arrangement will promote general understanding of the hospital among the foreign-born groups.

SOCIAL-SERVICE DEPARTMENT

In addition to the special adaptation necessary to overcome the difficulties of diet and language, every hospital receiving immigrants should have a socialservice department to establish human relations with each patient. Yet despite the fact that all leaders in medical and public-health work to-day recognize the necessity for social service in hospitals, there are only some three hundred hospitals in this country which have such departments.

Such a department can work effectively only when it is intimately associated with the hospital administration in general, and not an isolated and subsidiary element helping individual patients whose needs have attracted special attention. The head of the department should be directly responsible to the hospital superintendent. The workers should be chosen for their skill and training in dealing with the personal and social problems of people. The department should be charged with special responsibilities for foreign-born patients; not merely case work in the wards, but also certain functions at the admission desk of the hospitals and the development and maintenance of effective co-operation with certain outside agencies.

At the admission desk it is important to obtain a considerable amount of information regarding the patient's personality, family, occupation, and resources, for the sake of the hospital's medical work and financial

returns, and also for the sake of the patient's care and after-care. It is often impossible to secure all these necessary facts at the moment when a very sick patient is admitted, but the deficiency can usually be supplied later. The facts gathered by the social worker at the admission desk must be put to a much broader service than merely to determine what the patient can pay the hospital for care. When properly secured, such knowledge furnishes hospital and patient a basis for mutual understanding and for the best medical and social results.

This work for the foreign born should be in the hands of some one who is able to speak at least one of the foreign languages common among the patients, and who has studied the backgrounds and characteristics of several immigrant races. It should be her responsibility also to help and encourage various hospital employees, nurses, other members of the socialservice department, and internes, to secure knowledge about the backgrounds and characteristics of the chief immigrant groups. It should be made apparent that thus better histories can be obtained, better co-operation of the patient secured, and better medical results achieved. These measures should have the support not only of the hospital superintendent, but of the chiefs of the medical staff.

The same individual of the social-service department should develop co-operation with outside immigrant organizations, with immigrant welfare societies, or with both.

Most hospitals have been founded primarily for the care of acutely sick patients. The attention of their medical and administrative staffs has been cen

tered upon the outstanding items of disease. The need for after-care of patients following discharge from the hospital, for social service, and in general for the development of relationships between the hospital and the community outside has been slow of effective recognition in most medical institutions.

Hospital organization is generally of a somewhat rigid and military character. This is true not only in the operating room, where such might be expected and necessary, but in the general administration of the hospital. Hospitals have rarely functioned in close co-ordination with other organizations in a general community scheme for medical service. The usual unresponsiveness of hospitals to the special needs of foreign-born patients is merely one illustration of this characteristic.

Anyone even slightly familiar with hospitals can call to mind numerous instances of devoted attention by doctors and nurses to individual patients, and of much personal interest in their welfare. Grave or unusual illness calls forth ready and unstinted response. A patient whose personality is appealing naturally receives attention and evidence of interest irrespective of the seriousness of his case.

It is, however, the duty of a hospital organization to provide for the average patient in human as well as in technical medical ways. Imagine an Italian or Pole who lies ten days or three weeks in a ward amid strange surroundings, unable to speak English. He receives food which is unfamiliar and often distasteful, however well prepared from the American point of view. Perhaps he is without friends who can talk

to him even at the necessarily infrequent periods when ward visitors are allowed.

Is not such a patient humanly pitiable? Must not the promptest post-operative convalescence, or return to health after any serious illness, be retarded by such conditions? The best medical results for the patient require that he comprehend the doctor's directions as to diet, work, and regime of life, after he is discharged from the hospital. Failure to understand these directions may mean that much of the hospital's effort is wasted.

IMMIGRANT HOSPITALS

Some of the objections expressed by immigrants are met by hospitals run by members of their own nationalities. In several large cities immigrants of a given group, who have been in sufficient numbers and possessed of sufficient means, have developed special hospitals for their own people.

The Jews have established their own hospitals in most of the large centers of Jewish population. The dietary laws of the Jew furnish a special reason why the orthodox Hebrew objects to going to "American" hospitals. It is notable, however, that most of the larger hospitals put up and supported by Jewish people do not provide a strictly kosher diet, as food prepared according to the Jewish dietary laws is called. This is partly because of practical culinary difficulties and partly because these hospitals have in most instances been put up and are chiefly supported by groups of Jews who no longer observe the dietary laws strictly, if at all. On this account a movement is on foot in several cities to establish hospitals in

which there is strict conformity to the Jewish dietary regime. In New York several kosher hospitals are well established. In Chicago the gradual rise in numbers, wealth, and influence of the orthodox Jewish immigration has recently resulted in a similar kosher hospital independent of the long-established Michael Reese Hospital.

In New York City we find the Italian Hospital. In several other cities where the Italians are newer and not so numerous as in New York, a number of efforts can be traced to found such hospitals, supported by and for Italians. There are hospitals supported by Poles or closely associated with Polish groups in Chicago, Detroit, Cleveland, Buffalo, and elsewhere. The Japanese colony in San Francisco is developing plans for its own hospital. The desire of the Japanese to come close to the American community is illustrated by their efforts to affiliate this proposed hospital with the University Hospital in San Francisco, thus providing opportunities for well-trained Japanese physicians, while also utilizing the services of American physicians of standing.

In smaller communities individual physicians maintain small private hospitals for people of their own race. The demand of the older generations for a hospital run by their own people, and furnishing their familiar foods, is often reinforced by the desire of doctors of the same race to have opportunities for hospital work and experience which most of them cannot secure at the "American" institutions.

The endeavors of foreign-born groups to develop their own hospitals should not be interpreted as merely a desire to perpetuate their own nationality in this