It may be hoped that the census of the United States will follow the general principles of this memorandum in their enumeration of "races." Public health departments and other public and private organizations dealing with medical and health work will find it simple and easy to use in their routine recording of individuals, in birth and death returns, in hospital and dispensary records, and in the information gathered regularly about patients by visiting-nursing associations, tuberculosis and philanthropic organizations.

A classification based on mother tongue is, in practice, simpler to utilize for the average nurse, social worker, or clerk, than a classification based on the political country in which the individual was born. It is easy to secure the information from the patient, for he is never uncertain as to what language he spoke, whereas he is likely to give the name of a town or a district as the country of his nativity, just as though an American traveling abroad, and asked his nativity, should reply "Illinois" instead of "The United States of America." Once mother tongue is ascertained, it is necessary in some cases to find out the country from which the patient has come, but a preceding question about mother tongue makes this more certain of ready and correct answer.

The routine collection of information about racial origin, according to the system herein proposed, will be of untold value in connection with all forms of vital statistics. Public and private organizations will profit from it, and it will enable us to pursue many special studies, as well as to interpret routine statistical reports in terms of the important and neglected factor of race.

It has not been our aim in these chapters to present any final conclusions as to race differences in death and disease rates, for the known facts do not warrant such an attempt. It has been our endeavor to point out that those facts which have been collected show, prima facie, that certain race differences are of practical significance for the medical and health worker, the health officer, and the administrator; that further continued investigation of the racial factor, and consideration of it in the interpretation of most vital statistics, is a scientific and practical necessity. The need of uniformity in recording racial data is obvious, and a simple method of securing this accuracy and uniformity has been suggested for the consideration of the individuals and organizations who must do the work.

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IV

HOUSING VERSUS HEALTH

HOUSING is such a fundamental problem that it requires a more general review than a survey of any single community can give. In the large cities where do we find the immigrants living? Down in the busiest and most dilapidated section, from which the well-to-do part of the population has moved long since. Huddled in the many rooming and boarding houses which the men who emigrate alone establish in every community, jammed into tenements with other families, seeing nothing but the dirty streets, the immigrant must find his life. The ugliest and dreariest, as well as the most unsanitary, portions of city housing are his.

Tenement-house life, as seen by an immigrant at first hand, has been vividly described by Mr. Ravage in his book An American in the Making. A new arrival in New York City, he was taken in by a relative till he could gain a foothold for himself.1

During the day my relative kept up the interesting fiction of an apartment with specialized divisions. . . . I remember how overwhelmed I was with this impressive luxury when I arrived. But between nine and ten o'clock in the evening this imposing structure suddenly crumbled away in the

1 M. E. Ravage, An American in the Making, pp. 72–73.

most amazing fashion. The apartment suddenly became a camp. The sofas opened up and revealed their true character. The bureau lengthened out shamelessly, careless of its daylight pretensions. Even the washtubs, it turned out, were a miserable sham. The carved diningroom chairs arranged themselves into two rows that faced each other like dancers in a cotillion. So that I began to ask myself whether there was, after all, anything in that whole surprising apartment but beds.

The two young ladies' room was not, I learned, a young ladies' room at all; it was a female dormitory. The sofa in the parlor held four sleepers, of whom I was one. We were ranged broadside, with the rocking-chairs at the foot to insure the proper length. And the floor was by no means exempt. I counted no fewer than nine male inmates in that parlor alone one night. Mrs. Segal with one baby slept on the washtubs, while the rest of the youngsters held the kitchen floor. The pretended children's room was occupied by a man and his family of four, whom he had recently brought over, although he, with ambitions for a camp of his own, did not remain long.

Getting in late after the others had retired was an enterprise requiring all a man's courage and circumspection, for it involved the arousing of an alarmed, overworked, grumbling landlady to unbolt the doors, the exchange in stage whispers of a complicated system of challenges and passwords through the keyhole; the squeezing through cracks in intermediate doors, which were rendered stationary by the presence of beds on both sides; much cautious high-stepping over a vast field of sprawling, unconscious bodies; and, lastly, the gentle but firm compressing and condensing of one's relaxed bedmates in order to make room for oneself. It was on such occasions as these also that one first became aware of how heavy the air was with the reek of food and strong breath and fermenting perspiration, the windows being, of course, hermetically sealed with putty and a species of padding imported from home which was tacked around all real and imaginary cracks.

Quite contrary to the prevailing idea that the immigrant deliberately seeks out these regions, he has been driven to them by economic necessity and by the prejudice of the native mind toward him. The immigrant's attitude toward this segregation of his people is brought out by Ravage:1

I know that the idea prevalent among Americans is that the alien imports his slums with him to the detriment of his adopted country, that the squalor and the misery and the filth of the foreign quarters in the large cities of the United States are characteristic of the native life of the peoples who live in those quarters. But that is an error and a slander. The slums are emphatically not of our making. So far is the immigrant from being accustomed to such living conditions that the first thing that repels him on his arrival in New York is the realization of the dreadful level of life to which his fellows have sunk. And when by sheer use he comes to accept these conditions himself, it is with something of a fatalistic resignation to the idea that such is America.

When the immigrant lands on our shores at some large gate city, he often has no money other than the sum which he must have in his possession before the law permits his entry. Sometimes he does not know a soul on this side of the ocean. He neither speaks nor understands English. He must, then, turn to cheap quarters, and to a region where others live who speak his tongue. These factors, affecting the new arrivals for decades, have built up and overcrowded our Little Italies, Polands, and so forth. Those who come seek cheap quarters among their own races; those who are already here seek not only to increase their incomes by taking boarders and

1 M. E. Ravage, An American in the Making, p. 66.