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IN EUROPE GARBAGE AND WASTE WERE BURNED OR FED TO

THE ANIMALS

Refuse might be thrown out or burned. If, however, he throws an armful of rubbish out of the fourthstory window of a city tenement he is in trouble. Street-cleaning departments in some large cities have

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IN AMERICA DISPOSAL OF REFUSE IS A PUBLIC FUNCTION

spent thousands of dollars in posters and placards to teach immigrants how to dispose of garbage, how to use the garbage can, when to put it out, where it will be collected, where to keep it when not by the curbstone.

When the immigrant is suddenly transferred to a city in which such matters as housing, water supply, milk supply, contagious disease, the disposal of garbage and refuse are dealt with at long range by government agencies through housing inspectors, milk inspectors, food inspectors, school nurses, he can hardly be expected to understand. The change would be difficult for anyone. When the immigrant does not know the language, when no one explains the contrasts and their meaning, how should he comprehend them?

We must understand these contrasts if we are to appreciate the difficulties faced by the health officer, the visiting nurse, and the social worker in dealing with the health problems of the immigrants in our cities. We must also recognize the difficulties which the immigrant faces. Once we attain such a double understanding we can deal with the problem of education in an effective way. It is not by antagonism nor by the weight of the Big Stick, but by explanation of whys and wherefores in terms he will comprehend, and by enlisting his co-operation and that of leaders in whom he has confidence, that we help the immigrant to get the knowledge which life in a large city requires.

UNFAMILIARITY WITH MEDICAL RESOURCES

In many cases the immigrant comes from a small community, isolated from modern medical resources, to a city which has many more advantages. Even a small American city has more doctors in proportion to population than the place which the average immigrant left. In many of the backward districts of Eu

rope, from which hundreds of thousands of our immigrants have come, there is only one doctor to every 2,000 or even 5,000 of the population, whereas in the United States as a whole there is one doctor to every 700 persons, and even in very small communities the ratio is rarely less than one to 1,200. The immigrant has not been accustomed to use doctors as freely as has the native American.

This is also true in the matter of hospital service. To the peasant the hospital was a distant and unfamiliar institution. It was the resort in extreme emergency. People who went there generally died. The immigrant does not consider that perhaps they died because they waited too long before going to the hospital. The visiting-nurse association, the numerous societies for the prevention of different diseases—tuberculosis, cancer, infant mortality—were quite unknown to the immigrant at home.

NEW RELATIONS TO GOVERNMENT IN THIS COUNTRY

Certain groups of immigrants lived under oppressive governments before coming to the United States. The Poles, whether in Germany, Austria, or Russia, were under a government which they felt was trying to denationalize them. They bitterly resented the efforts of the government to crush out their mother tongue as well as other conditions imposed upon them. Their attitude toward local as well as national government after they come to the United States is

1 According to the 1918 American Medical Directory there were about 150,000 physicians in the United States, whose estimated population was about 105,000,000.

affected by this previous experience. The Pole has heard of America as a land of freedom, and after he comes here he is likely to note how much less the government interferes with his daily concerns than was usual in his native land. Yet his attitude toward government agents, the policeman, or the health inspector, or the nurse, may be colored by suspicion merely because of his former attitude toward the government of Poland and his incomprehension of the nature and workings of this government.

The Slovaks of Hungary had to live under the rule of the Magyars, and like the Poles felt that an oppressive hand was endeavoring to stifle their language and culture. Such, in greater or less degree, was the situation of practically all the southern Slavic peoples of Austria-Hungary. In a slightly different way the oppressive and corrupt government under which the Armenians and Syrians lived in Turkey is likely to determine their attitude toward government and local agents of government in this country. The Jews, in some instances, have emigrated from similar conditions.

Suspicion or undue and unthinking subservience is the usual result of such a previous experience. The health officer, in his plans for reducing disease, or the nurses or social workers who enter the homes of the immigrants without understanding their backgrounds, can hardly deal adequately with them and their problems.

CHANGED RELATION BETWEEN SOCIAL CLASSES

Distinctions between social classes on the basis of wealth, birth, or education are more rigid in the

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