- Author:
Mackintosh, M.A., M.D., D.P.H.,
Professor of Public Health and Hygiene, Glasgow University
The teaching of medicine in this country, until a
few years ago, has been bound up very tightly with
hospital practice, and diagnosis, prognosis, and
treatment have been related largely to the physical
or mental condition of the occupant of a hospital
bed. The field of medical study was often narrowed
down to a counterpane space of six feet by three.
As early as 1889 Sir Henry Ackland, the Regius
Professor of Medicine at Oxford, threw out a
challenge which was not taken up for many years.
In a letter to a colleague he said:
The present time is opportune for recon-
sidering the lines on which the University
should introduce her students to the higher
conception of Practical Medicine. Fifty years
ago, the Literae Humaniores were inadequate
representatives of knowledge. Now we see that
the complicated condition of human society,
with its pressing needs, demands such extended
estimate of the Physician’s functions as to
include not only the treatment but the prevention
of disease in individuals, in families, and in
communities, and the difficult problems of
comparative national health. Fifty years ago
some older practical men would ridicule a
young physician who gave attention to the
health conditions of dwellings, or even to
hospital construction… .
Let us suppose that it comes about that in
Oxford, a town of moderate size, the organiza-
tion for preventive and curative medicine
among the masses is perfected. Might not our
intelligent and appreciative students be easily
made personally familiar with such organiza-
tion ? They see it discussed in daily papers and
magazines. They hear of it at social gatherings;
why not so arrange that, without diverting them
from their precise scientific studies, they should
during their student days have studied it
practically. It would deeply interest all who
were worthy. With careful arrangement one
afternoon a week during their undergraduate
days would more than suffice to make them
familiar with the medical needs and state of the
sick poor.
Half a century later another distinguished
occupant of this Chair had still the melancholy task
of pointing out that
a man who goes into panel practice has
received little instruction in the subjects of the
preservation of health and of the prevention of
disease. His attention has been directed almost
entirely to the diagnosis and treatment of
disease, and mainly of established disease, ra^
than of early and slight departures ff0
health.*
It is therefore fitting that the University of Oxf?.r’
should lead the way in establishing a Chair of Socl
Medicine, with the object of organizing research $.
the social background of sickness. This develOP
ment has been made possible through the generos’
of the Nuffield Trust.
Social Medicine may be regarded as the meet*11-
place of clinical and preventive medicine.
two great branches of the art have evolved .
parallel lines for nearly a century, and at one tin*
it looked as if they might be produced to infi1”’
without coming together. Fortunately some imp0’
tant developments in the wider social field broUr
about a change. In 1885 Sir Charles Loch recogniz.
the need for some kind of social service within E
hospitals, if only to prevent abuse of charity. *?,
years later the Royal Free Hospital appointed
Almoner for this very purpose, but the minutes
the Board show that some of the members, at ^
rate, had a Pisgah-view of the future:
We have no machinery by which cases ,
needy and deserving patients can be foll?^
up after treatment. It must frequently hapr.
that a few weeks’ change and rest with g? .
food at the seaside or country would saS6..
valuable life, and there are various socie^
willing to help such cases, if their attention
drawn to them.
This shy little note is the charter of the Almofl^
and her financial duties are being discarded lifce’
chrysalis. ,
The next important advance in social work
its origin to Dr Richard Cabot of Boston (M^
who in 1905 began to use this new auxiliary
teaching. Dr Cabot set himself to study the soC”.
factors that might contribute to the patient’s .
using for this purpose trained voluntary socl.
workers whose duty it was to undertake ho^
visiting and present to the physician and his stude^
an account of the family and industrial backgrou11..
These social workers gradually became partners .
the clinical team engaged in both teaching ^
investigation, and by this means social medicine J1
become an essential part of the undergrade,
curriculum in the more progressive medical scho0,
in the United States. Progress has hitherto
almost imperceptible in Great Britain, but there K
signs?shrill squeaks of recognition?that the
for training medical students in social study
appreciated.
In the Mental Health field the beginning^^of r
Gained social work have been closely child s
with the Child Guidance Movement 1ft er s
Guidance Council, which was formed f nf L^rica, I
the aegis of the Commonwealth Fund o< the t
has from the start taken a special m orovides t
Gaining of psychiatric social workers, a P of ,
scholarships for this purpose. The fi S . <
porkers were trained in the United States. but ^ ^
j^-9 a special course was established in _ractical
he London School of Economics the pract^
tuihon being obtained at the London C hiatrjc
Clime and the Maudsley Hospital. Thepsy a
?r mental health social worker has J? usuany
^der field than the Almoner, because she is usuay
attached to clinics rather than hospital , jhe
deal of her work is in the homes of the P p ” d
Almoner is attached to a single h?f^’ scribed
sphere of her duties is quite naturally
by hs interests. other
The mental health social worker, oni th
^nd, is as a rule attached to a subject ratha $
an institution and the range of her
correspondingly wider. _ocial WOrker,
There are many other types ?f socia1 of
m?st of whom have qualified in a ba . sense
social study; but few of them are in a startt sens^
^edical auxiliaries. The position of,^use she
isitor deserves special mention, training,
undertakes a great deal of social work ^er ttainmg,
owever, is clinical rather than social, place
as a fully qualified nurse gives her a P duties
Ration to the practice of medicine. ^er
je in the main preventive and ^cati doctor in
? alliance should be strongest with th Health
Practice if he is to become in any real , care
Adviser to the families under his Pro^efssl?ial work
This leads us to consider the trend
ln relation to medical practice m the ?tu ? recon.
It is abundantly clear that, when ^ t^e
ruction is undertaken in earnest afte ‘ ^
Min,stry of Social Security will requires an^ in
social workers to deal with individual case
relation to unemployment, pensions, and general
social welfare. This service will not meet the
special needs of those who are incapacitated from
sickness or accident nor of the great mass of disabled
persons, including the blind, the cripples, the
tuberculous, and the mental cases. Additional
training in medical social work is necessary, and the
variety of training subjects is bewildering. Broadly
speaking, medical social work falls into three main
categories, although there is a good deal of common
ground:
Hospital Work?general and special.
Mental health work, in hospital and clinic.
(3) Social work in the homes of the sick who are
not under hospital or clinic supervision.
In all three categories the medical social worker
will have a duty to visit the home and to take into
consideration the industrial background of her
patient. Yet it is clear that some special training is
necessary to fit the members of each group for the
type of service which they wish to undertake. No
doubt the basic Social Study course of two years,
will remain; but there is much to be said for
organizing a comprehensive course for the medical
social worker, to cover the additional year. All
three groups have much in common, but one student
may wish to concentrate on hospital work, another
on mental health, and a third on general community
care. It may well be possible to provide, within the
framework of the year’s study, certain elective
courses to suit the needs of particular candidates.
This system has been adopted with success in the
Public Health Course at Johns Hopkins University,
and the principle of elective subjects seems equally
applicable to medical social work. However that
may be, I doubt if the future holds much place for
: excessive specialization. It should be enough for an
appointing authority, whether hospital, clinic, or
general local authority, to know that the candidate
; has had a sound basic training in social science and
f an additional course dealing especially with the
i medical aspects of social work.
Jlen as a result f upon the significance of mental deficiency in our domestic life after world peace is again attainedT
/ ‘^e basic ret r SUC^ exPer’ences as would accrue from the activities outlined above, we would be far more keenly aware
tf.*s unabie o u-11 mental deficiency to our social order. The mental defective is a menace to society chiefly because
f 5,service fa u- ?Wn resP?ns’bility to adapt himself to that society, and because we have been remiss in performing
0r-” . ‘ m- Even the low-grade feeble-minded are only a burden rather than a menace if suitably provided
fy^’ons o’nlv^’hope to succeed in our applications of psychology to the present emergency if we conceive our
herecis f’”, ^rrns of those developed in the last war. Our science has moved forward with extraordinary expansion,
in?rs a??, perh t0 caP’tahze the national opportunities for applying psychology which startled the world twenty-four
P?ssible a,., aPs We can in the present crisis make ourselves and our science a^ain available on a plane that was then
but ls now imperative
Dr Edgar A. Doll
(In Presidential Address to American Association for Applied Psychology, September 1941).
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See https://www.ncbi.nlm.nih.gov/pmc/about/scanning/
Social Work in Medicine
Mackintosh, M.A., M.D., D.P.H.,
Professor of Public Health and Hygiene, Glasgow University
The teaching of medicine in this country, until a few years ago, has been bound up very tightly with hospital practice, and diagnosis, prognosis, and treatment have been related largely to the physical or mental condition of the occupant of a hospital bed. The field of medical study was often narrowed down to a counterpane space of six feet by three. As early as 1889 Sir Henry Ackland, the Regius Professor of Medicine at Oxford, threw out a challenge which was not taken up for many years.
In a letter to a colleague he said: The present time is opportune for recon- sidering the lines on which the University should introduce her students to the higher conception of Practical Medicine. Fifty years ago, the Literae Humaniores were inadequate representatives of knowledge. Now we see that the complicated condition of human society, with its pressing needs, demands such extended estimate of the Physician’s functions as to include not only the treatment but the prevention of disease in individuals, in families, and in communities, and the difficult problems of comparative national health. Fifty years ago some older practical men would ridicule a young physician who gave attention to the health conditions of dwellings, or even to hospital construction… .
Let us suppose that it comes about that in Oxford, a town of moderate size, the organiza- tion for preventive and curative medicine among the masses is perfected. Might not our intelligent and appreciative students be easily made personally familiar with such organiza- tion ? They see it discussed in daily papers and magazines. They hear of it at social gatherings; why not so arrange that, without diverting them from their precise scientific studies, they should during their student days have studied it practically. It would deeply interest all who were worthy. With careful arrangement one afternoon a week during their undergraduate days would more than suffice to make them familiar with the medical needs and state of the sick poor.
Half a century later another distinguished occupant of this Chair had still the melancholy task of pointing out that a man who goes into panel practice has received little instruction in the subjects of the preservation of health and of the prevention of disease. His attention has been directed almost entirely to the diagnosis and treatment of disease, and mainly of established disease, ra^ than of early and slight departures ff0 health.*
It is therefore fitting that the University of Oxf?.r’ should lead the way in establishing a Chair of Socl Medicine, with the object of organizing research $. the social background of sickness. This develOP ment has been made possible through the generos’ of the Nuffield Trust.
Social Medicine may be regarded as the meet*11- place of clinical and preventive medicine. two great branches of the art have evolved . parallel lines for nearly a century, and at one tin* it looked as if they might be produced to infi1”’ without coming together. Fortunately some imp0’ tant developments in the wider social field broUr about a change. In 1885 Sir Charles Loch recogniz. the need for some kind of social service within E hospitals, if only to prevent abuse of charity. *?, years later the Royal Free Hospital appointed Almoner for this very purpose, but the minutes the Board show that some of the members, at ^ rate, had a Pisgah-view of the future:
We have no machinery by which cases , needy and deserving patients can be foll?^ up after treatment. It must frequently hapr. that a few weeks’ change and rest with g? . food at the seaside or country would saS6.. valuable life, and there are various socie^ willing to help such cases, if their attention drawn to them.
This shy little note is the charter of the Almofl^ and her financial duties are being discarded lifce’ chrysalis. , The next important advance in social work its origin to Dr Richard Cabot of Boston (M^ who in 1905 began to use this new auxiliary teaching. Dr Cabot set himself to study the soC”. factors that might contribute to the patient’s . using for this purpose trained voluntary socl. workers whose duty it was to undertake ho^ visiting and present to the physician and his stude^ an account of the family and industrial backgrou11.. These social workers gradually became partners . the clinical team engaged in both teaching ^ investigation, and by this means social medicine J1 become an essential part of the undergrade, curriculum in the more progressive medical scho0, in the United States. Progress has hitherto almost imperceptible in Great Britain, but there K signs?shrill squeaks of recognition?that the for training medical students in social study appreciated.
Sir Farquhar Buzzard, Harveian Oration for 1941.
In the Mental Health field the beginning^^of r Gained social work have been closely child s with the Child Guidance Movement 1ft er s Guidance Council, which was formed f nf L^rica, I the aegis of the Commonwealth Fund o< the t has from the start taken a special m orovides t Gaining of psychiatric social workers, a P of , scholarships for this purpose. The fi S . < porkers were trained in the United States. but ^ ^ j^-9 a special course was established in _ractical he London School of Economics the pract^ tuihon being obtained at the London C hiatrjc Clime and the Maudsley Hospital. Thepsy a ?r mental health social worker has J? usuany ^der field than the Almoner, because she is usuay attached to clinics rather than hospital , jhe deal of her work is in the homes of the P p ” d Almoner is attached to a single h?f^’ scribed sphere of her duties is quite naturally by hs interests. other
The mental health social worker, oni th ^nd, is as a rule attached to a subject ratha $ an institution and the range of her correspondingly wider. _ocial WOrker, There are many other types ?f socia1 of m?st of whom have qualified in a ba . sense social study; but few of them are in a startt sens^ ^edical auxiliaries. The position of,^use she isitor deserves special mention, training, undertakes a great deal of social work ^er ttainmg, owever, is clinical rather than social, place as a fully qualified nurse gives her a P duties Ration to the practice of medicine. ^er je in the main preventive and ^cati doctor in ? alliance should be strongest with th Health Practice if he is to become in any real , care Adviser to the families under his Pro^efssl?ial work This leads us to consider the trend ln relation to medical practice m the ?tu ? recon. It is abundantly clear that, when ^ t^e ruction is undertaken in earnest afte ‘ ^ Min,stry of Social Security will requires an^ in social workers to deal with individual case relation to unemployment, pensions, and general social welfare. This service will not meet the special needs of those who are incapacitated from sickness or accident nor of the great mass of disabled persons, including the blind, the cripples, the tuberculous, and the mental cases. Additional training in medical social work is necessary, and the variety of training subjects is bewildering. Broadly speaking, medical social work falls into three main categories, although there is a good deal of common ground:
Hospital Work?general and special.
Mental health work, in hospital and clinic.
(3) Social work in the homes of the sick who are not under hospital or clinic supervision. In all three categories the medical social worker will have a duty to visit the home and to take into consideration the industrial background of her patient. Yet it is clear that some special training is necessary to fit the members of each group for the type of service which they wish to undertake. No doubt the basic Social Study course of two years, will remain; but there is much to be said for organizing a comprehensive course for the medical social worker, to cover the additional year. All three groups have much in common, but one student may wish to concentrate on hospital work, another on mental health, and a third on general community care. It may well be possible to provide, within the framework of the year’s study, certain elective courses to suit the needs of particular candidates.
This system has been adopted with success in the Public Health Course at Johns Hopkins University, and the principle of elective subjects seems equally applicable to medical social work. However that may be, I doubt if the future holds much place for : excessive specialization. It should be enough for an appointing authority, whether hospital, clinic, or general local authority, to know that the candidate ; has had a sound basic training in social science and f an additional course dealing especially with the i medical aspects of social work.
Jlen as a result f upon the significance of mental deficiency in our domestic life after world peace is again attainedT / ‘^e basic ret r SUC^ exPer’ences as would accrue from the activities outlined above, we would be far more keenly aware tf.*s unabie o u-11 mental deficiency to our social order. The mental defective is a menace to society chiefly because f 5,service fa u- ?Wn resP?ns’bility to adapt himself to that society, and because we have been remiss in performing 0r-” . ‘ m- Even the low-grade feeble-minded are only a burden rather than a menace if suitably provided fy^’ons o’nlv^’hope to succeed in our applications of psychology to the present emergency if we conceive our herecis f’”, ^rrns of those developed in the last war. Our science has moved forward with extraordinary expansion, in?rs a??, perh t0 caP’tahze the national opportunities for applying psychology which startled the world twenty-four P?ssible a,., aPs We can in the present crisis make ourselves and our science a^ain available on a plane that was then but ls now imperative Dr Edgar A. Doll (In Presidential Address to American Association for Applied Psychology, September 1941).
Disclaimer
The historical material in this project falls into one of three categories for clearances and permissions:
While we are in the process of adding metadata to the articles, please check the article at its original source for specific copyrights.
See https://www.ncbi.nlm.nih.gov/pmc/about/scanning/