Popular Science Monthly/Volume 86/April 1915/Community Defense of National Vitality

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THE shadow of the tragedy in Europe can not wholly be lifted from our thoughts during the meetings of this Convocation Week. As the representatives of science and of the applications of science to the better ordering of the life of man, this barbarism shocks and amazes, as much as it saddens us. As scientific men, however, we are accustomed to recognize that slight constant factors may be as significant in their effects as large and occasional ones. It is well, as we take counsel at this time, to remember that peace, which has her victories as well as war, has also her defeats, and her ranks on ranks of killed and wounded.

It is tragic that a million or so of men should have perished in battle during the last six months of 1914, and that many more should have been wounded. It is also tragic that a million and a half men, women and children should have died in 1914 in the United States, and that some three million people should be on the sick list all the time. The most fearful thing about the war is that it seems to us at this distance so wantonly needless. Yet we are told on the good authority of Professor Irving Fisher that over forty per cent, of our annual toll of civil death and suffering is needless also.

These facts and this comparison are trite and familiar. Yet as a public health official, seeing close at hand the problems of preventable disease and the meager efforts made to solve them, I often wonder whether you and I really believe these things, and, if we do, why we do not act upon our knowledge. Is it merely a rhetorical phrase that 600,000 people die needlessly in our midst—or is it really true?

Let me rehearse very briefly the disasters inflicted upon our country during the past year, by foes whom we may conquer if we seriously will to do so. First of all, a quarter of a million infants were carried off before they had rounded out the first year of life. Try to get this out of the realm of statistics and visualize it as a solid fact. Think of what the suffering of a little baby's death means, and realize that the tragedy has come to more than one in ten of all the households gladdened by birth during the year. Yet nothing is more certain than that nearly half of these infant deaths are preventable, and by simple and definite procedures. The establishment of infant welfare stations for the instruction of mothers in breast feeding and the other essentials of maternal care is a measure that never fails to bring results. In New York City the infant death rate has been reduced one third by this means in a period of seven years, and a state-wide campaign along similar lines inaugurated last summer by the New York State Department of Health resulted during the first four months in a saving of 700 infant lives.

Many of us, I suppose, have felt that there must have been a strange lack, either of responsibility or of humanity, or of imagination, in the chancelleries of Europe when the bronze doors of Janus were unlocked. Is there not the same lack nearer home while this slaughter of the innocents goes on unchecked?

The children who escape the perils of infancy are next exposed to the attack of such communicable diseases as diphtheria, scarlet fever, measles and whooping cough. These enemies are less easy to control, but they may be held in check by measures for prompt diagnosis and intelligent isolation, and by the cultivation of habits of personal cleanliness. Against diphtheria, in particular, we have a practically certain defense in antitoxin, yet we lose 20,000 children every year from this disease because some of our trusted guardians, the physicians, neglect or postpone the use of this simple and specific weapon.

When the army of civil life is actually mustered in for active service, the enemies, typhoid fever and tuberculosis, make their great frontal attacks. Typhoid fever has been reduced to an almost negligible quantity in many communities, and those which lag behind pay their own penalty for special and conspicuous neglect. Against tuberculosis, on the other hand, we are all over the country doing little more than fight a drawn battle. The great wave of enthusiasm which swept over the United States ten years ago has not yet achieved all the results anticipated. There are still 150,000 deaths a year from this disease, of which three fourths should be prevented. The theory of the anti-tuberculosis campaign has been well thought out, but in few places has the practical machinery for carrying it out been adequately supplied in the shape of hospitals for the isolation of advanced, and the cure of early cases, and of visiting nurses to secure the proper care of patients in the home. Yet it is of little value to preach hygienic living without providing the means for practicing what we teach. Nowhere has the enemy been vigorously pursued into the insanitary tenements, and the dusty, unventilated factories where he gains his first foothold. The work of our tenement departments and state labor bureau is only a beginning of what must be done if we are to check the insidious influences which prepare the ground for the tubercle germ.

Final!}', the veterans of our army, who have resisted all earlier attacks, are exposed to their own peculiar dangers. Diseases of the heart and arteries, Bright's disease, and cancer together carry off 300,000 men and women every year, and we are face to face with the sinister fact that while at every other point of the battle line we are at least holding our own, these diseases of later life appear to be actually on the increase. Yet in any individual case, we know that the appropriate advice as to the hygienic conduct of a defective bodily mechanism would prolong life, often by many years.

If we really want to prevent preventable diseases, we must supply the machinery, the fortifications and munitions of war to use against the enemy. We must install effective water purification plants and adequate systems of sewerage and sewage disposal. We must provide infant welfare stations in the proportion of one for every 20,000 of the population, if the death rate of infants is to be effectively reduced. We must have adequate systems of medical school inspection and school nurses, not one for each 2,500 school children, but one for every 1,000, if our young soldiers of peace are to come to maturity in full vigor and free from physical defects. We must build contagious-disease hospitals, with a capacity of one bed for every 2,000 of the population. We must provide tuberculosis hospitals with a capacity of one bed for every 1,000 of the population for the cure of early and the isolation of advanced cases of this disease, and corps of visiting nurses to find incipient cases and secure proper care for patients in the home.

It is the health officer who must ultimately furnish expert guidance and leadership for the public health campaign. One of the most unfortunate aspects of the present situation is that too often the public distrusts its natural sanitary leaders, and sometimes the health officer is so blind to his opportunities that other agencies must perforce step into the breach. The most substantial progress can only be made, however, when constructive initiative and legal authority are conjoined. It is essential that the task of officering the army of the public health should be entrusted only to trained and experienced experts, qualified by knowledge and disposition for their work. Having obtained such men, the local and state departments of health must be given adequate powers and liberal appropriations. Fifty cents per capita should be a minimum for the city, and twenty cents per capita for the state, if the organization of the general health campaign is to be efficiently maintained.

All this will cost money—perhaps five or ten times what we are to-day devoting to our national defense against diseases. The United States spends each year three hundred millions of dollars for protection against human enemies who will probably never come. Surely we can spare one half of this sum for foes who will surely and inevitably kill a million and a half of our people this very year, if we do not stop the slaughter.

Material equipment and the provision of a standing army of experts is, however, only a part of the necessary preparation for the war against disease. The reserves are always at the front in its battles, and the warfare is a guerilla warfare in which each one must do his part. Education is the key-note of the modern campaign for public health. Tuberculosis and infant mortality are preeminent among all the causes of preventable disease and death as the greatest scourges, from the abatement of which the largest results for humanity are to be attained. In each case the fight must be won, not merely by the construction of public works, but by the conduct of the individual life. The same thing is true with regard to the spread of the acute contagia, the burden of venereal disease, the obscure ill effects of defective eyes and ears and teeth, and a dozen other problems which in greater or less degree concern the public health. In every one of these cases the results we are striving for can only be reached by spreading a clear knowledge of the ways in which disease spreads, and the ways in which it is prevented, among the mothers who bring up babies and the men who pay rent in the tenement and work in the stores and factories.

As an illustration of what may be done along this line of public education I may cite the efforts being made by the New York State Department of Health to bring about a more effective contact between the expert who has the knowledge and the individual citizen who must make use of it.

The monthly bulletin of the department is our official organ of communication with the public, and this bulletin we have first of all attempted to popularize and to convert into an effective medium of education. We have changed its name to Health News. We have banished from its columns all long and technical discussions (which when necessary are issued as Special Bulletins to a selected mailing list). We have attempted to print in each number half a dozen brief articles on timely health topics by men of national reputation in their respective fields. We have paid special attention to real news items in regard to current sanitary problems and sanitary progress in the state. Each number is illustrated with cartoons, diagrams and photographs. The edition has been enlarged to over 30,000 copies, and it is mailed during the winter months to each of the 15,000 school principals in the state. We look forward in the future to a day when biology and public health shall occupy not a subordinate, but a central position in the school curriculum.

In order to come in touch with a wider public than we can hope to reach with our own publications, we have asked the newspapers of the state to cooperate with us, and have met with generous response. We send out each week a 500-word health hint on such topics as Infant Feeding, Hot Weather Hygiene, Health on the Farm, County Hospitals and Taxes, Cancer a Preventable Disease, and the like. The "Hints" are mailed in proof or in electrotype, as desired, and over 400 daily and weekly papers are using them each week throughout the state. We estimate that by this means we are reaching a million and a half of readers.

The printed page must be supplemented by a more striking and vivid appeal to the eye, and the popular exhibit should form a part of any well-organised public health campaign. The work of the New York State Department during the summer was centered particularly upon the prevention of infant mortality, and to aid in this campaign we prepared three child-welfare exhibits, which between April and July were shown in twenty-five counties of the state. These exhibits led in many cases to the establishment of infant welfare stations and in every community through which the exhibits passed there has been left a trail of enthusiastic and constructive infant-welfare work. During the fall, these infant-welfare exhibits and others dealing with rural hygiene have been shown at forty county fairs throughout the state. The Department arranges for lectures upon health topics whenever requested, and the members of the staff as well as the sanitary supervisors are kept busy filling engagements of this kind. Three special lecturers on diseases of the eye and ear, on mouth hygiene and the care of the teeth, and on social hygiene are attached to the department and we plan during the coming winter to prepare and print a series of syllabi of lectures on all the more important public health topics, with a set of lantern slides corresponding to each lecture which may be sent out on request for the use of health officers and other local lectures. Original moving picture films dealing with infant-welfare work and rural hygiene are now being prepared for use.

I have dwelt somewhat in detail upon the public education work of the New York State Department of Health merely as a type of what many progressive state departments, like Virginia and North Carolina, and city departments, like Chicago, are carrying forward. The work of the Life Extension Institute is full of promise of a more direct and personal type of education under private auspices, and the Metropolitan Life Insurance Company is doing a splendid work in diffusing the principles of public health, not only among its own policyholders, but in the community at large.

One of the next tasks of the future, as it seems to me, is to add to the training of the public in the elements of hygiene and sanitation some plan of organization which shall make our health militia effective for all forms of necessary common action. We have in New York state, a corps of district sanitary supervisors, who form a link between the State Department of Health and the local health officer, bringing to the latter the expert knowledge and the moral support of the whole state. We have a State Sanitary Officers' Association, which is now being organized in county branches. Beyond the health officers, we want the leaders of the public to be informed as to local health needs and ready to move effectively to meet them. If each city and town and rural county had a group of public-spirited citizens organized to seek out and solve the more pressing problems of their particular locality, and to support the local and state authorities in the general conduct of the public health campaign, progress could be made by leaps and bounds. To-day we find in many a city an anti-tuberculosis association, a milk committee, a visiting nurse association, an associated charities and various churches' and merchants' associations and other bodies dealing with phases of health work, often working at cross purposes with each other and with the local health department. These forces should be knit together in local health associations like the revolutionary committees of correspondence for community defense against disease. They should be kept in communication with each other and with the most recent current advances in sanitary theory and practise, perhaps by developing them as local branches of the American Public Health Association. Plans are now under way in New York State for the organization of such militia companies. We have thought of many titles. Health Association, Health League, Life Extension League, Life Lengthening League, without finding quite the right one; but the thing itself we are sure we need.

Is it not time that a serious effort was made along some such lines as those I have outlined, to mobilize our people for the public health? The nation that first really accomplishes this task will be so strong, and at the same time so sensitive of the sacredness of human life, that neither the fear of others nor its own aggression will be likely to compel it to mobilize for any less noble cause.