RA 436 IV112p McBRIDE D 6 3 7 7 7 PHYSICIAN AND HUMAN CONSERVAHON THE LIBRARY OF THE UNIVERSITY OF CALIFORNIA LOS ANGELES THE lPHYSICIAN AND HUMAN CONSERVATION, JAMES H. ^ c B R I D E,^ M.D. PASADENA, CALIF. Reprinted from the Archives of Neurology and Psychiatry August, 1919, Vol. II, pp. 149-157 CHICAQO American Medical Association Five Hundred and Thirty-Five North Dearborn Street 1919 or^iVERSITY of CALIFOJRNI/ AT LOS ANGELES LIBRARY The Physician and Human Conservation JAMES H. McBRIDE, M.D. PASADENA, CALIF. 'l '*» \^\r THE PHYSICIAN AND HUMAN CONSERVATION* JAMES H. McBRIDE, M.D. PASADENA, CALIF. On this occasion, when you might expect me to speak in the line of the specialty, the subject of human conservation may seem rather remote. It has none of the interest of novelty and has no problems for the laboratory except that oldest of laboratories in which the problems of life are being solved. The subject is familiar, but life is made of familiar things of which we find it necessary frequently to remind ourselves, and experience teaches that it is much more profit- able to be reminded than to be instructed. The existence of so much disease that is preventable, the increasing amount of insanity, feeble-mindedness and imbecility that are usually evidence of individual and family degeneracy, the poor showing of young men in our recent war conscription, and other conditions of bad import too numerous to be recounted have led me to consider at this time the subject of disease prevention and human conservation. This can only be a suggestion, as there is no time to frame an argument; it can only be a hint of the facts, not a presentation of them. My subject is not so remote from our specialty as it may seem, for we are interested in disease and its prevention, and conservation deals with both. The great merit of prevention is that it begins at the source and that is the place to stop trouble. • To bring a dying man back to life and health is more attractive and picturesque than the homely process of preventing him from being sick. Just a plain healthy man may be useful, but he is not necessarily interesting — society, how- ever, prefers that a man should first be healthy. We have wasted a vast amount of human material in the past through mere neglect ; we have wasted as much more through being satisfied to care for the wreckage, without considering how to stop the supply. The result has been that while we have been building hospitals and asylums, disease has been increasing with the growth of population, so that the age-old "pestilence that walketh in darkness," in the form of devitalizing con- ditions, has been breeding disease and degeneracy and pouring its victims through the gates of charity. * Presidential address before the American Neurological Association at Atlantic City. N. J., June 17-18, 1919. 139885 There is much unused power in the medical profession in this country, some of which might surely be devoted to educating the public to understand the importance of human conserv^ation. Resolutions of societies and well-meaning presidential addresses, unassisted by organ- ized effort, will probably get no farther than to illustrate the infant death rate of good intentions. The physician witnesses the growth and the unmaking of men in a way that others do not. He sees that simple, wholesome living pro- duces healthy and eft'ective lives. He sees untrained and therefore incompetent men and women struggling in a bad environment, becom- ing prematurely old. -octogenarians at forty. He sees children who are underfed and dwarfed in mind and body repeating later in their own incompetence the incompetent lives of their parents. We doctors have in the main been carr}*ing on an ambulance service in the past, that is, we have been picking up the injured. It has been a great work unequaled by any other human agency. It has, however, been a partial service, in that it has dealt mainly with results and has achieved relatively little in the way of prevention. This was unavoidable as it has been only within the past few decades that our knowledge of the obscure sources of many diseases and degeneracies has permitted the formulation of a general plan for health conservation that would accomplish such results as are today possible. PLAN FOR CCXSERV.\TIOX OF HE.\LTH NEEDED A conservation plan should be much more than one to prevent con- tagious diseases or even to prevent all disease. It should be a plan for human reconstruction in the broadest sense, not alone for cripples or for defectives, but for rebuilding the bodies of all the people, beginning with childhood and not necessarily ending with completed growth. Such a plan should be administered by the government. The business of the profession will be to secure the adoption of a plan. It will require the united eft'orts of physicians acting in every com- munity to educate the people and show them what human conserva- tion means. Unless the general public can be convinced of the neces- sity for it. the government will be slow to put a constructive program in force. The large number of our young men who could not pass the exam- ination for the army during the recent war furnished convincing e\i- dence that there is in this countr}- a great deal of poor physical develop- ment. It is, too. quite possible that some defects were overlooked, but certainly enough were exposed to show the physical vigor of Americans is not what it mieht be or what it oueht to be. The fact that so much degeneracy was shown to exist in persons of the ages of those exam- ined, would indicate that there are others older and others younger who are equally at fault physically. The humiliating revelations of these army examinations are an admonition to the country to see that the boys and girls of our day have the training that will enable them to meet successfully the tests of active life. There is fortunately a growing interest in the medical profession in preventive measures which is reflected in activities of various states and in that of the general government. The health work in cities, the community nursing, the follow-up work of dispensaries and hos- pitals, the new interest in housing one of the biggest of human prob- lems, these and many other activities are educating the public for the comprehensive program that will some day come. NATIONAL HEALTH PLAN We have also in recent years been moving toward a national health plan in the activities of the marine hospital service, the work of the Surgeon-General's Office and the annual health lectures provided by the American Medical Association. The next step should be a com- prehensive plan for the entire country. It is not possible nor necessary to suggest a scheme here, but if the profession could induce congress to appoint a medical commission to investigate the need for a health program, such a body could easily produce evidence of the necessity for it and secure action. BEGINNING OF PREVENTIVE MEDICINE There is no finer chapter in medical history nor one that is more significant than that which records the first achievements in prevention of disease. When the genius of a country doctor connected the milk- maid with the cow, and devised prevention by vaccination, he took the first step toward doubling the usefulness of our profession by showing that some diseases may be prevented. What Jenner demonstrated was not only a matter of science but a social fact of great importance. The prevention of disease earlier received an impetus from the old Venetians when they put the word quarantine in the dictionary. They might have waited until the plague had developed in the city and then have administered their remedies ; they preferred prevention. SOCIAL LOSS FROM DISEASE Eleven thousand young men applied for the Naval Reserve in 1913 and only 316 were found physically fit. It has been said that these tests are severe. They are. Should the United States lower its standard to tit our degenerate youth or should we raise the physical level of our manhood? These tests are probably not higher than those any normal young man should be able to pass. The annual social loss f rjom disease is equal to the destruction of' a great war. This is all the more regrettable, because most of it is preventable. It is a serious thing that there are more than 500,000 deaths from preventable diseases in this country every year. 400 times the number that were lost on the Titanic, a tragedy that shocked the world. Three hundred thousand babies die before they are a year old, a loss of which the tigures are a poor measure. More people die before the fiftieth year in the United States now than in the time of our grandfathers, though in several European countries more people live beyond the fiftieth year than was the case two generations ago. Ripley says that of 100 Jewish babies born in Massachusetts, fifty will be alive at the end of seventy years. Of 100 babies other than Jews born in Massachusetts, fifty will be dead in forty-seven years. Why is there this dilterence of twenty-three years under essentially the same environment? Is it due to a more intelligent care of health and a better scheme of life? There are said by school authorities to be 500.000 feebleminded children in the public schools of this country, and it is probable that there are several times that number in the adult population. These morons breed true to the laws of degeneracy in families of ten and fifteen children. Where will this country find room for the 2,000,000 or 3,000,000 degenerates of this class that we will have two genera- tions from this time? Has this Association ever called public attention to the danger that the feebleminded may pollute the healthy blood of this nation? Man seems to be the hardest of all animals to kill. Human beings will survive mistreatment that would kill pigs and cows. If a man kills another with an ax or a pistol, he is punished ; if he should kill a man with a slum house, he is not punished, though the men who rent slum houses are so much more dangerous that men with axes and pistols are relatively harmless creatures. The owners of slum houses help to fill our hospitals with sick and insane, and in addition they furnish a large supply of degenerates who prey on society. A general plan of health conservation should remedy these and other like con- ditions that cause much of the disease we see in public hospitals and much of the degeneracy that we meet outside of them. These cases of disease are the natural drift from such sources as bad housing and its many attendant evils that are spreading like an epidemic not only in cities, but on farms and in villages. Such insanitary homes with their inadequate care of children are the causes of much stunted growth, incompetence and disease. Here also only a comprehensive program of health conservation can correct these evils. No discussion of this subject could properly omit mention of our educational system : While the government plan of health conservation could not be made to apply to education in the states, it could by sug- gestion and advice make health conservation in all the states the first consideration in education. Indirectly, therefore, a government plan would determine that the states did their duty. HEALTH CONSERVATION SHOULD BEGIN IN PUBLIC SCHOOLS If we are to prevent physical degeneracy, or rather if we are to stop that which is now going on, we must begin with the children in the public schools. Their health should not only be guarded, but the training of their bodies is quite as important as the training of their minds. This should appeal to the intelligence and public spirit and the essential loyalty of every physician, less, however, as a medical prac- titioner, than as a man who understands or ought to understand the importance of medical sociology. Every man and woman who walks the streets today is essentially a product, physically and mentally, of our schools. Has our educational system been a success — if not, why not? The power and much of the genius of a nation depends on the health of its citizens, and the preparation for effective living and national achievement should be made chiefly during the growing period. These little folks who are the raw material of our future citizenship are naturally outdoor animals. Their mental activity is founded on physical activity. Our schools will never be organized on the proper basis until we recognize and put in practice the fundamental principle that physical training should be the foundation of mental training. Every medical man should have an immediate interest in existing methods of education, and especially in the conditions under which those methods are applied, and of all physicians the specialist in ner- vous and mental diseases should have the greatest interest. Any one of the younger specialists of this Association could go into any public or private school today and select with an approximation to accuracy a pretty large group of pupils who will probably be his patients or his contemporaries' patients fifteen or twenty years from this time. He will need to interpret the significance of the nervous attitudes of the children, the instability of nerve centers shown in the facial expression and in the general irregular muscular movements and other familiar signs of imperfect development. One sees in these cases the results of half-starved nerve centers, and neglected muscular activities, struggling in vain for normal expression in a turmoil of wasteful efifort. 8 Hundreds of thousands of young people are yearly going out into the world unprepared for life because their only training in school, if training it may be called, has been a system based on word symbols. There is little or no discipline for young people in the unrealities of books ; they cannot connect them with life, for to them life is in doing. The failure that so many of them experience in after years is also due, in large degree, to a lack of proper physical development. From the bad mental training and the neglect of the bpdy there results much retardation, mental stagnation and physical disability, which make incompetents of many and invalids of others, while a few, through the miracles that nature daily performs, get into the small class of successful people. The commission appointed by the National Educational Association says in a recent report that it would focus secondary education on the great social objectives, and it places the health of the young at the head of the list. This is encouraging for our teachers as a class have been slow to recognize, if indeed they do recognize, the important fact that health and sanity and success in life depend more on good physical development than on all the book knowledge that has been or can be packed into the healthily rebellious minds of the young. It is true that manual training and kindred instructions is given in certain schools, but it has not reached the great mass of boys and girls of this country. It is a fundamental fact in human development that young people have a positive hunger for doing things, for learning as the race learned, to think by doing. The greatest discovery man has made to date was the first tool he fashioned. It was the chief means of the early development of the race, and so deeply is this primitive talent planted in the brain that every psychiatrist knows that the ability to do things is one of the last faculties lost. In teaching the young how to use the hands, the teacher is leading them over the long way the race came ; the teacher helps them to short-circuit the race process. In this way even a dull boy can be taught to do some one thing well, and such training will save many from the failure that has condemned thou- sands to insanity, crime or pauperism. Any physician who has seen much of the insane in public institu- tions must have been impressed with the large number of this class whose mental disorder, where the basic cause could be explained, has been chiefly due to the fact that they had never learned to do any one thing well. The dullards and incompetents that come from our public schools would, if they could speak, tell a tragic story of the failure of the educational side of our social system. RESPONSIBILITY OF MEDICAL PROFESSION FOR CONSERVATION OF HEALTH It is an important truth that nothing stands alone in this world, not even a medical association. We go up or down together. We are here today not solely because we are physicians, but also for the reason that society created us as a profession because it needed us, and we are therefore always serving its purpose. Our most private work is really a social and public work, so that in all we do we are going on the errands of society. Each one of us is an essential part of this moving human order that keeps society together and holds humanity to its sober tasks. The world is passing into a new era. Though wars cease and the harsher strifes of men may disappear, the old struggle will go on under other forms which in the long run will be quite as destructive. Again the final test is the individual test, for in last analysis the reserve power of a nation rests on the ability of men and women to endure stress. We cannot say that race decay has not already begun among the people of this country. There is much evidence that it has begun. No race nor nation, not even our own, can ever be free from the con- ditions that produce degeneracy. These are inherent in every form of human organization. They are all the more dangerous for being subtle and obscure in operation. They may act through generations lowering the resistances of individuals and families, and in widening circles a nation becomes involved. Every medical association and every society should do systematic educational work with the public in the interest of a human conserva- tion program. Medical men should not be willing to leave to others the credit or the task of leading in this movement, which is specifically a social duty of physicians. The profession owes it to society and to its own character as a scientific and progressive body to demand that the health and physical vigor of the men and women of the nation be cared for by the nation, and raised to the highest standard. For this, or any association of specialists, to take official notice of this subject, I realize would be a departure from custom. Departures from custom, new activities, are generally highly beneficial. They furnish stimulating experiences and a new form of spiritual exercise that is needed by the best of men and even by associations. They take the individual into bracing altitudes ; they have been tonics to the social body in many an invalid period. All advance has been due to departures, that is, to new views, and new ideals that in all ages have set men's thoughts in higher, and better ways. It has been such departures that have roused the inquiring, pioneering spirit that has led to great discoveries and kept men moving toward new horizons. 10 In this period of industrial and social reconstruction when all inter- tests are becoming intertwined, when human interspaces grow smaller, and new relations create problems that change our views of life and society, it is necessary that the medical profession also make certain readiustments, that it annex human interests to its older activities, if its members are to maintain its fine traditions and keep step with social progress. All professional life is beset by the danger of a certain bias which habits of work in any special line tend to create, ^^'e humans are made of malleable material and we are likely to be moulded to a rather definite shape by our occupation, all the more likely because the process is unconscious. It is not easy to resist the common tendency to become set in certain habits and ways of thinking, with the result of lessening of general interests, a limiting of intellectual curiosity and growth, which cause many men to atrophy on some of the best sides of character. Society needs now, and needs more than ever before, men who answer to that severest test of character — the ability to grow. Xot the linear growth that is in the direct way of men's daily work and which is a relatively easy process ; men are needed who are capable of lateral growth, who recognize the new human borderland of interests that increasingly demand attention. It needs men who take the social view of their work, who understand the individual and social value of life and see the importance of increasing that value. The people of this country do not appreciate the need of human conservation ; they have not been told as only doctors could tell them that it is necessary and urgent. Shall we wait and allow society finally to lead, or shall we take the wider view of our mission, and become the pioneers of a great constructive movement? And now permit me, gentlemen, to indulge my fancy. Fifty years from this time a medical historian will refer to this Congress and the proceedings of this section. To make the record complete he may mention the poor performance of this presidential hour. I read what he will write : "At the opening of the neurological section the president omitted the subject of neurology and spoke on human conservation, though he did -this rather apologetically, as though he were afraid of ofifending someone. Being, however, an elderlv man and evidently a person of good intentions, he was listened to politely. "After that time the medical profession went far beyond the feeble suggestions of the speaker, of 1919, and the American Neurological Association in particular recognizing the importance of medical sociolog)^ made itself famous by developing a plan that has achieved 11 astonishing results in fifty years. Briefly, the physique of the Amer- ican people has been recreated since that time and they now are known as the most vigorous and virile and efficient nation in the world. 'The writer regrets to say that, after careful research, he has failed to find any record of the name or the fame, if he had any, of the president of the American Neurological Association of 1919." 139885 MAY : University of California SOUTHERN REGIONAL LIBRARY FACILITY 405 Hilgard Avenue, Los Angeles, CA 90024-1388 Return this material to the library from which it was borrowed. D 000 630 777 THIS BOOK CARD J ^1 ir^ ^ University Researcii Library