sideration; and that there are even wider differences in psychological and social reactions between native and foreign born which necessitate careful adaptation of methods to each group in order to secure the best results in medical or health work.

The laissez-faire theory is a useful corrective to the overeagerness of some reformers, but it is too simple to be true. As the Yankee who did not like French, translated it, the laissez-faire theory is a lazy theory, and not fair.

THE DEMOCRATIC THEORY

A new conception has taken practical shape in health work during recent years which we may call the 100-per-cent Idea. Suppose one thousand babies a year are born in a certain community. Suppose there is a bureau of child hygiene of the local department of health, or a private association doing infant-welfare work. Suppose the baby clinic or infant-welfare station had an attendance of one hundred and fifty different babies during the course of a year. How then shall the bureau of child hygiene or the infant-welfare association measure its results?

They may compare the death rates up to one year of age among the one hundred and fifty babies reached with the corresponding death rate among babies in the community at large. They may take pride if a reduction is shown. But if they have the 100per-cent Idea in mind they will also be humble, because they have reached only 15 per cent of the community's babies. Their measurements of results will thus be more modest. Their program for future effort will be expanded.

Possibly these people feel that the most needy babies were the very 15 per cent which their work reached; but that cannot be told without a canvass, a survey, of all the babies. Funds may not permit the work to reach 100 per cent. A certain proportion of parents may be too well to do to wish to have their babies "reached." But after all it is the principle on which the infant - welfare work proceeds that will determine its quality, its program, and the extent to which it ultimately realizes its program. The 100per-cent Idea sets the goal and furnishes a yardstick for measuring annually the steps toward ultimate attainment.

A recent development in health work, which embodies the 100-per-cent Idea, is the health center. Essentially, the health center is an endeavor "to do things for everybody and to do things together, within a given district." In various forms these centers are being established throughout the country in increasing numbers. Previous to the war such cities as Philadelphia, New York, Pittsburgh, Cleveland, Cincinnati, Boston, Dayton, and others, had them in one form or another. The war necessarily interrupted progress, but its final effect has been a vast stimulant to medical and health work in almost all forms, the health center included.

In the cities and towns where health centers have been established the details have varied greatly. The idea of co-ordinating local health activities has been prominent in some. Infant-welfare stations, prenatal clinics, tuberculosis clinics, dental clinics, with their related medical and nursing services, have been brought together within a single building. Sometimes

various other kinds of medical, educational, or philanthropic work have been brought within the center.

The idea of confining effort to a definite area and of doing intensive work for that area is also a characteristic feature of the health-center movement. The 100-per-cent Idea requires localization at the present stage of progress, where it is rarely possible to secure enough funds to reach a whole community intensively. Localization has brought with it a more intimate adaptation of the medical and health work to the needs of the neighborhood, with its various economic, racial, and other characteristics. It has necessitated the co-operation of individuals within the district, or of local, racial, social, fraternal, or other organizations. The utilization of psychological and social elements, as well as points of medical technique, is suggested, stimulated, and developed by the driving force of the 100-per-cent Idea.

A characteristic feature of the majority of health centers has been location in a district largely peopled by foreign born. In some cases the work is in an area where the great majority of the population are of a single race or national group. The health center started in 1915 by the New York Health Department was in the Jewish district of the lower East Side. The center of the Bowling Green Neighborhood Association is in a section largely Syrian. In Cleveland one health center is in the Hungarian section; one amidst Poles and other Slavs; others among mixed populations. Many other illustrations could be cited of health centers in areas inhabited by foreign born from different national or race groups, now one and now another predominating.

No one imbued with the big-stick theory would start a health center if he realized what he was about. The 100-per-cent Idea requires a study of community needs, a canvass or survey of the district, and an appeal for local co-operation, such as can hardly be achieved by the use of mere authority. The health center is by no means the only manifestation of the democratic theory in medical and health work, but a real health center can only exist where there is a democratic idea in mind and an effort toward realizing it.

Some of the success of medical and health work depends upon the judicious use of authority, but more depends upon effective education. Much of the efficiency of a physician, a hospital, or a dispensary, in curing disease, depends upon how fully the patient understands the medical man's directions and advice. In the case of chronic disease the educational element is of the greatest importance, because old life habits must often be changed and new ones developed. In an acute disease the educational element is sometimes less obvious, but it is always present, especially during the period of convalescence. In all branches of disease prevention, the intelligent co-operation of the people is the greatest single element.

The diminution of typhoid fever in a city, through an improved water supply, depends on public support for the necessary financial appropriations. Considerable sections of a community may participate little in such an educational campaign and yet benefit by its results. But in the efforts against tuberculosis, infant mortality, the deaths and disabilities from child-bearing, the venereal diseases, cancer, the de

generative diseases of middle life, success depends fundamentally upon the extent to which the understanding co-operation of individuals can be secured.

Education is the foundation of success in these endeavors. Knowledge of the nature of various diseases, their modes of spread, and the methods of preventing infection, should be continuously sought. But a mass of existing knowledge is already on hand, waiting application to large groups in every community. Yet this knowledge lies fallow because too few of the people have been educated to understand the benefits that would follow its application and therefore to support the steps necessary to it.

We cannot educate with a hammer. The ruler has been abandoned as the chief instrument in educating children. The principle of interest is now the guide, not the principle of compulsion. This is still more true with adults. With them interested participation is essential to success. There must be a motive which creates interest, and a method on the part of the educator which maintains this interest and develops it. During the course of this study the most characteristic examples of successful health work with the foreign born are found to be closely connected with the principles of local co-operation and adaptation to community needs.

In its application to medical and health work the democratic theory requires that the physician, the health officer, the executive, the nurse, and the social worker must study people as well as technique. They must discover how far differences among people or between different groups of people require differences in methods, and what these differences are. A ready