The influence of unaccustomed alcoholic indulgence in leading to the first “slip,” often with the production of life-long disease, is well known.
Nor must we leave out of account the tolerance of vice in conversation between young men, as a frequent excuse of and even excitant to vice. The happiest young man is he who can go to the marriage ceremony with the same sexual purity as is even now expected from the bride. Is it too much to expect that our social conscience will grow up to this standard? I think not; and when this point has been reached, venereal diseases will have almost entirely disappeared, and the sum total of human happiness and efficiency will be enormously enhanced.
Meanwhile partial remedies must be pushed for all they are worth—and this is much. Fear of consequences may deter some from vice; fear of consequences to future wife and child form a much more potent argument. Treatment of venereal diseases, especially of syphilis, is a most valuable means of preventing their spread. This treatment may be urged even at the stage after exposure to infection before any symptoms of illness appear; and the more promptly this is done the more successful is it. There has been much heated debate as to whether persons known to intend to expose themselves to possible infection should be provided with disinfectant or other arrangements for obviating infection. This cannot be done without some loss of moral position; it almost makes the provider a co-partner with the sensualist. It may be urged, however, but with dubious cogency, that if the man is told beforehand that immediately afterwards he can have access to disinfectant provisions, the same objection holds good. I do not regard the provision of “outfits” as wise. Evidence tends to the conclusion that they are commonly not used efficiently; and there is a distinct loss in the moral position by their use. The whole subject is one of great difficulty. The prevention of venereal diseases is clearly, however, not merely a medical problem; and the physician who realises this and throws the weight of his influence, in warning and in counsel, on the side of moral restraint, is adding greatly to the value of his social service to the community.
Other instances will occur to you, illustrating the importance of a broad outlook in the causation of disease or other forms of social misery. I will adduce one more. It is well known that infant mortality is much heavier among the poor than among the well-to-do. The rule does not hold universally in rural areas, but in towns it applies almost without exception. And it is assumed by a large school of social workers that enlightenment of the ignorance of the poor mother will effectively correct this evil. Such a lop-sided view ignores many of the elements of the problem of infant mortality. Think for a moment of the contrast between the working-class mother of five children living in a small city tenement, and the mother of an equal number of children in easy circumstances, living in a residential suburb, and having domestic servants, a nurse, and a physician always available. The two mothers probably differ but little in their knowledge of the hygiene of infancy; but the one has helpers to ensure scrupulous cleanliness, to prevent over-fatigue of the nursing mother, to detect the first sign of infantile illness and provide the needed action; while the other mother has to struggle alone in respect of her infant, without either domestic or nursing assistance, the struggle being complicated by the fact that the care of four older children and of her husband is on her shoulders. Even when there is no actual direct poverty in the working-class home, the differences thus indicated—supplemented by the inability of the mother to obtain medical advice for apparently minor ailments—outweigh enormously the factor of ignorance as a cause of excessive infant mortality. By all means let instruction be given by public health nurses or other agencies, and this is most valuable; but it does not fully meet the needs of the case. There is required also actual domestic, as well as nursing, assistance in the home of the overworked working-class mother, especially after the birth of her infant and when illness attacks any of her children; and unless the physician realises these elements in the problem, his efforts in securing the welfare of his patient and in reducing infant mortality can have but partial success.
The main lessons arising from the foregoing illustrations of medical and social problems are two: Each evil should be attacked in its causal relationships; and causation is multiple.
Hence—apart from total prohibition—in attacking alcoholism, the physician may bless the efforts of tee-total advocates, of those engaged in reducing the number of saloons, of those securing better dietetics and cooking, less industrial fatigue, or more satisfactory domestic sleeping accommodation, and of parents and teachers engaged in promoting self-control in the young as a habit of life; and he will call them all in aid of his curative and preventive life work.
So, also in the control of venereal diseases, early and prompt diagnosis and treatment must go hand in hand with police measures for the suppression of prostitution, with educational work respecting these diseases, and with the inculcation of a higher standard of morality, considered as part of the general cultivation of moral self-restraint.
And in the prevention of infant mortality and of the even more serious handicapping of the up-growing child produced by the factors of infant mortality, we need to bring to bear all our medical and hygienic knowledge, and to realise that until every mother in the land is furnished with the elementary requirements, domestic, sanitary, social, and medical, for rearing a healthy family, we have no right to mental comfort while enjoying these elementary needs of family life ourselves.
Coöperation and solidarity of effort are needed on the part of the multitude of workers engaged in social work for the community—official and non-official; and in bringing this about the physician of the early future will, I am confident, take a leading part.