are very similar in all forms of medical and health work.

Generalization, therefore, throwing emphasis upon the personal instead of the technical elements, is particularly applicable to work among the foreign born, provided always that we have workers with the necessary qualifications. Medical and health work with the foreign born places an emphasis upon personality and upon understanding of people, more than upon skill in technique, and only through personality and understanding of the people can results in technique be realized.

SERVICE ORGANIZATION

The unit of area selected for field work should not be the same as the area from which professional services are to be drawn. A much larger unit of population is necessary to supply all the various facilities and personnel which are included in a complete medical and health service. The Social Unit in Cincinnati has proceeded as if the personnel, at least for the medical service, must be drawn from within the same area as that selected for field work. Proceeding on this theory, specialists in pediatrics and obstetrics, for example, could not be included. In selecting the nonmedical personnel, such as the nurses, this theory was not applied.

In the Framingham Community Health and Tuberculosis Demonstration this mistake has been avoided, and outside physicians have been brought in to see patients at the request of local physicians or at the patient's own desire. As a result, the physicians of the community are provided with expert consultants

without interference with their practice, and the people receive a quality of service which, under ordinary conditions, would not be available to them.

All the factors necessary to a complete medical and health service ought to be available for every neighborhood in every area of a community or of a state. The professional personnel of the neighborhood must not be the sole, or the determining, factor, but a cooperating element in the organization of professional services.

In many small cities and towns there is a sort of local self-consciousness, or pride, which renders it difficult to include so-called outside talent in the service organization. A very worthy human sentiment is at the basis of this feeling, but a thorough understanding that the community can secure satisfactory service only if a broader area is drawn upon will go far to render the right plan practicable. This is especially important in case of the emergency needs of epidemic or disaster.

The right kind of service organization includes specialists, e.g., oculists, orthopedists, psychiatrists, experts in the diagnosis of tuberculosis, who visit the appropriate clinics in the community just so often as is necessary. A small town may require one half or the whole of a dentist's time for the school children, or for the public in general. Psychiatrists for a mental clinic would be needed by the same community only once a month or even less often. The nature of the work, or the relative frequency of the particular diseases in a population, determines the time required from different consultants and specialists.

The service organization must include state as well

as local or county personnel and functions. The experts or the district supervisors of the state health department should furnish organizing ability and a standardizing influence. We have good examples of this in the administration of the venereal-disease program in a number of states during and since the

war.

Health literature for use in clinics and in the homes can be more efficiently and economically prepared by a state or national organization than by each local community for itself. The diagnostic facilities of a state laboratory should be, as they are in many states to-day, made available to physicians and clinics in every community. Expensive equipment, such as an X-ray outfit, should be provided for such an area or population as can utilize it fully. So should a hospital, or a dispensary, with all its varied diagnostic and therapeutic apparatus.

DISTRIBUTION OF THE FINANCIAL BURDEN

The expense of health work must be distributed over an area sufficiently large to equalize local resources with local needs. Whereas the need for medical and health work is almost exactly in proportion to the number of the population, the financial resources of an area are not by any means determined by the number of people living in it. The financial power or tax-paying ability of an industrial city or a well-to-do residential suburb may be many times greater than that of large rural areas, including an equivalent population. Yet the interests of the city in the prevention of disease, the promotion of a wholesome life

for the state as a whole, and of industrial efficiency in the workers, give its residents, its business men, and its taxpayers a direct interest in better medical and health service for the country and the state.

It is proper and fitting that the local community organization should bear the primary financial responsibility of local medical and health service, but a larger area (sometimes the county, sometimes the state, perhaps the Federal government) may well share certain expenses. The venereal-disease campaign, financed in part by national and in part by local funds, and the work of vocational education, financed partly by state and partly by national funds, have begun to make the application of this principle familiar to the people at large.

The organized use of hospitals in one community by those in smaller neighboring communities or rural areas, is now possible, with the development of motor transportation. The possibilities of transportation make very small hospital units (twenty beds or less) rarely necessary, because larger units, better equipped and more economically administered, can be used not only for obstetrical and all forms of emergency service, but for general medical and surgical work as well. Small local units are necessary in most instances only as first aid or temporary relief stations.

The provision of nurses is properly a function of the local organization, but state or county aid should be provided in organizing nursing service and in standardization and general supervision of its work. It would be an appropriate and requisite health measure for some states to subsidize visiting-nursing service in certain sections.