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Page 58
It is very difficult to say, but it seems as though there is an
increasing unevenness in the distribution of wealth, an increase in
the number of persons who live at the expense of the laboring class.
Mass labor, effective though it be, makes it easier to divert the
proceeds of labor from the laborers. The evidence of this is seen in
the increase in number and the prosperity of those pursuits which
purvey to luxury, as the automobile industry and the florists' trade
and the greatly increased scope and activity of the social game. On
the other hand, there is an increase in the number of people who are
to a greater or less extent dependent upon extraneous aid, evinced
among other ways by the increase in the asylum populations. Both these
conditions, wealth and poverty, are important disease factors.
Tuberculosis is now a disease of the proletariat chiefly. The measures
both of prevention and cure can be and are carried out by the
well-to-do, but the disease must remain where there are the conditions
of the slums. Of all the conditions favoring infant mortality poverty
comes first. In Erfurt, a small city of Germany, of one thousand
infants born in each of the different classes, there died of the
illegitimate children three hundren and fifty-two; of those of the
laboring class, three hundred and five; of those in the medium station
(official class largely), one hundred and seventy-three; of those in
higher station, eighty-nine. The same relation of infant mortality to
poverty becomes apparent when estimated in other ways. In Berlin, with
an average infant mortality of one hundred and ninety-six per
thousand, the deaths in the best districts of the city were fifty-two
and in the poorer quarters four hundred and twenty. The effect of
poverty is seen particularly in the bottle-fed infants; with natural
nursing the child of poverty has almost as good a chance as the child
of wealth. From reasons which are almost self-evident, the mortality
in illegitimate infants is almost double that of the legitimate. The
greater infant mortality in poverty is due to the more numerous
children preventing individual care, the separation of the mother from
the nursing child in consequence of the demand made upon her earning
capacity, and the decline in breast nursing. Wealth is on the whole
more advantageous from the narrow point of view of disease than is
poverty, but if we regard its influence on the race its advantages are
not so evident. Nothing can be worse for a race than that it should
die out, and wealthy families have never reproduced themselves.
Conditions always tending to destruction are a necessary part of the
environment of poverty; wealth voluntarily creates these conditions,
and chiefly by the pernicious influence of its amusements on the
young.
A new and in many respects a nobler conception of medicine has been
developed. Formerly medical practice was almost exclusively a personal
service to the sick individual, and measures looking toward the
general relief of disease and its prevention received scanty
consideration. The idea of a wider service to the city, to the state,
to the nation, to humanity rather than the personal service to the
individual, is becoming dominant in medicine. This is seen in the
establishment of laboratories by boards of health in cities and states
in which knowledge obtained by exact investigations can be made of
direct service to the people; in the medical inspection of schools and
factories; in promulgating laws directed against conditions which
affect health, in the extension of hospitals, and in divers other
ways. The idea of public service and of returning to the people in an
effective way some of the results of their labor also underlies the
large donations which have been given for the creation of special
laboratories and institutes in which, through research, greater
knowledge of disease may be obtained and made available. The
researches which have been made on the nutrition of man and the
nutritive value of different foods are of great importance, and this
knowledge has not yet begun to be applied as it should be.
There seems to be a balance maintained between the restriction of
disease by prevention and the increased influence of social conditions
which are in themselves factors of disease. Preventive medicine seems
to have made possible, by restricting their harmful influence, the
increase in industrialism, in urban life, and in the
intercommunications of peoples. The most important aid in the future
to the influence of preventive medicine must be the education of the
people so that the conditions of disease, the intrinsic and the
extrinsic causes and the manner in which these act, shall all become a
part of general knowledge, and the sympathy of the people with health
legislation and their active assistance in carrying out measures of
prevention may be obtained. The effect of social conditions on disease
must become more generally recognized.
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