The nurses at the station would not themselves be inspecting officials of the Department of Health, which would have the legal authority over the midwives, but the actual contacts between nurses and midwives, as it works out now in New York or Newark, would assist the practice of the better midwives and make the practice of the dirty and untrained ones much more difficult. The officials administering the law of regulation and supervision would be greatly assisted by the knowledge gained through these contacts.

THE CO-OPERATION OF THE LAYMAN

A program of maternity care for the immigrant can be only an academic proposal unless we have always in mind its far-reaching human significance. If we regard the immigrant not as a transient dweller in our midst, but as a part of this country, for good or ill; if we see that Americanization means learning to live together, the approximation of different racial or group standards, the understanding by each of the best in the other, a unifying of communal life into a richer whole than before then this plan for maternity care can be a powerful instrument in our hands. At the very beginning of life is a strategic time to approach the immigrant, for then a little understanding and sympathy from the American health worker can arouse the maximum return of understanding and sympathy in the immigrant family.

It is well at this point to observe how little the general American public realizes that maternity care

is a problem; that in America, even among the native born, the death rate of women in childbirth or from causes directly due to childbirth is shockingly large compared to that of most other civilized countries. Cognately the general public knows little about the midwife or any facility for maternity care other than the private physician.

The native American has not used midwives for a long time. He has heard about them in a vague way, as a rather shady resource of immigrants. He would be astonished to learn that midwives deliver more than a million women in the United States in a year. If he lives in a large city which has a medical school, he would be equally surprised to learn that several hundred, or maybe several thousand, women are delivered annually by medical students.

The people who do use the midwife, the people who do call in the obstetrical teaching service, are the immigrants and the poor; but these have not made known their experience because they rarely have access to the channels of public expression. The specialists have conducted a discussion, chiefly within their own circles. The Federal Children's Bureau has recently been showing in its publications the high rate of maternal mortality in the United States and the grave deficiencies in service to mothers at confinement, discovered in its surveys of rural communities and of towns. These facts are just beginning to filter into lay journals and to receive the attention of public meetings, women's clubs, and other groups wherein plain people come together.

It is well that this is beginning to be so, for whatever policy medical men, health workers, nurses, stu

dents, and surveyors may decide upon, in so large a matter as maternity care for the women of this country a program can be effective only if there is a general appreciation of the facts on the part of the public, a keen sense of the needs that must be met, and an aroused discontent with conditions that must be bettered.

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XII

IMMIGRANT DIETS AND AMERICAN FOOD

"SOMETHING to eat" is likely to be the immigrant's first thought after landing, and this fact places food in the first rank of importance in our plans for Americanization. Most of our friends from other countries come to America in the very cheapest way and are unaccustomed to travel. They leave home with many of their cooking utensils in a cloth bag and continue their housekeeping on shipboard, in the steerage, feeding their children and themselves from stores brought from home. Their first impression of America is often got in a poorly housed restaurant, whose proprietor is of their nationality. From him they learn where to get some of their native foods, both raw and cooked.

Usually they establish their homes in neighborhoods or colonies of their own countrypeople. Here they find unfamiliar housing conditions. They are confronted by many new and strange appliances, such as agate and tin cooking utensils instead of copper and iron. There are "so many kinds to learn how to use," such as double boilers, "funny egg beaters that you turn as you do a hand organ," bread pans, and egg poachers. Then, too, there are "stoves with no fires in them and no place for the wood, just

holes in irons, and if you turn a handle and apply a lighted match fire comes."

In the colony there is no opportunity to learn about American foods, either raw or prepared, nor what American dishes approximate the food values of their various native dishes. Neither do they know the kind and amount of food needed in a day's dietary under the new living conditions. If they have come from countries in which the climate is very different from this, or if their occupation here is more strenuous than at home, or less so, they do not change their menu accordingly. They have always eaten certain kinds of food prepared in certain ways. Why change?

Certain changes, however, are forced upon them by the American market. Some of their old staples are beyond their financial reach altogether or cost more than they seem to the immigrants to be worth. As a result they limit themselves to the few familiar foods easily obtainable, thereby eliminating various essential elements and completely upsetting the balance of the traditional diet, which is not restored by the gradual addition of American products chosen without regard for food values. There is no one to tell them which of their foods to keep and which of this country's to adopt, nor how to prepare them.

There is much that we may learn from these people and equally much for them to learn from us with profit. If we study their ways and customs and acquaint ourselves with their foods, we shall be able to help them to adjust themselves to new conditions with as few changes as possible.

During the influenza epidemic of 1918 it was