was licensed for every five thousand population. In the United States grocery and dry-goods stores carry drugs. In hands of the ignorant drugs are sold to the ignorant.

For myself, I do not care. But it isn't fair to American druggists to let these stores and mail-order houses sell these things, and then not be responsible. The druggist is responsible. Why, they sell paregorics by the bottleful and stomach-trouble cures! Maybe for an alkaline stomach they sell bicarbonate of soda and for an acid stomach some acid. Here in this country a druggist does everything: telephones, soda fountains, information bureau, doctor. In Hungary he is a skilled pharmacist.

When a woman comes to me for something for her child, if she says, "Summer complaint," I tell her to go to a doctor right away. That is too serious to try anything with. I usually refer such requests to a doctor, though I do prescribe for minor ailments. People do not like to bother with a doctor. He is a nuisance. He says not to eat this nor give the baby beans, or something else. Some medicine which the druggist says will cure you surely is so much simpler.

In the large cities the local druggist plays a similar part amid immigrant colonies, but families do not depend upon him so heavily as in smaller places and he feels the competition of American drug stores on the main streets more keenly.

PRIVATE PHYSICIANS

The line between legally recognized medical practice and drug-store practice in dealing with disease is not a sharp one, as the preceding quotation illustrates. The "drug-store man" goes as far as he can, sometimes as far as he dares, according to his knowledge and his conscience, in prescribing remedies for

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the symptoms of which his customer or "patient" tells him.

Perhaps after home and neighborly resources the advertising doctor is best known to the immigrant. He may not be localized in the immigrants' section, but his advertisements reach them through the foreign-language newspapers. His methods and advertised medicines are discussed later in this report.

Both native and foreign-born physicians carry on reputable private practice in immigrant neighborhoods, and to these the immigrant has reasonably easy access. One of them may even be retained by his lodge to care for sick members.

According to American medical ethics the doctor does not advertise except by a simple shingle outside his office. So, except as their offices are in his neighborhood, the immigrant can with difficulty ascertain the names of reputable native-born physicians. Doctors of many foreign races follow their native custom of inserting professional cards in the newspapers of the language, and this is a substantial assistance to the immigrant. Such advertising doctors are in no sense the notorious quacks who exploit the immigrant so extensively.

Interviews with private physicians, either foreign born or of foreign parentage, whose practice was largely among immigrant families, were obtained in New York, Chicago, and other large cities to the number of more than one hundred and fifty. Interviews were also held with native private physicians who had special contact with the foreign born. Studies of medical work in rural districts and in

particular fields were made. The first aim of this investigation was to discover how far different immigrant races develop their own professional men and to what extent this has solved their special health problems.

INADEQUATE SUPPLY OF IMMIGRANT DOCTORS.

It was possible to estimate the number of foreign doctors in three ways. The American Medical Directory gives lists of doctors graduated from foreign medical schools, as stated for each community. Lists of doctors include those with foreign names. Interviews were had with at least two leading doctors of each nationality in each community. From these sources approximate figures were deduced. There are in Chicago not less than 300,000 Poles, with not more than 100 Polish doctors. On the other hand, the Jewish population in Chicago, which is probably about the same as the Polish, includes from 1,200 to 1,500 doctors. The 80,000 Lithuanians are said to have 12 doctors. The Bohemians, numbering perhaps 100,000, have about 40 doctors. The Greeks have between 15 and 20 doctors of their own race, for a population of 20,000. The Italians in a population of 150,000 have about 70 doctors.

The marked contrast between the Jews and all other groups is noticeable. The Jews have developed a large number of physicians, who, however, do not confine their practice to Jewish people. The Greeks in Chicago have a larger number of doctors in proportion to population than any other group except the Jews. The proportion of doctors in these races

holds true, roughly speaking, for other cities. The proportion of Italian doctors to Italian population in Chicago (43 per 100,000) approximates the corresponding figures for Boston (33 for 80,000 or 41 per 100,000), and for Providence, Rhode Island (27 doctors in estimated 60,000 population, 45 per 100,000). The proportion of Polish doctors to Polish population in both Boston and Chicago is between 25 and 30 per 100,000.

In small communities there will often be found no doctors of the race to which a considerable number of the population belongs. Maynard, Massachusetts, has a population of about 2,000 Finns in a total population of 6,000, yet not one of the five doctors of the town is Finnish. In Duluth, Minnesota, with an estimated population of about 5,000 Finns, there are only 2 Finnish doctors out of 109 doctors of all nationalities. The Ohio Health Insurance Commission reported that the physicians in the mining communities of Ohio and Illinois are almost entirely native born, despite a very large number of foreign born in the population.

Not a few immigrant groups in large cities are now encouraging their young men to enter professions, such as law and medicine, and often assist them to get a start. A Polish physician, who occupied an important hospital post in one of our large cities, and who had been in this country for thirty years, told how he had watched the growth of Polish immigration and the increasing efforts in several large centers of Polish population to develop young professional men. As we see, the results of these efforts are only beginning to appear. The unusually large proportion of

Jewish physicians is perhaps accounted for by the Jewish aptitude for intellectual work, the high estimation in which the professional man is held by the Jewish people, and the economic success and mutual helpfulness of the group.

We can hardly overestimate the contribution made to American life by those immigrants who, despite all obstacles, have won their way to success in a profession which requires so long a training and yields such slow financial returns as medicine. Some of our foreign-trained or foreign-born physicians have been notable leaders in the American medical profession, and many young men of foreign parentage are now winning their way to well-deserved distinction.

On the other hand, it must be recognized that the medical service for the mass of immigrants must be from average rather than exceptional men.

Moreover, no immigrant group, apparently, confines itself, or wishes to confine itself, to doctors of its own race. This may be partly for the reason already pointed out, that there are not enough doctors of the recent immigrant groups, except perhaps among the Jews, to provide all the medical service needed; but the testimony of the Polish, Italian, Russian, Hungarian, and Greek doctors is all to the effect that their practice is among native born as well as among people of their own race. The foreign doctor has the great advantage of understanding the language and customs of his people. On the other hand, the native-born doctor may, and often does, carry prestige because he is native born. Except among the Jews, very few foreign doctors have been