Popular Science Monthly/Volume 68/May 1906/The Disease and the Remedy
By ALFRED E. P. ROCKWELL, M.D.
WE stand in this country on the threshold of a great civic awakening, a great economic renaissance, and we should hasten to forge from every opportunity offered by public sentiment, some substantial token of a larger and more exalted citizenship.
Government is the means by which the will of the people finds expression, and in a republican more truly than in any other form of government the character of the laws, and the efficiency with which they are administered, justly interpret the character and enlightenment of the average citizen.
The evolution of the individual, in proportion to the opportunities which the times afford, the suitable husbandry of the public purse, the proper development of natural resources, the conservation of human energy, the time required to convert what is known as public sentiment, all make it imperative that we now lay the foundation for the more efficient application of those principles which have been found best calculated to further those ends.
The physical, mental and moral qualities of the average citizen should be the unit of measurement upon which all estimates of national wealth, wisdom and virtue are based. The nearer these three personal qualifications approach perfection the greater becomes the value to society of the individual, and so intimately are they associated that derangement in one of these spheres is productive of more or less disturbance in the others.
Good physical health is the foundation upon which the mental and moral natures are built. Physical deficiencies in a large measure are responsible for mental and moral defects.
Every human life should be an asset of the nation; an asset the value of which should be determined by its productivity. By productivity is meant every exercise of creative, constructive power in the physical, mental and moral spheres. The highest productive potential is developed from the proper combination of two factors, in the creation and operation of each of which both the individual and the state share certain responsibilities. In the wholesomeness of the moral stamina, the efficiency of the mental equipment and the extent of the physical energy we find the first factor, and may measure the worth of those qualities which the individual is in honor obligated to contribute to THE DISEASE AND THE REMEDY 447
social progress, and for the attainment of which he is largely to be held accountable.
It is the duty of the state, on the other hand, to furnish as the second factor the best possible environment for the cultivation of those attributes, which will secure to him, his neighbor and posterity the largest measure of ' life, liberty and happiness.'
Obviously, then, the best interests of both the state and the in- dividual are mutual, and the benefits derived by each from the faithful performance of duty are reciprocal. The individual and the state can not be divorced.
Every human life, however, is not an asset. All lives at some period are not only non-productive, but are the source of considerable expense to the state or relatives and friends, and each unproductive life becomes a proportional burden upon all productive society.
The chief cause of unproductiveness in the adult is inefficiency, and the chief cause of inefficiency having been found by competent investigators to be disease, we must feel that health and disease have too long been considered from the narrow standpoint of an individual blessing or calamity. As our commercial and intellectual activities in- crease, our socio-medical problems have been multiplied until it has become imperative that we view them in their economic aspects and deal with them accordingly.
To the ultra-conservative or the uninformed it may appear that the elevation of preventive medicine, in its largest and most compre- hensive sense, to the importance of a great economic issue, is a step unpractical if not unnecessary.
If, however, under the conditions which now prevail, we add to the cost of human suffering, mental and physical, the financial cost of disease to the individual and to the state in the maintenance of hospitals, asylums, jails, permanent and periodic quarantine regula- tions with their accompanying commercial disturbance, and then subtract from this total the cost of those diseases which, in the present light of science, are known to be preventable, provided adequate prophylactic measures can be enforced, we shall readily discover in the remainder the warrant for presenting this subject in the dignity of one of national economic consequence.
If adequate relief is to be rendered, it is necessary that ultimate, not proximate, causes and remedies be sought. We shall, therefore, undertake to view in a full yet not extravagant light the terms and factors with which we must deal.
Few people realize the value and importance of a human life. If its value were better understood, a very different conception would prevail regarding the necessity of certain measures, which thoughtful and far-seeing persons are endeavoring to call to popular attention.
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The courts have arbitrarily placed the value of one productive male at $5,000. This is estimated on the basis that the interest on $5,000 at six per cent, is $300, the amount of wages which a man would earn at $1 a day for three hundred working days. If then, the husband of a family is killed by the railroad, and his wife secures a judgment of $5,000, it is believed that she has obtained in this sum the equivalent of his services to her and her children. This is not true. That life was worth more than $5,000 to the family and to the nation. Few common laborers in this country to-day earn less than $1.50 per day; for three hundred working days this would be $450, which is 6 per cent, of $7,500. But the wife in these days could not obtain 6 per cent, interest on this sum in any safe investment. We will not here speak of the progressive increase in the cost of living compatible with the maintenance of self respect, a very important consideration. If she could safely secure, in the Eastern States, at least, 4 per cent, she could consider herself fortunate, and if the judgment instead of $5,000 should be $10,000, this at 4 per cent, would not amount to her hus- band's annual wage.
In the case of the death of a mechanic earning $2.50 per day, the loss to the family and the state, computed on the 4-per-cent. basis, would be represented in round numbers by the sum of $19,000. As we advance in the social scale we find that intelligence begets increased productivity, and increased productivity in the individual represents to the state and to the family, the social unit, greater monetary value as an asset.
Some lives are of much greater value to society than are represented merely by their physical and mental creative powers. How are we to estimate the value of such lives as Lord Lister, Lady Henry Somerset, Lincoln, Clara Barton, Edward Everett Hale, Charles W. Eliot, An- drew Carnegie, Bishop Brooks, Ralph Waldo Emerson, Tolstoi? Not in the value of their actual physical and mental productivity during life can the estimate readily be made. Not even in the value of the force of their example alone, but in the great impetus which such personalities give to the realization of high ideals, the purification of social and political life, and in the betterment and advancement of the race are we to look for a just estimate of their worth. A worth which it is impossible to calculate on a commercial basis. Yet these units are subjected to practically the same chances of infection from con- tagious diseases, and countless other dangers, as the average citizen. It is not the duty of the state to provide special means for the pro- tection and preservation of such lives, but to institute such general measures as will reduce to the minimum such agencies as menace all human life, thus saving to the service of the state lives of all classes of society, the annual ruthless waste of which now amounts to hundreds-
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of millions of dollars in value. It is beginning to be understood that, from the monetary standpoint alone, the value of a productive male life to the state is even greater than its value to the family dependent upon that life. The state makes a financial investment in every life, and every day the amount of that investment is increased, and every day the value of each human life should be greater than ever before. In other words, it costs the state a number of hundred dollars (in Massachusetts about $500), to educate alone, and rear to the normal producing age each human life, and when a life is lost much more is lost in addition to the sum invested and the compound interest thereon. That life can never be replaced. Its power to produce is gone forever, and no one can take its place. All others living and to be born have their own work to do, must bear their proportional part of the state's burden.
The causes contributing to impair the quality or shorten the period of productiveness in the individual may be classed as preventable and unpreventable. Those included in the latter class are storms, floods and other forces of nature, unforeseen accidents, the few unpreventable diseases, and like fortuitous conditions. Among the preventable causes of unproductiveness we find insanity, crime, preventable diseases (con- tagious and otherwise), unsanitary factories and schools, bad sewerage, poor water supply, and the like.
The efficiency of a life becomes impaired and is a potential social burden through disease. Disease is a deviation from the normal, and is now understood to mean more than mere physical disability, for in- dividual and national productiveness is found to be impaired through the manifestation of disease in three forms : First, poor physical health, largely the result of preventable diseases; second, poor mental health, insanity for example, the cure for which lies in the direction of its prevention; third, poor moral health, as illustrated in the various forms of what is called crime, most of which can be prevented.
We have seen that the causes contributing to a greater or less im- pairment of individual usefulness are of fundamental importance, and universal in their distribution, and any remedy which is to be success- fully and economically applied must be likewise basic in character, and of sufficient scope to meet the conditions present.
It becomes incumbent upon us then to strive to raise the standard, physical, mental and moral, of each voter, thus expediting the task of showing him the importance of the relation between the activities of the state and those of the individual.
For generations we have waited, and are still asked to wait, for our school children to develop and rise to carry these burdens; to improve politics; to enact more righteous laws; to secure to the people a more uniform and beneficent government ; and we forget the while that when
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they leave, with meager education, the public school, they must im- mediately plunge into the breadwinning maelstrom to emerge the same fatigued, misguided voters that their fathers are. Much of the information which it is essential that the intelligent voter possess, in order that he may make the most of every day in his life, can not be taught by the public school system. First, because the amount of knowledge which they are obliged to purvey is so great that the entire public school machinery is already overworked, and they could not, even if they thought it feasible, install the necessary equipment to extend their labors to other fields. Second, because the juvenile mind is not capable of weighing and determining matters of economic importance.
A large proportion of our voters, after securing a rudimentary education, are obliged to labor, and fail to pursue further the studies begun. They seldom read anything save a more or less misguided, hysterical and misleading newspaper. The fatigue resulting from daily physical labor is not conducive to intellectual activity in the form of instructive reading at night, and hence we find our average voter growing up woefully ignorant of the essentials of good govern- ment, and dependent, as already indicated, upon self-interested, irre- sponsible and unreliable sources for his misinformation.
The great disease at the root of almost all evil is ignorance, and the remedy is education. Were it not for ignorance, that universal malady, it would not be possible for so many agencies to exist which diminish the happiness and its corollary, the producing capacity, of the race.
In the supplemental education of the laboring adults upon a broad and practical basis rests the remedy for the present unhappy condi- tion. A large proportion of our countrymen fail to keep abreast of the times in their methods of thinking and of living, because the de- mands which breadwinning makes upon their strength and time pre- vent their obtaining authoritative information on the thousand and one subjects, a knowledge of which would lighten their burden and brighten their pathway.
If it can be borne in upon the public mind that many diseases can be avoided, that the amount of insanity can be reduced, that crime with its great attendant expense can be decreased, that the producing capacity of man can be increased, while augmenting at the same time the number of his comforts and the extent of his leisure, there will be a demand for something looking toward relief, and almost any reason- able measure will be actively supported.
Information of the sort needed to secure the interest and co- operation of the voter, whose support is essential to the accomplish- ment of his own betterment, must be easily accessible, and presented in
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a form sufficiently authoritative and attractive to insure its reception and assimilation. He does not know that if it were possible to pre- cipitate upon society any of the millennial measures which are fre- quently advocated by a certain class of agitators, confusion, anarchy and woe would result. It would not be possible for man to adjust himself to new conditions so suddenly thrust upon him. He must be shown that only by advancing step by step along evolutional pathways already well defined, can permanent progress be made, knowing that any radical departure therefrom inevitably invites disaster.
We are confronted with a profound economic problem, and for its solution federal authority and machinery are necessary. There should be established by the federal government a Department of Public Betterment, which should consist of a board known as the Board of Public Betterment, appointed by the President, together with a cabinet officer known as the Secretary of Public Betterment, to be selected by the President. Their entire time should be devoted to this department, and a salary sufficient to insure this result should attach to the position.
In personal character they should resemble the personnel of the United States Supreme Court, and should be selected from the country at large with special reference to their high intellectual attainments, and with the view of associating together men who severally are au- thorities upon pedagogy, medicine, economics, industrial problems, finance, and similar interests which affect every citizen. In the in- terest of convenience and economy the work of the department should be divided between two bureaus. One for the accumulation and classi- fication of knowledge valuable to the department, which might be known as the Bureau of Eesearch of the Department of Public Better- ment, and one designed to disseminate and apply the knowledge thus obtained, which might be known as the Bureau of Publicity of the Department of Public Betterment.
It should be the function of the former to ascertain the causes of diseased conditions, and search for the prevention of those causes. It should investigate, compile and supply data relative to the numberless problems associated with municipal government, crime, insanity, im- migration, child labor, the length of the working day, the preservation of the sabbath day, and extension of holidays ; the construction, ventila- tion and sanitation of public buildings, and the vehicles of common carriers; educational hygiene; modern philanthropic methods, idleness, divorce, marriages against public policy; public institutions, their character, establishment and administration ; strikes, commerce and the like.
The Bureau of Publicity of the Department of Public Betterment should be empowered to institute such measures as seem wise to correct the evils above indicated. It should have authority to pre-
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vent the spread of diseases; to stop the publication of indecent lit- erature; to close all factories producing injurious foodstuffs; to divorce politics from the public schools, to deal vigorously with the tenement-house problem, the liquor habit and like evils which impair individual, and consequently national, health and productivity. In the event of pestilence, famine, flood, drought, war, or any similar calamity in any part of the land, it should be the function of this bureau to render immediate assistance as required. This bureau should have power to appoint from time to time as needed competent tribunals to adjust and prevent strikes and the like, selecting for service men especially fitted to deal with special conditions as they may arise.
The Bureau of Publicity of the Department of Public Betterment should organize a corps of lecturers, the men composing which should be recognized authorities in the departments of knowledge which they severally represent. They should be selected with the greatest care. The highest authority on a given subject would not necessarily be the most useful lecturer for the department. The best man for the pur- pose of this plan would be one who has the gift of conveying in com- paratively simple and concise English scientific facts, and who, withal, is an attractive and entertaining speaker. Excessively technical treat- ment of any subject would soon result in empty lecture rooms. To understand the need for, and the appreciation by the public of, such free lectures as here contemplated, one has but to familiarize himself with the history and operation of free lecture courses as given in some of our large cities. It is idle to address people on subjects which do not interest them, and matters in which the population of one district, affected by a certain combination of conditions, are greatly interested, would not attract the slightest attention in another section of the country where other conditions obtain. There are certain subjects relative to personal health, municipal administration, trusts, patent medicines and the like, which should prove popular as material foi lectures throughout the country.
The elaboration of a schedule for the suitable distribution of lectures and their varied subjects is but an administrative detail. Some plan incidentally determining the relative popularity of the several lectures upon given subjects would serve as a valuable guide in the matter of their selection. It would also tend to stimulate in each lecturer a desire to improve his matter and his style. At times there would be a greater demand for lectures upon certain subjects than at others. When a city was considering the reorganization of its school system, or the improvement of its water supply, there would naturally, in response to the popular interest in these matters, be a greater desire to secure authoritative information upon these subjects than at other times. In the event of the invasion of the Pacific coast by the bubonic plague,
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the people of that section would be much more interested in securing instruction for its extermination than the New Englander. Manu- facturing interests in the state of Ehode Island would demand in many respects very different treatment from the coal mining sections of Pennsylvania, and each of these would fluctuate in local and general interest.
In short, the Department of Public Betterment should not only stand ready to answer rightly questions of public interest, but, further, take an active part in their just solution and adjustment.
In view of these considerations it would be unwise to keep a fixed number of lecturers constantly employed, but secure, as the demand developed, the men necessary for the work.
It may be urged that the daily press in a measure already does the work aimed at. In reply to this contention, it should only be neces- sary to call attention to the growing distrust prevalent regarding the reliability of newspaper science and sociology. Moreover, from the earliest times, the instruction given by word of mouth has always been more eagerly sought after, and has proved more fruitful in results than the printed page.
The objection may be raised that political preferment and intrigue will soon permeate, and finally paralyze, the department's activities. In answer to this, we need but call attention to the United States Supreme Court, against which similar prophecies have been made, only to be unfulfilled. No intelligent person has ever entertained a sus- picion that political evil ever invaded the sanctity of that august body. If, as is entirely practicable, the same great care be exercised regarding the selection of the members of this board, and the preservation of its political isolation, no anxiety need be felt with regard to its integrity, and the efficient and impartial exercise of its functions.
It should be the duty of the Department of Public Betterment to make a careful study of the needs of the people, and supply them with necessary information whereby they may secure their own betterment. This is now done in a limited way for certain classes. For example, the Department of Agriculture, the annual expense of maintaining which is about $6,000,000, has experiment stations scattered through the land which investigate the special needs of the farmers of different sections, and as rapidly as information is secured it is printed and given as wide distribution among agricultural and similar interests as its character warrants. It is well known that this policy has not only saved to the individual farmer the expense of personal experimentation, but has been the means of enriching him, and has incidentally de- veloped the productiveness and increased the acreage of farm lands of this continent, reduced the price of foodstuffs, and put many millions into the public treasury. Why should not this same thing be
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done in an appropriate and practical manner for other classes of society, the mechanic, the miner, the laborer, according to their special needs ?
It should further be the duty of the Department of Public Better- ment to systematize and consolidate, in the interest of efficiency and economy, all efforts now being made to convey to the people a knowl- edge of how to live better. Many states, for example, spend large sums annually to support a State Board of Health which does much work that is merely a repetition of that done elsewhere, and most of which could be done better and more economically by the Department of Public Betterment.
There is ample excuse for the existence of such a department in this government. There are many odds and ends left over from the work of other departments which could more properly and more satisfactorily be centralized in the department suggested. Much of the work of the existing departments does not properly belong to them, and is, there- fore, imperfectly done or periodically neglected. All this should be turned over to the Department of Public Betterment, which should, when properly developed, attain a position of first importance in the federal service, for the extent of the field to which the activities of such a department might be legitimately applied is almost limitless.
It may be urged that we already have local boards of health and health officers, seaboard and other quarantine regulations, general and insane hospitals, laws governing the questions of factory and school sanitation, child labor, the liquor habit, and the like. Praiseworthy and helpful as are the present efforts to preserve the public health, they are entirely inadequate to meet the demands of an ever-progress- ing civilization.
The officers who have in charge these agencies for the prevention of disease, and upon whose vigilance we are each dependent for our personal safety, even though selected for their good moral character and fitness, are not given the necessary authority and funds to enforce adequate preventive measures, are underpaid and are constantly hampered and humiliated by the intrigue of political meddlers. This is not a suitable system of preventive medicine for a self-respecting and highly civilized republic.
Expensive as may be the execution of the plan herein outlined, its possibilities as an economy in the administration of the state, in its prevention of crime, insanity, costly physical suffering, and the main- tenance of the public institutions which these things entail, far out- weigh the consideration of the cost of its installation.
It must be remembered that the accomplishment of all these things would not only result in great saving in individual, city, state and national expense, but would further create a more intelligent citizen-
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ship, which would, through its own increased productivity, own more property on which larger taxes would be collected and expended for the benefit of all. This should be borne in upon the voter's mind, and when he fully comprehends its real import, true socialism will have been born. Take to the voter a direct and consistent story, show him the ruthless waste of treasure which comes primarily from his purse, point out to him the intelligent exercise of the franchise as the remedy, and improved civic conditions will prevail. But, in order to be helpful and of the highest usefulness, this plan must follow certain well-known laws of social evolution, and paternalism with its attendant subtle evils must be guarded against with the greatest vigilance. And in passing it may be well to register a protest against the present epidemic of uncoordinated, misdirected and impotent ' philanthropy ' which, not- withstanding its well-meant purpose, fails to do aught but blight the fiber of the receiver, and fritter away the energies of the giver, thus proving injurious alike to both. Such heterogeneous and pestilential efforts might well be termed criminal philanthropy.
Let the better element in society forget class distinctions, sectional strife, sectarian differences and personal bickerings, and take up seri- ously the consideration of these problems.
Unless thoughtful persons are prepared to formulate and act as a unit in the furtherance of some such plan as here indicated, it will very appropriately be asked, "If these people who are accredited with possessing superior intellectual attainments, and who profess humani- tarian purposes, can not agree among themselves when there are at stake matters of such vital consequence to all mankind, how can they expect to attain their ends, and obtain from less talented persons the cooperation necessary to succeed ? "
Nor let us squander our resources in needless discussion and the costly delay it entails. It must be remembered that time also is a national and individual asset, for the proper use of which a higher power is to hold us accountable. When the welfare of human life is in the balance, trivial and senseless controversy is criminal.
Notwithstanding the industry with which the medical profession, already overworked, and frequently grievously misunderstood, seeks to propagate progressive ideas regarding the acquirement and maintenance of health, personal and public, never can a decisive conquest of ultra- conservatism, bigotry and ignorance be made without the active support of thoughtful and discerning people.