Euthenics, the science of controllable environment Part 10

So the duties and responsibilities of a Health Department are not only changed, but they are very greatly increased and are constantly increasing. And on broad lines to cause the citizen to do the things he can and ought to do, and then to do for him the things that he cannot do, but which should be done, is the duty of the State, and that, being interpreted, means the real prevention of disease.

_Eugene H. Porter, Report, New York State Department of Health, 1909._

The whole difference of modern scientific research from that of the Middle Ages, the secret of its immense successes, lies in its collective character, in the fact that every fruitful experiment is published, every new discovery of relations.h.i.+ps explained. In a sense, scientific research is a triumph over natural instinct, over that mean instinct that makes men secretive.

_H. G. Wells, New Worlds for Old._

Public or governmental hygiene has been chiefly concerned with pure air and pure food, and with organisms producing epidemic diseases. Boards of health are a recent invention, and in this country they have as yet been only imperfectly developed. They can never become the power they should be until, first, public opinion better realizes their usefulness and the fact that their cost to the taxpayer is saved many times over by the prevention of death and disease; second, more and better health legislation is enacted--national, state, and munic.i.p.al; and, third, special training is secured for what is really a new profession, that of a public health officer.

_Report on National Vitality._

CHAPTER VIII

LEGISLATIVE COMPULSION

Government is delegated to persons specially set apart for the oversight of the people's welfare.

Personal conduct was free from such delegated power in the Anglo-Saxon thought. The Englishman's house was his castle inviolate. This was especially true of the early American settlers. Laws interfering with personal liberty, a man's right to drink tea, to punish his own children, to beat his own wife, to keep his own muck-heap, have been deeply resented by the American citizen. Each step in the protection of his neighbor has been taken only by a struggle extending the common law of nuisance to a variety of conditions.

The protection of the man against himself, and of his wife and child against his ignorance or greed, is one of the twentieth century tasks yet hardly begun.

The control of man's environment for his own good as a function of government is a comparatively new idea in republican democracy. The cry of paternalism is quickly raised, on the one hand, of socialism, on the other. Each gain has been at the cost of a hard-fought battle.

But it is certain that the individual must delegate more or less of his so-called rights for the sake of the race, and since the only excuse for the existence of the individual is the race, he must so far relinquish his authority.

It is a part of the urban trend that the will of the man, of the head of the family, should be superseded by that of the community, city, state, nation.

Even though all the agencies for the education of both young people and adults that have been discussed in the preceding chapters were set in motion at once, there would still remain many thousands in towns.h.i.+p and city untouched by these forces, or so touched as to arouse rebellion against such novel notions.

Only the child can be educated to acquire habits of right living so perfectly that the suitable action takes place unconsciously. Twenty years hence these trained children will be the chief citizens of the republic, the leaders of public opinion. Today, however, less gentle means, less gradual processes, must be used in order that these children may have a chance to grow up.

In the social republic, the child as a future citizen is an a.s.set of the state, not the property of its parents. Hence its welfare is a direct concern of the state. Preventive medicine is in this sense truly State Medicine, and means protection of the people from their own ignorance.

In the laws made with this end in view lies one of the greatest educative agencies known. We have referred in the last chapter to the need of drawing attention to defects and dangers in order that people may know what the results of their careless ways may be. No surer way has been found to fix attention than to attempt to enforce a law or collect a fine for disobedience of it. A marked ill.u.s.tration of this truth is given in the case of the ordinance against spitting in street cars. In many cities a notice was posted in each car--usually with little effect. In some a fine of five dollars was added, with little more result. Boston was one of the first cities to pa.s.s an ordinance, and it accompanied the law with a fine of one hundred dollars. This compelled attention--a sum which represented to the workman more than his yearly savings, more than any single expenditure. To the business man, even, it was a sum not to be lightly dropped on a filthy car floor. This mere statement of the value of cleanness made an almost instantaneous change in the habits of thousands. Within two days the car floors became practically free without a single fine being collected within that time, as far as the author is aware.

The law imposing fines for neglect of removal of garbage or of screening stables must be occasionally enforced in order to express degree of disapproval. A petty fine is of little use.

Conditions of motion, of rapid intermingling of distant populations--a thousand miles in a day is now possible--make national control a necessity. It is proved that quick results may be gained in saving lives and property by that prompt and thorough action which well-equipped Federal forces alone possess. The stamping out of yellow fever in Cuba, the redemption of Panama, the suppression of sporadic outbreaks at New Orleans, the quick response to a discovery, as in the cases of pellagra and the hookworm--all these show what a thoroughly alive government may do.

It is no disgrace to an individual or a city to have the national laboratory make discoveries, to have the national power put down epidemics, as it does civil rebellion, for the good of the whole nation. It is disgraceful, however, for the citizen to remain indifferent or obstructive, to grumble over the cost. The indifference of the people themselves is today almost the only stumbling block to national prosperity.

The time lost to the average worker by inefficient labor is a drain on the community largely avoidable, and is the cause of that other drain on the moral as well as physical vitality--charity.

Preventive medicine is a science by itself, a combination of social and scientific forces guided by research quickly applied, and it must be accepted and upheld by those whom it benefits, namely, all the citizens. The nation is in many cases the only power strong enough to command confidence, and in the combination of government effort an international science of human welfare is bound to be evolved.

It is a waste of effort for each state to prepare a fly pamphlet. The correctness of a Government Bulletin would give an added value as well as the rapidity of circulation. The bulletins of the Agricultural Department are an example.

The Weather Service, with its quick notifications, shows what a health service might do. A monthly or weekly _health chart_ would give the best and worst spots.

Precautions really workable might be furnished the a.s.sociated Press.

In short, system and science might be put at the service of the local health officer, of the traveler, and even of the housewife.

The Library of Congress now furnishes cards in duplicate to a large number of centers, thus saving time to the investigator and giving information often not otherwise obtainable.

The Farmers' Bulletins of the Department of Agriculture are also most valuable to the people who are in search of help. Such agencies might be extended without fear of trespa.s.s on any existing agencies.

Just as the individual, if he is to do and be his best, accepts his limitations, obeys Nature's law, and thrives in body and estate in consequence, and as the community banding together makes and carries out with penalties for deviation certain regulations for mutual benefit, so must the still larger groups--the state and the nation--use their larger wisdom and wider knowledge for the benefit of all. The individual should recognize the value to himself of this more complete investigation, and instead of raising the cry of paternalism and national interference, should welcome all aids to increased efficiency.

State hygiene is necessary to supplement munic.i.p.al hygiene. Often the rural district has no other hygiene, and the city and the country are interdependent, the city dependent upon the country for its water, milk, and other supplies.

Almost all the states are alive to the importance of milk inspection.

As early as 1869 in Ma.s.sachusetts, Dr. Bowditch called the Board of Health "The State Medicine," and quotes from Dr. Farr: "How out of the _existing_ seed to raise races of men to divine perfection is the final problem of public medicine." That is the function of all boards of health. If factories are incorporated under state laws, they must also be governed by the state regulations for health.

Here in America we are always locking the stable door after the horse has been stolen. Not until many "accidents" had occurred in the use of ant.i.toxins did Congress pa.s.s an act (1902) regulating the manufacture and interstate sale of the viruses, serums, toxins, etc. The supervision and control were vested in the Secretary of the Treasury through the Public Health and Marine Hospital Service. Previous to April 1, 1905, there was no official standard for measuring the strength of diphtheria ant.i.toxin. Previous to October 25, 1907, there were as many units or standards for teta.n.u.s ant.i.toxin as there were producers. One was labeled "6,000,000 units per c.c." and another "0.75 unit per c.c.," while, according to official standard, the first had only 90 and the latter 770.

The point to be made is that however faulty an official or Federal standard for sanitary devices may be, it is a standard, and so is of service in protecting the people, especially those away from active centers of research.

CHAPTER IX

_There is responsibility as well as opportunity. The housewife an important factor and an economic force in improving the national health and increasing the national wealth._

It would indeed seem that opposition to woman's partic.i.p.ation in the totality of life is a romantic subterfuge, resting not so much on belief in the disability of woman as on the disposition of man to appropriate conspicuous and pleasurable objects for his sole use and ornamentation. "A little thing, but all mine own," was one of the remarks of Achilles to Agamemnon in their quarrel over the two maidens, and it contains the secret of man's world-old disposition to overlook the _intrinsic_ worth of woman.

_W. I. Thomas, Women and Their Occupations, American Magazine, October, 1909._

The president of the British Medical a.s.sociation about 1892 said, "I wish to impress it upon you that the whole future progress of sanitary movement rests, for its permanent and executive support, upon the women of our land."

In a letter to Madame Bodichon, dated April 6, 1868, George Eliot writes: "What I should like to be sure of as a result of higher education for women--a result that will come to pa.s.s over my grave--is their recognition of the great amount of social _unproductive_ labor which needs to be done by women, and which is now either not done at all or done wretchedly."

_Quoted by Mrs. Nixon in a paper before the Conference of Women Workers in England, 1904._

CHAPTER IX