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is vitiated by the character and extent of medical aid provided.

Testimony as to this is plentiful and points all in one direction. The attitude of the members of these associations toward the physicians employed by them under contract is significant. One Italian said that although his society furnishes a doctor free of charge to him and half price to his family, they never call him-do not like him at all. Said another, "My husband belonged to two societies, but left them, as they were too much camorista-that is, too full of grafters." In general the society doctors are neither highly respected nor are they fully used by members.

Numerous interviews with foreign-born and native physicians have brought out richly the attitudes of both the members and the doctors:

When these organizations were first started they were of very high type and of great benefit to Hungarians, but they are fast deteriorating. When they were first organized they had as medical advisers very efficient men; but now a doctor is sometimes not chosen because of any great skill, and a man with good practice has no time for such work.

These doctors are not chosen for any superiority in their profession, but because they are popular with or related to the officers of the organization. As a consequence many times very inferior men hold these positions.

They seem to have the idea that if a doctor comes for nothing or very little, he is no good. They think that any good doctor charges large prices.

An Italian doctor stated that some of his colleagues liked to have an income assured, but "do not care too much about giving care.'

They are often retired doctors or doctors who have not made a success in their practice. They are looked down upon by the other doctors in the profession.

Among the Jews the testimony is similar:

The people have little respect for these doctors. They are usually young doctors who accept the position for the purpose of becoming acquainted with the members of the community. I have been asked several times to accept such a position, but have always refused because I felt that the work was degrading. The Jews have little esteem for these doctors. . . . The lodge doctors are chiefly young men just entering the profession or else rather elderly men. Another reason for this lack of confidence in the lodge doctor is the fact that he is a "brother" and consequently too familiar a person to command much respect, for the Jews seem to admire aloofness.

A Portuguese doctor on the Pacific coast stated that the societies there

had found it impossible to get the good doctors at the prices they could pay. The result has been that either they have attracted the poorer class of doctors or those who have come recently to the community.

Evidence of this sort could be multiplied indefinitely. Sufficient has been given, however, to indicate that the medical service secured by these societies is of a low grade. There are some first-class and highly respected physicians in lodge or society practice, but the great majority do not fall into this category.

The burden of the evidence presented in this chapter brings out a number of reasons why the small local or church benefit societies are very much lim

ited as health agencies. So far as can be ascertained, they are of a transitory character, reaching a limited number of immigrants. The benefit too often provides funeral flowers when it might have gone for the medical care which would have prevented the necessity for flowers. When it is designated for sickness it too often fails to gain its end, either because it is inadequate in amount or because the type of doctor provided is unacceptable to the patient. Last of all, the small benefit societies are often on an unsound actuarial basis and are thus doomed to failure or excessive handicap in competition with the larger societies or commercial insurance companies. From these facts it is apparent that they can play no large or influential part in medical care of the immigrant.

ADVANTAGE IN FRIENDLY ASSISTANCE

✔If the preponderance of the evidence is not in favor of the small benefit society, some of its advantages must not be overlooked. Its required medical examination often affords an initiation into American health practices and standards that might not otherwise be accomplished for some time. It certainly tends to introduce the minimum standard of health and hygiene which prevails in this country. Furthermore, it accustoms the newcomer to a voluntary healthinsurance plan. This particular plan might prove unsound, but the habit of depending on some form of insurance would be established.

In addition, it is fair to assume that belonging to a benefit society made up of friends and fellow countrymen, gives to many of its members a sense of

assurance and security which the stranger too often lacks. If the mutual-benefit society can bridge the first period of uncertainty and adjustment it will not be a wholly negligible quantity. Its tangible accomplishments are not always apparent, but the friendly offices it performs in times of trouble have an influence in adapting the foreign born to American ways of doing things.

VI

IMMIGRANT BACKGROUNDS

SOME health officers declare that immigrants love to live in dirt. A housing inspector is said once to have complained that immigrants stored coal in the bathtubs when they happened to be in a tenement with "modern conveniences.' This story was probably true somewhere and sometime. But it has been told many times and almost everywhere. Some health workers say immigrants are suspicious, set in their ways, if not stubborn. Many declare them to be densely ignorant of hygiene and unwilling to use facilities for medical care or health service, even when such are offered.

Stories of this kind about the immigrant have been multiplied, but after all discounts are made there remains a kernel of truth in the complaint that the immigrant frequently increases the problem of sanitation, that he and his family do not respond to suggestions so quickly or so completely as the American health worker would like.

Our task is not to distribute praise or blame. It is to state facts, to understand conditions, and then determine, if we can, how conditions can be made more as we wish them. We can hardly know conditions, and we can never comprehend the reasons for them, unless we know the immigrants as well as their

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