It must be realized that this cost will cover other activities not itemized in the above list and that very substantial financial returns may be expected from certain of the services. Further, aside from financial returns, the industrial work more than compensates the industries in the conservation of labor, the efficiency of employees, etc.

The fact that many essentials of this plan are already in operation in Framingham, adds to its value.

To put these principles into practice all over the vast extent of the United States, with its several thousand small communities, is an enormous undertaking. The Framingham experiment as yet stands practically alone as the one carefully considered effort to deal with the problem, and it is still in its earlier stages. We need at once similar experiments in other communities of different types. We need constant comparison and analysis of methods and results, so as to develop fully the principles on which the methods have been based, the extent to which different principles have been successful, the reason for their success or their failure, and the bearing of all this upon national and local programs of medical and health service.

XIX

NATIONAL APPLICATIONS

THE beginning of Americanization is with Americans. The beginning of effective medical health work among immigrants depends on the right point of view among American health officers and health workers-a point of view which is sympathetic, democratic, and based on understanding of the people with whom the health worker is dealing.

Knowledge of immigrant backgrounds and characteristics is the right foundation for this point of view, and for successful work with and for the immigrant. Some knowledge of the language, even a few words, is most useful to the field worker. But knowledge of backgrounds and characteristics is even more important because it gives the ability to utilize interpreters, foreign-language literature, and personal contacts, with real effectiveness.

TASKS FOR NATIONAL AND LOCAL ORGANIZATIONS

For the development of technique with the foreign born in the various practical measures which have been outlined, it is desirable that there be committees or bureaus of national organizations to fulfill the following functions:

(a) Collation and publication of the methods and

results of local organizations in medical and health work with the foreign born. This same body could serve to instigate and co-ordinate studies in the vital statistics of the foreign born.

(b) Stimulation, development, and standardization of the education of field workers for effective service among the foreign born.

(c) Practical assistance to local organizations in the development of medical and health service for their immigrant population. This will be particularly valuable during the next few years, when all experiments along this line will be profitable to other communities.

There is a tendency in America for every new idea to call forth a new organization. The development of better medical and health work for the foreign born in this country is not a new idea, but, as this survey has shown, special attention to the foreign born is not yet characteristic of American medical and health agencies. Much must be done to put into practice by the many the ideas, the ideals, and the methods which have already been conceived or tested out by the few. Yet this advance ought not to require a new organization. There are already in existence a host of national societies, local associations, and governmental agencies performing medical or health work, training medical or health workers, carrying on research, or devoting themselves to publicity and popular health education.

The chief organizations carrying on curative medical work are the hospitals and the dispensaries. Some of these are organized locally, and the whole body have their national organization, the American Hospital Association. The visiting nurses and the medical social workers of the country are each nationally

organized. So are the dietitians. In the field of preventive medicine the health departments and the militant health agencies have several national and many state organizations. Chief among these is the American Public Health Association. The aim is to make each of these organizations perceive that the successful accomplishment of its purpose requires more attention to the special problems of the foreign born and to the special methods necessary for greatest efficiency in work among them.

Considering the already bewildering multiplicity of medical and health organizations in the United States, it is unwise to establish a new organization if it can be avoided. The study of the problems of health and disease among the foreign born, and of better methods for their solution, ought rather to be undertaken by special sections or committees, or specially appointed executives, of existing organizations.

National and state organizations do not, as a rule, undertake much detail work in the field, but confine their efforts to research, publicity, or advisory service. Such bodies sometimes subsidize local organizations for a piece of research or of experimental field work. Further comparison of the morbidity and mortality statistics for native and foreign born, and for different race groups, is one of the fundamental and constructive tasks ahead. All local, state, and national organizations having anything to do with medical or health work, have a direct interest in such investigations. Among the organizations which have already collected statistics on this subject, or have pursued special investigations, are the United States Census Bureau, life-insurance companies, local and state departments

of health, and local voluntary medical and health agencies. Sporadic investigations of this type need both encouragement and co-ordination.

NEED FOR A CENTRAL STANDARDIZING AGENCY

It would be well for some national body, representative of these various organizations, to serve as a central stimulative and advisory agent-helping to standardize technique so that the results of different studies should be comparable, suggesting new problems or questions on which research is needed, and collating, publishing, or stimulating the publication of coordinated results and surveys.

A Committee or Bureau on Health Work with the Foreign Born, of a representative national body properly financed, would fulfill a highly important national function, not only in stimulating statistical research, but also in collating and advancing methods of health education and field work among the foreign born, and in disseminating whatever knowledge and advice such activities would yield.

TRAINING HEALTH WORKERS

The training of health workers for successful service among the foreign born is another major task. Among the organizations now chiefly concerned with such training are the schools for health officers, the nurses' training schools, particularly those schools offering special courses in public-health nursing, and the special schools or college departments which are training men and women for social service. The most numer