and that people who come to this country from elsewhere ought as quickly as possible to make themselves, or else be made, like Americans.

In health work the application of the big-stick theory means reliance upon police power, the enforcement of sanitary regulations by punishing people who violate them. It means trying to educate a community toward better sanitary standards by telling people what they must do and the penalties for not doing it. There are those who consider it un-American to use foreign languages in educational or health work, regarding this as a concession to the foreign born which is unwarranted, if not un-American.

Many big-stickers would protest that they do not hold the foreign born to be "inferior." Often a belief in inferiority is subconscious, but no less real. Sometimes it appears in the statement that the immigrant has no right to retain habits, customs, or traditions which he brought with him to this country. Oftener it is apparent when men are called "wops" "hunkies," or in the mere tone in which immigrants. are referred to. How does such a theory bear comparison with the Declaration of Independence?

Every important social group believes in itself. The conviction that "We are the people" is perhaps more characteristic of Americans than of others. The wish to make other people like this desirable model is a natural result. It takes time and effort to perceive that our true goal is not uniformity, but unity; not one vast note of blaring sound, but a harmony of many tones.

No sane man questions the necessity of authority and of its use under certain conditions. The strong

hand of the law must and should deal with the careless consumptive who endangers his wife and children by promiscuous spitting about his home; the infectious syphilitic, recalcitrant to treatment and persistent in evil courses; or the family which maintains a gross sanitary nuisance. In such extreme cases the course of policy is clear. But, as a rule, it is important to determine the degree of authority which proves effective in securing results.

Is it best to teach by compulsion? When? How? Or do we get better results by some other method? The question at issue is not the presence or absence of the principle of authority from the armamentarium of medical or health work, but the manner and extent in which this instrument proves effective as compared with other means.

The use of compulsion as a method is one of those questions of degree which amount, in practice, to questions of principle. No sensible man objects to the proclamation of martial law under certain conditions. Martial law has its place among the instruments which a wise society will have at its command for use when necessary. But under what conditions is it necessary? How often? How much? Would we wish to live in a society in which martial law was the habitual method of administration? If not, let us seek to define its place, so that we shall know where and when to employ it, and when and where to avoid it.

If we proceed in medical or health work with the big-stick theory under our caps, we are likely to adopt policies and methods because we think they ought to work, without constantly testing them to see how they do work. Doubtless we all wish to attain a

unified, harmonious community, with high standards of personal and public hygiene. What is the best method of attainment? The test of method in medical or health work is the same as in any other field of practical endeavor. Policies and methods must be tested by results.

The big-stick theory ought to be applied just as far as it will work-in a democratic society. And how far it will work is to be determined not by our preconceptions of policy, not by an a priori theory of Americanization, but by the dispassionate study of principles and the practical test of facts.

THE LAISSEZ-FAIRE THEORY

The traditional American, when not under pressure of war or the dread of some social upheaval, is an energetic individualist. He sees a chance to push himself ahead, and he admits the other fellow's right to the same opportunity. He follows the principle, live and let live, which in application to health work can best be expressed by the reverse, die and let die.

The laissez-faire theory is based partly on the optimism of ignorance. The belief is briefly as follows. The immigrants who have "the stuff" in them take care of themselves and become "Americans" without any great difficulty. The incapable must be taken care of anyway. America is the world's melting pot. All varieties of the human species have come here. The melting pot transforms all into Americans, like us who were born here. A piece of the philosopher's stone is always somewhere in the crucible, and turns every good bit of alloy into American gold.

Frequent as are contemporary expressions of the big-stick theory of Americanization among medical and health workers, still more frequent expressions indicate the attitude of laissez faire.

"I hardly think it desirable to work out special diets for foreigners," writes the chief of dietetics in a large city hospital, "for I am told by the nurse that they do not complain of the meals served."

"This state has a large number of immigrants of all nationalities. We are not making any special effort to reach these people other than publishing certain literature in their native language," says the head of a state department of health.

The limitation in some cases of this kind is lack of funds rather than lack of desire, but many evidently feel with the health department of a large Middle Western city, that "Our foreign population is not a problem in any sense."

In application to health work the laissez-faire theory is illustrated by the health department, which provides various facilities, which is ever seeking larger funds, but which expects people to seek out what is provided. Investigations to determine what needs exist are rarely undertaken where this point of view dominates, nor are districts surveyed to discover what groups of people have or have not been reached by antituberculosis or infant-welfare campaigns. Neither is it likely that those imbued with this easy point of view will consider the foreign born as a special problem, the study of which is necessary in order to determine effective policies and methods.

"We object," said a health officer of a large city department, "to giving any special consideration to

the health problems of the foreign born. This would be discrimination. Our aim is to treat everybody alike."

In almost the same words the superintendent of a large hospital stated his policy. These people remind one of the Dutch judge who said that it always troubled him to hear both sides of a case. It is easy to proceed upon the supposition that everybody is alike or near enough alike for practical purposes. Have in mind a standard. Consequently, have your scheme of sanitation or education or medical care. Maintain your standard. Offer your scheme. Let those who come to be benefited by the work profit by its blessings.

The laissez-faire theory, as applied to the field of medical or health work, means the assumption that the foreign born have no special health problems and that methods of health work need not be specially adapted to immigrant characteristics or needs.

No sensible person will question the value of throwing the responsibility for a man's success upon himself, or of expecting that those who wish to be blessed should seek the places of blessing. But here again the test of theory must be by results. The danger is that we mingle our prejudices with our practice instead of guiding our practice and controlling our prejudices by constant tests of efficiency in getting results.

In the descriptive portions of this book evidence will be presented to show that the presupposition of uniformity on which the laissez-faire theory is based is not correct. We shall endeavor to demonstrate that differences in health problems between native and foreign born exist, sufficient to warrant practical con