medical or health work among their employees, must be considered from a technical point of view, to see how their methods have been adapted to the foreign born, or have failed to be so adapted. Examples of effective methods which might be of practical service if generally known, should be presented in some detail wherever possible. This is the case with problems of diet for the foreign born, a matter of great practical importance to hospitals and to health workers in the homes. So also with the urgent and picturesque subject of the medical quack and his all-too-effective methods among the foreign born.

The war forced Americanization upon the public attention. Some developed a definite conception of Americanization without much serious thinking. To them it meant teaching English and civics. It meant getting the immigrant naturalized. It meant making people Americans by putting them through certain instructions, crowned by the laying on of hands.

But the war made many others think about this matter. It brought them to see that Americanization implies more than mere instruction and more than naturalization. The assimilation of ten, twenty, or thirty million people into a nation of over one hundred million should mean mutual understanding, not the swallowing of one by the other. A common language must be achieved, but also mutually respected habits and standards of life. Full Americanization is impossible without an all-round transfusion of all the important elements in human life.

Health matters, as one of the important aspects of life, have an integral part in the process of Americanization. The numberless habits, customs, standards,

upon which personal and family hygiene are based are of importance to the physician, and the health department, in relation to the care and prevention of disease. They are also everyday elements in determining the extent to which people are developing as Americans, members-in-full of an American community.

Do

Have people such habits and standards of household life that if good housing is available facilities will be used and not misused? This question involves health and Americanization at the same time. people know how to use the facilities for the care of disease, such as, hospitals, sanitariums, clinics, welltrained private doctors? Or are people too ill informed to make the best use of what is available? This is not only a question of health. It involves the extent to which the people are intelligent participants in the American community. Are people intelligently cooperative with the school nurse, with the department of health, the infant welfare or antituberculosis agencies, public or private? Are people subject to the exploitations of medical quacks because of ignorance of good medical facilities combined with inability to read English? These, again, are matters of both health and Americanization.

Perhaps the chief difficulty in such a study as this is that of starting with a clean slate. Too many people have made up their minds concerning Americanization before thinking about it. It is easy to be led into a certain policy perhaps unconsciously, because of an a priori theory. We may hold in the backs of our heads cherished ideas about Americanization or about the differences between races. Consciously, or even un

consciously, we may have prejudices against certain kinds of people. Our attitude toward Americanization may be deeply influenced also by a fear of Bolshevism. Our selection and interpretation of facts, and our final conclusions, must not be determined by such preconceptions.

It is all too easy to let race prejudice or antagonism to foreign language be a controlling element in our judgments. This is particularly true when we are hardly conscious of our prejudices. It is well, therefore, to discuss, at the beginning, the three prevailing groups of preconceptions or "theories" about Americanization activities from the point of view of medical and health work especially. Such a review will render us conscious of the place and limitations of each theory, and we shall be less likely to be led astray without knowing it.

THE BIG-STICK THEORY

"Sorry to say it, but most of them must be scared into doing things." Thus the executive of a Western health organization sums up his policy of dealing with them the foreign born. The health officer of a large city writes:

In most cases of contagion among foreigners, especially those who will not observe quarantine, we keep a quarantine officer in the neighborhood, who does not hesitate to arrest any offender, and generally after the first arrest we have no further trouble. This is a drastic measure, but it is the only efficient one we know.

A surgeon connected with a large industrial establishment says:

What we need to deal with the health problems of the foreign born is adequate health laws and power to enforce them.

A health officer of a Middle Western city of moderate size says:

The foreign element in our city are most difficult to deal with because they are generally inclined to help themselves rather than accept skilled medical assistance and advice.

The same theory as that expressed in the previous quotations appears here by implication. It stands out still more plainly in the following, from a childwelfare bureau in a large Eastern city:

We have never modified the type of work to suit any special groups of people. We have always attempted to mold the groups to our way, so that our work would be uniform. We do, however, tell our workers never to encroach upon customs of different nationalities, if those customs do not conflict with our regulations or teaching.

An official from another large city writes:

In hospitals they [the foreign born] cannot be made to understand the treatment, and do not seem to improve under unfamiliar conditions.

A devoted worker, himself of foreign extraction, who has spent years of his life wrestling with this problem in great hospitals, illustrates his experience as follows:

Internes, as a rule, wonder how Polish mothers can be for ten years in America without knowing the language of the country. My answer was that those Polish mothers were exempted by the United States government by having brought forth and educated ten to twelve strong and healthy sons and daughters that are able to speak two languages.

But our social workers are more severe in their judgment. In their fervor they would like to call upon the United States army and navy to do away with all those foreign languages.

What may be called the big-stick theory shows its head more or less frankly in these citations. This theory has taken on new vigor because of the war. Through its influence the continuance of foreign customs and ideas among people who have come to this country has been made to appear un-American or antiAmerican, and compulsion has been recommended as the remedy. These ideas find almost classic expression in the comic paper's recommendation to the worried mother when she wished to know how her children should take the necessary but disagreeable pills prescribed by the doctor:

How should they take 'em?
You hold their noses,

And step on their toeses,

And thus you make 'em.

Analyzed more seriously, the big-stick theory seems to imply:

Americanism as a dogma.

Inferiority (of the foreign born) as a datum.

Uniformity as a social goal.

Compulsion as a method.

Undoubtedly a large number of persons feel that America is the best place in the world-Americanism the best thing-and they then proceed to the conclusion that Americans are persons like themselves,