THE OBSTACLES TO AND IDEALS OF HEALTH PROGRESS[15]
There are two ways in which Health Problems can be approached: what
may be called the microscopic method, which examines in minute detail
each individual problem; and the conspective method, in which an
attempt is made to obtain an unbiased and comparative view of the
chief problems concerned, in order that their relative importance may
be assessed, and the possibilities of improvement may be gauged. In
proposing to myself the latter and more difficult task, I appreciate
the impossibility of discussing all the items which emerge.
I would not have us forget what has already been achieved. Taking
the national figures for England and Wales as an illustration, it
is noteworthy that the death-rate from all causes fell from 22.4
per 1,000 of population in 1846-50 to 13.8 in 1911-15, a reduction
of nearly 40 per cent. Comparing the decennium 1871-80 with the
quinquennium 1911-15, the incidence of reduction of death-rate at
different ages was as follows:
_Percentage reduction in death-rate_
Age
0-5 42
5-10 48
10-15 43
15-20 46
20-25 51
25-35 50
35-45 42
45-55 25
55-65 15
65-75 10
75-85 7
85 and upwards 15
The survey is saddened by the terrible losses of War, and the even
more devastating ravages of influenza; and we realize our inadequacy
to prevent catarrhal infections, until further research into
preventive possibilities proves successful, and until the standard
of universal conduct for catarrhal affections becomes much higher
than at present. We realize furthermore that probably at least half
the deaths from all causes which occur could be postponed until old
age. But the standard of health of the general population has greatly
improved; typhus has practically disappeared under peace conditions;
yellow fever approaches its demise; malaria and typhoid are
controllable; tuberculosis and venereal diseases are only waiting for
systematic, complete, and continuous measures to secure their rapid
decline or actual disappearance; the mortality from childbearing and
of young children has greatly declined; and this is an incomplete
statement of what has already been done.
_Obstacles_
This improvement is all the more remarkable in view of the additional
obstacles imposed to health improvement by modern conditions of urban
and industrial life.
_Urbanization_
The population during the last century has steadily flocked to the
towns from country districts. Streets have taken the place of green
fields; rows of unsatisfactory dwellings have replaced country
cottages; we have dust and belching smoke and noise instead of
sunshine and country air and quiet; bustle and turmoil instead of
life in close touch with mother-earth: and this change has been
associated with an almost unlimited inter-communication of human
beings, and a corresponding increase in opportunities for the
convection of germs of disease.
Until the time of the industrial revolution in England modes of
locomotion were little if any more advanced than among the ancient
Egyptians; and disease, when it travelled at all, travelled by slow
and deliberate stages. Now the infections of the entire world may be
sampled in any one district in the course of a few weeks. Man has, in
fact, reverted from the land-tied condition involved in agriculture
to the migratory habits of an earlier period of man’s life on the
earth. As Wells has put it: “in every locality ... countless people
are delocalised,” and it is not the least evil of urbanization that,
in consequence of this, the administration of local affairs falls
too often “into the hands of that dwindling moiety which sits tight
in one place from the cradle to the grave,” or of persons who have a
financial axe to grind.
The difficulties of water supply, of scavenging, and of drainage,
until they were overcome, have made towns the inevitable destroyers
of mankind. The conditions of housing are worse in towns than in
country districts, higher rents and less ground space implying that
each family on an average lives in fewer and more crowded rooms than
in rural districts.
Furthermore, in towns there is greater difficulty in securing
satisfactory arrangements for the storage of food, especially milk,
and in obtaining fresh milk and vegetables; and there is the serious
disadvantage, especially for children, that their playgrounds are in
streets instead of the fields, and that the possibilities of deriving
infection from dried expectoration and from fæcal or other organic
contamination in yards and backstreets as well as directly from other
children or adults are multiplied manifold.
Even more important, town life for the father of a family generally
means an indoor and often a dusty indoor occupation; the mother
not infrequently is also industrially employed; and these adverse
circumstances, so far as they are allowed to continue, now affect
three-fourths of the population of England and Wales and probably
one-half of that of the United States.
And yet the death-rate from all causes, and especially from
communicable diseases is steadily declining, to an even greater
extent in urban than in rural communities.
It is but fair to add that the differences between urban and rural
populations tend to decrease; at least this is so in England;
probably the same is true to a less extent in America. The nominally
rural population is becoming more and more urban in character, and
composed not solely of rustics,—who live in and by the soil and are
altogether more natural in their habits,—but largely of town-dwellers
who only sleep in country dormitories. But this makes it all the more
remarkable that notwithstanding the multitudinous circumstances which
have tended to increase disease, the death-rate has been lowered to
an amount already indicated, and life has been prolonged to an extent
which has secured an increase in its average expectation of 10 or 11
years within the last thirty years.
_Industrialism_
Considerations of time render it impracticable to discuss in this
address the mischievous influence of modern industrialism on national
health. This influence runs collaterally with that of urbanization;
and in it in the past can be seen the evil results of overwork, of
dust inhalation, of chemical poisoning, of industrial infections
including tuberculosis, and of the general depressing effect of
protracted monotonous work. The evils of industrialism like those of
urbanization are happily being in a large measure counteracted.
_Poverty_
The problems of industrialism in relation to health cannot be
adequately discussed apart from a consideration of the remuneration
for work, which necessarily depends on the power of the worker to
strike a satisfactory bargain with his employer, and the extent to
which he can ensure regular employment. If these conditions cannot
be fulfilled, or if the breadwinner is dead or disabled, poverty
results, using this word here in the sense of inability to provide
for the personal and family essentials of health. And here we are at
once faced with the problem of relation of population to means of
subsistence. Malthus in 1798 advanced the pessimistic hypothesis that
poverty is the inevitable result of increase of population, which
entitles him to be characterised as the Schopenhauer of Political
Economy, as Schopenhauer was the Malthus of Philosophy. Without
attempting detailed discussion of Malthus’s hypothesis, it is clear
that the wealth of the population depends upon
1. The amount of food produced,
2. The amount of materials produced,
3. The efficiency in preparation of these materials, and
4. Convenience of transport.
In all these particulars means of subsistence, considered
internationally, have during the last century grown more rapidly
than population; and now, whether we like it or not, a new
element has entered into the problem in this and several other
countries,—voluntary control of births,—necessitating the estimation
of future growth of population on a radically different basis from
that of the past, and banishing the fear of poverty as the result of
too large a population.
It may even become necessary to adopt some method of national
remission of taxation or subsidisation of wages in accordance with
size of the family, not only in France, but hereafter in England, if
in England, as already in France, the voluntary control of births is
practised to an extent resulting in a stationary or even a decreasing
population. In America the possible need for such action will not
arise for several generations, during which, however, unless the
present trend of events is changed, Roman Catholics appear likely
largely to replace Protestants, and the Slavonic and Irish to
preponderate over the Anglo-Saxon elements of the population. It is
possible, of course, that in another generation the Roman Catholic
Church may not be able to continue its ban on birth-control, and that
the more “backward” (?) races will adopt similar devices, including
even the Japanese and the Chinese.
_The Malthusian Hypothesis_
(_a_) The Malthusian hypothesis has been held to justify _the laissez
faire, laissez aller_ policy which held the industrial world in its
malignant grip during the latter part of the eighteenth and the
earlier part of the nineteenth century, and from which we are not yet
completely freed. Workers were exploited and reduced to a position
of modified slavery; and this was assumed by clergy and political
economists alike to be part of the ordered course of life. This
doctrine was made to support the belief that God had ordained the
poor man’s lot, with its attendant misery and hopelessness.
On page 438 of the sixth edition of his book Malthus says:
that the principal and most permanent cause of poverty has little or
no direct relation to forms of government, or the unequal division
of property; and that, as the rich do not in reality possess the
power of finding employment and maintenance for the poor, the poor
cannot in the nature of things, possess the right to demand them,
are important truths flowing from the principle of population.
In the first edition of his book a more extreme, plainer statement
of the position, as assumed by Malthus, was given, but was omitted
from later editions (the extract is translated by Beale from a French
edition):
A man born into the world already occupied, if his family can no
longer keep him, or if society cannot utilise his work, has not the
least right whatever to claim any share of food, and he is already
one too many upon the earth. At the great banquet of Nature there is
no cover laid for him. Nature commands him to go and she is not long
in putting this order herself into execution.
Malthus supplied the clue which helped to start Darwin on his
epoch-making investigations; and to the present day there are men who
do not appreciate that the mutual aid which is fundamental in human
society is an enemy to the continued operation of natural selection,
and that we cannot revert to natural selection without destroying the
characteristic work of civilization. To think otherwise is the secret
behind German aggression; to act otherwise is to revert to barbarism.
Man has definitely replaced natural by rational selection, and will,
I have no doubt, to a steadily increasing extent replace competition
by coöperation.
(_b_) The Malthusian hypothesis and the policy based on it ignored
the human element in industry. Happily revolt against the strict
application of the _laissez faire_ policy set in soon after
urbanization and industrialism (under the then conditions) began
their maleficient work, first in regard to children, then for women,
and latterly more general in character.
Nothing is more conspicuous in recent years than the growth of
sensibility on the subject of economic evils, especially as to the
conditions of industry. Economic efficiency, as a sole object,
appeared to preclude regard to morality of method, and the result
has been poverty for the masses of mankind. If this is to cease,
satisfactory minimum standards of comfort and welfare for the entire
population must be accepted, which will form a first charge on
industry. This can only be hoped for when there is complete practical
acceptance of the fact that “we are members one of another,” and
servitude is completely replaced by the ideal of mutual service.
(_c_) The Malthusian hypothesis ignores the great though paradoxical
truth, that although under circumstances permitting malnutrition and
defective training, large families spell poverty, especially when
population is not distributed where it is needed, the real wealth of
the world after all depends on man himself. Nature gives him little
that he can use in the form in which he finds it. It is by him and by
him alone that “wealth” is created by converting useless into useful
matter.
It appears to me clear that over-population need not excite
apprehension; that population in itself is the only means by which
national wealth can materialise; and that our chief aim in securing
national efficiency must be to train each unit of the population
adequately for work, and to prevent the terrible loss of efficiency
due to avoidable sickness.
And this brings me to the direct statement of the truism that health
progress can only be secured by preventing preventible illness.
Poverty and disease are allied in the closest relationship; and
while it is true that the removal of poverty would effect a great
improvement in national health, it is even truer that the prevention
of illness forms the most important means for the avoidance of
poverty.
In various reports it has recently been shown that in a number of
districts an inverse correlation exists between infant mortality and
the amount of the family income; the implication appearing to be that
increase of the lower income is the best and perhaps the only method
for obviating excessive loss of infantile life.
In such an argument poverty evidently is considered as an element,
instead of as a highly complex phenomenon needing to be further
analyzed into its constituent parts. In the instance quoted, the
fact that the correlation between poverty and high infant mortality
is not essential can be shown by examples of low infant mortality
in communities in which poverty is the rule; by examples of high
infant mortality in which wages are high; and by other examples of
communities in which high infant mortality has been lowered without
any change in economic conditions.
The social conscience cannot be satisfied until every family has
an income sufficing for all its essential needs; but there are
possibilities of successful attack on infant mortality which can
be pursued when economic change is not within reach, and when such
economic change would not obviate the need for further measures.
Among such measures may be mentioned the abolition of alcoholism, the
provision of a pure and adequate milk-supply, increased attention to
domestic and municipal sanitation, health teaching by public health
nurses, and prompt and adequate medical and nursing assistance when
required.
_Ignorance_
It may have surprised you that I have not placed ignorance in the
forefront, before industrialism, urbanization, and poverty, as the
chief enemy of personal and public health. I have no hesitation in
making the statement that although there is need for large additions
to present educational work in hygiene, the utilisation of existing
knowledge by those holding responsible positions is even more
important. Is it not true that it is easier to promote educational
“drives” for any single branch of health education, than to obtain
money for the actual execution of health work?
Let us look more critically at educational work in hygiene. Whose
ignorance is it proposed to enlighten? Ignorance is common to
all classes, and it is fundamentally important that systematic
instruction in physiology and hygiene should be given in all our
schools; and that especially every teacher should have adequate
training in these subjects, and in the recognition of the common
mental and physical defects of children. If a course of instruction
were given for all, approaching that which is given for public
health nurses at Yale University, how much more hopeful would be the
prospect of public health progress, both in New and Old England.
But this does not cover the entire needs of the case. Consider, for
instance, the relation of maternal ignorance to excessive child
mortality.
Maternal ignorance is sometimes regarded as a chief factor in the
causation of excessive child mortality. It is a comfortable doctrine
for the well-to-do person to adopt; and it goes far to relieve his
conscience in the contemplation of excessive suffering and mortality
among the poor.
This doctrine has found favour in occasional official reports and
in miscellaneous addresses. It embodies an aspect of truth, but it
is mischievous when it implies, as it sometimes does, that what is
chiefly required is the distribution of leaflets of advice, or the
giving of theoretical instruction as to matters of personal hygiene.
There is little reason to believe that the average ignorance in
matters of health of the working-class mother is much greater than
that of mothers in other classes of society. Furthermore, it would
appear that working-class mothers give their infants the supremely
important initial start of breast feeding in a larger proportion of
cases than do the mothers in other stations of life.
The mothers in both classes may be ignorant; in both there is
deficient training in habits of observation, especially in regard
to the beginnings of illness; but the mother in comfortable
circumstances is able to ensure for her infant certain advantages
which the infant of the poorer mother often cannot obtain. What are
these?
1. The well-to-do mother is commonly able to devote herself to her
infant and have assistance in this duty; the working class mother is
single-handed, and has also to perform, unaided, all the duties of
her household, including the washing and cooking for her husband and
herself and possibly for several children.
2. The well-to-do mother is commonly able to ensure that the milk
for her infant is purchased under the best circumstances, is stored
in a satisfactory pantry, and is prepared under cleanly conditions.
The working-class mother often is supplied with stale, impoverished
milk, may have no pantry, and, except when suckling her infant, is
handicapped at every stage in the cleanly preparation of her infant’s
food.
3. If the well-to-do mother is ill, adequate medical and nursing
assistance is at once available, and the child’s welfare can be
safeguarded; if the working-class mother is ill, the child usually
must suffer with its mother.
4. If the child of the well-to-do mother falls ill, everything
that good nursing and medical attendance can furnish is commonly
at once available; for the child of the working-class mother the
state of matters is remote from the ideal. Facilities for obtaining
medical attendance and nursing vary greatly in different districts;
but in none are they satisfactory for the poor, and especially for
the classes who have limited incomes, but do not as a rule receive
skilled hospital treatment, or avail themselves of help from nursing
associations. Prompt medical assistance at home commonly cannot be
afforded for children of wage-earners, and particularly not for the
children of unskilled workers.
5. Infants and nursing mothers are very rapidly influenced by their
environment. This environment is complex. The mother is the main
element in the environment of the infant. If she is overworked and
suffers from chronic fatigue her infant must suffer; directly,
because the mother’s milk under these circumstances is liable to be
scanty or impoverished or otherwise unwholesome; or indirectly, owing
to her being unable to give sufficient attention to her infant. The
infant of the well-to-do mother is less likely to suffer in either of
these ways.
6. Not only are the milk supply, and the storage and preparation
of artificial food, important parts of the environment of the
infant, but so also are the housing conditions of the family, and
the sanitary conditions of the back-yard and of the street in which
the house is situate. The superiority of the circumstances of the
one mother and infant over those of the other in these respects is
obvious.
There is no reason to assume that the one mother is more ignorant
than the other. But the ignorance of the working-class mother
is dangerous, because it is associated with relative social
helplessness. To remedy this what is needed is that the environment
of the infant of the poor shall be levelled up towards that of
the infant of the well-to-do, and that medical advice and nursing
assistance shall be made available for the poor as promptly as it is
for persons of higher social status.
The assistance given will include advice, but it will be the advice
which a medical practitioner gives to his patient; which a health
visitor or public health nurse gives as to personal hygiene; and
which a sanitary inspector gives to a householder. It should include
also the advice given by a trained midwife or midwifery nurse, who is
in a favourable position to secure the adoption of her advice by the
mother. Such advice is becoming available to a steadily increasing
extent, but in some industrial towns a majority of midwives and
midwifery nurses are still untrained women, who are not competent to
give the best advice.
I would not have it assumed that I do not attach high values to the
teaching which the physician gives to his patient and the public
health nurse to the healthy mother and infant; but unless this is
combined with assistance to provide the necessary means to health,
whether this be hospital treatment, home nursing, pure milk, improved
domestic conditions, or help to the over-tired mother, the advice
falls far short of its potentialities for good.
There is need for further instruction of the public in all branches
of hygiene; and we need, if we are to be efficient in social work,
to follow the advice of Oliver Wendell Holmes, to remove the
intellectual _membrana nictitans_ from our eyes, and to consider the
physical and moral as well as the intellectual obstacles to health.
In the cultivation of communal health
_Defects of Character_
are even more pernicious than lack of knowledge. No member of any
of our local authorities can fail to have been warned that typhoid
fever is still being spread in many communities by impure water, and
as the result of inadequate hospital isolation of cases. The means
of prevention of tuberculosis are well known; but how few local
authorities will face the problem of supplying adequate funds for
clinics, for examination of contacts, for hospitals for bed-ridden
cases, and for convalescent homes; and how few are willing to give
help to ensure that the consumptive patient has a separate bedroom?
In how few instances are the regulations against indiscriminate
expectoration enforced, and how seldom are physicians called to
account for not obeying the law as to prompt notification of cases of
tuberculosis? Will all the “drives” against tuberculosis effectually
remedy this condition of things? Would not public opinion amply
support _the one “drive” which, above all others, is necessary_: a
systematized effort on the part of all social workers to exact a
definite promise from every candidate for local or state office that
he will give earnest support to all well-considered anti-tuberculosis
measures, for the diminution of venereal diseases, for improving the
welfare of mothers and their children, for promoting school hygiene,
and for improving the housing of the poor. Democratic Government,
alas! hitherto, has meant government by active minorities. The great
danger of democracy is that the minority may and often does consist
largely of persons having a mercenary interest in the machinery of
local government. Why should not it become an active and preponderant
minority of health gospellers? This will involve the taking of
infinite trouble to overcome the multiform activities associated
with “political pull”; it will involve the watching of the record
of each elected person, merciless exposure of those who do not
whole-heartedly support reforms, and systematic effort to prevent
the reëlection of all whose record proves unsatisfactory. Are we
equal to this task? Is our national and local patriotism equal to
this heroic test, involving most prosaic work, the surveillance and
the “besting” of the politician? If not, our indirect attack on the
enemy by means of special educational drives can have relatively
little effect. Where the enemy is, there our fight should be; and
the chief enemies of health are local authorities possessing powers
to secure health for the community, who corruptly or parsimoniously
refrain from their duty. Nor can we avoid responsibility, or the
need for strenuous effort after efficiency by not taking part in
official or voluntary administrative work. We may have sufficiently
good reasons for this abstinence; and onlookers have their rôle in
life. If all were authors, where would be the readers? There are many
indifferent writers who would be appreciative readers, and the same
remark applies in local administration. Appreciation is necessary as
well as a subject to be appreciated; and the onlooker at social work
may be most helpful. If he is to be helpful he must be kindly and
charitable, as well as watchful. Rancorous and ill-informed criticism
must be avoided, and the onlooker must be ready to do justice to good
work, or attempted good work. Nothing has made it so difficult to
secure good men to undertake the burden of local government as the
undiscriminating and uncharitable criticism aimed at those engaged
in it. Criticism of representatives has often been deserved; but
critics are too often those who will not aid to the slightest extent
in the work which, often without sufficient knowledge of the facts,
they vilify. When we read of administrative scandals, it is desirable
to have a sense of proportion, and to remember, as the reader of old
records or even of Pepys’ diary will scarcely need to be reminded,
that corruption was rampant in the past, and especially to remember
that the best way to remove that most subtle and mischievous form of
corruption which consists in giving and accepting appointments as
political rewards, is by ourselves taking a part in local government,
or by steadily upholding those who are doing so with integrity.
The onlooker, then, has his duty to perform as well as the
administrator. He cannot do his duty unless he intelligently studies
local administration, even though he takes no part in it. A chief
need is this interested study of the phases of local administration
by the general inhabitants of each district. Happily there are
indications of the increasing local patriotism which such study
implies. The exact knowledge thus acquired is the best means
of neutralising much of the ill-natured, because ill-informed,
criticism with which the founts of local administration are too often
fouled. A high moral ideal on the part of onlookers as well as of
administrators is needed if we are to secure that high standard of
social efficiency which is an indispensable condition of the further
triumphs of preventive medicine now waiting to be secured.
_Ideals_
In my discussion of the difficulties of health progress, I have
evidently encroached here and there on the second division of my lay
sermon. Let me now attempt to state more systematically some ideals
of health and means for their realisation.
Intelligent human society, permeated more than we realise by the
essentials of Christianity, has already gone far in securing
remedies, notwithstanding the too frequent other-worldliness or
lack of vision of those who should have been foremost in rebuilding
Jerusalem in this green and pleasant land. Industrialism no sooner
huddled together labourers and their families in the courts and
alleys of insanitary towns and overworked them for scanty wages, than
the voices of such philanthropists as Percival, Oastler, Shaftesbury,
Owen, and of many others were heard in favour of interference with
that freedom (!) of contract between workers and employers, which the
professors of the dismal science regarded as a fundamental principle
in political economy. And so gradually, too slowly, regulated
industry, improved sanitation, better housing, the isolation and
hospitalisation of infectious cases, the readier access than in rural
districts of all sick to skilled treatment, higher wages, better
food began to counteract the evils of industrialism and urbanization.
Communal action was taken in the regulation of industry, in the
promotion of sanitation, in providing elementary education; and the
result is seen in the remarkable fact that, notwithstanding its
enormous handicap, urban life has become almost as safe as rural
life, so far as life itself is concerned, though not in standard of
health.
The first lesson, then, which has already been partially learnt, is
that _no member of a community can live to himself_. We now believe
in the solidarity of society; that the sores of one section of it
means peril for all. And we are gradually learning to appreciate
that this is true not only in respect of the acute infectious
diseases, and of chronic infectious diseases, such as tuberculosis
and syphilis, but of every disease and of every other factor in life
which causes individual inefficiency, and which consequently inflicts
additional burdens on the competent section of the community. I do
not wish to underestimate the basic self-centredness, if not actual
selfishness, which, to a varying extent, is part of the nature of all
of us; but in industrial, as in other social problems, whatever may
be the intermediate turmoil and misunderstandings and disturbance
which appear to loom so threateningly, it is plain that the mere
cash nexus of relationship is becoming more and more entangled in
a moral nexus; and that a prophet’s vision is scarcely needed to
forecast a future of consolidation and conformity of efforts of
employers and employed such as has never yet been generally realised.
In such a consolidation the idea of servitude will disappear, and
mutual service will take its place. This will happen by the growth
of an idealistic standpoint; even more, perhaps through motives of
community self-defence.
Secondly, the Great War, though the most terrible calamity to
humanity of the ages, has brought out a most comforting and elevating
thought. _Our brothers and our sons_,—and our daughters also in a
multitude of munition and other works,—have proved that, under the
overwhelming moral compulsion of national need, they _are willing
and ready to lay down their lives for great impersonal things_, and
in their hundreds of thousands they have done so. Coincidently with
this, a great impetus has been given to work for the health and
welfare of the civilian population, and especially of mothers and
their children. The removable horrors and losses of peace, in the
aggregate, are greater than those of war. Cannot an equal spirit
of sacrifice be induced against these? Is it not possible to evoke
a like devotion to secure the triumph of good over evil, of clean
administration over political pull, of fair dealing over industrial
exploitation, of adequate output over “slacking,” of determination to
spend and be spent to secure the welfare of all, in peace as in war?
Thirdly, prior to the war, for years, many among us had been
realising to an increasing extent the supreme importance of the
Mother and the Child, in safeguarding family life, and in securing
the beginnings of personal and national health. In past years
medical officers of health have been busily occupied in struggling
to overcome epidemic diseases, and in attacking the circumstances
favouring their prevalence. But for twenty years, at least, the
outlook has widened; the physiological as well as the pathological
aspects of hygiene have received attention; and it has been realised,
more and more, that in the conservation and upbuilding of the health
of the infant and the pre-school child rests the chief hope of the
future; and somewhat more recently, public health policy has directed
itself to the protection of motherhood, on which depends essentially
the welfare of the child.
This can only be done by ensuring, chiefly through its mother, _for
every newcomer on the stage of life, in all essential points, a
footing of equality of opportunity, physical, mental, and moral, with
all others_.
The ideal that every child should have equality of opportunity is
really part of a general upward movement in our national ethical life.
The thoughts of men are widened with the process of the suns.
We begin to appreciate the full significance of the older words,
“it is not the will of your Father that one of these little ones
should perish”; and this ideal happily is now certain to replace the
materialistic doctrine of the German type which drives the weaker to
the wall.
Progress has been slow; but when we recall how true it was in St.
Paul’s day that “the whole creation groaneth and travaileth in pain
together until now”; and how gradually through the ages the mass of
human suffering has been abated, we can, while regretting the slow
rate of progress, gain encouragement for more rapid future advance.
The abolition of slavery, the higher position of women, the steadily
increasing force leading towards one standard of sexual morality
for both sexes, the improved conditions of housing and sanitation
notwithstanding the impediments of urban life, and the increasingly
humanitarian conditions of modern industrialism, all give us reason
to lift up our hearts.
There have been three stages in the attitude of mankind to altruistic
work. The first of these is illustrated by the attitude of the
father who said to his son: “Learn, my son, to bear tranquilly
the calamities of others.” Is not the second stage, illustrated
by the sleeping disciples in the Garden of Gethsemane, ignorant
or regardless of the impending tragedy; while the third stage
is manifest in the thousands of earnest social workers,—and the
supremely important conscientious members of our governing bodies
come in this group,—who are endeavouring to secure the realisation
in communal practice of every measure for uplifting mankind.
It is well for mankind that the Mother and the Child have become the
foundation on which, more and more, we expect health progress to be
built.
A child more than all other gifts
That earth can offer to declining man
Brings hope with it and forward looking thoughts.
(Wordsworth.)
The history of the Mother and Child summarises the history of the
uplifting of mankind: and although there are not lacking sinister
elements in the present position, it is a great gain that both
in regard to the Mother and Child and to the saving of life and
improvement of national health generally, we are beginning to realise
that this is not merely a question of self-interest, personal or
national; but that we are concerned also with duty, and honour, and
chivalry.
FOOTNOTES:
[15] A lecture given to the Alumni Association of the University of
Yale, January 22, 1920.