I think the future of cure by drugs is very hopeful. I do not feel hopeless of our discovering drugs for the one hundred and forty-two out of one hundred and fifty diseases which we still cannot cure. But if we falsely suppose that we have a cure already, we do not hustle around to get it. It is not until we realize that we have not a cure already, that we do hustle around to get it. It is not until we realize that we are now very helpless in medicine that we shall labor in a way to become less so. At present the best that we can do for most patients is to explain what the trouble is, let them know what is going to happen, to preach some hygiene, and above all to make them realize that we care and suffer with them. That is the essence of medical work and of the social assistant's work in the dispensary and in the home.
Industrial disease
Industrial disease is a phrase we have heard much in the last ten or fifteen years, meaning that diseases are caused—some of them—by the conditions to which people are exposed in industry. A great deal of indignation, some of it fruitful, much of it harmful, has been aroused against employers and against the whole system of industry—because we have now recognized the fact of industrial disease. Employers in the past have been more interested in their machinery than in their human help. That is not only bad, but very stupid. Most of us believe that because it is stupid it is not likely to continue indefinitely.
But aside from all these matters of controversy, there is one important distinction to make at the start. (a) Industrial disease in the narrow, strict sense, i.e., something produced by the industry, something which would never have occurred in any form if the person had not been in that industry. (b) Disease affected, modified, in some way by industry, but due in part to other causes.
There are very few clear-cut and common industrial diseases. Lead poisoning is almost the only one. Disease due to the inhalation or swallowing of other poisons and the penetration through the skin or irritation of the skin by definite poisons are real dangers, but not common. More common, more difficult to deal with, and therefore more within the province of the social worker, are the diseases in which industry is only one factor in the complicated skein of causes. Take such matters as exposure to unusual heat or cold, unusual humidity or dryness in industry—very common conditions; or still more, exposure to unusual strain and hurry from what we call "speeding-up" or from the piece-work system. I do not think there is any good evidence that those things produce any single disease. I think there is excellent evidence that they often dip the scale whereby a person who has been in equilibrium, able to get along with his outside troubles, and to keep his balance, is finally knocked down into disease.
A person has tuberculosis. One of the favorite tricks of unscrupulous political orators is to say, "Look at all that tuberculosis due to the greed and the cruelty of employers!" Bad conditions of industry are doubtless a factor in the production of tuberculosis, but we must realize how many and important the other factors are. The eight or ten hours a person spends in industry is often a small factor in producing his ill health, compared to the fourteen or sixteen hours he spends outside the industry. Hence if we are to understand the diseases of workmen we must investigate these hours just as carefully as those in the factory. That is what we ordinarily omit. We find so many cases of tuberculosis in a given industry, and we say, "Ah, then, these cases are due to the hardships of that industry."
In refutation of this idea there is one more dogma packed for transportation, which I should like to offer in the form of a logical fallacy which the mediæval logicians put down in Latin terms: "Post hoc, ergo propter hoc": "After this, therefore because of this." One of our duties as doctors and social workers is to combat fallacies, to teach people to think straight instead of crooked about their ill health and their other troubles. When thus occupied, a large part of our labors will consist in trying to overcome the popular fallacy quoted above. "You went into a particular industry and you had tuberculosis: therefore you had tuberculosis because you went into that industry." "You had a given disease and you took a certain remedy: you got better, therefore the remedy cured the disease." So the superstitions flourish. I do not believe it is easy for any of us to extricate ourselves from that particular fallacy, but we must try.
In industrial disease we have the causative factor of industrial hardship intimately mixed up with other factors. One of my colleagues, Dr. Roger I. Lee, of whose book I have already spoken, investigated, in our clinic at the Massachusetts General Hospital, the cases of one hundred young working-girls, factory employees, who either had tuberculosis or were suspected of tuberculosis—were in what is wrongly called the "pre-tubercular stage," when the doctor has not made up his mind whether the patient has tuberculosis or not. He studied these cases, as people ought to study them, always in proper coöperation with a social worker. He made his own careful observations in the dispensary. Then he employed a social worker to study the girls in the home and outside the home, following up in their lives and personalities the tangles of disease. His total result was that he could not say in any given case that industry had produced a single one of the diseases which he found, though he was not willing to swear that it had not done so. He found that a certain number of these girls, in their perfectly natural search for recreation, were running around the streets or elsewhere until the small hours of the morning. That is an obvious factor in producing a diseased state. It is not that we want to blame people for seeking recreation; but the results cannot also serve as evidence of the harm done by industry, except in a very wide sense in which we might say that industry does harm because it does not provide for recreation, which is, I think, an extreme view.
Dr. Lee's social assistants found that a good many of these girls had no habits of eating. It was not that their habits were so bad, but that they had none of any kind. Sometimes they ate very well and sometimes they did not. Then he found, as of course one would know that he would, the psychical factors in many of these cases—their love affairs and other worries which were often much more deleterious to their health than their habits of sleep or food or even their industrial conditions.