PREVENTIVE MEDICINES.
By DR. MARY E. DONOHUE.
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| DR. MARY E. DONOHUE. |
The doctrine that public health is public wealth is accepted by all. To maintain it, to improve it must therefore be the constant aspiration of individuals and society. But if we might indulge in lofty anticipations which the progress of this century might seem to justify, it is evident that hygiene and medicine are separating and drifting apart, each into distinct fields of study and activity. Its significance is manifest in the fact that with the progress of civilization cure must more and more yield to prevention. As exponents of this science, it becomes our duty to understand the means of preventing impairment to health, to be vigilant, ever on the guard ready to protect the health of individuals and communities, to discover causes and remedies.
In order to secure health in adult age we must begin our labors during the early years of life; and if we would have healthy homes the future fathers, and above all the future mothers of our race must be so instructed that they will themselves appreciate the advantage by applying the elementary principles in their daily intercourse with their families.
The great physical degeneration of the present age is due to aggregations in towns and cities, over-crowding, vitiated air, impure water, unhealthy occupations and the diseases to which they give rise. The last census tells us that blindness and mental troubles are on the increase. In the state of Delaware blindness has increased in greater ratio than the population. What is true of Delaware may be true of other states. Blindness is in a large measure a preventable condition. If suitable legislation were enacted much could be done to prevent the increase or occurrence of blindness.
In England alone, according to the last statistics of 1890, there are 23,000 men and women blind, 1,000 less women than men; 14,000 men and women deaf and dumb, 12,000 less women than men. There are 97,000 men and women mentally deranged, of these no less than 51,000 are women. In our own country, according to last reports, indicates that insanity has increased 50 per cent in some states. The increase is greater than that in other states. There are several problems of public interest involved in the relations of society to this last named class. Among the more important of these are questions of the dependence and prevention of insanity.
If we exclude from the human family all preventable diseases, including those produced by mental strain, by physical strain, by alcohol, narcotics, tobacco, impure air and foods, occupations, indolence, irregular hours, moral contagion, all of which are evils that may be avoided, how small a percentage would be left for drugs. If intermarriage of disease were considered in the same light as that of poverty, hereditary transmission of diseases, the basis of so much misery would be at an end in a generation or two. Or if a candidate for matrimony were obliged to submit to a physical examination, as they do in Brazil, and if found in a proper physical condition a certificate of marriage would be granted, and not otherwise.
Candidates for a life insurance policy are subjected to a rigid physical examination, and if found in an unsound state of health by reason of hereditary taint or vicious habits, the candidate is rejected, as the risk is considered too great for a reputable life insurance company to run. And when we consider the danger to health and even life itself to which innocent and pure girls are exposed when entering the state of matrimony, as many believe in two codes of morals, one for women and the other for men, so long as women will submit to this injustice and indignity, just so long will marriage be a failure. If they will not muster up sufficient moral courage to demand of the man that they expect to marry that he be every whit as pure as they, just so long will disease be propagated and divorce increase. Unprecedented progress in human knowledge characterizes the present century, and has not been wanting in preventive medicine. How much it has operated for the public good, and how much it is gradually imbuing the public mind with modern sanitary knowledge that prevention is not only better, but often easier, than cure, that health and happiness may be preserved, that life may be prolonged by the observance of certain simple laws. To have perfection in the adult we must begin our labors with the child. To have perfection in the child we must begin our labors with the grandfather. We now have the future grandfathers and grandmothers of the nation in our hands. The primary cause of much if not all of the present misery is due to the neglect of the moral and industrial training of children at home, and later at school, during the pliable period of youth. It is no easy matter for one to raise the voice against abuses that every one knows about. Not only the members of school boards, but parents and teachers also become involved in this same conspiracy of silence. Of all places in the world, the public school is least open to sanitary influence. Many valuable lives are lost because no one puts into operation the means that could and would save them. One by one they fall and pass out of sight, because those whose duty it is to speak lack the moral courage to do so, or are so completely engrossed in their business, pleasures and vices that they do not throw out the life-preservers that are at their hand. The state annually spends large sums of money for the protection of the imbeciles and the vicious, but a very small amount in comparison for the thousands that are in perfect health of mind and body, and who not only contribute to their own support, but that of others, and are law-abiding citizens. As a result, the state loses annually by death enough of her best citizens to form of themselves a small city, while the worst element increases and multiplies under the protection afforded them by the state. If women had the opportunity of entering into the field of politics, they could make their power felt in the legislation and correct many of the existing evils.
Physical inspection of children in schools, asylums and reformatories involves several questions of general interest.
"It is recommended that in all schools and institutions the general health, sight, hearing and teeth of the children should be periodically examined." Physical examination is useful as a means of selecting cases for special training. A physician would have an opportunity of observing children in various conditions, mental and physical; nervous children with catarrhs and headaches, and partially deaf or blind—conditions without a fatal termination and not preventing a modified and adapted education. Such children should be trained in and along certain lines. Without it they would probably tend to failure and incapacity in after life. There are quite a number of children that are more or less defectively developed in brain and body. If they are not properly trained, there is great probability of mental and moral deterioration.
Putting the bright with those who are mentally deficient, an injury is done to the former by preventing them making the advance they otherwise would, while the latter is not benefited. It was in evident recognition of this principle that a deputation from the British Medical Association lately advised the members of the school board that many children are mentally or otherwise unfit for the ordinary course of study, but might be taught usefully on certain special lines. They contended that certain children of defective brain construction would, unless their deficiency were thus particularly recognized and treated, grow up idle or vicious as a natural consequence. A solid industrial, as well as an intellectual training, is required for every boy and girl in order to fit them for their duties as citizens, and as a permanent guarantee against poverty and crime, if a boy or girl is not so educated as to be able to earn their own living, he or she is liable to become, directly or indirectly, a public charge. We are now ready to raise the question as to the right and duty of the citizens and the state in this matter. The state has a manifest right in the matter. It is clearly the right and duty to see that as far as possible this is done. To secure this, the hand needs to be trained as well as the brain. Thus the opportunity for an industrial training should be an integral and essential part in our school system. While the present system is retained in our schools, it will be simply impossible to impart to the children of the poor an education calculated to fit them mentally, morally and physically for the performance of their duties in life. They will elevate pecuniary considerations above those which are educational, and set up a false gage of efficiency in the minds of teachers, pupils, trustees and inspectors. "This will raise a system of over-pressure or 'cram,' which will be fatal to intelligent teaching." Our education is too theoretical. Its object is to educate the mind without regard to the great hereafter of school life. What becomes of our sweet girl and boy graduates who are launched, year after year, upon the country? They go to swell the ranks of the unemployed who possess nothing but their education, and are more dangerous to society than those possessing less knowledge, because they are more discontented. We are forced to the conclusion that in the world of action the self-educated man and woman is the most successful. It is an undisputed fact that many of our most distinguished men and women have achieved wonders without education, technical or otherwise. A contempt for manual labor seems to be the natural outcome of the many acknowledged faults of our artificial social system. We can not deny that if our education does not attain the truth by developing the body and mind it is certainly at fault.
Physicians, especially lady physicians, have opportunities, and they have no holier duty than to use these opportunities wisely and gravely. "By all means let them importune the public law to do all that it can do, and more than it ever has done, for the protection of the young." But the remedy of this great evil will not come from legislation alone. The remedy will surely come through the cultivation of purity in thought, word and deed in the home, in the school, in the newspapers. A proper knowledge of physiology and anatomy is one of the hopes of a better state of things. These are essentially moral and religious questions. They arise in each individual when passion is strong and judgment and experience are weak. In other words, they arise in the human mind when it is in great danger of being misled by the body. By all means let public law be on the side of the weak and those that need its help. Let our streets be cleaned of their vile theatrical advertisements and literature that now disgraces our cities. Virtue is too important an element of health to be neglected. The publicity of sins against this virtue has all the evils of publicity and few of its advantages, and should not be so much as named among Christian people. This is the philosophy of Saint Paul, who devoted himself as none have done since to the cultivation of whatsoever is pure. Among the lower classes impurity is forced upon the people by the condition of their existence; but among the wealthier it is sought in its voluptuous and revolting forms; it implies the possession of money to command it. Acquired habits are often transmitted to the offspring. A disposition to unchastity is often inherited, hence the greater need of safeguards in our schools, or the acquired disposition may become second nature. If the evil is to be removed, something must be done, or the conditions which fostered these will engender others. The poison and the antidote are side by side. The education of youth should be placed under regular sanitary inspection by appointed officials. The principle of medical inspection is of precisely similar character as that recognized by the government in the emigrant service for the prevention and spread of disease on board of ships, and is found to work well. An investigation into many of the fatal outbreaks of diphtheria, etc., would show what active centers large schools are in propagating infectious diseases. And yet this source of danger could be so readily removed. The success attending the systematic inspection of troops, emigrants and others, in checking the outbreaks of infectious diseases, still more convenient would the work of supervision be in the case of schools. Instead of a changing mass of people of all ages, the inspectors would have to deal with the same persons for several years, and that at an age when the face soon indicates illness. To obtain good results the inspection ought not to be of the intermittent kind. By such means the extension of disease would be checked and much of the illness incidental to childhood and consequent suffering in adult life caused by conditions in the schoolroom be obliterated.
It is incumbent on us as women to see with all care that the growth of children during their years of puberty, which is of vital importance, is not disturbed, or disturbed by influences adverse to nature.
The education of the young people of a nation is to that nation a subject of vital importance. This fact has been clearly recognized at all periods of the human race. Into the hands of the children now at school we must in the near future place the destiny of this great nation. With them it rests to decide the question whether our national greatness, wealth, industry and well-being shall continue, shall not only continue, but increase. From all points of view, religious, social, moral, political or utilitarian, it is necessary that young America be properly educated; surely it behooves us carefully to consider how we may best impart the requisite knowledge with the least detriment to health.
We turn to the main question: is it, or is it not, the fact that in simply applying a uniform pressure to a vast number of boys and girls, some must be in the nature of things too weak or not sufficiently developed to bear the strain thrust upon them? It would seem to us a proper time for a declaration of rights in behalf of helpless children, and in behalf of future generations, whom we shall load with a burden more disastrous and heavy than the national debt, a burden of disintegration and disease. What a monstrous and inexplicable blunder, this insistence upon a level code of education for all! Even as regards a soldier or sailor, a medical examination precedes the commencement of the drill, and medical inspection from time to time keeps the question of health in view. Muscular weakness is not half so serious a bar to physical training as mental weakness is to intellectual exercise. Is it not strange then that, without any medical examination whatever, the brains are formed of multitudes of children, the majority of whom are under-fed? It is not enough to know the age of a recruit for the army or navy; means are taken to ascertain whether his heart, lungs and organs generally are healthy, and medical officers are specially appointed to examine them from time to time with a view to determine whether he is bearing the strain healthily; but no provision is made for testing or watching the immature cerebral organs upon which the public pedagogue is not only left free, but is required to operate. The brain, according to all we know of that organ, is the last to reach perfection of growth and maturity of any in the body, and therefore of all others the last that should be overworked in childhood, when its specific gravity and development are utterly incomplete and unfitted to bear overstraining. Whereas as the body ceases to grow after twenty-five years, the brain, we know absolutely, grows in bulk for fifteen years longer. And if the mind is any index of its perfection it certainly increases in strength and capacity for work for fifteen years after that. The functions of the brain may be stunted and crippled as those of the body often are. They may be cramped, dull or precocious, accordingly requiring intellectual work in proportion to their development.
The days of whipping children to death are gone. We are more refined now; we whip their brains instead, and if the brutality is not so repulsive, it is equally efficacious in the end, and far more cruel, as the process is slow and its ultimate consequences are far more serious, for it effects the generations yet unborn. There is over-pressure and over-crowding, and the effects are becoming evident in the prevalence of nervousness, especially among girls, due to the circumstances of school, such as overwork, punishments, the excitements of examinations, harsh treatment, etc. The origin, progress and development of St. Vitus dance is probably due to the causes named above.
Statistics report that during the last decade the American quota to the population has fallen off over one million, that the negro and the lowest of the foreign born have greatly increased. We must never lose sight of the elements which go to make a powerful and enduring nation. It is not by propagating the worst elements. Time is not given me to enter into the discussion of this serious question. It is the duty of every American woman to arraign herself at the bar of her own conscience and call her duty in question in this matter, for it has a close relationship to the many mental and physical ills that afflict the women of the day, which specialists have recognized and profited by. A noted foreign specialist who has achieved fame and fortune through the practice of his specialty condemns vivisection on animals, but does not hesitate to experiment on women. An American gynecologist equally successful has in his annual report of a few years ago stated that after an experience of over twenty-five years in his specialty that more than half of the operations performed by him during the last ten years were errors. We may well ask if during the latter period more than half are acknowledged errors, how many errors were there during the first fifteen years? We are forced to the conclusion that at least two-thirds were.
As a woman intimately and widely concerned in the application of human knowledge for the preservation of human life and the relief of human suffering, I would say that we are in great need of restrictive legislation for this practice. And were we properly educated in physiology public sentiment would demand these restrictions. This branch of surgery calls for special exercise of the protective and educational functions of the state.
A writer in the New York Tribune, of July 6, 1893, says: "If hospital experience makes students less tender of suffering vivisection deadens their humanity and begets indifference to it." And again: "By experimentation that has no restrictions but the will of the experimenter, by the slow process of benumbing pity in the young students, may it not be tending to deteriorate one of the chief safeguards of society, the moral sensibility of the future physician? There is an astounding record of utterly heartless crime by educated men. What else is the cause of it? What is the underlying cause of that mysterious outbreak of homicide among physicians revealed by the criminal records of 1892? The object of one physician for the commission of several homicides was the pleasure of killing. That of nearly all the others was money." The great crimes of history may be often traced to the education of youth. Surely this is a serious question. Cassandra goes on to ask, "to what lengths unrestrained by law or religion a scientific investigator sometimes permits himself to go." Another evil is the use of hypnotism by the medical profession, of which a recent medical authority says: "Therapeutically the value of hypnotism is obviously but slight and occasional. Its moral and social perils are certain and serious." I would say in conclusion, "that there is an urgent need for the protecting services of women as physicians, as officers of public health, factory inspectors, members of school boards and school inspectors, superintendents of all hospitals, asylums and places where women and the young of both sexes are kept and employed. There are obviously a vast number of complaints of evils that should be remedied, and of inconveniences that should not be suffered, which would much more readily be brought before the notice of women inspectors than before men occupying a similar position, or would be made to the latter under any circumstances. We may hope for many improvements in the condition of women when their interests are guarded by one whose training and tastes have been so congenial to the subjects which would be brought under her constant notice. There are many among my audience who have nothing to learn in the matter of enlightened and energetic work for the benefit of humanity. Many it is safe to say from the chairman of these congresses, Mrs. James P. Eagle, to Mrs. Mary Pugh Hart and many of the members of the Board of Lady Managers whose lives were honorable examples of self-sacrifice to duty. But something more is required than individual initiative and exertion, however well directed and exemplary. The field for woman's work in the hygienic re-habilitation of America is not only broad but easily understood and attractive. The main factors will be personal and public well being, and will contribute to that most desirable consummation by which every individual shall be taught to become the intelligent custodian to her own health." By thus inculcating the future generations, particularly the women, in all that conduces to the healthy and natural life, there is prepared that public opinion so sorely desired. On you, the women of America, rests the moral and physical regeneration of American youth. In this combat for humanity there are posts innumerable. Let each select her part, great or small, according to her strength, her vocation. Let us consider it a sacred duty to give of our means and abilities to the nation's wards. And so from the luminous examples of female heroism which honor women, will emerge the collective power of educated duty. Not by self-seeking, but by spontaneous instinct and sentiment will become one of the most vigorous of the healing forces of national well being. A ladies' national health association would have the strength of angels and of men. Any great sanitary improvement of the nation must be the result of elaborate co-operation, legislation and administration before we can effect any good result. Everything that concerns health and morals and education occupies the minds of women ten times more than it occupies the minds of their husbands or fathers. Their standards of administrative ability are fifty per cent higher than that of men. Woman holds the key to the solution of this serious problem.
Preventive medicine covers all physical and moral evils. The social relation of the classes to each other, and of labor to capital, of man to woman, of both to the state, are destined to be tested by that new power which is just feeling its strength. It is of vital importance to us that the guiding of this new power should be in the hands of those who are actuated by deep and enduring principles, and prepared to use their influence.
In these glorious days of the nation's history, these days of Columbian celebration, the rise and progress of this great American nation from 1492 down to 1893 has been recognized, eulogized and glorified. The achievements of every walk in life, the wonderful discoveries, the innumerable inventions, the magnificent results which are found here displayed in this magnificent White City, the Woman's Building, its beauties, its comforts, its joys and delights, must all be considered. And the sum total stands unparalleled in the history of nations.
During a period of four hundred years, great work has been accomplished, and we stand before the gaze of the entire world, at this moment, as a nation exemplifying the truest type of Christian civilization. While all this progress has been reviewed and considered, American work can not be said to be a mere herald and forerunner of a still greater and better; that its proud distinction was to have found man ignorant of much that concerned health and happiness and to have left him better protected against illness and misery; to have found him insensible to their moral and intellectual power, and have awakened them to a sense of duty and responsibility to which God and nature had called them.
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Dr. Mary E. Donohue is a native of Ohio. Her parents were the late Sara Can and John Donohue. She was educated at the Convent of Notre Dame, Cincinnati, Ohio. Her principal literary works are "Art in Public Places," "School Hygiene," and "Temperance Teaching." Her profession is that of medicine, and she has spent much time in the interest of public health. In religious faith she is a Roman Catholic. Her postoffice address is Cincinnati, Ohio.