"With the approval of the President and with the coöperation of the Department of Agriculture,[15]the [national quarantine] service has undertaken to prepare a complete report upon the milk industry from farm to the consumer in its relation to the public health." This promise of the United States Treasury insures national attention to the evils of unclean milk and to the sanitary standards of farmer and consumer. Nothing less than a national campaign can make the vivid impression necessary to wean dairymen of uncleanly habits and mothers of the ignorant superstition that babies die in summer just because they are babies. When two national bureaus study, learn, and report, newspapers will print their stories on the first page, magazines will herald the conclusions, physicians will open their minds to new truths, state health secretaries will carry on the propaganda, demagogues and quacks will become less certain of their short-cut remedies, andeverybody will be made to think.
The evolution of this newly awakened national interest in clean milk follows the seven stages and illustrates the seven health motives presented in Chapter II. I give the story of Robert M. Hartley because he began and prosecuted his pure-milk crusade in a way that can be duplicated in any country town or small city.
Robert M. Hartley was a strong-bodied, strong-minded, country-bred man, who started church work in New York City almost as soon as he arrived. He distributed religioustracts among the alleys and hovels that characterized lower New York in 1825. Meeting drunken men and women one after another, he first wondered whether they were helped by tracts, and then decided that the mind befogged with alcohol was unfit to receive the gospel message. Then for fifteen years he threw himself into a total-abstinence crusade, distributing thousands of pamphlets, calling in one year at over four thousand homes to teach the industrial and moral reasons for total abstinence. Finally, he began to wonder whether back of alcoholism there was not still a dark closet that must be explored before men could receive the message of religion and self-control. So in 1843 he organized the New York Association for Improving the Condition of the Poor, which ever since has remembered how Hartley found alcoholism back of irreligion, and how back of alcoholism and poverty and ignorant indifferencehe found indecent housing, unsanitary streets, unwholesome working conditions, and impure food.
Fighting Infant Mortality by a School For MothersFIGHTING INFANT MORTALITY BY A SCHOOL FOR MOTHERS IN THE HEART OF NEW YORK CITY,—JUNIOR SEA BREEZE
FIGHTING INFANT MORTALITY BY A SCHOOL FOR MOTHERS IN THE HEART OF NEW YORK CITY,—JUNIOR SEA BREEZE
Providing Against Germ GrowthPROVIDING AGAINST GERM GROWTH AND ADAPTING MILK TO THE INDIVIDUAL BABY'S NEED,—ROCHESTER'S MODEL DAIRY
PROVIDING AGAINST GERM GROWTH AND ADAPTING MILK TO THE INDIVIDUAL BABY'S NEED,—ROCHESTER'S MODEL DAIRY
Hartley's instinct started the first great pure-milk agitation in this country. While visiting a distillery for the purpose of trying to persuade the owner to invest his money in another business, he noticed that "slops smoking hot from the stills" were being carried to cow stables. He followed and was nauseated by the sights and odors. Several hundred uncleaned cows in low, suffocating, filthy stables were being fed on "this disgusting, unnatural food." Similar disgust has in many other American cities caused the first effort to better dairy conditions. Hartley could never again enjoy milk from distillery cows. Furthermore, his story of 1841 made it impossible for any readers of newspapers in New York to enjoy milk until assured that it was not produced by distillery slops. The instinctive loathing and the discomfort of buyers awakened the commerce motives of milk dealers, who covered their wagons with signs declaring that they "no longer" or "never" fed cows on distillery refuse. But Hartley could not stop when the anti-nuisance stage was reached. He did not let up on his fight against impure or adulterated milk until the state legislature declared in 1864 thatevery baby, city born or country born, no matter how humble its home, has the right to pure milk.
Clean Milk for New York City (pamphlet page 1)
Clean Milk for New York City (pamphlet page 2)
Clean Milk for New York City (pamphlet page 3)
Unfortunately Hartley and his contemporaries had never heard of disease germs that are carried by unclean milk into the human stomach. Science had not yet proved that many forms of barnyard filth could do quite as much harm as distillery refuse. Commerce had not invented milk bottles of glass or paper. The law of 1864 failed in two particulars: (1) it did not demand cleanliness from cow to consumer; (2) it did not provide means for its own enforcement, for learning whether everything and everybody that had to do with milk was clean. Not knowing of germs and their love for a warm climate and warm food, they naturally did not prohibit a temperature above fifty degrees from the time of milking to the time of sale. How much has been left for our generation to do to secure pure milk is illustrated by the opening sentence of this chapter, and more specifically by the programme of a milk conference held in New York in November, 1906, the board of health joining in the call. The four-page folder is reproduced in facsimile (excepting the names on the fourth page), because it states the universal problem, and also because it suggests an effective way to stimulate relevant discussion and to discourage the long speeches that spoil many conferences.
This conference led to the formation of a milk committee under the auspices of the association founded by Hartley. Business men, children's specialists, journalists, clergymen, consented to serve because they realized the need for a continuing public interest and a persisting watchfulness. Such committees are needed in other cities and in states, either as independent committees or as subcommittees of general organizations, such as women's clubs, sanitary leagues, county and state medical societies. Teachers' associations might wellbe added, especially for rural and suburban districts where they are more apt than any other organized body to see the evils that result from unclean milk. The New York Milk Committee set a good example in paying a secretary to give his entire time to its educational programme,—a paid secretary can keep more volunteers and consultants busy than could a dozen volunteers giving "what time they can spare." Thanks chiefly to the conference and the Milk Committee's work, several important results have been effected. The general public has realized as never before that two indispensable adjectives belong to safe milk,—cleanandcool. Additional inspectors have been sent to country dairies; refrigeration, cans, and milk have been inspected upon arrival at night; score cards have been introduced, thanks to the convincing explanations of their effectiveness by therepresentatives of the Bureau of Animal Industry of the national Department of Agriculture; 8640 milch cows were inspected by veterinary practitioners (1905-1907), to learn the prevalence of bovine tuberculosis (of these thirty-six per cent reacted to the tuberculin test); state societies and state departments have been aroused to demand an efficient live-stock sanitary board; magistrates have fined and imprisoned offenders against the milk laws, where formerly they "warned"; popular illustrated milk lectures were added to the public school courses; illustrated cards were distributed by the thousand, telling how to keep the baby well; finally, private educational and relief societies, dispensaries, settlements, have been increasingly active in teaching mothers at home how to prepare baby's milk. In 1908 a Conference on Summer Care of Babies was organized representing the departments of health and education, and fifty private agencies for the care of sick babies and the instruction of mothers. The superintendent of schools instructed teachers to begin the campaign by talks to children and by giving out illustrated cards. Similar instructions were sent to parochial schools by the archbishop.
Night Inspection Of Country Milk Upon Arrival In New York CityNIGHT INSPECTION OF COUNTRY MILK UPON ARRIVAL IN NEW YORK CITY
NIGHT INSPECTION OF COUNTRY MILK UPON ARRIVAL IN NEW YORK CITY
As elsewhere, there are two schools of pure-milk crusaders: (1) those who want cities todo things, to pasteurize all milk, start milk farms, milk shops, or pure-milk dispensaries; and (2) those who want cities and states toget things done. So far the New York Milk Committee has led the second school and has opposed efforts to municipalize the milk business. The leader of the other school is the noted philanthropist, Nathan Strauss, who has established pasteurization plants in several American and European cities. The discussion of the two schools, similar in aim but different in method, is made more difficult, because to question philanthropy's method always seems to philanthropy itself and to most bystanders an ungracious, ungrateful act. As the issue, however, is clean milk, not personal motive, it is importantthat educators and parents in all communities benefit from the effective propaganda of both schools, using what is agreed upon as the basis for local pure-milk crusades, reserving that which is controversial for final settlement by research over large fields that involve hundreds of thousands of tests.
A New York Milk Committee's Infant Depot And School For MothersA NEW YORK MILK COMMITTEE'S INFANT DEPOT AND SCHOOL FOR MOTHERS
A NEW YORK MILK COMMITTEE'S INFANT DEPOT AND SCHOOL FOR MOTHERS
Pasteurization, municipal dairies, municipal milk shops, municipal infant-milk depots, are the four chief remedies of thedoing thingsschool. European experience is cited in support of each. We are told that cow's milk, intended by nature for an infant cow with four stomachs, is not suited, even when absolutely pure, to the human infant's single stomach. Cow's milk should be modified, weakened, diluted, to fit the digestive powers of the individual infant; hence the municipal depot or milk dispensary that provides exactly the right milk for each baby, prescribed by municipal physicians and nurses who know. That the well-to-do and the just-past-infancy may have milk as safe as babies receiveat the depot, municipalization of farm and milk shop is advocated. Some want the city to run only enough farms and milk shops to set a standard for private farmers, as has been done in Rochester. This is city ownership and operation for educational purposes only. Finally, because raw milk even from clean dairies may contain germs of typhoid, scarlet fever, or tuberculosis, pasteurization is demanded to kill every germ. There are advocates of pasteurization that deprecate the practice and deny that raw milk is necessarily dangerous; they favor it for the time being until farms and shops have acquired habits of cleanliness. Likewise many would prefer private pasteurization or laws compelling pasteurization of all milk offered for sale; but they despair of obtaining safe milk unless city officials are heldresponsible for safety. Why wait to discuss political theories about the proper sphere for government, when, by acting, hundreds of thousands of lives can be saved annually? These methods ofdoing thingswill not add to the price of milk; it is, in fact, probable that the reduction in the cost of caring for the sick and for inspecting farms and shops will offset the net cost of depots, farms, and dairies.
One Of Rochester's Schools In CleanlinessONE OF ROCHESTER'S SCHOOLS IN CLEANLINESS
ONE OF ROCHESTER'S SCHOOLS IN CLEANLINESS
Rochester's Model Dairy FarmROCHESTER'S MODEL DAIRY FARM
ROCHESTER'S MODEL DAIRY FARM
As to pasteurization, its cost is negligible, while the cost of cleanliness is two, four, or ten cents a quart. Whether ideally clean milk is safe or not, raw milk that is not clean is unfit for human consumption. All cities should compel evidence of pasteurization as a condition of sale. Large cities should have their own pasteurizing plants, just as many cities now have their own vaccine farms and antitoxin laboratories. Parents in small towns and in the country should be taught to pasteurize all milk.
Thegetting things doneschool admits the need for modified milk of strength suited to the infant's stomach; affirms the danger of milk that contains harmful germs; demands educational work by city, state, and nation; confesses thattalk about cleanliness will not make milk safe. On the other hand, it denies that raw milk is necessarily dangerous; that properly modified, clean, raw milk is any safer when pasteurized; that talking about germ-proof milk insures germ extinction. It maintains that pasteurization kills benign germs essential to the life of milk, and that after benign germs are killed, pasteurized milk, if exposed to infection, is more dangerous than raw milk, for the rapid growth of harmful germs is no longer contested by benign germs fighting for supremacy. While it is admitted that raw milk produced under ideal conditions may become infected by some person ignorant of his condition, and before detection may cause typhoid, scarlet fever, or consumption, it has not been proved that such instances are frequent or that the aggregate of harm done equals that which pasteurized milk may do. Pasteurization does not remove chemical impurities; boiling dirt does not render it harmless. The remedy for germ-infected milk is to keep germs out of milk. The remedy for unclean milk is cleanliness of cow, cow barn, cowyard, milker, milk can, creamery, milk shop, bottle, nipple. If the sale of unclean milk is prevented, farmers will, as a matter of course, supply clean milk. By teaching farmers and milk retailers the economic advantages of cleanliness they will cultivate habits that guarantee a clean milk supply. By punishing railroads and milk companies that transport milk at a temperature which encourages germ growth, and by dumping in the gutter milk that is offered for sale above 50 degrees, the refrigerating of milk will be made the rule. Purging magistrates' courts of their leniency toward dealers in impure, dangerous milk is better than purging milk of germs. Boiling milk receptacles will save more babies than boiling milk. Teaching mothers about the care of babies will bring better results than giving them a false sense of safety, because only one of many dangers has been removed by pasteurization. Educating consumers to demandclean milk and to support aggressive work by health departments leaves fewer evils unchecked than covering up uncleanliness by pasteurization.
New York Milk Committee's Graphic Method Of Showing Babies' ProgressNEW YORK MILK COMMITTEE'S GRAPHIC METHOD OF SHOWING BABIES' PROGRESS
NEW YORK MILK COMMITTEE'S GRAPHIC METHOD OF SHOWING BABIES' PROGRESS
Producing Winter Conditions In Midsummer By Proper Refrigeration For Milk In Freight CarsPRODUCING WINTER CONDITIONS IN MIDSUMMER BY PROPER REFRIGERATION FOR MILK IN FREIGHT CARS
PRODUCING WINTER CONDITIONS IN MIDSUMMER BY PROPER REFRIGERATION FOR MILK IN FREIGHT CARS
When doctors disagree what are we laymen to do? We can take an intelligent interest in the inquiries that are now being made by city, state, and national governments. Because everybody believes that clean milk is safer than unclean milk, that milk at 50 degrees will not breed harmful germs, we can demand milk inspection that will tell our health officers and ourselves which dealers sell only clean milk at 50 degrees and never more than 60 degrees, that never shows over 100,000 colonies to the cubic centimeter. We can get our health departments to publish the results of their scoring of dairies and milk shops in the papers, as has been done in Montclair. We can tell our health officers that the best results in fighting infant mortality are at Rochester, which city, winter and summer,by inspection, correspondence, and punishment, educates farmers and dealers in cleanliness, not only censuring when dirty or careless, but explaining how to make more money by being clean. Finally, mothers can be taught at home how to cleanse the bottles, the nipples, all milk receptacles, and all things in rooms where milk is kept. Absolutely clean milk of proper temperatureat the shopmay not safely be given to a baby in a dirty bottle. Infant milk depots, pasteurization, the best medical and hospital care, breast feeding itself, cannot prevent high baby mortality if mothers are not clean. The most effective volunteer effort for pure milk is that which first makes the health machinery do its part and then teaches, teaches, teaches mothers and all who have to do with babies.
Neither Pasteurization nor Inspection can make it Safe to Sell "Dip Milk" Under Such Unclean ConditionsNEITHER PASTEURIZATION NOR INSPECTION CAN MAKE IT SAFE TO SELL "DIP MILK" UNDER SUCH UNCLEAN CONDITIONS
NEITHER PASTEURIZATION NOR INSPECTION CAN MAKE IT SAFE TO SELL "DIP MILK" UNDER SUCH UNCLEAN CONDITIONS
"Clean air, clean babies, clean milk," has been the slogan of Junior Sea Breeze,—a school for mothers right in the heart of New York's upper East Side. In the summer of 1907 twenty nurses went from house to house telling 102,000 mothers how to keep the baby well. This was the only district that had fewer baby deaths than for 1906. Had other parts of the city shown the same gain, there would have been a saving of 1100 babies. The following winter a similar work was conducted by nurses from the recently founded Caroline Rest, which has an educational fund for instruction of mothers in the care of babies, especially babies not yet born and just born. Heretofore the baby has been expected to cry and to have summer complaint before anybody worried about the treatment it received. If the baby lived through its second summer, it was considered great good fortune. Junior Sea Breeze and Caroline Rest start their educational work before the baby is sick, in fact, before it is born. Their results have been so notable that several well-to-do mothers declare that they wish they too might have a school. Dispensaries and diet kitchens and more particularly maternity wards of hospitals, family physicians, nurses, and midwives, should be required to know how to teach mothers to feed babies regularly, the right quantities, under conditions that insure cleanliness whether the breast or the bottle is used. Perhaps some day no girl will be given a graduating certificate, or a license for work, teaching, or marriage, until she has demonstrated her ability to give some mother's baby "clean air, clean body, clean milk."
[15]Libraries should obtain all reports on milk, Bureau of Animal Industry, Washington, D.C.
[15]Libraries should obtain all reports on milk, Bureau of Animal Industry, Washington, D.C.
No profession, excepting possibly the ministry, is regarded with greater deference than the medical profession. Our ancestors listened with awe and obedience to the warnings and behests of the medicine man, bloodletter, bonesetter, family doctor. In modern times doctors have disagreed with each other often enough to warrant laymen in questioning the infallibility of any individual healer or any sect, whether homeopath, allopath, eclectic, osteopath, or scientist. Yet to this day most of us surround the medical profession or the healing art with an atmosphere of necromancy. Even after we have given up faith in drugs or after belief is denied in the reality of disease and pain, we revere the calling that concerns itself, whether gratuitously or for pay, with conquering bodily ills.
Self-laudation continues this hold of the medical profession upon the lay imagination. One physician may challenge another's faults, ridicule his remedies, call his antitoxin dangerous poison, but their common profession he proudly styles "the most exalted form of altruism." Young men and women beginning the study or the practice of medicine are exhorted to continue its traditions of self-denial, and in their very souls to place human welfare before personal or pecuniary advancement. Newspapers repeat exhortation and laudation. We laymen pass on the story that we know is not universally true,—physicians know, physicians apply what they know without consciousness of error, physicians must be implicitly trusted.
For a physician to give poison when he means to give food is worse, not better, than for a layman to make the same mistake. Neither the moral code nor the law of self-preservation enjoins a tuberculous mother to take alcohol or to sleep in an unventilated room, even if an uninformed physician prescribes it. Instruction in physiology and hygiene would be futile if those who are educated as to the elementary facts of hygiene and physiology must blindly follow blind physicians. A family doctor who gives cod-liver oil for anæmia due to adenoids may do a child as much harm as a nurse who drugs the baby to make it sleep. The physician who refuses to tell the board of health when smallpox or typhoid fever first breaks out takes human life just as truly as if he tore up the tracks in front of an express train. This is another way of saying that parents and teachers must fit themselves to know whether the family physician and their community's physicians are efficient practitioners and teachers. Every one can learn enough about the preventable causes of sickness and depleted vitality to insist upon the ounce of education and prevention that is better than a pound of cure.
For its sins of omission, as for its sins of commission, the medical profession shares responsibility with laymen. For years leading educators, business men, hospital directors, public officials, have known that communicable diseases could be stamped out. The methods have been demonstrated. There is absolutely no excuse to-day for epidemics of typhoid in Trenton, Pittsburg, or Scranton, for epidemics of scarlet fever in the small towns of Minnesota, for uninterrupted epidemics of tuberculosis everywhere. Had either laymen, physicians, or school-teachers made proper use of the knowledge that has been in text-books for a generation, this country would be saving thousands of lives and millions of dollars every year. Ourdoingandgetting donehave lagged behind ourknowing.
The failure of physicians to "socialize" or "humanize" their knowledge is due to two causes: (1) no one has been applyingresult teststo the profession as a whole and to the state in its capacity as doctor, testing carefully the sickness rate, the death rate, and the expense rate of preventable diseases; (2) physicians themselves have not needed to know, either at college or in practice, the tax levied upon their communities by preventable sickness. Public schools can do much to secure result tests for individual physicians, for the profession as a whole, and for boards of health. Schooling in preventive medicine, or, better named, schooling in preventive hygiene, will fit physicians to do their part in eradicating preventable disease.
Preventive hygiene is not an essential part of the training of American physicians or nurses to-day. Not only are there no colleges of preventive hygiene, but medical schools have not provided individual courses. It is possible for a man to graduate with honors from our leading medical colleges without knowing what "vital statistics" means. Even boards of health, their duties and their educational opportunities, are not understood by graduates; it is an accident if the "social and economic aspects of medical practice," "statistical fallacies," "hospital administration," "infant mortality," are familiar terms. It is for this reason, rather than because physicians are selfish, that indispensable and beneficent legislation is so generally opposed by them when the prerogatives of their profession seem in danger. Practically every important sanitary advance of the past century has been fought at the outset by those whose life work should have made them see the need. Physicians bitterly attacked compulsory vaccination, medical inspection of schools, compulsory notification of communicable diseases. What is perhaps more significant of the physician's indifference to preventive hygiene is the fact that most of the sanitary movements that haverevolutionized hygienic conditions in America owe their inception and their success to laymen, for example, tenement-house reform, anti-child labor and anti-tuberculosis crusades, welfare work in factories, campaigns for safety appliances, movement for a national board of health, prison, almshouse, and insane-asylum reform, schools for mothers, and milk committees. The first hospital for infectious diseases, the first board of health, the first out-of-door sea-air treatment of bone tuberculosis in the United States, were the result of lay initiative.
Dr. Hermann M. Biggs says that in America the greatest need of the medical profession and of health administration is training that will enable physicians and lay inspectors to use their knowledge of preventive hygiene for the removal of living and working conditions that cause preventable sickness. A physician without knowledge of preventive hygiene is simply doing a "general repair" business.
For a few months in 1907 New York City had a highly efficient commissioner of street cleaning, who, in spite of the unanimous protests and appeals of the press, refused to give up the practice of medicine. Hitherto the board of health of that city has been unable to obtain the full time of its physicians because professional standards give greater credit to the retail application of remedies than to the wholesale application of preventives.
Statesmanship as well as professional ability is expected of physicians in the leading European cities, more particularly of those connected with health departments. There it is not felt that a medical degree is of itself a qualification for sanitary or health work. After the professional course, physicians must take courses in preventive hygiene and in health administration. Medical courses include such subjects as vital statistics, duties of medical officers of health, sanitary legislation, state medicine.
The needless cost for one year of "catching" diseases in New York City would endow in perpetuity all the schools and lectureships and journals necessary to teach preventive hygiene in every section of this great country. That city alone sacrifices twenty-eight thousand lives annually to diseases that are officially called preventable. The yearly burial cost of these victims of professional and community neglect is more than a million dollars. When to the doctor bills, wages lost, burial cost of those who die are added the total doctor bills, wages lost, and other expenses of the sick who do not die, we find that one city loses in dollars and cents more every year from communicable diseases than is spent by the whole United States for hospitals and boards of health.
Many diseases and much sickness are preventable that are not communicable. Indigestion due to bad teeth is not itself communicable, but it can be prevented. One's vitality may be sapped by irregular eating or too little sleep; others will not catch the trouble, although too often they imitate the harmful habits. Adenoids and defective vision are preventable, but not contagious. Spinal curvature and flat foot are unnecessary, but others cannot catch them. Preventive hygiene, however, should teach the physician's duty to educate his patient and his community regarding all controllable conditions that injure or promote the health.
In the absence of special attention to preventive medicine new truth is forced to fight its way, sometimes for generations, before it is accepted by the medical profession. So strong are the traditions of that profession and so difficult is it for the unconventional or heterodox individual to retain the confidence of conservative patients, that the forces of honorable medical practice tend to discourage research and invention. The man who discovers a surgical appliance is forced by the ethics of his profession eitherto commercialize it and lose his professional standing, or to abide the convenience of his colleagues and their learned organizations in testing it. Rather than be branded a quack, charlatan, or crank, the physician keeps silent as to convictions which do not conform to the text-books. Many a life-saving, health-promoting discovery which ought to be taken up and incorporated into general practice from one end of the country to the other, and which should be made a part of the minimum standard of medical practice and medical agreement, must wait twenty-five or fifty years for recognition.
The Disciple of Fresh Air and Home Instruction is still an Outcast in Scores of HospitalsTHE DISCIPLE OF FRESH AIR AND HOME INSTRUCTION IS STILL AN OUTCAST IN SCORES OF HOSPITALS
THE DISCIPLE OF FRESH AIR AND HOME INSTRUCTION IS STILL AN OUTCAST IN SCORES OF HOSPITALS
For want of a school of preventive medicine to emphasize universally every new truth, the medical colleges are permitted to remain twenty-five or fifty years behind absolutely demonstrated facts as to medical truth and medicalpractice. In 1761 a German physician, Avenbruger, after discovering that different sounds revealed diseased tissue, used "chest tapping" in the diagnosis of lung trouble. In 1815 Lëannec discovered that sound from the chest was more distinct through a paper horn. On that principle the modern stethoscope is built. He made an accurate diagnosis of tuberculosis, and while suffering from that disease treated himself as a living clinical study. In 1857 Pasteur proved the presence of germs "without which no putrefaction, no fermentation, no decay of tissue takes place." In 1884 Trudeau started the first out-of-door care of pulmonary tuberculosis in America. In 1892 Biggs secured the compulsory notification of pulmonary tuberculosis. In 1904 began our first out-of-door sea-air treatment for bone tuberculosis. Yet there are thousands of physicians to-day who sincerely believe that they are earning their fees, who, from houses shut up like ovens, give advice to patients for treatment of tuberculosis, who prescribe alcohol and drugs, who diagnose the disease as malaria for fear patients will be scared, who oppose compulsory registration, and who never look for the tuberculous origin of crippled children. Just think of its being possible, in 1908, for a tuberculous young man of thirty to pay five dollars a day to a sanatorium whose chief reliance is six doses of drugs a day!
In 1766 America's first dentist came to the United States. By 1785 itinerant dentists had built up a lucrative practice. In 1825 a course of lectures on dentistry was delivered before the medical class at the University of Maryland. As early as 1742 treatises were written "Upon Dentition and the Breeding of Teeth in Children." In 1803 the possibility of correcting irregularities was pointed out, as was the pernicious effect of tartar on the teeth in 1827. In 1838 attempts were made to abolish, "in all common cases, the pernicious habit of tooth drawing." In 1841 treatises were written on the importance of regulatingthe teeth of children before the fourteenth year and on the importance of preserving the first teeth. Yet in 1908 it is necessary to write the chapter on Dental Sanitation. Few physicians, whether in private practice or hospitals or just out of medical college, consider it necessary to know the conditions of the mouth before prescribing drugs for physical illness.
Osteopathy furnishes an up-to-date illustration. Discredited by the medical profession, by medical journals and medical schools, it has in fifteen years built up a practice of eight thousand men, having from one to three years' training, including over one hundred physicians with full medical training plus a course in osteopathy. There were means of learning fifteen years ago what was truth and what was quackery about the practice of osteopathy. By refusing to look for its truth and by concentrating attention upon its quackery the medical profession has lost fifteen years. Whereas the truth of osteopathy should have been adopted by the medical colleges and a knowledge of its possibilities and limitations required of every practicing physician, a position has been reached where alleged quackery seems in several important points to be discrediting the sincerity, the intelligence, and the efficiency of orthodox medicine. No appeal to the natural can be stronger, no justification of schools of preventive medicine more complete, than the following paragraph from an osteopathic physician who is among the small number who, having both the medical and osteopathic degrees, see both the possibilities and limitations of manual surgery and demand the inclusion of this new science in the medical curriculum.
The physical method of treating disease presents a tremendous and significant departure from the empiricism of medicine and the experimentation of dietetics, the restricted fields of electricity, suggestion, water cures, and massage. The patient as an individual is not treated; the disease as a disease is not treated; thesymptoms are not treated; but the entire physical organism, with its many parts and diverse functions, is exhaustively examined until each and every abnormal condition, whether of structure or of function, causing disease and maintaining symptoms, is found and administered to with the skill of a definite art, based upon the data of an exact science.
The physical method of treating disease presents a tremendous and significant departure from the empiricism of medicine and the experimentation of dietetics, the restricted fields of electricity, suggestion, water cures, and massage. The patient as an individual is not treated; the disease as a disease is not treated; thesymptoms are not treated; but the entire physical organism, with its many parts and diverse functions, is exhaustively examined until each and every abnormal condition, whether of structure or of function, causing disease and maintaining symptoms, is found and administered to with the skill of a definite art, based upon the data of an exact science.
Likewise the truths underlying Christian Science have been disdained by medical schools and medical experts, just as its spiritual truth has been disdained by religious leaders, until it has grown to such strength that laymen are almost forced to question the sincerity and the efficacy of the conventional in religion as well as medicine. In May, 1907, the Emmanuel Church in Boston organized a clinic for the purpose of utilizing for neurasthenics particularly both the spiritual and the physical truths underlying religion and the various branches of medical science. Daily papers and magazines are giving a great deal of space to this experiment in "psychotherapy," which is discussed in the chapter on Mental Hygiene. Schools and chairs in preventive hygiene would soon give to the medical profession a point of view that would welcome every new truth, such as the alliance of religion and medicine, and estimate its full worth promptly. Truth seeking would be not only encouraged but made a condition of professional standing.
Just what attitude any particular physician takes can be learned by the teacher or parents whose children he treats. If he pooh-poohs or resents board of health regulations as to isolation of scarlet-fever patients, he is a dangerous man, no matter how noble his personal character. If he says cross-eyes will straighten, weak eyes will strengthen, or nose-stopping adenoids "absorb," he is bound to do harm. If he says tuberculosis is incurable, noncommunicable, hereditary, or curable by drugs, or if he tries to cure cancer by osteopathy, he can do more injury than an insane criminal. If he fails to teach a mother how to bathe, feed,and clothe the baby, how to ventilate a room for the sick or the well, he is an expensive luxury for family or for school, and belongs to an age that knew neither school nor preventive hygiene. If he takes no interest in health administration; if he overlooks unclean milk or unclean streets, open sewers, and unsanitary school buildings, street cars, churches, and theaters; if he does not help the health board, the public hospitals, the schools, the factory, and tenement departments enforce sanitary laws, he is derelict as a citizen and as a member of an "exalted profession."If he sees only the patients he himself treats or one particular malady, he is derelict as a teacher, no matter how charming his personality or how skilled in his specialty. If a school physician is slovenly in his work, if he spends fifteen minutes when he is paid for an hour, should the efficient school-teacher conceal the fact from her superiors because he is a physician? If private hospitals misrepresent facts or compromise with political evils for the sake of a gift of public money, their offense is more heinous because of their exalted purpose. The test of a physician's worth to his patients and to his community is not what he is or what he has learned, and not what his profession might be, but what happens to patient and to community. Human welfare demands that the medical profession be judged by what it does, not by what it might do if it made the best possible use of its knowledge or its opportunity.
Too Many Physicians and even Maternity Hospitals fail to Teach MothersTOO MANY PHYSICIANS AND EVEN MATERNITY HOSPITALS FAIL TO TEACH MOTHERS, EITHER BEFORE OR AFTER BABIES ARE BORNCaroline Rest Educational Fund was given to show the value of such teaching
TOO MANY PHYSICIANS AND EVEN MATERNITY HOSPITALS FAIL TO TEACH MOTHERS, EITHER BEFORE OR AFTER BABIES ARE BORNCaroline Rest Educational Fund was given to show the value of such teaching
A dispensary that treats more patients than it can care for properly is no better than a street-car company that chronically provides too few seats and too many straps. Unless physicians test themselves and their profession by results, we shall be compelled to "municipalize the medical man." Preventable sickness costs too much, causes too much wretchedness, and hampers too many modern educational and industrial activities to be neglected. If the medical profession does not fit itself to serve general interests, then cities, counties, and states will take to themselves the cure as well as the prevention of communicable and other preventable sickness. Human life and public health are more precious than the medical profession, more important even than theories and traditions against public interference in private matters. The unreasoning opposition of medical men to government protection of health, their concentration on cure, and their tardy emphasis on prevention have forced many communities to stumble into the evil practices mentioned in Chapter XVI. Incidentally,the best physicians have learned that the prosperity of their profession increases with every increase in the general standard of living. It is the man in the ten-room house not the man in one room who supports physicians in luxury. It is the healthy man and the healthy community that value efficient medical service.
Many American cities maintain dispensaries and hospitals for the poor. Whether they will go to the logical conclusion of engaging physicians to give free treatment to all regardless of income depends largely upon what the next generation of private physicians do. The state already says when a physician's training fits him to practice. It will soon expect him to pass rigid examinations in the social and economic aspects of his profession,—its educational opportunity, vital statistics, sick and death rates. Will it need to municipalize him in order to protect itself?
Obviously the teacher or parent should not begin cooperation with physicians by lecturing them or by assuming that they are selfish and unwilling to teach. The best first step is to ask questions that they should be able to answer:
What causes cholera morbus or summer complaint? When does milk harm the baby? How can unclean milk be made safe? Whose fault is it that the milk is sold unclean and too warm? What agencies help sick babies? What is the health board doing to teach mothers?
What causes cholera morbus or summer complaint? When does milk harm the baby? How can unclean milk be made safe? Whose fault is it that the milk is sold unclean and too warm? What agencies help sick babies? What is the health board doing to teach mothers?
Or, if a school physician, the teacher can ask:
Why not remove these adenoids? What causes them? When will they disappear by absorption? What harm can they do in the meantime? How long would an operation take? Would it hurt very much? What would be the immediate effects? Why not act at once? What provisions are there in town for such operations? Why have the physicians paid so little attention to breathing troubles? What could your state do to interest physicians in school hygiene? Will the school physician talk to amothers' meeting? What agencies will give outings to sick children? What dispensaries are accessible? Who is the proper person to organize a public health league?
Why not remove these adenoids? What causes them? When will they disappear by absorption? What harm can they do in the meantime? How long would an operation take? Would it hurt very much? What would be the immediate effects? Why not act at once? What provisions are there in town for such operations? Why have the physicians paid so little attention to breathing troubles? What could your state do to interest physicians in school hygiene? Will the school physician talk to amothers' meeting? What agencies will give outings to sick children? What dispensaries are accessible? Who is the proper person to organize a public health league?
Physicians love to teach. If teachers and parents will love to learn and will ask the right questions, all physicians can be converted into hygiene missionaries, heralds of a statesmanship that guarantees health rights to all.
Licensing the Practitioner
Three parties are interested in setting a high standard for physicians, dentists, druggists, nurses, and veterinary surgeons—the profession itself, the schools that educate, and the general public on whom the arts are practiced. The schools and the practitioners are, for the most part, primarily interested in protecting a monopoly of skill. Their interest in restrictive legislation is analogous to that of the labor union which limits the number of apprentices. This trade unionism among professional colleges and professional graduates of these colleges has gradually developed a higher and higher standard that results in greater protection to the public. The first step is generally to demand that all persons entering a profession after a given date shall prove to the state their ability to "practice" without injury to clients. It is almost impossible to get such laws through unless the original law exempts all persons by whatever name, who are practicing the art in question at the time the law is passed. Whether we are speaking of medicine, law, dentistry, accountancy, osteopathy, or barbering, this has been the history of compulsory restriction and of state examinations.
As with regard to most other legislation, the enforcement of the law lags behind its definition. Moreover nothing is done after a man has passed a certain examination to see that he remains fit and safe to treat the public. Because no supervision is provided except on the day ofexamination, it is possible for men and women to fill their brains for a week or two weeks with the information necessary to pass what coaches and tutors have learned will, in all probability, be asked. Forever after, the public is left to protect itself. Out of this condition have arisen the evil, unethical, and unprofessional practices represented particularly by painless dentists, by ignorant or dishonest physicians, and by osteopaths and careless nurses.
The machinery for preventing these evils is discussed in Chapter XXIX. Suffice it here to present to parents and teachers the need for examination in advance of certification that will show whether or not those who make a livelihood by caring for others' health are equipped to mitigate rather than aggravate evils, and for further tests by which the public can learn from time to time which, among those professional men who are protected by the public against competition, continue to be safe. Finally, if, as will be clearly seen, it is desirable that what we call professional ethics persist and that self-advertisement be discouraged, society must, for its own protection, adopt some other means than epithets to correct the evils of self-advertisement and quackery. Even though we admit the responsibility of each citizen when he goes to the house of a private practitioner who has made no other effort to lure him thither than to place a card in the window, it must be seen that we cannot hold responsible for their choice men and women who receive through newspapers, magazines, or circulars convincing notices that Dr. So-and-So or the Integrity Company or the Peerless Dental Parlor will place at their disposal, at prices within their reach, skill and devotion absolutely beyond their reach at the office of an efficient private practitioner. Some way must be found by which departments of health will currently impose tests of methods and results upon physicians, opticians, pharmacists, manufacturers of medicine, and dentists.
As laymen become more intelligent regarding their own bodies and healthy living, it grows harder and harder for quacks and incompetents to mislead and exploit them. Better than any possible outside safeguard is hygienic living. Fortunately, we can all learn the simple tests of environment and of living necessary to the selection of physicians, dentists, and opticians, or other "architects of health" whose efficiency and integrity are beyond question.