cient basis of interest and knowledge for them to be emotionally warm and intellectually understood; but once the field agent's interest is aroused, it is surprising how little information about the Poles, the Jews, the Italians, or the Lithuanians she needs as a basis on which to build further knowledge automatically. Too much care cannot be taken that the attitude toward the immigrant is not based on the premise that we are right and he is wrong. A few associations express a wish, and many show a need, for more sympathetic understanding of the foreign-born patients. Witness such complaints as, "They don't seem to know anything about American customs or about tuberculosis."

When nurses complain that immigrants have too many children, that they seem to cling to their own customs, it shows a kind of provincialism and ignorance even worse than that of their patients. Especially refreshing, therefore, were the replies from two organizations who admitted that perhaps the difficulties were due to lack of knowledge and understanding on our part, an attitude of mind which could profitably be encouraged without any sacrifice of American standards. One executive recognizes this as at least one of the causes for failure in Americanization work. He says:

I think that your committee might do an immediately needed piece of work for public-health nurses if it would compile a list of books and magazine articles touching upon the problems of our foreign born by racial, occupational groups or any other way. If this list can be made of books which should be procurable either from a public library or a bookseller it would be all the more valuable. Doubtless there are such lists, but most of us don't know of them.

This is a need less obvious, but more fundamental, than that of phrase books. Such knowledge of immigrant backgrounds is needed by the public-health nurse, the social worker, and, in fact, by everyone who has to deal with his foreign-born neighbor.

LOCALIZATION OF HEALTH WORK

Another suggestion is that we take the trouble to go to the foreign born with what we have to give, be it a baby clinic, a housekeeping center, or an English class. By locating it in his part of town we avoid the necessity of drawing him away from his familiar streets and buildings. One baby clinic in a Texas city trebled the enrollment of Mexican babies when it moved just a few blocks into the Mexican district. Another association reached the foreign children by sending a nurse daily to make inspection and give lessons in hygiene at a Polish parochial school.

The mother in her home, seldom, if ever, getting out to gatherings of any sort, is the hardest member of the immigrant group to reach, and often the slowest to give up her racial habits; yet in her position as homekeeper she has most to do with the health of her family. Taking our health work into her neighborhood is the surest way to get acquainted with her. If her headquarters are near by, the nurse makes more friendly visits, calling often to foster familiarity and affection.

Above all, our most hopeful approach is through the baby and the growing children, and these can be more easily reached by a neighborhood unit. Many replies indicate that it is considered practically im

possible to enlist the attention of mothers except through service offered to their babies and younger children:

A great many of the habits of the immigrant we have been able to change after getting the mother interested in our welfare association. I consider the infant-welfare station to be one of the biggest factors in Americanizing the foreign mothers that we can possibly organize. (Buffalo, New York.)

Others mention the Little Mothers' clubs, which teach the younger girls in the schools, as the best approach to the parents:

Teaching "Little Mothers' Clubs" seems to clear the way for Infant Welfare work, and we often find the children have ordered the mother to give the baby only boiled water if ailing and while waiting for the nurse to come. (Manchester, New Hampshire.)

Care must be taken to see that the children do not scorn their parents' habits, but recognize the good features in them. The public school, through cooperation between the school nurse and the teacher and through parent-teacher's meetings, can be a powerful factor in determining this attitude, and at the same time appeal to mother love, the strongest motive in the world, to effect changes in the habits of generations.

In local health work it is often possible to reach a foreign-born group through its own leaders. The co-operation of lodges, labor unions, and religious bodies of the foreign born has been sought by a small number of tuberculosis associations, twelve reporting definitely upon such endeavors. The co-operation of the priest is not infrequently referred to. In the

somewhat slow and difficult task of securing the cooperation of immigrants or of their organizations, the primary need for democratic and sympathetic approach has often not been recognized. A notable exception indicates the right path.

In 1910 the Committee on the Prevention of Tuberculosis of the Charity Organization Society of New York, under the direction of Dr. Lawrence Veiller,1 organized a special Italian committee. One of its first activities "was to get up a very attractive colored poster containing a picture of Venice from a famous painting, in very attractive colors, and then printing along on the side of the picture advice about tuberculosis, with reference to the nearest tuberculosis clinic for that district." This poster was also printed in reduced size, and distributed from house to house through the Italian tenement districts on the lower East Side of Manhattan.

Later [says Doctor Veiller] we transferred our activities to the newer Italian quarter on the upper East Side in the neighborhood of Thomas Jefferson Park, around 114th Street, after having first made a study of the need of a tuberculosis clinic for the Italians in that section. Having through that study developed this need, we then got the Health Department to establish a new clinic in that district and after that we then proceeded to build up business for the clinic by having our Italian visitor go from house to house and flat to flat with the small Venetian poster and on it a reference to go to the clinic in that district. Also, we gave them a little card of reference to the clinic. The result was that we in a very short time built up a big business for the clinic. It was a very practical and effective piece of social co-operation.

1 The citations are from a personal letter from Doctor Veiller.

This Italian committee continued for several years. After two or three years, the first interest having worn off, it became difficult to keep up the interest of the members of the committee, yet it was felt that the committee had by that time accomplished its purpose.

Doctor Veiller says, "It more than justified our expectations and more than warranted the expenditure we put into it."

SUMMARY

The material received from many health workers, visiting nurses, infant-welfare workers, tuberculosis agencies, and social-service departments, regarding methods of field work with the immigrant, may be summed up in several conclusions. The chief problem peculiar to work with immigrants is that of winning their confidence and reaching their understanding over the barriers of mutual unintelligibility in language, habits of life, and former experience.

1. The first necessity of the field worker is to find a medium of communication with the foreign born. The majority will have to depend upon interpreters. Since the employment of trained, paid, full-time interpreters is rarely practicable, some plan for securing them when needed must be developed. The chief point is that securing interpreters must be systematic, not haphazard. In field work, calling in or taking along one of a certain number of regular local interpreters is much better than calling in a chance neighbor or child. Valuable means exist here of building up organized co-operation with and among the foreign born. In so far as the field agents are equipped with enough knowledge of the backgrounds and charac