Proceedings of the second National Conservation Congress at Saint Paul, September 5-8, 1910

by United States. National Conservation Congress

Our chief difficulty lies in coordinating the various forces and agencies which are essential to success in the eradication of sickness.

There is no blanket method of preventing all diseases. Quarantine and fumigation are now found to have but a limited application. Vaccination, which is practically an absolute and the only reliable protection against smallpox, cannot be applied to such diseases as malaria, yellow fever, and diphtheria. The use of antitoxin, which prevents annually many thousands of deaths from diphtheria, does not help us in many other diseases. Our knowledge of mosquito-borne disease, which has reorganized life in Cuba, Panama and the Philippines, is not of much practical use in our northern States. As there is no single cause, so there can be no single method either of cure or prevention.

These considerations should not discourage us. They show us, however, the need of further study, and the imperative demand for employing the services of trained physicians, biologists, chemists, engineers, statisticians, sociologists, educationists, and other experts and of coordinating all their efforts. We must steer a middle course, avoiding on the one hand the Scylla upon which those run who become discouraged in the face of what they believe to be the unknowable, and, on the other hand, the Charybdis of that fateful tendency to minimize the actual complexities of the present day health problem. Fatalist and faddist are equally dangerous.

It is fair to count upon the same progress in the adaptation of physical, chemical, biological, social and other sciences to the diagnosis, cure and prevention of disease as in their application to man's comfort, convenience and economic development. It is clear that the efforts of all the various workers in the different fields must be coordinated; yet the difficulties of coordination are at once apparent. The forces and agencies may be roughly divided into international, National, State, county, municipal and institutional, as well as individual. Each one of these is capable of still further subdivision into two classes, one of which is official or governmental and the other is voluntary. Improvement in public health requires cooperation and coordination of all these.

Successful public health administration consists largely in making individuals do what they do not wish to do—or that of which they do not appreciate the necessity—for the good of themselves and others. This brings us naturally to the consideration of another National weakness. We encounter some of the same difficulties in public health work that we meet in the exercise of our other public functions. Rampant individualism is of even greater danger in matters of health conservation than in other affairs of public concern, largely on account of the fact that health is too often regarded as a purely personal rather than a most important public asset. The individualist objects to authority in matters of health control. Consequently he resents dictation as to his personal action, and fails to recognize the need for special training in health administration as in other branches of public service.

Public service of many kinds, and particularly that which relates to the conservation of health in our country, is all too often relegated to voluntary agencies, while in other countries it devolves upon official and governmental agencies. This volitional duty is nobly discharged. The main function of the volunteer should be, however, to afford to the general public object lessons of what is needed and of how progress can be made. In this he rarely fails, although he labors under tremendous difficulty imposed by lack of authority. Funds which are furnished from private sources are frequently insufficient to permit of the employment of experts of the highest order. Public apathy, on the one hand, and the development of an abnormal interest on the part of voluntary workers on the other, frequently lead to their continuance in service long after they have ceased to be useful, with the result either that the public delays the establishment of an official organization, or, if such an organization be established, there is a conflict between the official and voluntary forces. If municipal health departments, hospital services, police departments, water, school, poor and park boards, and other official servants and representatives of the people were supported by the people and were quick to see and to seize their opportunities, there would be less need of associated charities, of visiting nurses, pure water and milk commissions, tuberculosis camps, play-grounds associations, and other such voluntary organizations. Is it not humiliating that public lethargy made it necessary for Mr Rockefeller to provide funds for the investigation and eradication of hookworm disease?

In Germany, the Government, through its public health service and universities, provides for medical and other research so that Nation has become a leader of the world in scientific health protection and scientific economic development.

Having seen some of the difficulties which stand in the way of satisfactory conservation of the public health, we might perhaps ask ourselves what proof of the possibility of conserving this asset is available. If, at this day and time, the American public is unconvinced of the need and possibility of conserving public health, it is undeserving of the respect of other nations, or even of self-respect. The daily and weekly press, our magazines, and governmental and other publications, have overflowed with information. Our attention has been particularly called to the possibility of preserving the health of men in the field by Japan's experience in the recent war with Russia. Our life insurance companies have been quick to see the practical possibilities of prolonging the lives of their insured and of thus increasing the earnings of their stockholders.

As illustrating our progress, the report on "National Vitality, Its Wastes and Conservation," which was issued by the American Association for the Advancement of Science, is a masterpiece; it was prepared and presented by Professor Irving Fisher, of Yale University. The publications of the various committees of the American Medical Association, and the speech of Senator Owen in the Congressional Record of March 24, 1910, as well as Federal, State, municipal and other health reports, afford examples of what can be done.