tuberculous in need of institutional care, still nearly all of the 60,000 beds in the 689 sanatoria and special hospitals, day camps and preventoria (Jan. 1 1921) have been provided since 1900. This is true also of most of the convalescent homes, the many specialized clinics prenatal, “baby,” dental, venereal disease, psychiatric, etc. the medical examination of school children, the nursing service of schools and health departments. The level of knowledge about tuberculosis and other preventable diseases and about personal hygiene has risen perceptibly. A new type of agency is now becoming prominent “health centres” and “well-baby clinics,” for example directed towards the preservation of the health of those who are well.
Provision for the treatment of mental disease also has continued to increase, until in 1920 there were 232,680 patients in institutions; and the tendency already well established in the 19th century towards public care, by the state rather than by local units, has progressed until, in all but 8 states, all insane who are public charges are in state hospitals (i.e. not in almshouses or other county or city institutions). In 12 states there were, in 1921, psychiatric hospitals, psychiatric wards in general hospitals, detention hospitals, or other provision for the temporary care of mental cases. The corollary, however, is that in 36 states there is no such provision and in these 12 only a fraction of the population is thus served. The hospitals in most states are sadly overcrowded. Notwithstanding this pressure, the Scotch plan of boarding out selected cases of certain types, which has long been followed with success in Massachusetts, has not been adopted elsewhere. National prohibition, however, has already cut down the number of admissions to the alcoholic wards, and it may be that this influence will enable the states within the next few years to match accommodation with applications. A few institutions undertake to keep watch over the patients discharged as cured or improved, and a few private organizations supplement the work of the public institutions in this way, and also try to avert the development of insanity in incipient or suspected cases brought to their attention. In New York a state system of clinics has been organized under the joint auspices of the state hospitals, the state Department of Health, and the Committee on Mental Hygiene. In general, however, the prevention of mental disease and the promotion of mental hygiene are comparatively rare.
For mental defectives provision has increased rapidly as compared with that at the beginning of the century, but slowly as compared with the need. There were about 40,000 feeble-minded in institutions in 1920, which was twice as many as in 1910, but not more than 6% of the estimated total in the country. There were still, in 1921, 14 states which had no separate institution for such patients. In the conduct of the institutions the tendency is towards making them less custodial in their atmosphere, more medical and educational, less like a poorhouse, more like a combination of hospital and school. Special classes for backward children were maintained in 1921 in over a hundred cities, but the aggregate enrolment of over 20,000 represents only a small portion of such children even in these cities.
In connexion with crime the greatest advance has been made in the case of juvenile delinquents, who are now treated rather like neglected children than like criminals. Nearly three-fourths now come before courts intended especially for children's cases, the best of which have facilities for thorough physical and mental examinations and social investigation, and before judges who are expert in this work. All the states except Wyoming had made by 1919 some provision for probation for juvenile offenders, and about half the juvenile courts had a probation service in operation. Children in small villages and the country are hardly touched by these new methods. The proportion of juvenile delinquents sent to institutions is smaller than 20 years ago, and these institutions have become in some instances excellent schools. They have made more progress than those for dependent children in transforming their plants and their methods to correspond with current theories. The interests of adult criminals have not advanced so much. It is more generally admitted, however, that every correctional institution should be a “reformatory,” and more of them are than formerly. There is increased attention to physical conditions and needs, better ventilation, improved sanitation, more physical exercise, and in the reformatories some use is made of psychological tests and some attention paid to the correction of physical defects. The value of academic instruction and of productive occupation is more generally realized in the state prisons, and the reformatories also provide vocational training. The old perplexity of how to prevent prison labour from competing with free labour has ceased to be a practical problem, with the general acquiescence of organized labour on the “state use” system. Contract labour, however, is still found in many state prisons, and there has been little progress in making the work of the man in prison contribute to the support of his family at home. The convict lease system in the South has almost disappeared. A few county gaols have been remodelled, and a few others have been replaced by farm colonies. The use of probation for adult offenders has increased, though less rapidly for juvenile delinquents.
Private enterprise in the field of correction has concerned itself chiefly with furthering the movement for juvenile courts and probation; promoting specialized provision for women offenders, including policewomen and separate detention houses; developing protective work, especially for girls; securing the establishment of night courts and special courts for cases involving family desertion and other domestic relations; and in a few places, intermittent efforts to secure a rational treatment of beggars, drunkards, and other misdemeanants. Interest in 1921 seemed to centre round protective work for young offenders; the need of separating the feeble-minded from those of normal mental powers in reformatories and of distinguishing between them throughout the correctional system; problems of court organization and procedure, including the proposal for merging juvenile courts and the so-called domestic relations courts into “family courts,” to deal with all cases involving family life.
While it would be out of the question to review in this place the progress which has been made during the 20th century in the general standard of living and the conditions under which the mass of Americans live and work, still so large a part of the social work of these 20 years has been consciously directed towards this object that it would be equally impossible to omit all reference to it. The contribution of organized social work cannot be definitely disentangled from that of any of the other factors which have been influential in bringing about these improvements, but it is patent to any student of the period that it has been an important factor. The educational social movements, through their research, their programmes, their publicity and their propaganda, have to a large extent enlisted the interest of the other factors, determining which questions should have precedence, and how they should be presented to the public.
“Welfare work” in mercantile and industrial establishments has an obvious historical association with those kinds of social work which deal with health, housing, recreation, and the standard of living. In America, however, it is now generally conceived, not as an expression of altruistic interest on the part of the employer, but rather as a subdivision of personnel administration. Scientific management, industrial medicine, vocational guidance and other factors have influenced its development.
In many instances welfare activities have begun with a restroom, a lunch-room, first-aid appliances. From these modest beginnings they have expanded to include everything which might directly or indirectly increase the efficiency of the workers. Their home life, savings, investments, education of children, and social opportunities have been included. Industrial goodwill between the management and the workers has come to be looked upon as an asset to be cultivated. The Y.M.C.A., and other agencies which prefer to avoid industrial controversies and to operate within the “zone of agreement,” have found here a useful and congenial field. (L. Br.; E. T. D.)
VI. The American Labour Movement
The labour movement in the United States has been distinguished from that in other countries by being less class-conscious,
