LEGISLATIVE COMPULSION
Government is delegated to persons specially set apart for the
oversight of the people's welfare.
Personal conduct was free from such delegated power in the Anglo-Saxon
thought. The Englishman's house was his castle inviolate. This was
especially true of the early American settlers. Laws interfering with
personal liberty, a man's right to drink tea, to punish his own
children, to beat his own wife, to keep his own muck-heap, have been
deeply resented by the American citizen. Each step in the protection
of his neighbor has been taken only by a struggle extending the common
law of nuisance to a variety of conditions.
The protection of the man against himself, and of his wife and child
against his ignorance or greed, is one of the twentieth century tasks
yet hardly begun.
The control of man's environment for his own good as a function of
government is a comparatively new idea in republican democracy. The
cry of paternalism is quickly raised, on the one hand, of socialism,
on the other. Each gain has been at the cost of a hard-fought battle.
But it is certain that the individual must delegate more or less of
his so-called rights for the sake of the race, and since the only
excuse for the existence of the individual is the race, he must so far
relinquish his authority.
It is a part of the urban trend that the will of the man, of the head
of the family, should be superseded by that of the community, city,
state, nation.
Even though all the agencies for the education of both young people
and adults that have been discussed in the preceding chapters were set
in motion at once, there would still remain many thousands in township
and city untouched by these forces, or so touched as to arouse
rebellion against such novel notions.
Only the child can be educated to acquire habits of right living so
perfectly that the suitable action takes place unconsciously. Twenty
years hence these trained children will be the chief citizens of the
republic, the leaders of public opinion. Today, however, less gentle
means, less gradual processes, must be used in order that these
children may have a chance to grow up.
In the social republic, the child as a future citizen is an asset of
the state, not the property of its parents. Hence its welfare is a
direct concern of the state. Preventive medicine is in this sense
truly State Medicine, and means protection of the people from their
own ignorance.
In the laws made with this end in view lies one of the greatest
educative agencies known. We have referred in the last chapter to the
need of drawing attention to defects and dangers in order that people
may know what the results of their careless ways may be. No surer way
has been found to fix attention than to attempt to enforce a law or
collect a fine for disobedience of it. A marked illustration of this
truth is given in the case of the ordinance against spitting in street
cars. In many cities a notice was posted in each car--usually with
little effect. In some a fine of five dollars was added, with little
more result. Boston was one of the first cities to pass an ordinance,
and it accompanied the law with a fine of one hundred dollars. This
compelled attention--a sum which represented to the workman more than
his yearly savings, more than any single expenditure. To the business
man, even, it was a sum not to be lightly dropped on a filthy car
floor. This mere statement of the value of cleanness made an almost
instantaneous change in the habits of thousands. Within two days the
car floors became practically free without a single fine being
collected within that time, as far as the author is aware.
The law imposing fines for neglect of removal of garbage or of
screening stables must be occasionally enforced in order to express
degree of disapproval. A petty fine is of little use.
Conditions of motion, of rapid intermingling of distant populations--a
thousand miles in a day is now possible--make national control a
necessity. It is proved that quick results may be gained in saving
lives and property by that prompt and thorough action which
well-equipped Federal forces alone possess. The stamping out of yellow
fever in Cuba, the redemption of Panama, the suppression of sporadic
outbreaks at New Orleans, the quick response to a discovery, as in the
cases of pellagra and the hookworm--all these show what a thoroughly
alive government may do.
It is no disgrace to an individual or a city to have the national
laboratory make discoveries, to have the national power put down
epidemics, as it does civil rebellion, for the good of the whole
nation. It is disgraceful, however, for the citizen to remain
indifferent or obstructive, to grumble over the cost. The indifference
of the people themselves is today almost the only stumbling block to
national prosperity.
The time lost to the average worker by inefficient labor is a drain on
the community largely avoidable, and is the cause of that other drain
on the moral as well as physical vitality--charity.
Preventive medicine is a science by itself, a combination of social
and scientific forces guided by research quickly applied, and it must
be accepted and upheld by those whom it benefits, namely, all the
citizens. The nation is in many cases the only power strong enough to
command confidence, and in the combination of government effort an
international science of human welfare is bound to be evolved.
It is a waste of effort for each state to prepare a fly pamphlet. The
correctness of a Government Bulletin would give an added value as well
as the rapidity of circulation. The bulletins of the Agricultural
Department are an example.
The Weather Service, with its quick notifications, shows what a health
service might do. A monthly or weekly _health chart_ would give the
best and worst spots.
Precautions really workable might be furnished the Associated Press.
In short, system and science might be put at the service of the local
health officer, of the traveler, and even of the housewife.
The Library of Congress now furnishes cards in duplicate to a large
number of centers, thus saving time to the investigator and giving
information often not otherwise obtainable.
The Farmers' Bulletins of the Department of Agriculture are also most
valuable to the people who are in search of help. Such agencies might
be extended without fear of trespass on any existing agencies.
Just as the individual, if he is to do and be his best, accepts his
limitations, obeys Nature's law, and thrives in body and estate in
consequence, and as the community banding together makes and carries
out with penalties for deviation certain regulations for mutual
benefit, so must the still larger groups--the state and the
nation--use their larger wisdom and wider knowledge for the benefit of
all. The individual should recognize the value to himself of this more
complete investigation, and instead of raising the cry of paternalism
and national interference, should welcome all aids to increased
efficiency.
State hygiene is necessary to supplement municipal hygiene. Often the
rural district has no other hygiene, and the city and the country are
interdependent, the city dependent upon the country for its water,
milk, and other supplies.
Almost all the states are alive to the importance of milk inspection.
As early as 1869 in Massachusetts, Dr. Bowditch called the Board of
Health "The State Medicine," and quotes from Dr. Farr: "How out of the
_existing_ seed to raise races of men to divine perfection is the
final problem of public medicine." That is the function of all boards
of health. If factories are incorporated under state laws, they must
also be governed by the state regulations for health.
Here in America we are always locking the stable door after the horse
has been stolen. Not until many "accidents" had occurred in the use of
antitoxins did Congress pass an act (1902) regulating the manufacture
and interstate sale of the viruses, serums, toxins, etc. The
supervision and control were vested in the Secretary of the Treasury
through the Public Health and Marine Hospital Service. Previous to
April 1, 1905, there was no official standard for measuring the
strength of diphtheria antitoxin. Previous to October 25, 1907, there
were as many units or standards for tetanus antitoxin as there were
producers. One was labeled "6,000,000 units per c.c." and another
"0.75 unit per c.c.," while, according to official standard, the first
had only 90 and the latter 770.
The point to be made is that however faulty an official or Federal
standard for sanitary devices may be, it is a standard, and so is of
service in protecting the people, especially those away from active
centers of research.