- among, 74
liesonly through children, 153; mis- PECULIARITIES of a child possibly feeble-
taken diagnosis by one, 358 minded, 444, 446
Pedagogical Anthropology: by Marie Montea-
sori, 45
OBJECTS OF FIRST INTERVIEW: summarized,
114 PENAL COMMISSIONERS, STATE: consultation!
OBSERVATIONS, FIRST-HAND: of employer,
with, by social agencies, 287
more valuable than his inferences, 243 PENDLETON, HELEN B., 131
OBSERVERS: and witnesses, contrasted, 52 PENSION BUREAU, U. S.: data needed to
Occasional Papers of the London Charity Or- obtain reports on pensioners from, 264
ganisation Society, 31 PERSONALITY: inside truths of, need to be
OCCUPATIONS: queries regarding, for any grasped in first interview, 126
famijy, 379-380; in native country of an PHILOSOPHY: of case worker shapes every
immigrant group, 383; for an immigrant process leading to diagnosis, in; under-
family, 389-390, 393; for a deserted lying case work, 365-370
family, 397, 398, 399; for a widow's
family, 403-404; for family of a neglected
PHYSICAL CONDITIONS: school evidence as to,
child, 406-407 ; for an unmarried mother, 227
415, 417; for a blind person, 423; for a PHYSICAL CONDITIONS, DEFECTS, CHANGES,
homeless man, 427; for a person possibly HISTORY, ETC. queries regarding, for any
:
insane, 438 family, 379; for an immigrant family.

OFFENDERS, FIRST: as subjects for probation, 392; for a deserted family, 399; for a
9i
widow's family, 402; for a neglected
child and its family, 406, 408, 409; for a
OFFICE INTERVIEW: advantages and disad- blind person, 421-422; for a homeless
vantages of, 106-110 man, 427-428; for an inebriate, 431; for
On Thousand Homeless Men: by Alice W. the parents of a patient possibly insane,
Solenberger, 73, 425 436; for the patient himself, 437-438,
ORAL TESTIMONY: main reliance of social 430-440; for a child possibly feeble-
diagnostician, 61; strength and weak- minded, 443
ness of, 317 PHYSICIANS: can throw direct light on social
Our worker's problems, 62; information re-
Slavic Fellow Citizens: by Emily G.
Balch, 75. 386 garding, in first interview, 125-126; as
sources of information in three cities, 167;
OUTGO: queries regarding, for any family, examples of helpful reports to and by,
380; for a widow's family, 404 209; importance of asking for prognosis
OUTLINE of a work record, 239 from, 213; economy of resources needed
503
INDEX
PHYSICIANS (continued) PRINCIPLES governing choice of sources of

by social workers in dealing with, a 13-21 5 ; information outside family group, 169-
antagonized by medical opinions from the 176
non-medical, 216; fuller reports often Principles of Judicial Proof: by J. H. Wig-
obtained from, by fellow practitioners. more, 49, 68, 69, 305
216-217; aa witnesses on non-medical
Printers' Ink: advertiser writing la, quoted,
matters, 219; records of birth kept by,
256; private, statements of, as evidence 54
of age, 257; letters of inquiry to, 331 Prisoners and Paupers: by Henry M. Boies,
PICTURES: useful hi first interviews with im- 285
migrants, 118 PRISONERS, WORK FOR: hampered by condi-
tion of court records, 265
"Pittsburgh as a Foster Mother:" by Florence
L. Lattimore, 135, 194, 299 PROBABILITIES, METHOD OF: should not be
PLANS: premature, in first interviews, 130; used if it is possible to get the facts, 97
queries regarding, for any family, 381; PROBATION: first offenders as subjects for, 91
for an immigrant family, 391; for a PROBATION OFFICER: illustration showing in-
deserted family, 397; for a widow's fluence of, 70; illustration of bias on part
family, 403, 404; for an unmarried of police given by, 75; experience of,
mother, 419; for a homeless man, 428; with girl shoplifters, 77-78; method of,
for an inebriate, 432-433; for a child la first interview, modified by nature of
possibly feeble- minded, 448 task, 105; often fails to see fathers of
Play in Education: by Joseph Lee, 292 children, 143; tells of girl who held
PLAYGROUND AND RECREATION DIRECTORS: grudge against mother, 152; experience
utilization of experience of, 233 of, with relatives, cited, 184; case of co-
operation from relatives reported by,
POETRY: illustrating folk ways in native 193-194; report of, regarding a teacher's
country of immigrant groups, 385 evidence on feeble-mindedness, 226; ad-
POLES: attitude of, toward Russians, 75; vantages of early visit to school reported
estimate of cost of food for her family by by, 232; need of care in consulting em-
a Polish woman, 149 ployers reported by, 244; quoted on use
and found bu- of present neighbors, 274; use of present
POLICE DEPARTMENTS: lost
reaus of, 261 neighbors in a court case reported by,
277; quoted on value of police in social
POLICE OFFICIALS: bias on part of, as seen by work, 285; case of girl who gave false
a probation officer, 75; differences in use name reported by, 318; instance of self-
of, as sources of information in three
supervision by, 349-350
cities, 167; as witnesses, uses of, 285-
PROBATION WORK, ADULT: included in sta-
287; one quoted on unsatisfactoriness of
tistical study of outside sources, 161;
letters, 317-318 use of present neighbors hi, 273
POLICE PRECINCT BOOK: use of, as a source
of information, 261
PROBATION WORK, JUVENILE: origin of, 33;
included in statistical study of outside
Poor Relief System in Elberfeld: by A. Doyle, sources, 161; no study of, possible in two
28 cities, 167; teachers' evidence and, 222:
Positions in Social Work: by E. T. Devine records of conduct of other members of
and Mary Van Kleeck, 25 family hi, 265
POSTMASTERS: consultations with, by social PROBATIONERS: work for, hampered by con-
agencies, 288; use of, as sources of in- dition of court records, 265
formation, 336 PROGNOSES, MEDICAL: conflicting, illustrated,
POVERTY, CAUSES OP: distinguished from 206; importance of asking for, 213
causal factors in the particular case, 360 PROMISES, PREMATURE: in first interview,
PREDISPOSITIONS OF SOCIAL WORKER: risks 129, 130
arising from, 94, 98 PROOF: defined, 55
PREJUDICES OF SOCIAL WORKER: may influ- PROPERTY: a matter of public record, 123
ence judgment, 97
PROPERTY RECORDS: consultation of, in three
Preliminary Treatise on Evidence at the Com- cities,255; as revealing whereabouts,
mon Law: by James B. Thayer, 49, 56, 260; uses of, 262-264
269 PSYCHIATRIST. A DISTINGUISHED: quoted re-
PRENATAL HISTORY: of a patient possibly in- garding questionnaire on a child possibly
sane, 437; of a child possibly feeble- feeble-minded, 228
minded, 443 PSYCHIATRISTS: Dr. Adolf Meyer's instruc-
PRESSURE OF WORK: influence of, upon social tions to, applied to method of conducting
diagnosis, and how it may be overcome, first interview, 115
361-363 Psychic Treatment of Nervous Disorders: by
PREVENTIVE MEASURES: promotion of, an Paul Dubois, M.D.. 116, 136, 347
important part of charity organization PSYCHOLOGICAL CLINIC of University of Penn-
work, 32-33; and transfer among agen- sylvania, 34
cies, 3I3-3U PSYCHOLOGISTS: can throw direct light on
PRIESTS letters to, by a worker for the blind
: ,
social worker's problems, 62; inquiry
331-332 into witnesses' powers, etc., must come
PRINCIPALS. See Teachers from, 66
504
INDEX
PSYCHOLOGY: in psychological clinic and psy- RECREATION: queries regarding, for any
chopathic institute, 34; need that case family, 381; in native country of immi-
workers should know more about, 49; grant groups, 383; for a deserted family,
social diagnosis as an adjunct to, 358; 399; for the blind, 424; for a child pos-
two concepts of, that underlie social case sibly feeble-minded, 446
work, 367-370 RECREATION MOVEMENT: influence upon case
PsYCHONEUROTic PATIENT: analysis of initial work of, 32
interviews with a, 457-461 RECURRENCE, NOTATION OF: a duty of case
PSYCHOPATHIC INSTITUTE of Chicago Juvenile worker and supervisor, 352
Court, 34 REFERENCES: definition and history of term,
PUBLIC DEPARTMENTS: character of investi- 52; investigating of, by one unfamiliar
gations in some, 302 with problem, 176-178; worthlessness of ,
PUBLIC OFFICIALS as sources of information, 2S4
285-288 REFORM SCHOOL: consultations with relative!
Public Organization of the Labor Market, Part by a, 180
II of the Minority Report of the English REFORMS, SOCIAL: and social case work, in-
Poor Law Commission, 237 terdependence of, 25, 32, 365; in which
PUTNAM, JAMES JACKSON, M.D., 4, 26, 136 teachers are interested, 231; that have
been outgrowths of case work, 365
REGISTERED LETTERS: uses of, 336
QUESTIONNAIRES: place of, in this study, 8,
REGISTRATION BUREAUS: beginnings of, 294,
9: objects and dangers 373-374; use
of,
See also Confidential Exchange
of, illustrated, 374-375; regarding any
family, 378-381 regarding an immigrant
;
REHABILITATION AGENCIES, FAMILY. See
family, 387-394; regarding a deserted Family Agencies
family, 395-400; regarding a widow with RELATIVES: not necessarily competent wit-
children, 400-404; regarding a neglected nesses regarding a client, 65 bias of self-
;
child, 405-412; regarding an unmarried esteem as affecting testimony of, 78; for-
mother, 414-419; regarding a blind per- mal questions as to, likely to bring untrue
son, 421-424; regarding a homeless man, answers, 123, 124; use of term in this
425-428; regarding an inebriate, 430- book defined, 124, 180; illustration of
433; regarding a patient possibly insane, client's error in thinking consultation
436-441; regarding a child possibly with, useless, 124; importance of securing
feeble-minded, 441-448; for supervision clues as to, in first interview, 125; who
and review, 440-453 are members of family group, influence of,
156, 157; as sources of information in
three cities, 167$ principle that should
RACIAL OR NATIONAL BIAS of witnesses, 73-75 govern consultation of, 170-172; on two
REAL EVIDENCE: defined, 56, 57 sides of family, need of seeing, 175; num-
REASONING: from particular cases to general bers consulted by different types of agen-
cies, 1 80; objections of clients to having
rule, 81; from general rule to new fact
social worker see, 180, 186; prejudice and
about particular case, 82, 83; risks in-
volved in, 87-93; sound, fundamental to partisanship of, 181-183; failure of, to
social diagnosis, 09; processes of, illus-
know and understand, 183-186; discrimi-
trated in two first interviews, 120, 121;
nation needed in choice of which ones to
see, 185; tendency to turn children pve_r
place of, in early stages leading to diag-
to care of, 185-186; as sources of indi-
nosis, 178
vidual and family history, 186-187; as
RECONSTRUCTION: importance of noting sources of insight, 188; backing and co-
assets for, 157 operation from, 189-194; right of, to be
RECORDS, MEDICAL: faults of, 207; non- considered, 194; questions of support
medical information contained in, 219 from, 195-200; examples of unwise ap-
RECORDS, PUBLIC: ages and property in, 123;
proach to, 198, 199; enforcement of finan-
cial responsibility upon, 199; illustration
as sources of information in three cities,
of concealment of, 279; undertaker as a
167; consultation of, in three cities, 255;
source of information regarding, 280-290;
indicating whereabouts, kinds and uses,
letters of inquiry addressed to, 322-323;
260-262; keeping of, in different places,
method of consulting, 260-271; essentialsin letters of inquiry to, 328-329;
269;
photographic copies of, in New York, 270. queries regarding, for a widow's family,
See also Marriage Records, Birth Records, 404; for a homeless man, 428
etc. RELIEF: questions of, in interviews with rela-
RECORDS, SOCIAL CASE: study of, made for
tives, 198; prevention of overlapping
this volume, 7; edited for teaching, 7; of, and the confidential exchange, 307;
careless handling of facts in some, 54; queries regarding, for any family, 381;
defects in, pointed out by a law school for an immigrant family, 392; for a de-
serted family, 397. 400; for a widow'i
graduate, 59; J. M. Vincent quoted on,
68; uses of face card of, in drawing in- family, 402; for a neglected child, 410,
ferences, 83, 85; instruction to enter 411, 412. for a blind person, 423-424
"nothing but the facts" on, 94; proc- RELIEF DEPARTMENTS: public and private,
esses by which diagnosis arrived at not included in statistical study of outside
revealed in, 348; reasons why they can- sources, 161; public outdoor, consulta-
not be reproduced, 352 tions with relatives by, 180
505
INDEX
RELIEF ORDER, PUBLIC: inference regarding SCHEDULE USED IN STUDY OF OUTSIDB

possibility of family's living on, 82 SOURCES: result of early experiment
RELIEF SOCIETIES: careless handling of facts with. 163; reproduced, 466
by one, S3; changes in policy as to place SCHOLARSHIP: evidence of teachers regarding,
of first interview by, 106; consultations 224
with relatives by, 180; use of present SCHOOL CENSUS RECORDS: use of, reported
neighbors by, 273 by a child labor committee, 262
RELIGION: in native country of immigrant
School Efficiency: by Paul H. Hanus, 368
group, queries regarding, 384
RELIGIOUS AFFILIATIONS: SCHOOL EVIDENCE: in cases studied, 221;
queries regarding,
for any family, 380-381; for an immi- place of, in social work, 222; as to grade,
223; as to scholarship, 224; as to atten-
grant family, 391; for a deserted family,
dance, 225; as to behavior, 226; as to
399; for a widow's famijy, 404; for the
family of a neglected child, 407; for an physical condition, 227; as to mental
condition, 227-229; as to home care, 229;
inebriate, 433
as to results of social treatment, 230-231;
Report of the Inspector under the Inebriates Act, defects of, 231-232; method hi gathering,
1909: by R. W. Branthwaite, 429 232-233
REPORTS TO MEDICAL SOURCES: useful in SCHOOL HISTORY RECORD CARDS: informa-
strengthening relations, 218 tion called for on, 223
RESEARCH, SOCIAL: investigation and, 53 SCHOOL RECORDS: as evidence of age, 257-
RESIDENCE: inference regarding constant 258
changes of 8 1 legal, need of establishing,
, ; SCHOOLING : queries regarding, for any family,
261 380. See also Education
RESIDENCES, PREVIOUS: obtaining informa- SCHOOLS: advantages and disadvantages of
tion regarding, in first interview, 126; social work connected with, 105, 106;
principle of choice of those to be visited, information regarding, easily obtained hi
278, 279 first interview, 126; as sources of infor-
RESOURCES: queries regarding, for an immi- mation in three cities, 167; as one-
grant family, 393; for a widow's family, headed sources, 175; individual and mass
404 treatment hi, 368
"Responsibility of Family Life:" by Annie L. SCIENCE, NATURAL: methods of, contrasted
Chesley, 192 with those of social case work, 40, 43;
observers hi, contrasted with witnesses,
RESTATEMENT of certain aspects of earlier
53
processes in social diagnosis, 342-347
SCIENTIFIC SHOP MANAGEMENT: need of
RETARDATION IN SCHOOL: inference as to, 89
social technique in, 48
RICHMOND, M. E., 147 SCOPE: of first interview, 111-114; of a work
RISKS: involved in thinking, 87^-93; arising record, 239
from the thinker's state of mind, 94 SEAMEN. See Sailors
ROOMS: number of, occupied, inference from, SEARS, AMELIA, 81, 88, 155, 241, 349, 274,
81. 86; extra, inference from family's 276, 282
not renting, 83, 85, 86; dark, duty of
social worker regarding, 151
SEIGNOBOS, CHARLES, 49, 64, 68, 69
SELF-DISCIPLINE: in training memory, im-
RULE, MISTAKEN GENERAL: as source of portant to case worker, 127
error hi reasoning, 87, 88-90
SELF-ESTEEM: collective, a form of self-Inter-
RULES that save trouble of thinking, 171 ested bias, 77, 78; social workers' lia-
RUMORS: regarding property too often ac- bility to bias of, 79
cepted, 252; unfavorable, visits to former SELF-HELP: importance of beginning to de-
residences may disprove, 279 velop, in first interview, 114
RUSSELL SAGE FOUNDATION: this study made SELF-INTEREST: bias due to, as affecting
ince author became a member of staff of, testimonial evidence, 76-78
6; associates of author in, 10 SELF-SUPERVISION: suggestions for, 340-351
RUSSIANS: antipathy of Poles for, 75 SELF, THE WIDER: concept of, underlies
social case work, 368-370
RUTHENIANS: attitude of, toward Poles, 75
Sermons, Biographical and Miscellaneous, by
Benjamin Jowett, 138
ST. Louis: investigation of foundlings in, 163 SETTLEMENT LAWS: as complicating factors
in social work, 261
SAILORS: evidence contained hi discharge
papers of, 249 SETTLEMENTS, SOCIAL: considered in this
book among social agencies, 282; type
SALMON, LUCY, 9 of evidence supplied by, 209-300; train-
SALMON, THOMAS W., M.D., 435 ing of worker in, compared with that of
SALOON KEEPER: as a witness, 282 C. O. S. worker, 300; objections of, to
use of confidential exchange, 307 advice ;
SANITATION: inference as to relation between of leaders in, value to social worker study-
part of house occupied and, 89 ing foreign groups, 386; service of, in
SAYLBS, MARY B., 10 interpreting immigrant life to public, 386
5 06
INDEX
SEWING MACHINE COMPANY: used aa a clue SOCIAL RELATIONSHIPS: of a child possibly
in discovering whereabouts, 289 feeble-minded, 445
SEX LIFE: of a person possibly insane, 438. SOCIAL SERVICE EXCHANGE. See Confidential
See also Morality Exchange and Social Service Exchange,
SHEFFIELD, MRS. ADA ELIOT, 9, 182, 413, 414
New York
SHERIFFS: consultations with, by social SOCIAL SERVICE EXCHANGE, NEW YORK:
variable spellings in, 270; specimen list
agencies, 287
of variable spellings in, 472-479
SHIFTING FAMILY: inference regarding, 81, 90
SOCIAL STATUS: of parents of a patient possi-
"SHOP:" knowledge of, as to home condi-
bly insane, 436
tions, 241
SOCIAL TREATMENT: school evidence regard-
SIDGWICK, ALFRED, 49, 87, 97 ing, 230-231
SlMKHOVITCH, MRS., 196, 197 SOCIAL WORKERS: invited to send criticisms of
SISTERS: legal responsibility this volume to the author, n; in U. S.,
of, for support
in different states, 195 a large group, 25 desire of physician to
;
engage one, for service to a private pa-

SLAVIC NATIONALITIES: racial bias among, 75 tient, 27; beginnings of training for, 31,
SMITH, ZILPHA D., 72, 197, 270, 308, 310 32; and court, difference in point of view
between, 42, 43; need of diagnostic skill
SOCIAL ADJUSTMENT: queries regarding, for in dealing with courts, illustrated, 45;
an immigrant family, 390-392 attitude of, toward hearsay evidence, 57;
SOCIAL AGENCIES: that trust intuitions, as tendency on part of some, to accept un-
witnesses, 66; types of, included in sta-
favorable testimony too readily, 59; char-
tistical study of outside sources, 161 as ;
acter evidence as used by, 61, 62: should
sources of information in three cities, 167 ; understand tests of a witness's bias and
records of, as evidence of age, 257; con- competence, 64, 65; will have to apply
sultations with, in 2,800 cases examined, elements of psychology in social work, 66;
296-297, 298; as witnesses, of their own funded thought of, 67-68; suggestibility
of clients as affecting work of, 70; dan-
experience, 297-301; as witnesses, of
data that they have gathered, 301-303; gers of leading questions to be guarded
changes of management in, 302; influ- against by, 71; should shun small sub-
ence upon, of a confidential exchange, terfuges, 72; racial or national bias as
304-305; in Boston, use made of confi- affecting work of, 73~75; cannot ask wit-
dential exchange data by, 308-310; trans- nesses to violate their own standard of
fers and co-operation among, 313-314; ethics, 76; liability of, to bias of self-
conferences of representatives of, about esteem, 79; use of hypothesis by, 85;
risks arising from predispositions of, 94;
difficult cases,315; indirect communi-
cations between, unwise, 315; letters of formerly instructed to enter "nothing but
inquiry to, 333; queries regarding rela- the facts" on records, 94; risks arising
tions with, for any family, 381; for a from assumptions of, 95; habit of con-
deserted family, 397, 400; fora widow's sulting same few sources hampers some,
family, 402; for family of a neglected 96; absorption in individual case and op-
child, 410-411, 413 pression by condition of mass among, 97 ;
and Ethical Mental warning to, about use of method of proba-

Social Interpretations in bilities, 97; risk that personal prejudices,
Development: by James Mark Baldwin, etc., may influence judgment of, 97, 98;
369 desire of, for prompt action, responsible
SOCIAL CASE WORK: methods and aims should for invalid inference, 98, illustrated, 350;
be same in all types of, 5 beginning proc-
; skill of, as shown in first interview, 104;
esses of, alone discussed here, 6, 26; method of, in first interview, as modified
and social reform progress together, 25, by nature of task, 105; method of, as
365; uses of, in other fields, 27; develop- modified by place of first interview, 106-
ment of technique in, 32; dangers to, no: method of, as modified by origin of
when an adjunct in clinic or court, 36; application, 106; mental equipment and
danger that beginners in, will become philosophy of, as affecting first interview,
hypercritical, 79; drawing inferences in; one of long experience quoted on
from a face card good drill for a beginner method in first interview, 1 12-1 13; asked
in, 83; extreme subdivision of, 106; as to write analyses of first interviews, 120;
team work, 114; sources consulted in two types of interviewers among, 121,
different types of, 167-169; four stages in 122-123; one quoted on misuse of face
development of, in U. S., 293: third stage card, 122; should train memory, 127;
of co-operation in, 294-295; highest form convictions of, about family, influence
of co-operation in, 295-296; ways of ad- and are influenced by his work, 134; acts
vancing standards in, 362-363; part of, of, may influence members of family he
inwork for the inebriate, 425, 429-430. has not seen, 134; should take family
See also Social Workers history and home conditions into account,
SOCIAL CONDITIONS: queries regarding, in 134-137; welcome chance to see family
case of an inebriate, 432 together at beginning, 137; should seek
to grasp main drift of family life, 139;
SOCIAL DATA: and medical data, 207-211; suggestions as to study of food habits of
queries regarding, for any family, 378- family by, 148-150; housing defects that
379 should arrest attention of, 151; habit
SOCIAL INSTINCTS: of a person possibly in- of some, of dealing with families only
sane, 438-430 through children, 153; not over invest!-
507
INDEX
SOCIAL WORKERS (continued) locating men reported by, 260; use of
gating, 163; tendency of, to dwell on present neighbors by, 273, 274, 276, 277;
present situation of clients, 169; seven unfounded complaint from a landlord re-
principles that should govern choice of ceived by, 281; suggestion as to dealings
clues to be followed up by, 170-176; with police offered by worker in, 286;
principles that should govern, in dealing case reader's notes on effects of a change
with medical data, 187; responsibility of, of management in, 302 court work ren-
;
for obtaining early medical diagnosis, 211, dered unnecessary by other measures in,
should never attempt to make a medical 314; letter to a father by, 332; letters
diagnosis, 211, 216; medical literature for, shown by clients copied by, 335; use of
212; need of economy of -medical re- telephone in rural districts reported by,
sources on part of, 213-214; etiquette of 339
relations of, to incompetent physicians,
214; can sometimes obtain fuller reports SOLENBERGER, MRS. ALICE W., 73, 42$
from physicians through physicians, 217; "Some Conditions Affecting Problems of In-
school sources imperfectly used as yet by, dustrial Education in Seventy-eight A meri-
221 help that may be given teachers by,
;
can School Systems:" by Leonard P.
233; employed by industrial establish- Ayres, 202
ments, approach should be made through, SOURCES OF INFORMATION: habit of consult-
247 warned to distrust their own knowl-
;
ing same few, 96
edge in accident cases, 247-248; substi-
tution of a developing for a static pro- SOURCES OF INFORMATION OUTSIDE FAMILY
gram by, in dealing with employers, 251 ;
GROUP: reasons for consulting, 160; sta-
can seek source behind document, 254; tistics of, how gathered, 161, 162; average
interest of, in securing better public number consulted, means little, 163;
Fecords, 255; too likely to accept hear- twenty most used in three cities, 165;
say evidence regarding property, 262; order of consultation in three cities, 166;
acquaintance with public records needed most used in different types of social
by, 271 importance of relations to client
;
work, 167-169; principles governing use
and to other agencies, compared, 294; of, 169-176; groups of, one-headed and
duplicate letters of inquiry by, 326; les- other, 175; method in visiting, 176-178;
8ona drawn from Dr. Cabot and Dubois importance of discovery of new, 284; pro-
for, 347-348; Index Expurgatorius of, portion of out-of-town, among those con-
349; two kinds of equipment needed by, sulted in 2,800 cases, 321; in consulting
376; knowledge of local laws and ordi- which, inquiry can safely be narrowed,
nances regarding deserters assumed in, 343-344; discrimination in choice of, 344-
295; Dr. Adolf Meyer's advice to, quoted, 346; queries regarding case worker's use
434-435 a supervision and review ques-
;
of, 430-451; form used in gathering sta-
tionnaire for, 449-453 tistics regarding, 466; table giving in full,
for three cities, 467-469; table giving by
SOCIETY: discussion of theories of, no part of agencies, for one city, 470-471
plan of this book, 134
SPECIAL DELIVERY LETTERS: and registered
SOCIETY TO PROTECT CHILDREN FROM
letters, 336
CRUELTY: worker who went from a
charity organization society to, quoted, SPECIALIST: overemphasis of the, need of
39; method of agent of, in conducting guarding against, 96
first interviews, 104, 129; opinion of gen-
SPECIALIZATION AMONG SOCIAL AGENCIES:
eral secretary of, as to place of first inter-
necessitates exchange of information, 303
view, 1 08; account of first interview by
worker in, 117; emergency interview re- SPELLINGS, VARIABLE: each community
ported by agent of, 132; interviewing of should work out its own list of, 270; con-
husband and wife by worker for, 143; fusion caused by, illustrated, 271; list of
included in statistical study of outside specimen, recorded in a social service
sources, 161; distinction of supplemen- exchange, 472-479
tary clue in work of, 175; consultations SPORTING EDITOR: consultation with, re-
with relatives by, 180; experience of,
ported by a medical-social department,
with relatives, illustrated, 183, 184; case
290
of children improperly placed with grand-
parents cited by, 186; story of reuniting Standard of Life: by Helen Bosanquet, 368
of brothers placed out from a foundling Standard of Living: by R. C. Chapin, 128
asylum supplied by, 195; approach to STANDARDS IN SOCIAL CASE WORK: attempts
relatives in a difficult case by agent of,
to establish, 25, 30; ways of advancing,
201; instance of non-social attitude on
part of a physician reported by, 205 ex- ;
362-363
perience of, with conflicting medical diag- STATE ARCHIVES: in which birth records are
noses and prognoses, 206; illustration of assembled, 256
mistaken diagnosis by, corrected by evi-
dence from medical field, 208; habitual STATE BOARD OF CHARITY: letter of inquiry
consultation with schooj sources by, 222; by a, cited, 330
fellow pupils consulted in a few tasks of, STATISTICAL STUDY: made for this volume, 8
233; instances of valuable employer tes- STATISTICS OF OUTSIDE SOURCES: how gath-
timony reported by, 243; case of father
who left children alone reported by, 244- ered, 161, 162; form used in gathering,
245; cases where consultation of birth 406
records necessary, reported by 256; use STORE INSPECTORS, CITY: consultations with,
of voting list and enlistment records in by social agencies, 287
5 08
INDEX
"STREAM PICTURES": as evidence of feeble- TELEPHONE: communication by, uses and

mindedness, 43 dangers 337-340
of, 247,
STREET GUIDES: use before sending out-
of, TEMPERAMENT: queries regarding, for a pa-
of-town letters of inquiry, 333 tient possibly insane, 438-439; for a
STREET INSPECTORS, CITY: consultations child possibly feeble-minded, 445
with, by social agencies, 287 TESTIMONIAL EVIDENCE: probative value of ,
Street's Pandex of the News, 269 55; distinguished from other types of
evidence, 56, 57; direct and indirect, il-
SUGGESTIBILITY: as affecting the competence
lustrated, 59; an historian's tests of good
of witnesses, 69-71 faith and accuracy as affecting, 64; com-
Suggestions for Systematic Inquiry: by C. J. petence of witness in, 65-73 ; attention of
Ribton-Turner, 31 witness as affecting value of, 66-68;
SUICIDE: queries regarding, as to parents of a
memory of witness as affecting value of,
68-69; suggestibility of witness as affect-
patient possibly insane, 437; as to the ing value of, 69-70; leading questions as
patient himself, 440 affecting value of, 71-73! racial or na-
SUMMARIES: case, as an aid in securing medi- tional bias of witness as affecting value
cal co-operation, 218; written, use of, by of, 73-75; environmental bias as affect-
some case workers, 340; to case coming value of, 75-76; bias of self-interest
mittees, uses of, 348 as affecting value of, 76-78
SUMMARY: of certain aspects of earlier proc- TESTIMONIALS proffered by clients, 254
esses in social diagnosis, 342-347
TESTIMONY: given against self-interest, value
SUMMARY, DIAGNOSTIC: content of, 360; of of, 76; personal, when most, and when
the Ames case, 361 least, satisfactory, 254; social agency
Laws Relating two functions of, 296-303
Summary of State to the Depen-
dent Classes, 195 TESTS, MENTAL: need of repetition of, 47
SUNDAY SCHOOL TEACHERS: utilization of ex- THAYER, JAMES B., 49, 53, 56, 269
perience of, 233
THAYER, WILLIAM ROSCOE, 385
SUPERVISION AND REVIEW QUESTIONNAIRE,
THEORIES OF SOCIAL WORKER and his work,
449-453 mutual influence of, 134
SUPERVISION, SELF-: suggestions for, 349- THEORY: value of evidence gathered to cor-
351 roborate or disprove a, 87
SUPERVISOR, CASE: value of submitting find-
ings to, 348; suggestions for comparisons THERAPY, SOCIAL AND MEDICAL: relations of,
made by a, 351-352 to social reform and to medical science,
367
SUPERVISORS, CHAIRMEN OF BOARD OF: con-
THINKING. See Reasoning
sultations with, by social agencies, 287
SUPPORT: responsibility of relatives for, 195- THORNDIKE, E. L., 367. 369
200 TIME ELEMENT: in diagnosis, 361-363
SYNGB, JOHN, 183 TOILET ARRANGEMENTS: defects in, which
social workers should look for, 151
TOWN CLERK: as a source of information, 287
TEA, OVERUSE OF: Dr. Healy'a findings re- TRADE UNIONS: inference from membership
garding, 150 in, 81, 86; as one-headed sources, 175;
instances of co-operation on part of, 250
TEACHERS: information regarding, easily ob-
tained in first interview, 126; habit of TRADESMEN: former local, use of, in three
some of dealing with families through cities, 273 present local, use of, in three
;
children, 153; differences in use of, in cities, 273

three cities, 167; testimony of, to S. P.
C. C. and probation officers, 222; evi-
TRANSFER: to another agency, and the prob-
dence of, on grade, 223-224; evidence of, lem of co-operation, 313, 314
on scholarship, 224; evidence of, regard- TRANSITION PERIOD IN WIDOWHOOD: queries
ing attendance and behavior, 225-226; regarding, 402
evidence of, regarding physical condition, documents in a
TRANSLATORS: choice of, for
227; evidence of, regarding mental con-
foreign language, 271
dition, 227-229; evidence of, regarding
home care, 229-230; evidence of, regard- TRANSPORTATION AGREEMENT: among social
ing results of social treatment, 230-231; agencies in U. S., 337
questions that need not be asked of, 231
TRAVEL, BOOKS OF: as aid to study of native
;
interest of, in certain reforms, 231; de-

fects in evidence of, 231-232; reports to, country of immigrant groups, 386
by social workers, 233 TREASURER, CITY: consultations with, by
TEAM SENSE: in social work, 292 social agencies, 287
TECHNIQUE: in social case work,
49 Treatise on the Law of Evidence: by Simon
TELEGRAPH: communication by, 336-337 Greenleaf, 72
TELEGRAPHIC CODE: used by social agencies Treatise on the System of Evidence in Trials
in U. S.. 337 at Common Law: by J. H. Wigmore, 57
509
INDEX
TREATMENT. SOCIAL: wider usefulness of, 6; WATER SUPPLY, INSUFFICIENT: points re-
importance of case workers' conception garding, that social workers should note,
of possibilities of, n;
confidential ex- 151
change improves, 304; lack of connection "What Do Histories of Insanity Teach Us
between plan of, and investigation, 348;
Concerning Preventive Mental Hygiene
need of, in administrative tasks, 365; a During the Years of School Lifet" by
few questions on, included in question- Adolf Meyer, M.D., 114
naires, 378; queries regarding, basis for,
in any family, 381 in case of an inebriate,
;
WHEREABOUTS: records indicating, kinds and
uses of, 260-262; registered letters used
43>
to establish, 336
TUBERCULOSIS: need of noting. In family his-
tory, 187; possibility of diagnosing as WHIPPLE, GUY M., 68, 69, 70
unemployment due to laziness, 358 WIDER SELF: concept of, at the base of social
TURNER, C. J. RIBTON-, 31 case work, 368-370
WIDOW WITH CHILDREN: instance of unre-
liable evidence from an employer regard-
ing, 241; undesirabk relatives in home
UNDERSTANDING, A
GOOD: one of objects of of, is6_; account of investigation of, il-
interview, 112, 113, 114
first
lustrating principles governing choice
UNDERTAKER: as a source of information of sources, 171-172; questionnaire re-
regarding relatives, 290 garding a, 400-404
UNEMPLOYMENT: different types of, 236-237 WIDOWHOOD: formerly confused with deser-
UNION. See Trade Union tion, 358-359, 395
UNITED STATES: social workers in, a large WIDOWS WITH CHILDREN RECORDS: school
occupational group, 25; Octavia Hill's evidence in, 229-230
influence in, 30; children's courts in, 44; WIFE: and husband, common causes of trou-
frequent migrations within, as affect- ble between, 140; and husband, mischief-
ing consultations with relatives, 202 making by relatives between, illustrated,
United States Bureau of Labor Report on Con- 182; points to be remembered regard-
ditions of Employment in the Iron and Ing, in study of family group, 147-148;
Steel Industry, 237 queries regarding early life of, for deser-
tion cases, 398
United States Bureau of Labor Report on Con-
dition of Women and Child Wage-earners, WIGMORE, J. H., 9, 49, 56, 57, 68, 69, 7<>, 305
237 WILLIAMS, FRANKWOOD E., M.D., 69
UNMARRIED MOTHER, QUESTIONNAIRE RE- WlTMER, LlGHTNER, 34
GARDING AN, 413-419. See also Mother, WITNESSES: tests of bias and competence of,
Unmarried attention as affecting competence
64, 65 ;
USES OF A WORT RECORD, 236-238 of, 66-68; memory as affecting compe-

tence of, 68-69; suggestibility of, 60-71;
leading questions as affecting competence
of, 71-73; bias of, different kinds, 73-79;
VAN KLEECK, MARY, 25, 237 social diagnostician's ability in dealing
VERIFICATION: not the aim of inquiry into a with, as part of his equipment, 98; who
work record, 236 have made first-hand observations to be
Vicar of Wakefield, 153 preferred, 172-174; court, difficulty in
persuading present neighbors to become,
VINCENT, J. M., 68 277; evaluation of personality of, 278;
VISION: in a blind person, queries regarding, social agencies as, in supplying data from
421-422 their own experience, 297-301; social
VISITING NURSE ASSOCIATION: and C. O. S., agencies as, in supplying results of their
inquiries, 301-303; illiterate, direct re-
division of territory between, 296
plies from, in answer to letters of in-
VISITING TEACHERS. See Home and School quiry, 324; characteristics of, restated,
Visitors 346-347
VOCATIONAL GUIDANCE: need of social evi- WOMAN'S POSITION: in native country of im-
dence in, illustrated, 46-48 migrant groups, queries regarding, 384
VOLUNTEER VISITING: in Boston, influence of WOODS, POLICE COMMISSIONER, 285
Octavia Hill on, 30 WOODS, ROBERT A., 299, 386
VOTING LISTS as records of whereabouts, 260 WOODYARD, CHARITY: as a work test for an
Italian laborer, 86, 87; unreliability of,
"VOUCHING" In early English law courts, 52 in testing willingness to work, 88
WORK HISTORY. See Industrial History
WAGES: unstandardized,
WORK PLACE: unwisdom of trying to see
aa affecting Indi- man at, 144
vidual case treatment, 237. See also
Earnings WORK PROBLEMS: of a widow's family,
queries regarding, 403
WAR DEPARTMENT: consultations with, by WORK RECORD: inference regarding, drawn
social agencies, 288
from man's unwillingness to have em-
WASSERMANN REACTION: Dr. Lewellys F. ployer consulted, 88; uses of a, 236-238;
Barker quoted regarding, 366 cope of a, 239
510
INDEX
WORK SOURCES: miscellaneous, 250-351 WORKMEN, FELLOW: better witnesses than his
WORKHOUSE TEST: as a substitute for inves- family, to a man's habits, 123; value of
evidence of, 242 co-operation of, 250-251
tigation, 28
;
WORKING PAPERS: WORKMEN, FOREIGN: special points to be

requirements regarding, remembered regarding, 248-249
225
WORKMEN'S COMPENSATION LAWS: effect of,
WORKINGMEN: inference regarding, drawn upon social case work, and vice versa,
from fact of membership in union, 81, 86; 212, 247-248, 366
reluctance of, to yield to sickness, 85;
inference regarding unwillingness of, to
WORTHINESS AND UNWORTHINESS: social
have employers consulted, 88; interests workers no longer preoccupied with, 61,
62
of, to be kept in mind in interviews with
employers, 237. 238; consultation of WRIGHT, LUCY, 274, 420, 421
property records In interest of, 264. See
also Workmen, Fellow, and Workmen, YEAR BOOKS, STATE: as sources of informa-
Foreign tion, 266
511
LES
University of California
SOUTHERN REGIONAL LIBRARY FACILITY
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THE LIBRARY

WM. F.FELL CO PRINTERS

ZILPHA DREW SMITH

mainly written, and it is in bis social relations likewise that tbe

of reformers. It is more and more coming to be used in dealing

CHARLES HORTON COOLEY

Only the sham knows everything; tbe trained man understands

came apparent, however, that no methods or aims were peculiarly

the elements of social diagnosis, if formulated, should constitute

granted, in every social practitioner, a knowledge and mastery

This narrowed my proposed topic to the beginning processes of

ing for treatment an experience of all the various types of such

work. As the executive head, in those days, of a large family

things in the regular social agencies; they were developing quietly

the purpose of getting the benefit of criticisms. The papers were

As my own experience had been so largely in the charity organiza-

to light many valuable suggestions which are used in these pages.

treatment, though as a means of getting started and to arrive at

One of the minor methods of study adopted was to correspond

sifting of these data and the interpretation of what was significant

For the variations in the processes leading to diagnosis, still

pactly enough to be of daily service for reference? The plan was

case worker might find it worth while to ask of himself. Such a

questionnaires were prepared by one hand, some by another; while

in consultation with case workers. These latter in particular must

part written by a specialist by a physician, an armorer, a photog-

course of six lectures. I had to disclaim at that time and do now

any idea that one who "crams" technical discussions of method

For the benefit of those who find certain of the bibliographical

these have been deliberately cut to the briefest possible form

burdened practitioner is tempted to think their counsels im-

II. The Approach by Way of Child Study 33

II. Types of Evidence 56

II. The Husband and Father 143

III. The Wife and Mother 147

IV. The Children 152

CHAPTER VIII PAGE

III. Method 176

II. The Case for Relatives 186

II. Complementary Nature of Medical and of Social Data 207

I. The Social Evidence of Teachers 223

II. Method 232

CHAPTER XII PAGK

1 1 . Certain Failures of Employer Testimony 240

IV. Method 246

II. Use of Directories and Newspaper Files 265

II. Certain Business Sources 288

CHAPTER XVI PAGB

II. The Confidential Exchange 303

II. The Comparison of Material 347

CHAPTER XIX PACK

II. What Is True of Everybody? 375

CHAPTER XXVI FACB

Frequency of Use 165

3. Twenty Sources Most Used by Agencies Doing Work with