But I am not concerned this evening to discuss the machinery of social help or the attempts already made in different centres for securing their satisfactory coöperation. Nor am I disposed to discuss the economic problems underlying the need for social assistance of the poor. Ideally we must agree with St. Augustine’s statement: “Thou givest bread to the hungry; but better were it, that none hungered, and that thou had’st none to give him.” My present object, however, is to set out some elementary—and when stated fairly obvious—considerations bearing on social evils and their remedies under present conditions of society, the recollection of which if followed by practical action, would secure greatly increased efficiency in social work.
For the following reasons I do not hesitate to bring this subject before a gathering of graduate medical students:
First.—Every physician as soon as he engages in medical practice almost immediately comes into touch with organized and unorganized social workers, and his success—personal as well as communal—can almost be measured in terms of his outlook towards their work;
Second.—The physician, with his scientific training in the tracing of effects back to their causes, is in a specially favourable position to promote rational as contradistinguished from empirical social help; and
Third.—The physician is now learning to appreciate that he can only treat his patients satisfactorily in the light of knowledge of their social, including housing conditions, of their industrial relationships, and of their personal history and habits of life.
This is the age of anxiety to give social help.
I hold strongly the view that ere many of you are advanced in years the fundamentally important social help which is constituted by adequate medical attendance will be provided, for all who wish to have it thus, at the expense of the state, i.e., coöperatively by means of common charges on every member of the community according to his means, exactly as elementary education is now provided. This will involve radical reconstruction of the relationship between hospital and private medical practice, and will, I trust, include also the introduction of preventive medicine into the practice of every physician. But this is in the future. How can medical practice under present conditions, and how can non-medical social agencies, be made subservient to the fullest extent to the welfare of the community?
A few elementary illustrations will show the many unexploited or only partially exploited or misused opportunities for efficient social help.
The greatest science is to know the causes of things; and there is no branch of work in which this is more important than in medicine. But causation is complex. A given result commonly follows from a chain, or it may be a bundle of events: and as we shall shortly see the end links of the chain are oftimes joined, thus forming a circle.
If a man shoots a companion with whom he has quarrelled, it may be urged that a more rigid system of license for the use of firearms would have prevented the calamity; that the companion was also quarrelsome; that the homicide had been the spoiled child of his mother and had not had a satisfactory up-bringing; and that he inherited from his father a violent temper; but none of these circumstances,—all of which may have contributed to the murder,—is likely to succeed in preventing the murderer from being hanged after due trial.