Public health and insurance: American addresses

by Sir Arthur Newsholme

Ignorance

It may have surprised you that I have not placed ignorance in the forefront, before industrialism, urbanization, and poverty, as the chief enemy of personal and public health. I have no hesitation in making the statement that although there is need for large additions to present educational work in hygiene, the utilisation of existing knowledge by those holding responsible positions is even more important. Is it not true that it is easier to promote educational “drives” for any single branch of health education, than to obtain money for the actual execution of health work?

Let us look more critically at educational work in hygiene. Whose ignorance is it proposed to enlighten? Ignorance is common to all classes, and it is fundamentally important that systematic instruction in physiology and hygiene should be given in all our schools; and that especially every teacher should have adequate training in these subjects, and in the recognition of the common mental and physical defects of children. If a course of instruction were given for all, approaching that which is given for public health nurses at Yale University, how much more hopeful would be the prospect of public health progress, both in New and Old England. But this does not cover the entire needs of the case. Consider, for instance, the relation of maternal ignorance to excessive child mortality.

Maternal ignorance is sometimes regarded as a chief factor in the causation of excessive child mortality. It is a comfortable doctrine for the well-to-do person to adopt; and it goes far to relieve his conscience in the contemplation of excessive suffering and mortality among the poor.

This doctrine has found favour in occasional official reports and in miscellaneous addresses. It embodies an aspect of truth, but it is mischievous when it implies, as it sometimes does, that what is chiefly required is the distribution of leaflets of advice, or the giving of theoretical instruction as to matters of personal hygiene.

There is little reason to believe that the average ignorance in matters of health of the working-class mother is much greater than that of mothers in other classes of society. Furthermore, it would appear that working-class mothers give their infants the supremely important initial start of breast feeding in a larger proportion of cases than do the mothers in other stations of life.

The mothers in both classes may be ignorant; in both there is deficient training in habits of observation, especially in regard to the beginnings of illness; but the mother in comfortable circumstances is able to ensure for her infant certain advantages which the infant of the poorer mother often cannot obtain. What are these?

1. The well-to-do mother is commonly able to devote herself to her infant and have assistance in this duty; the working class mother is single-handed, and has also to perform, unaided, all the duties of her household, including the washing and cooking for her husband and herself and possibly for several children.

2. The well-to-do mother is commonly able to ensure that the milk for her infant is purchased under the best circumstances, is stored in a satisfactory pantry, and is prepared under cleanly conditions. The working-class mother often is supplied with stale, impoverished milk, may have no pantry, and, except when suckling her infant, is handicapped at every stage in the cleanly preparation of her infant’s food.

3. If the well-to-do mother is ill, adequate medical and nursing assistance is at once available, and the child’s welfare can be safeguarded; if the working-class mother is ill, the child usually must suffer with its mother.