comprehensive, but still definitely localized, area. The term "Health Center," which is now heard so frequently, suggests a combination of various forms of medical and health work, such as a number of different public-health clinics in the same building, either with or without clinics giving treatment in various branches of medicine.

Dispensaries have differed from hospitals significantly in the matter of clientele. The hospital generally accepts patients from all economic classes: those who can pay whatever is demanded go to individual rooms as private patients; those who can pay nothing or only the so-called ward rate go into large wards; persons in middle circumstances pay enough for small wards or semiprivate rooms, if the hospital has such.

With a very few notable exceptions dispensaries have limited their clientele to those who can pay little or nothing for medical service. Nominal fees are often charged, ten cents or twenty-five cents a visit, with or without small extra charges for medicines or special treatment; but the dispensary has been regarded, and has generally been operated, as an institution for medical relief of the poor, rather than an institution providing medical care for every social class, and receiving from each class according to its means. Considering the difficulty which many immigrants have in obtaining or in paying for adequate medical service, one might feel that the dispensary was peculiarly called upon to serve the immigrant.

We have seen something of the immigrant's attitude toward hospitals. Many of the same objections are raised against dispensaries. The distance and strangeness of the place, the inability to understand or to

make oneself understood, and the fear that doctors "practice on you," are all brought out in immigrant testimonies. The long waiting before treatment is an additional objection to the dispensary. This becomes a serious problem for mothers, when children must either be brought along or left at home in the care of a busy neighbor or of children too young to take the responsibility. A Polish woman says:

Mrs. C. was referred to the dispensary by the public charities. She had complained of blurring eyes and splitting headaches. The doctors in her neighborhood could not help her and the neighbors had told her all they knew about patent medicines. Since she came to the dispensary she felt better, but it is so far and the car fare is expensive. Besides, not being able to read and write, she does not know what car to take, and the neighbors, although they were willing to come with her the first time, find that they are too busy to give all the morning. Then, of course, she cannot speak English and does not like to explain to everyone why she cannot pay. So she had rather stay at home and suffer.

From an Italian comes this testimony:

Family have used several dispensaries. Her husband for his eyes, she for herself and her children. When her children were babies she used to go there for their feeding, as she could not nurse them. She does not like their methods of treatment. She feels that the doctors are students and experiment on the patients. Her child didn't improve, so she took her to a private doctor. Then, too, she says that one has to waste so much time waiting before being treated. On the whole, though the private doctor charges more, one remains more satisfied.

A Ukrainian doctor says:

Attitude toward dispensaries much the same as toward hospitals: they feel very strange and lost; the doctors do

not speak the language; and when the history of a case has to be taken through an interpreter there is so much talk going on which the patient does not understand that he goes away bewildered and discouraged. The dispensaries are not usually very near, the hours may not be convenient, there is the long waiting in line, and again the suggestion of charity.

A Jewish doctor says:

In regard to the dispensaries, the Jewish attitude is quite different, and the people flock to them. They know they will receive the care of a specialist, a professor, and they are only too glad to avail themselves of the opportunity. There the mother can go into the clinic with the child and is permitted to talk and explain herself freely.

USE BY IMMIGRANTS

In spite of these attitudes, one of the striking features of dispensary work is the wide variety of nationalities cared for and the large proportion of foreign born among the patients of many typical institutions. Thus, at the Boston Dispensary, which receives about 35,000 patients a year in its out-patient clinics, 34 different nationalities were represented during one recent year; 45 per cent of all the patients were foreign born, but 30 per cent additional were the native-born children of immigrants, only one fourth of the total clientele being of native stock. This proportion is not dissimilar to that which obtains in the local population.

There are, of course, some large dispensaries, in New York City, for example, where, because of the neighborhood or the racial affiliations of the dispensary, a vast majority of the patients are of a single racial

group. But the polyglot nature of the assemblage in the admission hall cannot fail to impress the visitor to almost any of the larger dispensaries in New York, Chicago, Baltimore, Philadelphia, Cleveland, St. Louis, or San Francisco.

With a view to understanding the order and rate of the immigrant's acquaintanceship with American medical resources, it is interesting to ascertain the relative use of dispensaries by different racial groups. Some valuable figures have been obtained from one of the largest dispensaries in Chicago.1 Out of 2,535 consecutive cases, 1,055 were from 6 chief immigrant groups:

TABLE XXX

NUMBER AND PER CENT OF 1,055 CASES TREATED BY THE CENTRAL FREE DISPENSARY, RUSH MEDICAL COLLEGE, BY NATIONALITY

It will be noticed that the number of Jews and Poles are nearly equal. Investigation of the sources from which the patients came, or of the reasons for their coming, disclosed the following facts. More than 55 per cent of the Poles were sent to the dispensary by

1 The co-operation of Mr. John E. Ranson, superintendent of the Central Free Dispensary of Rush Medical College, is gratefully acknowledged in this connection.

some agency, usually the Board of Education. Among the Jews, on the other hand, only 13 per cent had come from agencies, the large majority having come to the dispensary on their own initiative. The Italians occupy a middle ground between the Jews and the Poles, 45 per cent having been referred by an agency. Among the Polish patients only 10 per cent were fortyfive years of age or over, and 45 per cent were children of, or under school age, who came to the dispensary either to secure medical examination for working papers or because the school doctor or nurse had referred them for medical care. The percentages among the Bohemians and the Lithuanians were practically the same as for the Poles. Among the Jews, 20 per cent were over forty-five, and only 10 per cent were children.

The percentage of Jewish patients among the total patients of the Boston Dispensary was found to be just about twice as great as the proportion of Jews in the city population.

Figures secured in the study of the dispensaries of New York City, conducted by Dr. E. H. LewinskiCorwin, under the auspices of the New York Academy of Medicine, and generously placed at our disposal, showed the type of treatment secured by 3,536 sufferers from various ills in New York City, by nationality. The number using dispensaries is compared with the number using hospitals by race (Table XXXI).

From all these figures it is apparent that of the three large recent immigrant groups, the Jews are far and away the greatest users of dispensaries; the Poles and other Slavs use them least; the Italians occupy a middle division. Long residence in the country in