countries from which most of our immigrants have come, than they are in the United States. A welltrained American nurse once visited a Polish home to teach the mother something about the care and food for her baby. She reported that the mother seemed suspicious and unwilling to learn. Later the mother said, in substance, to a Polish-speaking visitor:

I do not know who sent that woman to my house. She must be one of the educated people and she must have done something wrong or she would not be going around this way instead of living with her own class and taking life easy as they do.

The Polish woman could not understand social class except as a status into which a person was born, or at least in which a person's position was fixed for life. She could not understand why a woman, evidently belonging to what would be called a superior class, should spend her time in the homes of inferiors.

Generally speaking, the American, as such, has prestige among immigrants. A person who looks, speaks, and acts like an American, as the immigrant conceives an American to be, will sometimes win his way despite ignorance of the immigrant's language. On the other hand, a person of the same race sometimes fails, despite familiarity with the language and national customs. The explanation is found in the peasant's suspicion of social class.

These considerations help determine the kind of health worker who will be most effective among different groups of immigrants. They apply with much more force to certain groups of immigrants than to

others, notably to Poles and most of the Slavic groups, somewhat less to the Italians, much less to the Jews.

TRANSITION FROM AGRICULTURE TO INDUSTRY

Within a few weeks the immigrant workman may pass from a quiet, agricultural community to the roar and motion of a steel mill or a stockyard. It has been more than once pointed out that an economic loss is involved when a worker who is skilled in an intensive, though in some respects primitive, agriculture, goes into a factory, mill, or mine, where his former experience counts as nothing, and where he must begin again as an unskilled laborer.

From the health standpoint this transition involves certain hazards, both of accident and of illness. The average peasant has been accustomed to slow motions. He has dealt with materials and processes which involved little risk of accident or of disease. He has not been used to machinery. His new job may necessitate quick motions, there may be poison in the materials to be handled, danger in the processes to be performed. Recent writers on industrial medicine have dwelt upon these contrasts. Let us appreciate the suddenness of the transition, the lack of preparation for it on the part of the immigrant, and the risks to health which are therefore involved.

PHYSIOLOGICAL STRAIN DUE TO CHANGE IN
ENVIRONMENT

The sudden changes and severe winters of New England, New York, or Minnesota are a violent contrast

to the warm climate of Sicily. Italians who make this transition have a considerable readjustment to make. Races from northern Europe find a less, but still a considerable, change in range of temperature and humidity.

Sometimes change in climate may be beneficial. People from the North take a trip to Florida in win

THE IMMIGRANTS LIVED, WORKED, AND PLAYED OUT OF DOORS IN EUROPE

ter, and people from South Carolina go to Massachusetts during the spring. When, however, the individual makes the transition without those comforts and safeguards enjoyed by the well-to-do American visitor to Palm Beach or to the North Shore, health may suffer instead of being benefited. Many peoples from different parts of Europe experience change in

climate upon coming to this country. This is generally accompanied by change from an outdoor to an indoor life. Important changes in diet may also be caused by the migration. Altogether, the change in climate, in food, and in time spent out of doors must frequently produce physiological stress upon the individual

What the influence of such stress may be upon *death rates, birth rates, and disease rates is unknown. It is difficult to separate these from other factors. It has been suggested by some writers that the processes of natural selection are accelerated by such a transition, and that individuals not sufficiently resistant to the new physical environment in this country will be more or less rapidly weeded out. Such a biological process, if it exists, may be far-reaching in determining the numbers, vigor, and prosperity of the present and the next immigrant generations.

UNFAMILIARITY OF LANGUAGE

The barrier of language between many groups of immigrants and the native-born American presents difficulties in all social relations as well as in medical and health work. Mutual difficulty of comprehension is one thing. A sense of isolation on the part of the immigrant is another. A sense of superiority on the part of the American is still a third. Difference in language too easily emphasizes all of these.

The segregation of immigrants of one race in the same part of a city or town, largely caused by their dependence on their mother tongue, of course accentuates certain of these difficulties. The learning of

English is made less easy. Group customs familiar abroad and fitted to conditions abroad are maintained or strengthened in the American colony, even though the conditions of American life render such customs unsuitable. Moreover, if he lives in a "colony" of his own people, the immigrant has less contact with his American environment and less daily opportunity for learning about it. It has already been indicated that the responsibility for the formation of immigrant colonies rests partly upon Americans.

Viewing the Old World traditions and customs, we find seven points of contrast with American conditions that complicate the health problem. (1) Private regulation of health matters at home ill prepares him to co-operate with public health administration. (2) Previous isolation from medical resources prevents his seeking those available in America. (3) Oppressive government at home has prejudiced him against public authority. (4) Rigid distinctions between social classes in Europe make him suspicious of friendly help from apparent "superiors." (5) Sudden transition from agricultural to industrial life involves health hazards, as do (6) marked changes in climate, diet, and time spent in the open air. (7) Ignorance of our language fosters misunderstanding.

We have reviewed the contrasts between the immigrant's tradition and experience abroad and the complex conditions of the United States. These contrasts affect all phases of life, industry, education, recreation, the home, and last but not least, the individual and the public health. It is essential that native Americans understand these contrasts. must learn something about the circumstances from

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