Ida Maud Cannon was one of the first to make hospitals recognize that their patients' health hinged not only on overcoming their illnesses but also on coping with community problems.
Through her example, books and articles, Cannon made social work an accepted and expected hospital service.
"She truly is the person who started healthcare social work," says David Harrington, a former board member of the American Hospital Association's Society for Social Work Administrators in Health Care.
Cannon, who died at age 83 in 1960, grew up in St. Paul, Minn. Her mother died when she was 4, and she and her two sisters and brother were raised by a stepmother and her father, a traffic controller for the Great Northern Railroad.
She graduated from St. Paul City and County Hospital Training School for Nursing in 1898. Her first job was to organize a hospital unit for the State School for the Feeble-minded in Faribault, Minn.
After two years, she studied sociology and psychology at the University of Minnesota. She then worked as a visiting nurse for the St. Paul Associated Charities.
Inspiration. In these positions, she cared for a ward of 20 patients during a typhoid epidemic and for those in the river slums of St. Paul. Later, she said that hearing Jane Addams, a renowned social worker in Chicago, give a speech on the health hazards of children living in slums "started me on my way toward social work as a life interest."
In 1906, Cannon, who never married, moved to Cambridge, Mass., to live with her brother, Walter Cannon, M.D., a physiology professor at Harvard Medical School, and his family.
She attended the newly opened Boston School for Social Workers, where she met Richard Cabot, M.D., who had created the country's first hospital social work program at Massachusetts General Hospital a year earlier.
"But I did recognize that here within my experience was a new kind of doctor and that he was expounding an idea that seemed to me the answer to my vague misgivings and desires," Cannon later wrote. "He was presenting the idea of social service within the hospital, where sick patients, although separated from their home and families, nevertheless cannot separate themselves from their personal problems."
Cabot's new program was relegated to a few small tables and a bench for patients placed behind two white screens in "The Corner," a high-traffic corridor in the hospital's outpatient department.
Cannon was one of Cabot's first volunteers and joined his staff permanently upon graduation in 1907. While Cabot invented the program, Cannon developed it, transforming it into a national example.
"Massachusetts General was the model everyone looked to," says Harrington. "It has become an accepted practice that hospitals have psychosocial components and that social workers are a part of that. She brought an awareness of the community to the hospital."
Following Cabot's initial work at Massachusetts General, more than 100 hospitals across the country opened social service departments.
Pioneers. During the winter of 1912, Cannon visited most of them to survey their progress. She found that their well-intentioned programs lacked specialized training for their social workers and standardized case work and organizational practices. "We are still pioneers," she declared.
Cannon's tenure at Massachusetts General continued to advance the nation's fledgling hospital social work profession.
She argued for systematic, confidential record-keeping of patients' progress and sought to clarify medical prescriptions and care plans for patients.
She also initiated programs addressing such issues of the day as tuberculosis, venereal disease, single mothers and various neurological conditions.
But Cannon's course was not all smooth sailing.
"My aunt was wise and steady, full of humor and warmth, and with a delicate grasp of the intricacies of administering medical social work as a new service in an extremely conservative hospital," wrote her niece, Marian Cannon Schlesinger, in a memoir of her family. "The hostility of the nursing staff and the antagonism of the doctors were formidable problems in the early days of my aunt's stewardship, but with her usual tact, confidence and humor she guided the evolution of the department."
Despite the turf wars and skepticism, Cannon was named the hospital's first chief of its new social services department in 1914. And by 1919, she had clearly proven the worth of the experimental program when the hospital introduced social workers to its inpatient wards.
Building the model. By the 1930s, Cannon had set down the hospital's social work policies and procedures, shaping a program that served as the mold for today's profession.
By this time, patients could go to a central office-not a corner-where they would find the social work department's director, secretaries, files, a conference room and some 20 professional social workers. They kept offices throughout the clinics and the wards to be near the roughly 6,000 patients they served each year.
Schlesinger recalls fondly her visits to her aunt's office. "We would find our Aunt Ida, looking much the same as she did at home, her thick brown hair coiled in a braided halo around her head, her pince-nez glasses pinned to her dress, and around her neck, suspended on a gold chain, a tawny piece of amber that she had bought in Sicily on a trip to her beloved Italy."
When Cannon retired in October 1945, her department had 31 social workers serving some 8,000 patients annually.
"It was Ida Cannon who had the vision, the practical wisdom, and the steadfastness to lay the firm foundations, define the principles, and demonstrate the service until it became worldwide," wrote Harriett Bartlett, who worked for Cannon. "Her continuity of service at the Massachusetts General Hospital, for nearly four decades, was phenomenal in social work."
Cannon was invited to share her experiences in travels across the country and overseas. Her philosophies toward medical social work are presented most in-depth in her 1913 book Social Work in Hospitals, which she dedicated to Cabot.
Evolution. Cannon believed that hospital-based medical social work represented an evolution of the hospital from a primarily clinical, professional and economic enterprise to a socially aware institution.
She compared the spreading of hospital social work to other social movements, such as the birth of welfare and the fight to end child labor.
"Hospital social service is then the tangible evidence of the working of the social conscience in the hospital," she wrote. "While it will always express itself tangibly in the activities of hospital social workers, its influence is likely to spread beyond the institution and make contributions to medicine, to nursing, and to general social work."
Cannon constantly emphasized the necessity for strong cooperation between physicians and social workers and advocated a policy of only accepting patients who had been referred by physicians.
"The physician recognizes physical symptoms and seeks for the underlying causes of disease," she said. "The skilled social worker recognizes social symptoms of human distress and also seeks their underlying causes that she may the more wisely help. The services of doctor and social worker then become interdependent, just as the physical and social conditions of the patient himself are interrelated."
Cannon illustrated her point with the case of a 69-year-old former shipbuilder who was diagnosed with a weak heart and a chronic kidney disease.
The doctor directed him to a state institution to receive care because he wasn't sick enough to remain in the hospital. But the physician also referred him to a hospital social worker.
She subsequently learned that the man had a wife and two sons but that he was reluctant to ask them for help. After persuading the man to let her talk to his family, one of the sons agreed to care for him.
Cannon further defined the role of hospital social workers by emphasizing their connection to community resources, such as private and public social agencies and religious groups.
"(Social workers) should not attempt to multiply the special activities with the hospital itself but should turn to the community to discover and use the many agencies already developed to deal with social wrongs and misfortunes," she wrote.
Cannon went on to help found the American Association of Hospital Social Workers in 1918 and two years later received the Massachusetts Public Health Association's award for distinguished service. Today, the AHA's Society for Social Work Administrators reserves as its highest honor the Ida Cannon Award.