blocks housing the 25,000 inhabitants of that highly congested area.

2. By making a single official, who was chosen for his familiarity with the human as well as the publichealth factors of the work, and who was in daily local attendance, the center for most official contacts between department and populace.

3. By emphasizing, through the generalized nursing service—one nurse to a family-the personal elements as distinguished from the professional elements.

It is said that among both the physicians of the district and the general population, a noteworthy increase in efficiency and friendliness developed during the rather short period that this interesting experiment was in effective progress.

This scheme involves the same principle of "line" and "staff" organization with which army procedure has made us familiar, and which is generally applied in public-school systems and other large enterprises. The "staff" is a group of experts, each concerned with a special function or group of functions. The "line" officers and employees are concerned with administering the work in its various functions.

Thus, in this East Side health center, the bureau chiefs were "staff" supervisors, each watching critically the performance of the special functions which came under his or her bureau. The local health officer and the nurses and others under him were "line" officers or employees. Further experiments of this type will be required to establish the desirability of such a scheme of localized health administration. In

herent in it are principles of successful medical and health work with the foreign born.

HEALTH CENTERS IN CLEVELAND

New York City is not alone in the development of district schemes. Cleveland has a system of health centers (at present eight in number, but probably soon to be increased) in charge of the health department. Their work includes tuberculosis and preventive service for mothers and babies, and each serves a definite district.

The health-department nurses do all the work except bedside nursing. One of these health centers is the so-called University Teaching District. The supervising nurse is an appointee of the Western Reserve University Medical School, who retains also a relation to the health department. The five nurses under her have each a special section of the district, and do general and bedside nursing, as well as special work. The training of public-health nurses is also carried on here.

In this district the population is largely foreign born. One nurse has a considerable proportion of Italians; another, almost all Slavs; still another, many Jews; still another, a "great mixture." The localization and districting of the work appears to have brought about much greater interest in the human factors, including the factor of race.

The plan, which divides the district up into small sections, each in charge of one nurse, appears to have interested each nurse in the special problems of her people; to have made her familiar with the particular

races or other groups characteristic of her area, and to have increased the intensiveness and the extent of both social and professional contacts. The tendency of such a plan is to produce more work than a given staff can carry. This is the best evidence of its success, since the ultimate purpose of such health work is to cause a growing demand for the service. The goal is to meet 100 per cent of the needs.

CO-ORDINATION IN BUFFALO

In Buffalo the health department and the co-ordinate Department of Hospitals and Dispensaries co-operate in administering health centers. Five such centers are maintained in different parts of the city, in each of which infant welfare, antituberculosis, and prenatal work is conducted. Localization is carried still farther in the infant-welfare work by eight "well-baby clinics" outside the centers, but part of the same system. Five district physicians are employed on salary by the Department of Hospitals. Each physician treats the sick in their homes and also runs a general clinic in the district health center, of which he is in general charge. Four of the five health centers have dental clinics. Thus curative and preventive medicine are combined, although not wholly, under a single direction.

The first of these Buffalo health centers was located in rented quarters in a distinctly Polish district, but the development of the service has justified the provision of a new building especially for the purpose. The localization of both preventive and curative work appears to have demonstrated its value to the com

munity in Buffalo. Here again the people to whom the services are rendered are largely foreign born.

A DISPENSARY IN BOSTON

The Maverick Dispensary, Boston, represents a number of agencies brought together in a single building in a district peopled largely by Italians. A general medical clinic, morning and evening, eye and dental clinics for both children and adults, and an obstetrical clinic are included in the curative work of the dispensary proper. The physician who is in charge of the general clinic visits and treats patients in their homes. The District Nursing Association of Boston has its local headquarters in the building. Its nurses do bedside nursing and prenatal work in the district. The local "well-baby station" was formerly in the building, but has been driven out by lack of space. It is, however, in the immediate neighborhood, and works in close co-operation with the dispensary. The local clinics act as referring stations from which patients are sent to the large dispensaries and hospitals equipped for more elaborate work or for major operations.

Boston is as fully provided as any city in the country with general dispensary service. Yet the development of this local dispensary in a section largely foreign born seems to be fully justified during recent years by the rapid and steady increase in the number of cases cared for. The number of visits to the treatment clinics increased from 7,044 in 1915, to 10,859 in 1918, a growth of over 50 per cent. Undoubtedly friendly contact with this local center has served to familiarize

many foreign-born families with American medical

resources.

THE SOCIAL UNIT PLAN

Much the most comprehensive attempt to enlist and organize the co-operation of a district has been that of the National Social Unit Organization in Cincinnati. The so-called Mohawk-Brighton District, in which the experiment has been conducted, has a population of about 15,000, between 5 and 10 per cent of which are recent immigrants. These are mostly Rumanians and Hungarians, who live in one corner of the district and are in large proportion men without families. The bulk of the district is a comparatively long settled and stable family population of German-American stock. The findings of the Social Unit Plan are therefore limited in their application to the problems of the foreign born.

Activities up to the time of this writing have been chiefly along health lines, consisting largely of infants', children's, and prenatal work. Medical examinations and advice were given following the influenza epidemic. A statement dated January, 1919, gives an account of the "baby service."

The first service to be established for the neighborhood was a baby service which was decided upon by the MohawkBrighton Citizens and Occupational Councils and opened on December 17, 1917. It was found at once that because the block workers were elected representatives of the blocks, because they were neighbors of the babies' mothers, the work of discovering the babies and of interesting the mothers in bringing them to the station was greatly simplified. The doctors and nurses also were neighborhood