which the immigrant has come, as well as about the conditions which he faces here. We must know the backgrounds and the foregrounds, and fit them together to make a complete picture of the immigrant as a human being and a fellow citizen.

Knowledge of immigrant heritages and of the immigrant's environment in America is the foundation for any impersonal, unprejudiced study of the immigrant and for successful dealing with his problems of health and disease. Neither a program of health nor a program of Americanization as a whole can rest securely upon any other foundation.

VII

IMMIGRANT RESOURCES FOR MEDICAL CARE

THE immigrant's usual background, habits, and living conditions must be held in mind when we consider his answer to the question, "What to do when sick?" The answer to this question is serious enough for the native-American wage earner, and yet the American family is likely to be fairly well acquainted with the physicians and the hospitals of the community and probably knows at least one physician in the intimate relation of family doctor. The problem of the American family is not so much unfamiliarity with resources as financial limitation.

With the immigrant it is quite different. His answer to the question, "What to do when sick?" depends not so much upon the medical resources which are available in the community as upon what he knows about them.

The readiness with which medical resources become known to the average immigrant is largely determined by three factors: (a) their localization; (b) their advertising; (c) their contacts with the immigrant through people or organizations of his own race. These three points should be considered in all plans to make American medical resources more readily available and more thoroughly utilized by the foreign born.

J

Resources for the care of illness become known in somewhat the following order to the average immigrant coming from a small community to a city in the United States:

Home and Neighborhood

The home remedy or "wise" woman

The midwife

The drug store

Doctors

The advertising doctor, medical institute, or quack
The private physician

The lodge doctor

Organized American Agencies

The nurse
The hospital

The dispensary

HOME AND NEIGHBORHOOD

It seems the part of wisdom to the immigrant to try resources that are near at hand and that do not cost much, before turning to others. In minor illnesses the immigrant, like the native born, appeals to the home remedy. Traditionally potent herbs and concoctions familiar in the home village play a large part in the family dosing of many immigrant adults and their children.

The uneducated mind of the immigrant turns also, with a confidence at which the sophisticated American can only wonder, to the neighbor or friend of reputed wisdom. The grandmother of one's own or more often of a neighbor's family, the witchwoman, known in the old country, and now in her little circle here, as one having power to heal or to prevent healing—

these have frequently been mentioned to visitors investigating the health habits and resources of immigrant families. The more or less experienced woman is put to a specialized use in midwifery. This practice is prevalent among immigrants and requires discussion in a later chapter. When a visiting nurse finds a family curiously slow to respond to her wellmeant advice it is probable that the wise friend or witchwoman has already furnished them with advice of the opposite nature.

THE DRUG STORE

The local drug store, the place where most patent medicines are purchased, is an important center of medical advice. There are several reasons for this. Usually the local druggist or some one in his employ speaks the immigrant's language, and if there is a large colony of any one mother-tongue group there are certain to be several drug stores where the language is spoken. The drug store is localized and therefore readily becomes known to the immigrant. We must appreciate also that the pharmacist is regarded by many immigrants as a man of learning. The drug store is anxious to co-operate with the immigrant and the immigrant's local organizations.

The result is not always what we would wish, but the drug store must be reckoned with. A young pharmacist, born abroad but trained in America, told his plans for his first venture as a druggist:

"I can speak Russian, Polish, Yiddish, and German. I know that neighborhood [in which the drug store was to open] and the people there. I just bought out the old

man who has been running that store. He has not made good, but I am sure I can. He only speaks English. He has had a Yiddish-speaking clerk, but the clerk was more interested in himself than in the business."

"Do you know some doctors in the neighborhood so that they will send you their prescriptions?"

"I know one doctor, but the people will know me better than they know the doctors before long."

Drug stores are important from the medical standpoint because it is to them rather than to the doctor that the immigrant first turns. New arrivals and people who have not had occasion to use a doctor since their arrival frequently turn to the druggist for advice about doctors. Local doctors are, therefore, the friends of the druggist and his store is a meeting place both for social acquaintances who chat and for business competitors who keep an eye on one another.

An Italian store in Providence, a Greek in Lowell, a Finnish in Maynard, a Hungarian in Bridgeport all seem to be rather effective health centers for the surrounding colonies of their people. The Hungarian druggist here mentioned describes his business thus:

Hungarians do not use as many patent medicines as Americans. They make more of their own brews from herbs in the fields in Hungary. Hence I carry a large stock of these. The Hungarians use hardly any pills. The medicines they use are mostly in liquid form. The druggist will not sell any poisonous drugs whatever except on doctor's orders. This habit was acquired in Hungary, where the law forbids such sales. Long before the antinarcotic law was passed he did this.

In regard to suppression of the patent-medicine evil, he feels that only responsible and trained druggists should be allowed to sell drugs. In Hungary only one drug store