eration of immigrant backgrounds are essential to overcoming the barriers of language and point of view. The method of approach to the employee should be democratic, not paternalistic, and every effort should be made to enlist him in the support and the administration of industrial medicine.

One kind of industrial medicine that will never pay is the cheap kind. Good physicians require adequate salaries. It is the cheap men who conceive of and treat people cheaply. The keen, well-trained doctor appreciates the vital importance of the human factor in medical and business efficiency, and will perceive and strive to deal with the special problems of the immigrant employee.

The industrial physician should be directly responsible to one of the high officials of his plant, as the head of any major department would be. Only in that way will the full value and importance of the medical work be realized.

The larger problem of industrial medicine hinges upon the question of its place in community health work. How far should it go beyond the walls of the plant itself? Not a few industries have undertaken housing for employees, partly for sanitary, partly for other reasons. Medical care has been extended to employees in their homes and sometimes to their families as well, in many mining communities, and in some factories and labor camps.

The contract system, as developed in the iron and copper ranges of Minnesota and Michigan, is in the main a creature of the employer rather than of the community, and has the essential limitations of the manner of its creation. It is apparent that in a newly

opened country the contract system will assure the employees and their families medical services which would be beyond their reach if the industry did not come forward. But almost everywhere it is in use it shows the evils of any scheme of medicine which is on a commercial basis, but which has not developed with the understanding and co-operation of those who are to receive its care.

The entrance of industry into community medical care has been frequently observed to coincide with a low level of public-health work in the same area. This is particularly true in regions where the community consists largely of foreign-born employees too recently immigrated to take much part in normal community activities.

A marked contrast could be drawn between the conditions described on the iron and copper ranges in northern Minnesota and Michigan, where practically all the medical and health work is done by the industry for the community, and the situation in Akron, Ohio. Several large industries in Akron have their own well-developed departments of industrial medicine; they have also bent their efforts to a notable degree to advance and assist the health work of the community under the city government. Where industry has a farsighted view instead of a short-range commercial one, it will encourage community health work and not substitute industrial medicine for it.

On the whole, except temporarily under pioneer conditions, the development of industrial medical service outside the industrial establishment itself must be regarded as an influence against Americanization in the larger sense, and against the more permanent

interests of the communities' medical and health work. If the administration of industrial organizations, and therefore industrial medicine, were wholly co-operative and democratic, this might not be true. But under present conditions it is to be hoped that medical and health resources will be developed and strengthened as much as possible from community rather than from direct industrial resources.

Industry should do its share as a part of the community, but not more than its share. The initiative and self-dependence of immigrants and their families, and their understanding of the purposes and methods of medical and health work, can be promoted only when they have responsibility and participation as citizens.

1

Mr. Whiting Williams of Cleveland, in an article printed for circulation by the United States Department of Labor, says:

The price of maximum production is maximum personality for every human producer. Of this, the price is maximum outlet for that human producer's best and biggest feelings. That in turn can be bought only with right relationships and associations with all the persons of his world. Of that the price and the prize is democracy.

1 Whiting Williams, Human Relations in Industry, leaflet printed by the United States Department of Labor, 1918.

XVII

PUBLIC HEALTH WORK

THE health department is the fundamental agent of the community to serve, protect, and advance the physical well-being of its members. Any survey of American policies and methods in medical and health work leads to the health department. Any program of medical and health work must place in the foreground the policies and methods of the health department, as they are or as they should be. In order to secure material for this study public-health officials in all cities of 25,000 population and over were asked to state what special problems they have met in dealing with the foreign born, and what methods they have used in solving them.

From the answers it is apparent that the special problems of health standards and care among the foreign born have made very little impression on the mind of the average health officer. To be sure, one finds striking exceptions to this rule, which only bring .into greater relief the indifference of the large majority.

The reason for the apparent neglect of such an important element in health work is clear. Public-health administration, in the majority of cases, is just beginning to come into its own as to equipment, trained personnel, and a modern conception of the powers and duties of the department. With the exit of the "yellow flag" and "shotgun" quarantine methods

have come careful analysis of the causes of disease, and the application of rational methods to its prevention and control.

Valuable answers were received from 116 health officers. As the outstanding health problems of the foreign born, 64 per cent mentioned housing and home sanitation, 44 per cent child and infant welfare, and 32 per cent care of contagious diseases. In discussing these problems all points of view were expressed.

Too often there appeared the attitude that the foreign born "lack willingness to learn the precautions of health." Based on this premise is the inevitable conclusion that the only way to deal with health situations involving the foreign born is the big-stick method. The head of a middle-sized city in New York (Albany) says with emphasis that the only way to control communicable disease among the foreign born is by police quarantine. In this he is seconded by one of the larger cities of the Far West (Denver). It is refreshing to find in Texas (Beaumont) an official who is sure that we can educate the immigrants to believe that the health department is to benefit and not to prosecute them. This feeling is more than confirmed by a Massachusetts (Springfield) health officer of long experience, who says "that they can be educated that they cannot be controlled by prosecution. Further, that if we make the right approach the average foreign-born person will respond to efforts and carry out our recommendations." A public-health nurse in Massachusetts (North Adams) testifies that "as a rule the foreign born respond to advice and carry out instructions as faithfully as our own people in the same circumstances."