new country. The success of the large central dispensaries in reaching the newer immigrants, many of whom are particularly in need of their services, must rest largely upon the existence in the community of an adequate number of local clinics or health centers, properly co-ordinated one with another and with the central medical resources.

CO-OPERATION OF IMMIGRANTS

The dispensary is in a favorable position to secure the co-operation of the immigrants themselves, their leaders and organizations. Some dispensaries build up a list of those whom they call the "grateful patients" (G. P.) or "pleased patients," indexed by locality, nationality, language, and in various other ways, so that they can be called on at need for friendly service, as interpreters or to persuade patients to carry out medical treatment. Here again the social-service department should be the agent of the dispensary in making this idea effective. The local clinic or health center finds it comparatively easy to build up cooperation with neighbors or neighborhood organizations. Here, as elsewhere, the prerequisite is the right point of view on the part of the superintendent and managers of the dispensary, a point of view based on knowledge of the backgrounds and characteristics of the people with whom the dispensary deals, and filled with sympathy alike for their qualities, their deficiencies, their needs, and their achievements.

XVI

INDUSTRIAL HEALTH WORK

WHILE most manufacturers are probably conscious that they employ numbers of immigrants, a few figures may emphasize the importance of giving special consideration to this group in industry. In 1908-09 the United States Immigration Commission made an investigation of immigrants in industries, which was summarized by Jenks and Lauck.1

The proportions of foreign born among the operating forces of the principal branches of manufacturing and mining were as follows:

More than half of the iron and steel workers,

employees of oil refineries,

slaughtering and meat-packing establishments,
furniture factories,

leather tanneries and finishing establishments,
woolen and worsted goods, and
cotton-mill operatives;

about two fifths of the glass workers;
one third of the silk-mill operatives,
glove-factory employees, and

cigar and tobacco makers;

seven tenths of men and women garment makers; more than one fourth of the boot- and shoe-factory operatives;

four fifths of the wage earners in sugar refineries.

1 Jenks and Lauck, The Immigration Problem (1913 edition), pp. 148-149.

Does the immigrant employee, because of his foreign birth, present special medical, sanitary, and health problems to the industrial physician? If so, what methods of solving these problems are being tried out, and with what success? What should be the interrelation of industrial medicine and the general medical service of the community?

As in other branches of this study, information was secured partly by questionnaires and partly by personal visits and interviews. Health conditions and problems vary with the location of an industry, with its character, and with the racial elements of its employees. Consequently, manufacturing establishments in large cities and in small towns, mining communities in several parts of the United States, and finally some mercantile establishments, were visited. The Atlantic coast states, the regions around Cleveland and Chicago, parts of Pennsylvania, Minnesota, Michigan, Colorado, and California, were included. About fifty different establishments were visited, five or six people usually being interviewed at each. The industrial physicians, the nurses, the safety and sanitation departments, and the employment managers, were the persons sought for.

To get the industrial physician's own conception of what problems the immigrant brings to him, the questionnaire method was first used. We find in the replies expressions of every point of view, from the big-stick theory up. One doctor writes:

There is an endless field for doing good, and we are desirous of doing our part, especially teaching these men of foreign birth to respect and honor their adopted country. Teach them how to live in their homes, and

make them desirable citizens, proud to live [in the United States].

A contrast to this paternalistic approach is the following:

Give them a square deal, house them in habitations fit for humans rather than in hovels and rabbit warrens, appeal to them by means of pictures, talks in their own language, and an honest desire to help them, rather than, as has been done, work them to death, pay as poor a wage as possible to compel them to accept. . . . This is my idea of . . . what might be done to make them better physically, mentally. We must meet them on the level, and not condescend from a superior height.

The doctor who would force the immigrant to conform to our standards is well represented in the questionnaires. One physician suggests that we "eliminate as far as possible all foreign institutions," in the same breath that he advises the "abolition of the saloon." Another doctor feels the great need for "education of the employer" if these problems are to be solved. He is seconded by one who writes that both "employer and employee must be educated, the former to spend money for a first-class (welfare) organization, and the other to accept graciously that which makes him or her a more valuable worker.”

The following anecdote illustrates better than anything else an all too prevalent attitude toward the immigrant employee.

While I was talking with one of the nurses a Hungarian, small and dirty, violently gesticulating and speaking broken English, came bursting into the room next ours. The employment manager stepped in from the next room to try to quell the disturbance. When I passed through, the nurses and the employment manager were standing in

great annoyance, laughing at this little man. He was so frantically eager to make them understand his trouble that he was weeping at his inability to do so, while they merely grinned at him. The employment manager explained the trouble:

"Oh, that man's wife is sick and he wants us to pay the meat bill." Then he laughed. How many facts lay behind that statement it is hard to say, nor was any sincere attempt made to find out from the man the specific cause of his distress. He went out, returning in a few moments, still shaken by his excitement, to find the door ordered locked against his re-entry.

The industrial physician needs more than medical knowledge to deal with the problems presented by the immigrants in industry. It is difficult for him to feel anything but exasperation at the personal uncleanliness of an immigrant employee. Does he, however, know what the race habits of this people were with regard to bathing, or what bathing facilities this particular man now has in his American home? To accomplish the best results in preventing accidents, curing disease, and promoting health and efficiency among foreign-born employees requires both a consciousness of immigrant backgrounds and a knowledge of the conditions under which immigrants live in this country.

The ideal attitude of industry toward this question appears in the following quotation: "The manager of the future. . . will love men, and will work with them to make them better men. He will study men, for in the last analysis men are, and always will be, the foundation of industry and civilization. . .

1 Charles E. Knoeppel, "Industrial Organization as It Affects Executives and Workers." Address before the American Society of Mechanical Engineers, New York City, December, 1918.