ployees speaking the more common languages should be found. The conditions relating to the acquirement of foreign languages by visiting nurses and other field workers apply with equal force to social workers in a dispensary, particularly to those at the admission desk. As much knowledge of languages as is necessary to make a psychologically pleasant approach to each patient is invaluable at the admission desk, and some degree of this facility should be expected of any person regularly employed there. SOCIAL-SERVICE DEPARTMENT The most important step which a dispensary can take to adapt its internal administration to the needs of the immigrant is to organize a strong social-service department. The admission of new patients should be in the charge of this department; the worker or workers at the admission desk should hold permanent positions there, and be especially qualified to deal with the races and types of people who come frequently to the dispensary. In the dispensary, as well as in the hospital, the social-service department has a double function. In the first place, it is the agent dealing with patients who are under the doctor's care, assisting the physician in controlling the patient's personality and environment, so that medical treatment can be successfully carried out. But social service is also an administrative arm of the dispensary. The social worker is of value at the admission desk and in the dispensary clinic itself, because she is trained to study people and deal with them on co-operative human terms. In this respect the spirit of the social-service department tends to be a useful counterbalance to the highly specialized professional activity of the medical staff itself.1 VALUE OF FOOD CLINIC A food clinic is a valuable adjunct to a dispensary, since here, as in the hospital, dietary problems are a significant element in the treatment of disease. A well-trained dietitian can advise and instruct patients in the selection, purchase, and preparation of foods. She can work out family budgets and adapt a medically prescribed diet to the patient's previous food habits and the financial means available. Such a food clinic must take into account the accustomed foods of the foreign born. If this is well done the food clinic not only furthers the medical treatment of patients, but is an invaluable aid in winning their understanding and confidence. FOREIGN-BORN PERSONNEL The presence on dispensary staffs of foreign-born or foreign-speaking doctors is advisable, whenever it is possible to use such physicians without lowering medical standards. Many notable examples of invaluable service rendered by such physicians can be found, both in large, central dispensaries and in local clinics. Mention has been made of a certain lack of sympathy 1 Bertha C. Lovell, "Social Worker as Clinic Executive," Modern Hospital, August, 1919, vol. xiii, no. 12, pp. 153–155. shown by the foreign-born visiting nurse for people of her own country. The foreign doctor in the dispensary clinic has sometimes shown the same characteristic. This is a problem of personality. To secure just any foreign-speaking doctor is not enough. He must be a competent, worth-while foreign-speaking doctor, concerned with assisting his people. A large clinic needs a considerable administrative staff: a clinic secretary, a clerk, a nurse, a social worker-one or more of each. Where a number of people must be employed, careful planning and selection can get together a staff who, between them, have a knowledge of the languages and, what is even more important, an understanding of the backgrounds and characteristics of the immigrants chiefly encountered. Under a well-trained, wise clinic executive, a young woman of foreign parentage speaking one or more European tongues may be extremely valuable as a clerk and interpreter, her deficiencies of judgment about people and situations being balanced by her superior ability in communication. The selection and balancing of the staff of such a clinic is a problem for the superintendent or administrator, who should hold in mind both the purpose of adapting the clinic to the needs of the people and the necessity of understanding the people as a basis of such adaptation. NEED FOR LOCALIZATION One of the things which we have found to militate against the use of dispensaries by immigrants is distance away from the home neighborhood. To reach the people, and particularly to overcome the obstacles presented by lack of education and unfamiliarity with the American environment, the dispensary must be brought to the people, and not wait for them to come to it. This principle has been recognized by the publichealth dispensaries. They have not been institutional. They have done what the advertising men call "going out after the business." The establishment of a chain of clinics or of infant-welfare stations in neighborhoods which particularly need their services, is characteristic of recent public-health endeavors. The mere localization of a clinic, rendering the building, and at least some of the workers in it, familiar by sight to the neighborhood, and the neighborhood familiar to the workers, is a long step in adapting the institution to its clientele. The dispensary must compete with such commercial medical resources as the quack and the drug store. Localization removes one of the disadvantages under which the dispensary otherwise labors in a competition wherein the aggressive party has the advantage. If the principles of adaptation of the dispensary to the immigrant were to be listed, that of localization should have first place. In the metropolis, or even in the city of moderate size, a local clinic or health center can serve only a small area. Therefore, there should be a number of such clinics, each with a definite district. Large dispensaries or out-patient departments, however, must be located at central points in a city, or where transportation lines furnish ready access, and in each community there cannot be very many such large dis pensaries fully equipped with every modern resource for scientific work in medicine. How shall the large central dispensary, which necessarily draws from a wide area and cannot be familiar to many persons as a neighborhood agency, overcome the disadvantage of distance from many who need its services? COMMUNITY PLAN FOR MEDICAL SERVICE The answer to this question can be found only in a community plan for medical service. So long as each dispensary is planned, located, and administered as a wholly independent agency, the best adaptation of the large dispensary to the needs of special localities, and particularly of immigrant localities, presents almost insoluble problems. The local dispensaries or health centers should be interrelated both as to staff and as to administrative methods. These should refer patients needing treatment requiring the facilities of a large institution, to the central dispensaries. They will then build a bridge between the neighborhood and the big, central institution. The important thing to remember is that the obstacles are not so much material as psychic. Experience has proved that distance alone is a slight deterrent when patients know the institution to which they are to go, and are confident of securing there a greatly needed service. It is the fear of the unfamiliar, the rumor that strange doctors will practice on them, that stand in the way. The local dispensary, with its familiar quarters and visiting nurses, is the best means of acquainting the immigrant with the organized medical resources of his |