President Calvin Coolidge, in address the American Medical Association at its annual session in 1927 on May 17th of that year, spoke these words:
Ladies and Gentlemen:
America has so many elements of greatness that it is difficult to decide which is the most important. It is probable that a careful consideration would reveal that the progress of civilization is so much a matter of interdependence that we could not dispense with any of them without great sacrifice. But those who have witnessed the general paralysis which prevails when even a moderate epidemic breaks out can not help but realize that one of the most important factors of our everyday existence is the public health, which has come to be dependent upon sanitation and the medical profession. We are constantly in receipt of the beneficial activities of these efforts in the disposition of waste, the water we drink, the food we eat, and even in the air we breathe. This great work is carried on partly through private initiative, partly through Government effort, partly by a combination of these two working in harmony with the science of chemistry, of engineering, and of applied medicine. In its main aspects it is preventive, but in a very large field it is remedial. Without this service our large centers of population would be overwhelmed and dissipated almost in a day and the modern organization of society would be altogether destroyed. The debt which we owe to the science of medicine is simply beyond computation or comprehension.
These benefits have almost all come to the world within a few generations. Pure science, as we understand the term, has a very recent origin. In fact, we do not go back but a short distance to find the first modern comprehension of the difference between sound thought and visionary speculation. Since that day we have come to what is known as the scientific age. Almost all over the world men are making observations, collecting accurate information, comparing ascertained facts, and working toward established conclusions. Although great progress has been made and certain fundamental rules have become well established, we can not yet estimate the development of scientific research as much more than begun. But great effort is being put out all around us and a constant advancement of knowledge is in progress. This has been especially true in the science of medicine. Many of the diseases which laid a heavy toll on life have been entirely eradicated and many others have been greatly circumscribed. The average length of life has been much increased. But there is still an enormous economic loss in sickness, and the list of maladies for which no remedy is known is still large. How far the mind has an effect on the body is not yet accurately known. What mental reactions may be set up to preserve health or combat disease can not yet be stated.
If there is any one thing which the progress of science has taught us, it is the necessity of an open mind. Without this attitude very little advance could be made. Truth must always be able to demonstrate itself. But when it has been demonstrated, in whatsoever direction it may lead, it ought to be followed. The remarkable ability of America to adopt this policy has been one of the leading factors in its rise to power. When a principle has been demonstrated, the American people have not hesitated to adopt it and put it into practice. Being free from the unwarranted impediments of custom and caste, we have been able to accept whole-heartedly the results of research and investigation and the benefits of discovery and invention.
This policy has been the practical working out of the applied theory of efficiency in life. We have opened our mines and assembled coal and iron with which we have wrought wonderful machinery, we have harnessed our water power, we have directed invention to agriculture, the result of which has been to put more power at the disposal of the individual, eliminating waste and increasing production. It has all been a coordination of effort, which has raised the whole standard of life.
In the development of this general policy the science of medicine has had its part to play. No tendencies in recent history have been more outstanding than those toward conservation and cooperation, both in public and in private activities. For years the value of conservation of our material resources – forests, mineral deposits, water power, animal life – has been generally recognized. Movements have been started to cut down waste and unnecessary destruction in business and industrial operations. We are practicing economy in our governmental affairs. But the conservation of human health and life is one of the greatest achievements in the advance of civilization, both socially and economically.
What an incalculable loss to the world may have been the premature blotting out of a single brilliant creative mind which might have been saved through modern healing or preventive measures. Efficiency experts translate into dollars and cents what disease and the resulting loss of manpower mean. Directly, disease costs heavily. Indirectly, its results are even more costly. In the days before medical men robbed them of their terrors, a single case of yellow fever or cholera reported in New York Harbor caused such panic as seriously to interfere with business. Now such sporadic cases would scarcely cause public comment. Industry now figures what disease and temporary disability of employees, from the highest to the lowest, means on the yearly balance sheet. It is not uncommon for a corporation to take out an insurance policy for its own benefit on the life of an executive. Thus it attempts to neutralize the monetary loss it presumably might suffer through being deprived of his service.
Factory buildings now are equipped with modern sanitary and hygienic devices. Large industrial establishments employ not only doctors but nurses to care for their employees. Industry has found all of this not only a social but a financial benefit. The cost of such improvements has been returned many times in the amount of productive labor saved. Life insurance companies have health clinics and distribute hygienic literature. Several have sanatoriums for the treatment of their policy-holders.
There is no finer page in the history of civilization than that which records the advance in medical science. The heroism of those who have worked with deadly germs and permitted themselves to be inoculated with disease, to the end that countless thousands might be saved, was less spectacular but no less far-reaching than that on the battle field or of an isolated rescue from a burning building or a sinking ship.
In the early part of the nineteenth century there were only three medical schools in the United States and two general hospitals. Since then progress has been marked. Writing in 1920, William Osler said the average working life of English-speaking men had been doubled within three centuries. Most of that gain has been made in the past half century. The development of preventive medicine has been one of the outstanding features of that period. Whereas in the old days the doctor healed, if he could, those who had become afflicted, the greatest stress to-day is laid upon keeping the body sound and efficient. Proper methods of living are taught and suitable diets are prescribed. Hygienic conditions for the home, the workshop, and the factory have been adopted. Periodic physical examinations are urged in order that disease may be turned back before it has become seriously developed.
In all this work our Governments – National, State, and local – have recognized that the preservation of health and the conservation of life are in part public functions. Health boards have been established, hospitals built and maintained, public nurses employed, and hygiene taught in the schools. The Public Health Service of the Federal Government has taken a leading part in combating diseases and in sanitary education. No more striking achievement was ever accomplished than by Doctor Gorgas, of the United States Army, in cleaning up the Panama Canal Zone. Under French control, the death rate in that area was 240 per thousand. In 1913 it had dropped to 8.35 per thousand. Without this work the construction and operation of the canal would have been impossible.
Universities and colleges, and even secondary schools, have their resident doctors and infirmaries. Not a few individuals, who can afford such health assurance, retain physicians to look after them the year around. Only recently the movement for prevention, or relief in the early stages, has been extended to mental diseases. Cities are establishing mental clinics, and many educational institutions have departments for studying and alleviating mental distress which so frequently leads to serious consequences for the student.
Cooperation and tolerance, which have been developed so widely in industry and social relations, are now found in a marked degree in the medical profession. The work being done by the American Medical Association is a striking illustration of this. In years gone by physicians were apt to be suspicious and intolerant of other schools and of other methods of treatment. There has been a great change. The modern broad-minded physician is willing to use or to recommend whatever methods seem best suited to the case in hand. Furthermore, he is the strongest advocate of prevention. He it is who is taking the lead in the development of everything which promises to promote health and to reduce sickness to the minimum, even though its tendencies are to diminish the practice upon which he relies for his income.
All of these accomplishments are distinctly in the line of conservation through social service. The society of this country has become so well organized, its charities have become so broad and inclusive, that the great body of our population is able to secure adequate medical attention. This is true to a remarkable degree of all our great centers of population, and it is only in remote quarters that such service can not be provided. Our larger cities support free dispensaries, our hospitals have provision for free service, and of all the professions, with the possible exception of the ministry, our physicians give most unsparingly of their time and their skill for the alleviation of human suffering. Our governmental agencies, our organized charities, and our private benefactors are all giving generous support to this most important purpose.
This is an enormous contribution that has been made to human welfare. It is one of the undeniable evidences of the soundness and success of American institutions. The fact that our attainments and our blessings have become common is no reason why they should be ignored. Constructive criticism is always proper and ought to be helpful. Mere fault finding has no value except to reveal the poverty of the intellect which constantly engages in it. Our country, our Government, our state of society, are a long way from being perfect, but the fact that our structure is not complete is no reason for refusing to assess at their proper value the usefulness and the beauty of those parts which are nearing completion, or withholding our approval from the general plan of construction and neglecting to join in the common effort to carry on the work.
The human race is by no means young. It has reached a state of maturity. It is the inheritor of a very wide experience. It has located a great many fixed stars in the firmament of truth. No doubt a multitude of others await the revelation of a more extended research. But because we realize that we have not yet located them all is no reason for doubting the existence of those already observed or disregarding the records which reveal their position. To engage in such a course would lead to nothing but disaster. One of the difficulties in the world is not that we are lacking in sufficient knowledge, but that we are unwilling to live in accordance with the knowledge which we have. Approbation of the Ten Commandments is almost universal. The principles they declare are sanctioned by the common consent of mankind. We do not lack in knowledge of them. We lack in ability to live by them.
Somewhere in human nature there is still a structural weakness. We do not do as well as we know. We make many constitutions, we enact many laws, laying out a course of action and providing a method of relationship one with another which are theoretically above criticism, but they do not come into full observance and effect. Society is still afflicted with crime, and among the nations there are still wars and rumors of wars. In spite of all our progress and all our success, no one doubts that much yet remains to be done.
What part the physician will play in the further advancement of the well-being of the world is an interesting speculation. It is a well-known proverb that “Cleanliness is next to godliness.” No one can doubt that if humanity could be brought to a state of physical well-being, many of our social problems would disappear. If we could effectively rid our systems of poison, not only would our bodily vigor be strengthened, but our vision would be clearer, our judgment more accurate, and our moral power increased. We should come to a more perfect appreciation of the truth. It is to your profession in its broadest sense, untrammeled by the contentions of different schools, that the world may look for large contributions toward its regeneration, physically, mentally, and spiritually, when not force but reason will hold universal sway. As human beings gain in individual perfection, so the world will gain in social perfection, and we may hope to come into an era of right living and right thinking, of good will, and of peace, in accordance with the teachings of the Great Physician.
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