fluences the situation, by increasing familiarity with the language and with the existence and location of the dispensaries themselves. The nature of their work gradually becomes known through the stories of friends and acquaintances. Individuals and races differ obviously in their readiness to seek opportunity. The keenness of the Jew in this respect, combined with a sensitive organism which impels him to seek

TABLE XXXI

NUMBER AND PER CENT OF 3,536 NEW YORK CITY CASES USING HOSPITALS AND DISPENSARIES, BY NATIONALITY

prompt relief from illness or suffering, may account, at least in part, for his occupying first place numerically in the immigrant clientele of dispensaries.

One of the motives which lead persons to dispensaries for medical care is economic. They may go because they haven't the money to pay for a private doctor, or because they have been to a private doctor and have been dissatisfied with their treatment and have very little ready money left. The desire to secure high-class medical treatment is another power

ful motive. They seek the dispensary because the name of a famous doctor is attached to it; or something is the matter with the eye or other special organ, and they know they cannot afford the high rates charged by specialists at their private offices. The dispensary, in fact, offers the only opportunity for most persons of small means to see specialists.

Other motives operate to keep both native and foreign born away from dispensaries. The dislike of receiving charity is one; others are the inconveniences of waiting, of being crowded, of having less privacy than in a doctor's office, all conditions frequently found in dispensaries at the present time. The special deterrents caused by barriers of language, ignorance, superstitution, or fear, have often been referred to.

The dispensary cannot be regarded as merely an institution for furnishing medical charity. It is an institution for furnishing medical service to those who need it, and from this standpoint it is not only its privilege, but its duty, to adapt itself to their needs. Keeping in mind the immigrant point of view, let us ask what dispensaries in America have done to adapt themselves to the immigrant, and what they can do; what has been the point of view of doctors, nurses, social workers, and administrators toward the immigrant; what their understanding of his personality and needs; what their effort to give him what he needs in an acceptable manner?

MEETING THE NEEDS OF INDIVIDUALS

Many hospitals suffer from institutionalism or overorganization along military lines, and consequent inflexibility to the needs of the individual. Dispen

saries are liable to the opposite defect, of underorganization; a loose and careless manner of running. Hundreds of patients pour into the waiting room; their names and addresses are hastily entered by a clerk; they are moved along as rapidly as possible to the waiting rooms of various clinics; they wait until the doctors arrive and then until the doctors are ready to see them. Sometimes they wait a long time; see the doctors, who are perhaps in a hurry; some get advice; perhaps understand some of it; very likely get a prescription for medicine; get the medicine; go home. The three outstanding impressions given by the average dispensary to the average patient are (much crowding, much waiting, much hurry.)

These conditions have been remedied to a great extent in recent years in the better dispensaries, but they still prevail much too widely, particularly in the larger institutions. They are due chiefly to the lack of adequate administrative staffs, and the fact that the doctors are usually unsalaried and cannot afford to give sufficient time. In these respects, lack of adaptation to the needs of the foreign-born patients is merely part of a general level of inefficiency which applies to all patients. But the results of such inefficiency are usually more serious for the foreign born than for the native born.

The aim is to get results in treatment, not merely to see patients and diagnose their diseases. Success depends not only upon the doctor's skill and wisdom, but upon the patient's understanding his directions and the patient's intellectual and financial ability to carry out these directions.

The doctor's hastily spoken directions may be 80

per cent understood by an American with a good common-school education. The same directions might be 50 per cent understood by an Italian workman who had picked up a knowledge of English but had never been to school. They might be less than 20 per cent understood by a Jewish or Polish woman who spoke only a few words of English, knew little of the doctor's vocabulary, and nothing of the conditions to which he referred. The medical results of treatment would necessarily differ in these three cases. As an organization aiming for efficiency in medical results, it is the dispensary's business to equalize so far as possible the patients' ability to understand instructions and to carry them out.

MEDIUMS OF COMMUNICATION

The first and most obvious effort which dispensaries have made to overcome the difficulties of dealing with the foreign born has been against the barrier of language. Signs in different languages, directing patients where to go, are an administrative convenience usually found in dispensaries. The use of leaflets on the feeding of babies, and the care and prevention of tuberculosis or venereal diseases, already referred to in connection with field work, is fairly frequent in dispensaries. Foreign-speaking doctors have been employed in not a few institutions. For interpreters, dispensaries generally have depended upon some employee or some patient called in for the occasion.

IMPORTANCE OF THE ADMISSION DESK

One of the important stations in the dispensary is in the admission hall, where the patient visiting the dis

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pensary for the first time must be met, have his name, address, occupation, size of family, earnings, ascertained and recorded, and be referred to the proper clinic for diagnosis and treatment. The admission desk is a central point in dispensary administration. His treatment there largely determines the patient's emotional tone in his farther progress through the waiting rooms and the clinics, and the attitude of mind with which he receives and interprets his instructions.

Far too little emphasis has been laid by dispensaries upon the work at the admission desk. Too often it has been left to a clerk. Possibly some one has been engaged who can speak one or more of the prevalent foreign languages, but mere facility in language is not sufficient to insure tactful and wise handling of many personalities of varying races. Not infrequently nurses or internes are detailed to admission service, but for such short periods that they have no incentive to acquire special competence for the job.

One of the first needs of the dispensary, and one which has been rarely met, is the employment of skilled, permanent service at the admission desk. The employee should have received, or should be given opportunity to acquire, the special training necessary for really efficient performance of this work. Knowledge of the language, while a great convenience, is not so essential as knowledge of the backgrounds and characteristics of the people. In a dispensary an interpreter can almost always be secured in an emergency. It is impracticable to have paid interpreters sufficient to cover all the different languages found among patients in the average dispensary, but em