state institutions, insanity, negroes, sex problems, suicide, syphilis, tuberculosis, unmarried mothers and vagrants. This classification of social ills, most of them recognized only as diseases, is peculiarly worthy of note at a time when the government and the Red Cross also are trying to maintain health and social equilibrium. A certain army surgeon lately stated that in his opinion the greatest problems after the war would be: broken families, crippled soldiers, tuberculosis, mental and nervous complications, heart disease and venereal diseases. The social service department which offered the above list had found to its astonishment that its greatest problem was the broken family. It had more broken families than any other one trouble. Next to broken families and children, it was most concerned about cardiac patients, mental and nervous cases, and after them, the tuberculous and syphilitic. In other words, the war will create no new problems for social workers, but will only reveal or emphasize those already existing, especially those of death and disease.

Social workers who are in the habit of thinking of their social problems in other terms, economic, moral or mental, should notice how closely their ills are interwoven with these med co-social questions. It is worth while also to see which of these have been abandoned by the case worker. No social worker any longer believes that the time and money spent in an effort to reform a single drunkard are spent most worthily. She wants to see prohibition tried. There is no medical social worker who is not ready to ask for the public control of venereal disease, and for more institutional care for the feeble-minded, insane and epileptic. Because of the tragic cardiacs and the tuberculous she cries aloud for prevention and education rather than cure. The proved decrease of blindness, with the increase of eye troubles which keep children from school and impair the efficiency of workers, even more illustrate the criminality of indifference to prevention.

It has been said that every patient who enters the door of a dispensary is a social problem. Thus far, this is true. It is equally true that all social problems involve questions of health. Some day the public will be as impatient with people who are not well, who are not able-bodied for their jobs, as it is now with the man who cannot reach work Monday on account of Saturday's drink.

All social workers must take more and more into consideration

the problems of health, both for the individual and for his community, while the medical social worker should study more and more the larger social questions. If no social worker can know too much, no medical social worker ever knew half enough. In the beginning it was thought that such a worker must be a nurse. In some cities she still must be. Nevertheless, it is an admitted fact pointed out even by their leaders, that the nurses who make good social workers do so, not because they are nurses, but because they have ability in another profession as well. Social work, even medical social work, is not nursing. The average nurse, moreover, lacks general knowledge of people and affairs and is less likely to have the necessary broad education. Not only that, her training tends to close her eyes and dull her natural initiative; whereas, a social worker, if she succeeds, must have and use science, imagination, daring and ingenuity. As yet, she is most often a woman, and all of the qualities which a great mother or a successful teacher needs should be hers. For the patient's sake she should have imagination, sympathy and good judgment. She should be just, as well as kind. For her own sake she should have good sense, good health, wholesomeness of spirit, a sense of humor and unconquerable faith in folks. She should have a true knowledge of the texture of normal society, of modern social problems, of the inter-relation of dependence and disease. She should know humanity, out of her own experience with it or her belief in One who knew. "He looked out from his Cross upon a jeering multitude, symbol of the vaster multitude who forever jeer and crucify the good, and there He performed His supreme miracle. He believed in them. He saw what was in them. "5

Such a worker will never be blind to, nor lose sight of, any of the ills of her client or patient; never fail to seek the underlying cause of his trouble, either in his own life or in the society of which he is a part. She will never fail to seek medical care or advice for all who need it. But she also will advise and urge more education concerning health, more frequent routine examinations of babies, school children and workers. She will insist upon measures to lessen the state's vast expenditure for social wreckage due to disease and to increase those for the promotion of universal health. Such William Lowe Bryan, "He Knew What Was in Man." Indianapolis: The Bobbs-Merrill Company, 1913.

a worker will argue with wisdom concerning the just expenditure of effort and money and the possibility of success with the individual case, or, in losing it, will be comforted by the use of it as educative material which may serve to save others from similar fates. Any social worker who would obtain the greatest result, socially or medically, must forget himself in the pursuit of good for his client. He will get for him all that he can of income, health and happiness; but he will never forget that what he does or fails to do, if recorded, will add to human knowledge and echo to the end of time.

PRINCIPLES OF CASE WORK WITH THE FEEBLE-MINDED

BY CATHERINE BRANNICK, M.D.,

Psychologist, Massachusetts Reformatory for Women.

The subject of feeble-mindedness is now recognized as one of the most important educational and social problems of the day because of its relation to other social problems. Various researches have shown that it complicates practically every one of our social questions, poverty and dependence, delinquency, vice and crime, inebriety, vagrancy, unemployment and industrial inefficiency. Numbers and relative increase are the important factors in the problem: it is estimated that three in every one thousand individuals in the United States are feeble-minded, making a total on this basis of 275,000; in proportion to their population they are increasing at practically twice the rate of the normal population. The burden is heaviest in the fields of delinquency and crime: 48,000 feebleminded persons are committed yearly to correctional institutions in the United States, and the percentage of feeble-minded within these institutions is variously estimated from 15 per cent to 50 per cent.

As research has demonstrated the widespread significance of the problem, methods of meeting it have multiplied, with the idea. of prevention leading. At present thirty-two states make some provision for this group in special institutions. In many cities. special classes have been established under the public school system providing a curriculum adapted to their needs. A few states have passed permissive laws providing for sterilization and in effect debarring marriage under certain conditions. The department of immigration has recognized the problem by more careful examination and observation of the immigrant. An educational campaign has been directed by numerous organizations throughout the country interested in eugenics and mental hygiene and a special committee, national in scope, was organized in 1915 with objects "to disseminate knowledge concerning the extent and menace of feeblemindedness and to suggest and initiate methods for its control and ultimate eradication from the American people."

All forms of treatment revolve about the special institution for

training and segregation, but it has come to be accepted that it is impracticable and even undesirable to work for such provision for all members of the group. There can be no question but that institutional treatment is the most economical and the only rational one in the case of the low grade, the intractable and the clearly unprotected. On the other hand, it is quite as evident that given proper personal and social treatment, many more of the group will be safe and fairly useful members of the community. These two ideas, segregation limited or permanent, and special training with directed oversight in the community, are the guiding principles of the plan of treatment outlined by the mature and progressive 'students of the problem. In Massachusetts, which already leads in its provision for the feeble-minded, a state program has been outlined by the League for Preventive Work which methodizes these ideas. The program, known as the Fernald plan, provides care for the known defectives according to their individual needs and methods. of finding others. It includes:

(1) A state commission

(a) for friendly guidance of mental defectives who under supervision can live wholesome lives in the community,

(b) with authority to safeguard in a state school those who cannot. (2) A state-wide census of the uncared-for feeble-minded

(3) Clinics for mental examination easy to reach from all parts of the state (4) Special classes in public schools for mentally defective children (5) Special treatment by the courts of mentally defective delinquents (6) Completion of a third school for the feeble-minded

In addition, the State Board of Education is "planning a Statewide investigation to determine the number of subnormal children not being provided for in institutions," with the idea of formulating a state-wide policy for the special training of these children. It is hardly probable that such a model plan can soon be carried out in its entirety even in the most progressive states. Certain of its most important principles can be tried out, however, even in those states which are most backward in providing for the feeble-minded and chief of these is the principle of individualization of treatment.

The idea of applying this principle to work with mental defectives is new and as yet not very acceptable to the general social worker. In the words of one of these workers, "there's no such animal as case work with the feeble-minded." The assumption has