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

by United States. National Conservation Congress

Those who may be skeptical in regard to the ability of our people to compete with older nations in the prevention of disease, should note what has actually been done by Americans under the greatest of difficulties. In Cuba, our Nation overturned the existing order of affairs, and scientific discoveries, made and applied to sanitation by Americans, afforded a lesson to the world. There has been no greater factor in winning the world-wide confidence of other nations than the production of the existing sanitary state of affairs in the Canal Zone by our own citizens. Our work in Cuba, Panama, and the Philippines has served to bring about hygienic conditions in supposedly pestilential regions which are vastly superior to those which obtain at home. What Americans have done for others they have failed to do for themselves, owing largely to the lack of provision of adequate official and governmental agencies and to the failure to coordinate those which exist. Two Americans in Porto Rico showed the possibility of stamping out hookworm disease. The brains were furnished by the United States, and the money by the Island. We have the brains at home, but we refuse to pay the bills.

It is manifest that a full and complete discussion of life and health as National assets is impossible within the limits of a single paper. No attempt need be made to present a complete basis either of comparison or differentiation of health conservation from the other aspects of the National movement. It must be clear to all that in the conservation of lands, minerals, waters, and forests, effort is made to prevent the individual from taking that which belongs to the public. In the conservation of public health, our effort must be directed to preventing the individual from giving to the public something which neither he nor it desires. This is particularly true of infectious diseases. There are many other phases of public health than those which relate to infectious disease, but they cannot be discussed at this time.

I have the honor to be a Delegate to this Congress from both the American Medical Association and the American Public Health Association, which represent factors in the conservation of human life and health concerning which the public needs more information than it possesses; and with your permission, I shall briefly mention a few important matters:

In the past, individual physicians and local medical associations and societies have brought a scattering fire to bear upon the inactivity and ignorance of the general public in matters which pertain to public health. The public fails to believe in the urgency of health needs, when presented by individuals or groups of physicians, because of its inability to appreciate the motive which leads the physician to urge the establishment of machinery and the special education of officials, as also the provision of funds to carry on work which to the casual observer would mean a diminution of the individual physician's work and income. Physicians who have qualified by postgraduate training in bacteriology, pathology, epidemiology, and in public health, hospital, school and institutional administrative work must be drafted into the direct and official service of the people. This need is increasingly apparent. Others are required who can present evidence of special scientific training in chemistry, engineering, statistical, sociological, charity and other work. At present, great as is the actual need, the demand on the part of the public and the remuneration offered are so small and the possibility of employment so uncertain that universities, technical schools, and other institutions which offer special courses fail to attract students. The public seems to prefer as yet to jeopardize its most valuable asset by employing untrained public health servants who develop efficiency after, instead of before, their appointment. This means a payment in life and health instead of dollars.

The average individual seems willing to pay, and pay well, for a cure when he is sick. Communities pay the cost of epidemics, and will even pay for engineering services in relation to public utilities, such as water supply and sewage disposal; but this is usually done only under the stimulus of some recent or threatened disaster. They, like the individual, want a cure, not a protection. Clinical experts, life insurance examiners, and consulting and commercial engineers, are all sure of a good livelihood because they can help the individual or community out of difficulties. Sanitarians and municipal engineers are usually left to semi-starvation, because their function is to prevent those same difficulties, without, however, having either available public sentiment or funds to enable them to do it.

Physicians are naturally skeptical of the scientific training and possession of proper ideals on the part of those who have not been especially trained in medicine, and who may have failed to develop the "disease point of view." That they are, however, of a receptive frame of mind can be shown in many ways. The American Medical Association has a number of standing committees, including a Council on Medical Education. This Council, in the endeavor to raise the standard of medical teaching throughout the United States, prepared a standard schedule of minimal requirements, through the agency of ten committees, each of which consisted of ten representative men. One of these ten committees (which had to deal with hygiene, medical jurisprudence, and medical economics) contained in its membership university and college professors of chemistry, physiological chemistry, political economy, pathology, bacteriology and hygiene. There were also executive officers of State and municipal boards of health, and representatives of the Federal Health Service; whilst among the collaborators were engineers and many university professors. Bear in mind that this was a committee of the so-called "medical trust"—the American Medical Association.

Through oversight for which no one is responsible, this Second National Conservation Congress and the American Public Health Association are meeting on exactly the same dates, September 5-9, we in Saint Paul and the Association in Milwaukee—I was just able to get here from Milwaukee. This Association consists of some physicians who are in practice, but more particularly of Federal, State, municipal and institutional administrative officers, as also of laboratory, statistical, engineering, and other technical workers. The membership includes representatives from all of the leading universities and medical and technical colleges. It has three sections, namely, laboratory, vital statistics, and municipal health officer sections. You are familiar with the work of many of its officers and members. Colonel Gorgas, who was responsible for the administrative health work in Cuba, and who has made possible the building of the Panama Canal without undue loss of life, is a member of both associations. The late Dr Walter Reed, who eliminated yellow fever from civilized communities, was vice-president. It is an international association in which Canada, Mexico, and Cuba also participate, and much can be learned by attendance at these annual meetings. One of its chief benefits has been the formulation of standard methods of scientific procedure, applicable to the suppression of disease in various districts of the several countries.

We in this country are compelled to admit that our neighbors upon the north and south have much in the way of advantage which is denied to our own workers in the United States. In our sister countries, the tenure of office depends on the fitness and training of the incumbent. As a rule the compensation for public service is relatively higher, and the official organizations are better provided with an authority which is commensurate with their responsibility than is the case in our own country. Time will not permit extended discussion of these conditions, but the annual opportunity to compare notes; to tell each other of our successes, as also of our failures; and to help in the formulation of new methods and in an effort toward a higher standard of efficiency, is of untold value. This is, however, a purely voluntary organization maintained for over thirty years at the personal expense of its members in the face of public apathy. This will be realized if I ask, "How many of you knew that we have such an association," and "Did you know that it is now in session"?

There yet remain a few matters of which a general understanding would bring about yet greater cooperation between the doctor and the general public. The medical profession has realized for a number of years that its members must become teachers of personal hygiene to their patients and families, as also to schools and the general public. It is a new viewpoint, and involves the assumption of new responsibilities. The doctor has guarded himself against publicity except through his professional societies and journals and to his students, though ever eager to furnish details of his own discoveries and to recount his failures and his successes to those who could understand and sympathize. This kind of publicity has been regarded, however, by the lay public as a sort of soliloquy carried on in an unknown tongue, and intended for the mystification of that same poor public.