Popular Science Monthly/Volume 85/October 1914/The Value of Research in the Development of National Health
|THE VALUE OF RESEARCH IN THE DEVELOPMENT OF NATIONAL HEALTH|
By Professor BENJAMIN MOORE, M.A., D.Sc, F.R.S.
UNIVERSITY COLLEGE, LIVERPOOL
THE history of medical science presents to the curious student a remarkable development commencing in the latter half of the nineteenth century, and one worthy of special study, both on account of the light that it sheds on the present position and the illumination it affords for future progress.
If any text-book of medicine or treatise on any branch of medical science written before 1850 be taken up at random its pages will reveal that it differs but little from one written a full century earlier. If such a volume be compared with one written thirty-five years later, it will be found that the whole outlook and aspect of medicine have changed within a generation.
Erroneous introspective dreams as to the nature of diseases as "idiopathic" as the many strange maladies which their authors are so fond of describing have been replaced by fast-proven facts and medicine has passed from an occult craft into an exact science based upon experimental inquiry and logical deduction from observation.
What caused this rapid spring of growth after the long latent period of centuries, and are we now reaching the end of the new era in medicine, or do fresh discoveries still await the patient experimentalist with a trained imagination who knows both how to dream and how to test his dreams?
It is but a crude comparison that represents the earlier age as one of empiricism and imagination, and the later period as one of induction and experiment. Empiricism has always been of high value in science, it will ever remain so, and some of the richest discoveries in science have arisen empirically.
Imagination also is as essential to the highest scientific work to-day as it was a century ago, and throughout all time the work of the genius is characterized in all spheres of human endeavor by the breadth and flight of the imagination which it shows. The great scientist, whether he be a mathematician, a physicist, a chemist, or a physiologist, requires imagination to pierce forward into the unknown, just as truly as does the great poet or artist. Also, the inspired work of poet or painter must be concordant with a system of facts or conventions, and not outrage certain canons of his art, as certainly as the true and lasting work of the scientist must accurately accord with natural laws.
The scientist is as little able to prove the fundamental truth or existence of the groundwork upon which modern physical, chemical and physiological theories are built, as the artist is to prove the ethics, or perfect truth, or perfect beauty, of those conventions upon which poetry, painting or that great group of studies termed the "humanities" find their basis. But the artist or philosopher knows that, using these conventions as the best at present discovered, he can produce works of which the beauty and consistency appeal to all educated human minds capable of appreciation. Similarly, the conventions of natural science, properly understood, appeal to the imagination of the scientist, call forth new ideas to his mind, and suggest fresh experiments to test those ideas; or, a chance empirical observation of an experimental nature, which without theory and scientific imagination would remain isolated and sterile, placed in relationship to the rest of the scheme of science, awakens thought, and may lead to a fresh departure and a long train of important discoveries.
It was this correlation of the imagination with experimentation and the tracing out of relationship from point to point so as to develop the evolution of phenomena that characterized the science of medicine when new-born about seventy years ago and differentiated it from the older nosological medicine in which imagination and experimentation, while both existing, seemed to possess independent existences and pay little regard the one to the other.
It seems well-nigh forgotten nowadays by the majority of people that science and religion originally began together from a common thirst for knowledge, and usually in the same type of mind endowed with a divine curiosity to know more of the origin and nature of things.
Every great religion worthy of the name contains some account of the natural history and creation of the world, in addition to its metaphysical aspects, and reflects the degree of knowledge of natural science possessed by the nation in which it arose at the time of its birth.
The fundamental error throughout the ages of human conceptions, both in science and religion, was that of a non-progressive world to which a stereotyped religion, or science, could be adapted for all time. Perfection was imagined where perfection, we are now happy to realize, was impossible, and, believing in this imaginary perfection and that all things new deviating from it were damnable men were prepared to burn one another at the stake rather than allow error to creep into the world in either science or religion. Thus there have been martyrs for the scientific conscience just as for religious belief, and at this distance in time we can perhaps better understand both inquisitor and martyr and realize that both were fighting for great ideals.
Evolution has taught us that as knowledge broadens we must be prepared to have wider vision and abandon old theories and beliefs in the new-born light that makes the world better to-day than it was yesterday, and that also will show things up to our mental vision more clearly to-morrow than they stand out to-day. To the members of any great craft, or profession, or religious order, this scientific outlook which accepts as fundamental a progressive world and insists that its votaries should adapt their lives to such a doctrine, is peculiarly difficult of assimilation. Routine fixes all men, and so when any new discovery appears to demand change from that order to which the mind has become accustomed, it is immediately looked upon with suspicion, and there being little plasticity of mind remaining, it is rejected as heretical or revolutionary after but scanty critical examination. The cry of the craft in danger has been used efficaciously on many occasions since the days of the Ephesian silversmiths, nor is such a cry at once to be set down to pure selfishness. A craft is often worth preserving long after the forces which have called it into being have commenced to slumber, and conservatism of this type is at times an important factor in social progress. However, there are certain limits which must not be surpassed, room must be made by adaptation for the new knowledge, or it will establish a craft of its own iconoclastic to much worth preserving in the older system.
It is important to insist upon these limitations, because a too reactionary spirit abroad in medicine between 1860 and 1880 prevented the world from benefiting from those remarkable discoveries by Pasteur and their proposed applications by Lister, which laid the foundations of modern medicine and modern surgery. These pioneers of the new age in medical science had to wage for many years a stern and bitter fight against the strong forces of ignorance and prejudice. But for this illogical resistance by men who would not even test the new discoveries, and instead spent their time in sneering at the new geniuses who had leadership to give the world, France and Germany would have been saved many thousands of brave lives in the great war of 1870-71. Even thereafter, the slow struggle continued of the few who knew against the many who refused to be taught, and a perusal of any orthodox text-book of medicine published between 1875-80—that is, more than a decade after Pasteur's great discovery—will show that the etiology of scarcely a single infectious disease had become known, and that medical science was, for example, as ignorant of the nature of tuberculosis as we are to-day of the nature of carcinoma. Take, as an example, the following quotation from a well-known text-book of the theory and practise of medicine published in 1876: "It is now, however, generally admitted that tubercle is no mere deposit, but, on the contrary, a living growth as much as sarcoma and carcinoma are living growths." The tubercles were the only initial lesion observed, the infecting organism was entirely unknown, and the pathologists of this comparatively recent date argued at length as to whether tubercles were to be classed as "adenomata" or were something sui generis.
There is a gleam of sunlight for the future in this retrospect at the ignorance of the past, for, if men were as ignorant regarding tuberculosis thirty-eight years ago as to-day they are about cancer, then it may be argued that a generation hence as much may be known about cancer as is known now about tuberculosis.
It is particularly important at the present moment, when so much interest is being taken in national health, to point out the urgent necessity of allowing as little lagging behind as possible to ensue between the making of discoveries and the practical application of the results by organized national effort for the well-being of the whole community.
It must sadly be admitted that it is craftsmanship in imaginary danger fighting hard for the old methods unchanged which were in vogue fifty years ago, that stands most prominently in the way of advance. As great a harvest as that which followed the application of the principle of antisepsis in surgery awaits the application of the self-same principle in national sanitation to-day, but the very profession which ought to be urging forward the new era apparently stands in dread of it, and seems to prefer to reap its harvest from disease rather than to seize the noble heritage won for it by the research of pioneers and so stand forth to the world as the ministry of health. Fortunately it can not be, the bourne has been passed, and there is no going backward. The advances that have already been made have awakened statesmen and people alike to the needs of the situation, and all have resolved to be disease-ridden no longer. The laws of health must be made known to the people at large, and schemes laid before them for a national organization for the elimination of disease. Disease is no longer an affair of the medical profession, it is a national concern of vital importance. The problem is not a class question, all humanity stands face to face with it now in the light of modern research as it never has faced it before. It has been realized that disease never can be conquered by private bargains for fees between individual patient and individual doctor. Research into diseases of unknown causation can not be subsidized upon such individualistic lines, and in the case of diseases of known etiology and modes of propagation the passage of disease from individual to individual can not be controlled by such private methods as that of the afflicted individual subsidizing the doctor for his own protection. Cost what it may, a healthy environment must be produced for the whole mass of the population, and the laws of physiology and hygiene must be taught not only to medical students, but to every child in every school in the country. People can not live healthy lives in ignorance of the fundamental laws of health merely by paying casual visits to physicians, and no one class in the community can be healthy until all classes are healthy.
The problem of national health is one of peculiar interest to physiologists, and to the exponents of those experimental branches of medical science which have sprung from the loins of physiology, for it was with them that the new science of medicine of the last fifty years arose, and they ought to be the leaders of the world in this most important of all mundane problems.
It is well worth while to consider our opportunities and responsibilities and raise the question whether our present system and organization are the most suitable for attaining one of the most sublime ambitions that ever appealed to any profession. By definition, our science studies the laws of health and the functions of the healthy body, therefore, it is ours to lead in the quest for health. Is this object best achieved if we confine ourselves to research in our laboratories, and to the teaching of the principles of physiology to medical students, while we leave the community as a whole uninstructed as to the objects of our research and its value to every man, and trust the medical students whom we turn out to communicate, or not communicate as they choose, the results of their training and our research to the world at large?
There is little question that much of the ignorance abroad in the world, and much of the fatuous opposition to our experimental work and research, arise from this aloofness of ours. Here also lies the cause of much of the latent period in the application of acquired knowledge to great sociological problems, and the presence of untold sickness and death which could be easily prevented if only a scientific system of dealing with disease could be evolved.
The position occupied by scientists in medicine at the present day is largely that of schoolmasters to a medical guild, and even at that, one constructed upon lines which have grown antiquated by the progress of medical science. It ought now to become the function of the scientist to remodel the whole system so as to fight disease at its source. The whole situation at the moment calls out for such a movement. On the one hand, there exists a widespread interest on the part of an awakened community in health questions, evidenced by recent legislation dealing with the health of school-children, with the health of the worker, with the sanitary condition of workshops, with the questions of maternity and infant mortality and with the communication of infectious diseases. On the other hand, there is chaos in the medical organization to meet all these new demands, and the ample means recently placed at the command of the nation and of municipal authorities are being largely wasted by overlapping and misdirection for lack of skilled leadership. Surely it is a time when those who have laid the scientific foundations for the new advances should take counsel together, assume some generalship, and show how the combat is to be waged, not as a guerilla warfare, but as an organized and coordinated campaign.
There are two essentials in the inception of this organized campaign against disease on a scientific basis. The first is to demonstrate clearly to the public mind that modern scientific medicine arose from the experimental or research method, that it was only when experimental observation of the laws of health and disease, in animals and man, commenced on an organized and broadcast basis that medicine and surgery leaped forward and the remarkable achievements of the past fifty years began. Also that it is only by the organization and endowment of medical research that future discovery and advancement are possible. The second essential is to convince the public that a national system must be evolved placing medical science and medical practise in coordination, so that the discoveries of science may be adequately applied in an organized scheme for the prevention and treatment of disease. The method in which discoveries have been made in the past suggests an amplification and organization along similar lines for the future, and the banishment of many diseases by public health work in the past suggests that it is more efficiently organized and widespread public health work in the future, extended from the physical environment to the infecting individual, that will be most fruitful in banishing other diseases.
If it be queried by any one here, what has physiology to do with disease, it may be replied that the question comes at least fifty years too late. The methods evolved first by physiologists in experimentation upon animals have become the methods of all the exact sciences in medicine. Bacteriology is the physiology of the bacterium, and the study of protozoan diseases the physiology of certain groups of protozoa, Organo-therapy had its origin in physiology, and many of its most brilliant discoveries were made by physiologists, and all by scientists who used physiological methods. Serum therapy, experimental pharmacology, and the great problems of immunity all arose from the labors of men with expert training in physiology who branched out into practical applications achieved by the extension of the experimental, or research, method. The modern methods of medical diagnosis and the brilliant technique of contemporary surgery, what has opened the door to these but the experimental method? From the days of the first successful abdominal operation to the present day research in laboratory or in the operating theater has pioneered the way, and the sooner this simple truth is known to all men the better for medical science. Every time any surgeon first tries a new operation there is in it an element of experiment and research of which the ethical limits are well-known and definable, and any person who logically thinks the matter out must see that it is the research method which has placed the science and art of surgery where it stands to-day. Exactly the same thesis holds for medicine. How could any physician predict for the first time, before he had tried it experimentally on animal or man, the action of any new drug, the effect of any variation in dosage, the result of any dietary, of the employment of any course of physical or chemical treatment, or of anything in the whole of his armamentarium? Yet the public are rarely told any of these wholesale truths but are rather left to speculate that each medical and surgical fact sprang forth as a kind of revelation in the inner consciousness of some past genius in medicine or surgery, who, in some occult way, knew of his own certain foreknowledge what would be the definite effect of some remedy or course of treatment before he tried it for the first time on a patient, or perhaps had the ethical conscience and genuine humanity to test it on a lower animal before he administered it to man.
It may, in short, be taken as an axiom of medical science that everything of value in medicine and surgery has arisen from the applications of experimental research. Nor can future advance be made by any other method than the research method. It is true that accident may teach occasionally, as it did, for example, in the dreadful burns unwittingly inflicted on themselves and patients by the early experimenters in X-ray therapy and diagnosis. But accident is only the most blundering type of experimentation, and results obtained by its chance agency do not really invalidate the universal law that man only learns by experience or, in other words, by research. Research is, after all, only the acquisition of fresh experience by the trained expert, usually led on to his experiment by inductance from other known facts.
It has been said above that all that is valuable in medical science has been acquired by research; the converse may now be pointed out, that much that was valueless, dangerous, and even disgusting in medicine in earlier days was incorporated into the medical lore of the time and often remained there for generations stealing lives by thousands because physicians had not yet adopted the research method, and so based their practise upon ignorant and unfounded convention. It is noticeable in literature that up to somewhere in the beginning of the nineteenth century physicians and surgeons were often as a class looked upon by scholars and educated people with a certain amount of contempt. There were notable and fine exceptions in all ages, but, taken as a whole, the profession of medicine was not held in that high esteem and admiration that it is amongst all classes to-day. Take, for example, Burns's picture of Dr. Hornbook or Sterne's account of Dr. Slop in "Tristram Shandy," and similar examples in plenty are to be found in the Continental literature. The reason for the change is to be found in the comparative growth of medical science as a result of the research method. The physicians of those days were very often ignorant quacks employing the most disgusting and dangerous remedies, or methods of treatment, based upon no experimental knowledge and handed own in false tradition from ignorant master to ignorant and often almost illiterate apprentice. It is only necessary to peruse the volumes written on materia medica of this period to shudder at the nature of the remedies apparently in common use; the details are unfit for modern publication.
Even in the first half of the nineteenth century patients were extensively bled almost to exhaustion in a vast variety of diseases in which we now know with certainty that life would be endangered by such treatment and chance of recovery diminished. Thus, in a text-book published in 1844 by the professor of medicine in the most famous university in medicine of our country, and a physician in ordinary to her Majesty Queen Victoria, it is said that in the treatment of pneumonia
It seems scarcely creditable to us nowadays that about this same period a low diet, blood-letting, emetics and purgatives were employed as a treatment in phthisis, yet such is the case. It is in keeping with the above, and in strange contrast to modern treatment, to find it recommended that if the patient can not winter abroad he is ordered "strict confinement within doors in an artificial climate, as near as possible to 60° Fahr., during at least six months of the year in Britain." From the text-books of medicine of this period, only seventy years back, instances of wrongful and even dangerous treatment in most of the important diseases might be produced. There is no basis of accurate scientific knowledge of physiology, biochemistry or bacteriology underlying the visionary notions about disease. The real causes of the diseases being obscure, they are commonly set down to so-called diatheses or habits such as the "hæmorrhagic diathesis" or the "scrophulous habit." Also, the action of infective organisms and the intimate relationships in regard to infection of members of the same family being unknown or forgotten, such "habits" are erroneously set down as hereditary. When there is no other channel of escape the word "idiopathic" is coined to cover the ignorance of the learned.
If now we pass onwards about thirty years in time, halving the distance between the above period and our own time, and consult an important text-book of medicine published in 1876 by a Fellow of the Royal College of Physicians, a physician and lecturer at a famous London Medical School, and a lecturer on pathology and physiology, we find that the progress attained by research in physiology, and physiological chemistry, and a growing belief in the possibility of infection in many diseases by the microorganisms, now demonstrated so clearly in certain cases by Pasteur and his followers, have commenced to do their beneficent work in medical practise. The heroic bleedings and leechings and the scarcely less violent druggings with strong drugs have disappeared. The patient is less harassed by his doctor, who is more content to assist the natural processes of recuperation as his knowledge of applied physiology and hygiene teach him, rather than to thwart them and to lessen resistance as his predecessor often did a generation ago when he knew no physiology and less hygiene. Still, the comparison between the text-book of even forty years ago and one of the present day shows a wonderful advance, all flowing from the use of the research method in the intervening years, both in knowledge of the origins and in the treatments of the diseases.
Time and space forbid going into details, but the whole of serum, vaccine and organo-therapy were unknown, with the single exception of vaccination for variola. Enteric fever has been separated from typhus, but its etiology is still obscure, and, to a large extent as a consequence, the mortality from it is fifteen to sixteen per cent., or quadruple present-day figures, and it is one of the commonest of diseases. The cause of diphtheria is unknown, although it is now recognized as a "contagious" disease, and as yet research in bacteriology has supplied no cure for it. The unity of the various forms of tuberculosis is unsuspected, the infecting organism is unknown, and, as a result, it is not even recognized as an infectious disease and heredity figures most strongly in a dubious etiology leading up to a vacillating treatment. Pneumonia is not recognized as due to a microorganism, and is described as one of the "idiopathic" diseases. The cause of syphilis, and its relationship to tabes dorsalis, and general paralysis are unknown, and generally it may be said that the causes of disease are either entirely unknown or erroneously given in at least three quarters of the very incomplete list of diseases that are classified and described.
This, after all the centuries, was the doleful position of medical science in the year 1876, when suddenly light began to shine upon it, brought not by the agency of any member of the medical profession, but by a physiological chemist, and he was led to his great discovery, not in an attempt to solve some problem of practical medicine, but by scientific observations devoted to an apparently purely philosophical critical research into the supposed origin of life in a particular way.
It was the experimental or research method in biochemistry supported by physiological experiments on animals which in the hands of Louis Pasteur laid the foundations of true knowledge, and transformed medicine from what has been described above into the glorious, living, evolving science that we possess to-day.
The men who fought side by side with Pasteur in his famous struggle against orthodoxy in medicine as represented by the leading physicians and surgeons of the period between 1860 and 1880 were mainly chemists, biologists and physiologists, such as Claude Bernard, Paul Bert, J. B. Dumas, Biot, Belard and Sainte-Claire Deville, in his own country, and Tyndall and Huxley in ours. A few physicians and surgeons of scientific training in France and England recognized the importance of his discoveries, such as Alphonse Guérin, Villemin and Vulpin, in his own country, while Lister in ours was already at work, had experimented widely and wrote his memorable letter of congratulation to Pasteur in 1874, informing him of the work he had been doing in introducing antiseptic surgery in England during the preceding nine years. Against this intrepid little band of experimental scientists were massed all the batteries of orthodox medical nescience served by the distinguished physicians and surgeons of the time; but truth is mighty and must prevail. Davaine applying Pasteur's principles in a medical direction had found out the bacterial origin of anthrax, and although he was violently attacked by oratorical arguments in opposition to experimental proofs, and accused, as many physiologists are to-day of having "destroyed very many animals and saved very few human beings," his facts held fast, and combined with the later experiments of Koch and of Pasteur, not merely established the etiology of anthrax as we know it to-day, but gave a support and forward growth to that new-born babe, Bacteriology, which without such animal experiments could never have grown into the beneficent giant that it is to-day in all its glorious strength for the weal of humanity.
Pasteur himself meanwhile was hard at work in the small ill-equipped laboratory of physiological chemistry of theNormale at Paris from which the fame of his discoveries began rapidly to spread and shed a new light forth on the medical world. Pasteur at this stage had already largely rehabilitated the national prosperity of his own country by his successful researches on silk-worm disease and on fermentation maladies and the diseases of wines. All this effect upon national industries, it is to be noted, followed on from an inquiry of apparently no practical importance on spontaneous generation. He now turned his genius towards disease, there also utilizing the same discovery arising from a research that contained at first sight no possible applications to disease and the remainder of his life was devoted to the extension of these studies. The subsequent history of this discovery is the science of bacteriology with all its ramifications and manifold applications in industry, in agriculture, in medicine and in public health, investigated by the experimental method by thousands of willing workers all over the civilized world. Who but the ignorant Philistine, who knows not what he prates about, can deny the profound influence of animal experimentation, and the philosophic application of the principle of research upon the history of the world?
Let us now, from the vantage-point of the present, look back at the past and glean from the study of the manner in which this science took origin some knowledge to guide us, first, as to how research may be fostered and encouraged in the future, and secondly, as to how the results of research may be applied for social advantage.
The first and perhaps the finest thought of all is that research must be pursued with the highest ideals of the imaginative mind apart from all desired applications or all wished for material advantages. If we might personify nature, it would seem that she does not love that researcher who only seeks her cupboard, and never shows her finest treasures to him. She must be loved for her own beauty and not for her fortune, or she will ne'er beand won. Not even the altruistic appeal of love for suffering mankind would seem to reach her ears; she seem to say: "Love me, be intimate with me, search me out in my secret ways, and in addition to the rapture that will fill your soul at some new beauty of mine that you have discovered and known first of all men, all these other material things will be added, and then I may take compassion on your purblind brothers and allow you to show them these secret charms of mine also, so that their eyes may perchance grow strong, and they, too, led hither by you, may worship at the shrine of my matchless beauty." By all the master's discoveries in all the paths of science, Nature is ever teaching us this great doctrine to which we have closed our ears so long. She tells us the creation of the world is not finished, the creation of the world is going on, and I am calling upon you to take a part in this creation. Never mind that you can not see the whole, love that you see, work at it, and be thankful that I have given you a part to play with so much pleasure in it, and so doing you will rise to the highest ideal.
This is religion with thirst for knowledge as its central spring; does it differ much from those aspirations which have made men of all nations worship throughout all the ages? Anthropology teaches us that the religious system of a race of men gives a key to their advancement in civilization. If this be so, growth in natural knowledge must elevate our highest conceptions, furnish purer ideals and give us more of that real religion that is to be found running so strongly in the minds of great individuals such as Isaac Newton, Michael Faraday, Louis Pasteur, Auguste Comte. A great man may be strongly opposed to the orthodox creeds of his day, he may even sneer at them, he may be burnt at the stake by their votaries, and yet be a man of strong religious feelings and emotions which have furnished the unseen motive power, perhaps unsuspected even by himself, that leads to a whole life of scientific heroism and enthusiasm.
The practical lesson for us to learn from all this is that we must consider research as sacred and leave it untrammelled by fetters of utilitarianism. The researcher in functional biology, for example, must be left free to pursue investigations as inspiration leads him on any living structure from a unicellular plant to a man, and must not be expected to devise a cure for tuberculosis or cancer. In his research he must think of something higher even than saving life or promoting health, or he is likely to prove a failure at the lower level also.
As an example of the wrong attitude of mind towards science, there may be taken the point of view of those utilitarians who complain of the amount of time and discussion at present being given to the problem of the origin of life. These wiseacres with limitations to their brains say "that it is an insoluble problem, we shall never get to the bottom of it, let us simply assume, since it is here, that life did originate somehow, and, taking this as an axiom, proceed to some practical experimental problem; the origination of life does not lend itself to experimental inquiry."
Now it is, strange to say, just those problems that appear most insoluble upon which the inquiring type of mind loves to linger and spend its energies, and, although the problems never may be solved, the misty solitudes to which they lead are glorious and the fitful gleams of half-sunshine that come through are more kindling to the senses of such men than the brightest sunshine on the barest of hills. It is here, and in such quests, that the biggest of human discoveries are made and not all of them are in natural science alone.
The search after the mystery and origin of life had profound influence in raising man from a savage to a civilized human being, and is found as an integral part in all religions above a certain level of savagery. Much of the system of morals and ethics of civilized nations is unconsciously grouped round this problem, and we owe the existence of that social conscience which makes each of us our race's keeper to our interest in the nature of life, and our ties with other lives. Leave such a problem alone and attend to routine researches! Why, the human intellect can not do it, such problems compel attention! What, it may be asked, was it that started all this routine research in biology, in favor of which we are asked to abandon the search after the origin of life? The routine research would not exist, but for a discovery made in investigating whether life originated in a certain alleged way.
If the whole science of bacteriology emerged from a proof that a certain alley did not lead to the origin of life, how much more glorious may that knowledge become that finally leads us to this goal, or even one step onward in our true path towards it. The search after the origin of life is an experimental inquiry, it leads straight to research, that is all the physicist or chemist demands of a theory, it should be enough for the biologist. We who search for this are not occultists whatever may be said of those who oppose.
Let us then learn to have a catholic spirit about research, and try to convince the world that it commands devotion not merely because of material advantages which it may bring, but because it is the most lovely and most holy thing that has been given to man. So may we clear the fair name of science of the false charge of materialism that is so often brought against it by those who do not know and judge science purely by mechanical inventions.
Next let us consider the applications of scientific discovery and see if we cherish aright the gifts of the fairy godmother, for her gifts are dangerous if wrongly used. Consider, if this be doubted, the enormous advantages given by mechanical and chemical contrivances in producing the material comforts necessary to civilized human existence, and then turn your eyes to the reeking slums of our great cities. It is clear that natural science can not go on successfully alone, it must take sociology with it if our world is to be a better world to live in because of the gifts brought by scientific discovery.
Nor is the ideal and the outlook different in the least from that given above for pure research, when we come to consider its applications, the same high spirit must prevail in all our endeavors, or we shall defeat our own ends and miserably fail. Selfishness here, as everywhere, must recoil on the culprit, who only deadens his own soul. Health is needed not to grow wealthy or to prolong to greater length a "lingering death" as Plato puts it, but to fill life with happiness, and beckon the bold and adventurous forward to higher things. Here we must copy Nature's own plan and take care of the race as a whole instead of spending our energies upon single individuals or favored classes. Nor need any one fear that any individual or any particular class in the community is going to suffer from the adoption of the true scientific attitude towards disease. The penalty taken by nature on the more comfortable classes who have hitherto enjoyed the greater share in government for allowing the existence of poverty, disease and slumdom, is to utilize thisarea as a culture-ground for diseases, which invade the classes above. Nature is still at work creating, still conducting evolution at the highest level, and disease is at present the tool with which she is working. So long as those poverty-stricken slums are allowed to remain, just so long is she grimly prepared to take her toll of death and suffering from those who ought to know how to lead on and do it not. The disease and the crime below are to the social community what pain is to the individual, and just as the special senses become more highly organized and sensitive as the nervous system becomes more highly developed, so as the civilization of the community intensifies does the public conscience awaken to forms of mischief and crime in one generation that were unsuspected in a previous one. So social evils become intolerable and finally are removed. How then are we employing our knowledge as to the causation of disease to the public problem of its removal or abatement?
In regard to the physical environment much has been done during the past generation towards applying the laws of hygiene, as is shown in the sanitation of our great cities, and especially in regard to the question of water-supply. It is good, for example, that Glasgow goes to Loch Katrine for her water-supply, Manchester to the English lakes, and Liverpool to the Welsh hills. Each of these great cities carries for many miles the pure distillate of the hills to its million of inhabitants. It has cost much in pounds sterling, though not more than if each family had a pump in its backyard. On the other hand, think of the disease and suffering and death prevented, enteric fever almost gone where thousands would have died of it, and tens of thousands been debilitated, and these of the best of the citizens, for disease is no eliminator of the unfit. Think of all this, and then say, Did it not pay these great cities to bring the pure water from the lakes in the hills?
But why do these good cities content themselves to allow their little children at a most susceptible age to be supplied still with milk which contains the bacillus of tuberculosis in so large a percentage as five to ten per cent.? And why does the law of the land prevent these corporations from searching out tubercular cows in all the areas supplying them with milk? If it is part of the business of a municipality to see that its citizens have a pure water-supply, why should it not also be allowed to see that they have a clean milk supply?
Long ago the power to make the lame to walk was regarded as a divine gift. When is mankind going to awake to the fact that science has placed this gift in its hands? Much more than half of the lame and spinally-deformed children in our midst are in that condition because of infection of joints or spine with the bacillus of tuberculosis. By open-air hospitals and open-air schools we seek and succeed in curing a percentage of them, but how much better it would be if we took the fundamental problem of tubercular infection in hand and prevented them from becoming lame and deformed?
There is at present on foot in England a great scheme to enable the blind to read, and it deserves our support because it is our fault that these people are blind. The sad fate of the man born blind appeals to all kind hearts; but men are not born blind, they become blind within a week or two of birth because of an infectious disease contracted from the mother at birth. Science knows and has taught the world how this blindness can be quite prevented, and it is because of our faulty organization for attending to maternities amongst the poor that these people are blind. By proper organization practically all blindness arising at the time of birth can be prevented. Why is it not done? Thus our modern science can make the blind to see and the lame to walk, but it is so manacled by ancient ways and customs that it is left powerless, and so there are these maimed and darkened lives of innocent people, and they are left partially burdening the community which has only its own folly to blame for the whole stupid position.
Let us consider lastly a disease which collects the last toll from one seventh of humanity, and debilitates and enfeebles the lives of many whom it does not entirely destroy. At all ages, in infancy, in the prime of life, and in life's decline, it snatches away the best of our fellowmen. How are we organizing our campaign against tuberculosis? Bacteriology has taught us that it is an infectious disease and has isolated the organism. It is an undoubted fact, proven to the hilt by many inquiries and observations, that infection passes from individual to individual. How is this knowledge being applied, and how are we attempting to stem the tide of infection? In the United Kingdom alone about 70,000 persons die annually of the disease, and all over the civilized world the total death roll of human kind annually from tuberculosis probably does not fall short of a million souls. This tide of infection is kept up, year in, year out, and every 70,000 dying annually in Britain must have infected 70,000 fresh victims before they themselves are carried away. Can it not be stopped, this foul tide of infection? What is being done to stop it? Sanatoria are being provided for the early cases, the bad and most infectious cases are largely being left alone to sow infection broadcast and then die. This is the chief means being used at present to stop the tide. The early non-infectious case is deemed the more important to look after, and the well-advanced, open, thoroughly infectious case is left to itself to infect others and then to die. This is the condition of our public health attitude in regard to tuberculosis. It is a travesty on the application of all biological laws, and in direct opposition to all laws of racial preservation. Industrial conditions have produced an artificial environment and enhanced the chances of infection by the organism of this disease; it should be our plan to copy nature's method and safeguard the interests of the community, and to do this we must proceed on the plan of separating the source of infection—that is to say, the infectious individual from the sound individual. This is done with success in the case of smallpox and cholera, and this plan has eradicated hydrophobia; why should it not be carried out in the case of tuberculosis? Under present conditions men, women and children are going on unwittingly infecting one another by the thousand with tuberculosis in school, workshop and home, and we who know it take no public action and raise no clamant outcry against it. It is of more value to the community to isolate one pauper far advanced in tuberculosis than to send ten early cases to sanatoria. This disease must be stopped at its source as well as dealt with on its course. No disease has ever been eradicated from a community by discovering cures for it, and none ever will; many diseases have disappeared because their sources have been cut off.
Let us be scientific, let us search out the truth; having found it, let us act upon it, and let us conceal nothing that is true.
- Address of the president to the Physiological Section of the British Association for the Advancement of Science, Australia, 1914.