Celebrating a Century: Social
Work Turns 100
Today, with the Department of Social Work so fully entrenched in the fabric of The Johns Hopkins Hospital and with some 80 social workers seeing thousands of patients each year, it is almost impossible to imagine what it was like in the early 1900s, when medical social work was all but nonexistent. It took the capable leadership of some astute, hardworking women (yes, they were all women back then) to navigate this terra incognita and develop not only a department but also an entire field.
In late-19th century Baltimore, The Johns Hopkins University was the nerve center of social reform. Students and faculty were committed to eradicating poverty, and University President Daniel Coit Gilman was the driving force behind the establishment in 1881 of a reform group called the Charity Organization Society.
With the support of the COS, The Johns Hopkins Hospital, which had opened in 1889 in part to provide free care to the poor, began sending medical students out to visit patients in their homes. Physician-in-Chief William Osler championed the idea. He thought that knowing something of patients’ living conditions could help explain their illnesses.
The friendly visitors, as they were called, began paying calls in 1898. The program was so successful that it caught the attention of Osler’s counterpart at Massachusetts General Hospital, who in 1905 hired the first social worker to provide social services within the hospital. Johns Hopkins established its own hospital-based social work program in 1907.
For physicians, it was not a moment too soon. “I know firsthand what it is like to run a big active hospital without social service as well as with it, and the difference is as between day and night,” wrote Bertram Bernheim, an early Hopkins doctor. “If it was the poor soul who came in cold and sopping wet because she hadn’t the carfare to ride, we gave her ten or fifteen cents and hoped she’d use it to get a cup of coffee and ride home. These and other things plagued us, slowed up the work, impeded it—at times drove us almost to distraction.”
Bernheim hailed the advent of social service workers, “women chiefly—a vast organization that was capable, that had the know-how in matters borderline to medicine.”
The Brogden Years
The fledgling Department of Social Service was headquartered in the dispensary, a sort of outpatient center where the poor came for care. The building facing north on Monument Street, about where Carnegie stands today, had little to recommend it. Its foul-smelling rooms, used by one clinic in the morning and another in the afternoon, were poorly lit and badly ventilated. There was only one nurse. Patient records were handwritten on different colored cards and kept on open trays. They were not sent with the patient, so no doctor knew what the other had found or prescribed.
In 1909, when Margaret Brogden, a graduate of Hopkins’ Training School for Nurses, took charge of the Social Service, she found her office just off the dispensary’s main hallway. It was in a small room divided in two. The other half was the surgical supply room. There was no privacy, for the partition went only partway to the ceiling.
Poverty, ignorance, unmarried mothers and deserter fathers, sexual abuse and addiction, infectious diseases like tuberculosis, syphilis, typhoid and polio—such were the scourges of the day. Patients were in constant need of dental treatment, glasses and braces for polio. Return visits were few because of patients’ “inability to pay the ten-cent admission fee and for medicine when prescribed, and even more frequently that no special day for return was set or definite direction given them by the doctor,” Brogden wrote in 1915.
Things soon improved when Social Service started sending postcard reminders. Plus, people had started driving. “The use of automobiles has made it possible to bring patients to the hospital for treatment who otherwise could not have come, and materially increased the number of visits made by the staff workers to the homes of the patients,” Brogden wrote.
Perceptive, practical, at times witty, Brogden was always empathetic. She never moralized. In June 1914, she wrote about the six wet nurses at the Harriet Lane Home: “They come twice a day and average 13 and one-half ounces for each morning visit, and eight ounces for each afternoon visit. They are paid at the rate of three cents an ounce for the first eight ounces, and two cents an ounce for each additional ounce, per visit; so it amounts to a substantial addition to the income of a family of limited means.”
In their subtext, Brogden’s annual reports sought to persuade physicians and administrators of the value of the Social Service. Occasional anecdotes illustrated her staff’s resourcefulness and sheer gumption, like this one about a man who’d had part of a foot taken off and returned with a nasty case of diabetic gangrene:
The doctor who saw him in the dispensary, knowing that he was not eligible for free admission but also knowing that he was sorely in need of treatment, took him to the social worker and asked her to see if she could get him into the hospital. She applied to both the assistant director and the director of the hospital, each of whom refused to see him or consider admission and told the social worker to send him home. She knew well that neither of those men would send him away if faced with him. She brought him into the director’s office and left him. The next time she saw him, he was in Ward F.
In ill health in the spring of 1931, Brogden resigned. With the Great Depression came cost cutting: Social Service staff was reduced from 31 to 22. Brogden was not replaced. The department was run by its three separate divisions—hospital and dispensary, Harriet Lane Home, and Phipps Psychiatric Clinic—each headed by one of Brogden’s understudies, who carried on with minimal resources.
Social Services depended more heavily than ever on contributions from its longtime champion, the Hospital Women’s Board, and turned to community agencies to provide for Hopkins patients.
By 1937, the financial picture had brightened; staff numbered 26, plus a secretary. Baltimore Sun columnist H.L. Mencken described the Social Service this way:
“The Social Service does whatever it can for each and all. It hunts for easier jobs for the crippled. It looks up recreant husbands and wives, sons and daughter, brothers and sisters. It bestirs charitable neighbors and lodge brothers. It finds tranquil refuges for the incurable …. It watches over the diabetic, the epileptic, the tuberculor, the syphilitic, urging them to keep up treatment and bringing them in when they fail.
“It is a depressing business, but the ladies of the Social Service take it calmly, and seem, on the whole, to be very cheerful persons …. The Social Service deals with cases in its stride, avoiding moral indignation as much as possible.”
Mencken’s portrait, if patronizing, was probably idealistic, for Social Service was providing more in the way of incidental services than intensive casework. They were filling Christmas stockings, running the patient library, making train reservations, doling out carfare and driving patients home.
So in the fall of 1937, at the request of the Women’s Board, physician Canby Robinson was appointed to conduct a survey of the department. There was so much variation “in quality and type of work as compared with recognized standards that it is difficult to discern any guiding principles or general policies,” Robinson found. “Social casework is at best haphazard and almost negligible with but relatively little thought given to the needs of the patients.”
Inadequate salaries and lack of secretarial assistance and space drove down morale, he said. “The standards of social work should be brought more nearly in line with the high scientific and educational standards for which the hospital stands throughout the world. The fundamental needs seem obvious: a strong directing head of all social work, and an increase in funds.”
The War and After
That strong directing head turned out to be Amy Greene. A graduate of Smith College and its School of Social Work, formerly director of the Social Service Department of Children’s Hospital in Boston, she represented a new generation—not of nurses like Brogden but of professionally trained social workers.
With the support of the Women’s Board and an advisory committee chaired by Robinson, Greene, who took over in 1939, breathed new life into the department. She sought to integrate social work with medicine, nursing and allied health. She represented the hospital in the community, raised professional standards and hired graduates of social work schools. Some did research and supervised students doing field work. Morale improved; there was unity in the group.
Trained staff, though, was hard to find thanks to World War II, when the Red Cross drained off medical social workers. But ultimately, the war was in part responsible for raising the profile of medical social workers. They, wrote social worker Eleanor Entorf in 1949, were now “considered by many doctors professionals to be consulted. Men had experiences during war in situations where social workers were more generally accepted than at Hopkins.”
Celebrating 50 Years
Eight years later, over lunch in the Welch Library, surgery chief Alfred Blalock gave an informal talk on the important role social work had played over the years. That afternoon, in Hurd Hall, Charles Janeway, director of Children’s Medical Center in Boston, delivered the Margaret S. Brogden memorial lecture. The Department of Social Service was marking its 50th year.
It may have been a golden anniversary, but it was not a gilded age, for the department had recently experienced “the most serious problems known during the employment years of any of its present staff members,” wrote then-director Helen Woods. Thanks mostly to inadequate salaries, staff loss had been “swift and sharp.” Demand for medical and psychiatric social workers was increasing. “We cannot compete unless our financial problems can be solved.”
A second period of reassessing and rebuilding was soon to begin.
—Anne Bennett Swingle
Next month in Part 2: Social workers talk about how their department evolved into a modern-day model of its kind.