Civics and Health
by William H. Allen
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The commission hoped "that the facts and opinions they have collected will have some effect in allaying the apprehensions of those who, as it appears, on insufficient grounds, have made up their minds that progressive deterioration is to be found among people generally." In regard to the facts which started the fear, the report says: (1) the evidence adduced in the director general's memorandum was inadequate to prove that physical deterioration had affected the classes referred to; (2) no sufficient material (statistical or other) is at present available to warrant any definite conclusions on the question of the physique of the people by comparison with data obtained in past times.

The topics dealt with in the report refer to only a partial list of conditions that need to be carefully studied before we can know what environment heredity we are preparing for those who follow us:


Training of mothers, provident societies and maternity funds, feeding of infants, milk supply, milk depots, sterilization and refrigeration of milk, effect of mother's employment upon infant mortality, still births, cookery, hygiene and domestic economy, public nurseries, creches.


Anthropometric measurements, sickness and open spaces, medical examination of school children, teeth, eyes, and ears, games and exercises for school children, open spaces and gymnastic apparatus, physical exercise for growing girls and growing boys, clubs and cadet corps, feeding of elementary school children, partial exemption from school, special schools for "retarded" children, special magistrate for juvenile cases, juvenile smoking, organization of existing agencies for the welfare of lads and girls, education, school attendance in rural districts, defective children.


Register of sickness, medical certificates as to causes of death, overcrowding, building and open spaces, register of owners of buildings, unsanitary and overcrowded house property, rural housing, workshops, coal mines, etc., medical inspection of factories, employment of women in factories, labor colonies, overfatigue, food and cooking, cooking grates, adulteration, smoke pollution, alcohol, syphilis, insanity.


Medical officers of health, local, district, and national boards, health associations.

Scientists of the next generation will continue to differ as to heredity truths and heredity bugaboos unless records are kept now, showing the physical condition of school children and of applicants for work certificates and for civil service and army positions. The British investigators declared that "anthropometric records are the only accredited tests available, and, if collected on a sufficient scale, they would constitute the supreme criterion of physical deterioration, or the reverse.... The school population and the classes coming under the administration of the Factory Acts offer ready material for the immediate application of such tests." In addition to the physical tests proposed in other chapters, there is great educational opportunity in the records of private and public hospitals. Every nation, every state, and every city should enlist all its educational and scientific forces to ascertain in what respects social efficiency is endangered by physical deficiencies that can be avoided only by restricting parenthood, and the environmental deficiencies that can be avoided by efficient health machinery.

The greatest of all heredity truths are these: (1) the deficiencies of infants are infinitesimal compared with the deficiencies of the world with which we surround them; (2) each of us can have a part in begetting for posterity an environment of health and of opportunity.



Wherever the Stars and Stripes fly over school buildings it is made compulsory to teach the evils of alcoholism. For nearly a generation the great majority of school children of the United States have been taught that alcohol, in however small quantities, is a poison and a menace to personal and national health and prosperity. Yet during this very period the per capita consumption of every kind of alcoholic beverage has increased. Whereas 16.49 gallons of spirituous liquors were consumed per capita of population in 1896, 22.27 gallons were used in 1906. Obviously the results of methods hitherto in vogue for combating alcoholism are disappointing.

Why this paradoxical relation of precept to practice? Why is this, the most hygiene-instructed country in the world, the Elysium of the patent-medicine and cocaine traffic? If we have only the expected divergence of achievement from ideal, then there is nothing for us to do but to congratulate ourselves and posterity upon the part played by compulsory legislation in committing all states and territories to hygiene instruction in all public schools. If, on the other hand, our disappointment is due to ineffective method, then the next step is to change our method.

The chief purpose of school hygiene has hitherto been not to promote personal and community health, but to lessen the use of alcohol and tobacco. Arguments were required against whisky, beer, cigars, and cigarettes. As the strongest arguments would probably make the most lasting impression upon the school child and the best profits for author and bookseller, writers vied with one another in the rhetoric and hyperbole of platform agitation. What effect would it have upon you if you were exhorted frequently during the next eight years to avoid tobacco because a mother once killed a child by washing its head in tobacco water? What is the effect on the mind of a boy or a girl who sees that the family doctor, the minister, the teacher, the judge, the governor, the President, and the philanthropist use tobacco and alcoholic beverages, when taught that "boys who use tobacco and alcoholic beverages will find closed in their faces the doors to strength, good health, skill in athletics, good scholarship, long life, best companions, many business positions, highest success"? It is probably true that "a boy once drank some whisky from a flask and died within a few hours." But that story is about as typical of boys and of whisky as that a boy once drank whisky from a flask and did not die for ninety years afterwards, or that George Washington drank whisky and became the Father of his Country.

How special pleading has dominated the teaching of school hygiene is illustrated by a recent book which, for the most part, successfully breaks away from the narrow point of view and the crude methods hitherto prevailing. It presents the following facts concerning New York City:

Saloons 10,821 Arrests 133,749 Expense of police department $10,199,206 Police courts, jails, workhouses, reformatories 1,310,411 Hospitals, asylums, and other charities 4,754,380

It is fair to the author to state that she does not declare in so many words that the shutting up of the saloons would obviate all the arrests and all the hospital, jail, and charity bills. Instead of wipe out she says shrivel. No truth would have been lost by avoiding all misrepresentation.

The author probably felt as I did when I took my total abstainer's protest to a celebrated scientist who had exposed certain misstatements regarding the effect of small quantities of alcohol: "Is not the untruth of these exaggerated statements less dangerous than the untruth of dispassionate, scientific statement? So long as the child mind takes in only an impression, is it not better to write this impression indelibly?" He sadly but indulgently replied, "And in what other studies would you substitute exaggeration for truth?"

The reaction has already begun against exaggeration in hygiene text-books, against drawing lessons from accidental or exceptional cases of excessive use of alcohol, against classing moderate drinking and smoking with drunkenness as sins of equal magnitude, and against overlooking grave social and industrial evils that threaten children far earlier and more frequently than do tobacco and alcohol. Instead of adding an ell to the truth, text-book writers are now adding only an inch or two at a time. No longer do we favor highly colored charts that picture in purple, green, and black the effect of stimulants and narcotics upon the heart and brain, the stomach, the liver, the knee, and the eardrum, assuming that all resultant evils are concentrated in one organ. Menacing habits, such as overeating and indulgence in self-pity, are beginning to receive attention. It is also true that physiology and anatomy are progressively made more interesting. Publishers are looking for the utmost originality compatible with the purpose of the present laws and with the only effective public sentiment that has hitherto been interested in the interpretation of those laws.

A score of improvements in the method of carrying out a small ideal will not take the place of enlarging that ideal. If existing laws stand in the way of broadening the purpose of school hygiene, let the laws be changed. If text-book publishers stand in the way, let us induce or compel them to get out of the way. If we fear rumsellers, their money, and the insidious political methods that they might employ to bring in undertruth if overtruth is once sacrificed, let us go to our communities and locate the rumseller's guns, draw their fire, tell the truth about their opposition, and educate the public to overcome it. If, on the other hand, misguided teetotalism stands in the way, then, as one teetotaler, I suggest that we prove, as we can, in our respective communities that there is a better way of inculcating habits of temperance and self-restraint than by telling untruths, overtruths, or half truths about alcohol and tobacco. Let us prove, as we can, that a subject vital to every individual, to every industry, and to every government is now prevented from fulfilling its mission not by its enemies but by its friends. We can learn the character of hygiene instruction in our schools and the interest taken in it by teachers, principals, and superintendents. We can learn how teachers practice hygiene at school, and how the children of our communities are affected by the hygiene instruction now given. Finally, we can compel a public discussion of the facts, and action in accordance with facts. Without questioning anybody's avowed motive, we can learn how big that motive is and how adequate or inadequate is the method of executing it.

Alcohol and tobacco really occupy but a very small share of the interest and attention of even those men and women by whom they are habitually used. Hygiene, on the other hand, is of constant, uninterrupted concern. Why, therefore, should it be planned to have alcohol and tobacco displace the broader subject of personal and public hygiene in the attention and interest of children throughout the school life? Beyond the text-book and schoolroom a thousand influences are at work to teach the social evils, the waste of energy, and the unhappiness that always accompany the excessive use—and frequently result from a moderate use—of stimulants and narcotics. Of the many reasons for not drinking and smoking, physiology gives those that least interest and impress the child. The secondary effects, rather than the immediate effects, are those that determine a child's action. Most of the direct physiological effects are, in the majority of instances, less serious in themselves than the effects of overeating, of combining milk with acids, of eating irregularly, of neglecting constipation. Were it not for the social and industrial consequences of drunkenness and nicotinism, it is doubtful if the most lurid picture of fatty degeneration, alcoholic consumption, hardened liver, inactive stomach lining, would outweigh the pleasing—and deceiving—sensations of alcoholic beverages and cigarettes.

The strong appeal to the child or man is the effect these habits have upon his mother, his employer, his wife, his children. The vast majority of us will avoid or stop using anything that makes us offensive to those with whom we are most intimately associated, and to those upon whom our professional and industrial promotion depends. Children will profit from drill in and out of school in the science of avoiding offense and of giving happiness, but unless the categories—acts that give offense and acts that give happiness—are wide enough to include the main acts committed in the normal relations of son, companion, employer, husband, father, and citizen, those who set out to avoid alcohol and tobacco find themselves ill equipped to carry the obligations of a temperate, law-abiding citizen.

Things do not happen as described in the early text-book. Other things not mentioned hinder progress and happiness. The child at work resents the mis-education received at school and suspects that he has been following false gods. The enemies that cause him trouble come from unexpected sources. He finds it infinitely easier to eschew alcohol and tobacco than to avoid living conditions that insidiously undermine his aversion to stimulants and narcotics. The reasons for avoiding stimulants in the interest of others are more numerous and more cogent than the reasons for avoiding stimulants and narcotics for one's own sake. The altruistic reasons for shunning stimulants and narcotics cannot be implanted in the child unless he sees the evil of excess per se in anything and everything, and unless he becomes thoroughly grounded in the life relations and health relations to which he must adapt himself.

Unclean streets, unclean milk, congested tenements, can do more harm than alcohol and tobacco, because they breed a physique that craves stimulants and drugs. Adenoids and defective vision will injure a larger proportion of the afflicted than will alcohol and tobacco, because they earlier and more certainly substitute discouragement for hope, handicap for equal chance. Failure to enforce health laws is a more serious menace to health and morals than drunkenness or tobacco cancer.

If it is true that we must attack the problem of alcohol from the standpoint of its social and industrial effects, we are forced at once to consider the machinery by which cities and governments control the manufacture and sale of alcohol. It is not an exaggeration to say that courses in regulating the traffic in alcohol are more necessary than courses in the effects of alcohol upon digestion and respiration.

If Sunday closing of saloons, local option, high license, and prohibition have failed, there is no evidence that the failure is due to the principles underlying any one of these methods. Until more earnest effort is made to study the effects of these methods, the results of their enforcement and the causes of their nonenforcement, no one is justified in declaring that either policy is successful or unsuccessful. It is very easy to select from the meager facts now available convincing proofs both that prohibition does not prohibit and that high license leads to increased drunkenness. The consequence is that the movements to control, restrict, or prohibit the use of alcohol are emotional, not rational.

It is impossible to keep emotion, sensation, sentiment, at white heat. Most extremists worship legislation and do not try to keep interest alive by telling every week or every month new facts about the week or the month before. No new fuel is added to the anti-saloon fire, which gradually cools and dies down. Not so, however, with those who make money by the sale of intoxicants. The greater the opposition, the more brains, the more effort, the more money they put into overcoming or circumventing that opposition. Fuel is piled on and the bonfire is fed freely. Every day the anti-restriction bonfire becomes larger and larger, and the anti-saloon bonfire becomes smaller and smaller. By carefully selecting their facts, by counting the number of arrests for drunkenness and the number of saloons open on Sunday, by reiteration of their story the pro-saloonists gradually win recruits from the opposition, and, when the next election comes, their friends outnumber their enemies and the "dry" policy of a city, county, or state is reversed.

The failures attributed to prohibitive or restrictive measures are probably no more numerous than the failures of government in other respects. The present ambassador from England, James Bryce, writing his American Commonwealth, declared that municipal government was America's "most conspicuous failure." The mayor of Toledo, writing in 1907, says, "There has been a pessimism, almost enthusiastic, about the city." These failures are due not to any lack of desire for good government, not to any fundamental evils of cities, but to the fact that municipal reform, like the crusade against alcohol, has been based upon emotionalism, not upon definite proof. Reformers have been unable to lead in the right direction, because they have looked at their lantern instead of their road. Not having cumulative information as to government acts, they have been unable to keep their fires burning. To illustrate: in November, 1907, the governor of New York state, the mayor of New York City, and reformers of national reputation eulogized the tenement-house department; yet this department, whose founding was regarded as a national benefaction, was the only department of the city government that did not receive an increase for 1908. It is in the position of temperance legislation, the facts of whose enforcement or nonenforcement are not promptly and continuously made public.

Fear of the negro victim of alcoholism, social evils of intemperance, whether among white or black, industrial uncertainty and waste due to alcoholism, are the three chief motives that have swept alcohol traffic out of the greater part of the South. Knowledge of physiological evils has had little influence, except as it may have rendered more acceptable the claim that alcoholism is a disease against which there is no insurance except abolition of alcohol as a beverage. Religious revivals, street parades by day and by night, illustrated banners, personal intercession, lines of women and children at the polls, made it necessary for voters to make known their intention, and made it extremely difficult for respectable men, engaged in respectable business, to vote for saloons. Some states have gone so far as to prohibit the manufacture of alcoholic stimulants, even though not offered for sale within state limits. In Georgia wine cannot be used at the communion service, nor can druggists sell any form of liquor except pure alcohol. In Louisiana it is illegal for representatives of "wet districts" to solicit orders for liquor in any of the "dry districts." In Texas the sale of liquor in dining cars is forbidden, and the traveler may not even drink from his own flask. Congress is being urged by senators and congressmen, as well as by anti-saloon advocates, to pass laws prohibiting common carriers from delivering alcoholics to any "dry" community. The more optimistic anti-saloon workers believe it is but a matter of a short time when Congress will pass laws prohibiting the manufacture or sale of alcoholic beverages within any limits protected by the United States Constitution.

Southern states have been warned that they could not afford the depreciation of real estate values, of rents, and of business that would surely follow the "confiscation of capital" and "interference with personal liberty." This warning has been met by plausible arguments that the buyers of legitimate and nonpoisonous commodities could pay better rents, better profits on business and on real estate, if freed from the uneven fight against temptation to drink. The argument that schools and streets and health must suffer if the license money was withdrawn, has been met by the plausible argument that the ultimate taxpayer—the family that wants clothing, food, and shelter—will save enough money to be able to spend still larger sums than heretofore upon education, health, and public safety.

For the first time dealers in alcohol recognize the possibility of a great national movement and of national prohibition. Both the defects in methods hitherto used to oppose saloon legislation and the reasons for meeting the present situation by new methods are presented in the May issue (1907) of the Transactions of the American Brewing Institute. Under the title, "Social Order and the Saloon—the Measure of the Brewer's Responsibility," Mr. Hugh F. Fox, known throughout the Union as a defender of child rights, advocate of probation and children's courts, promoter of health and education, outlined a plan for research that is indispensable to the proper settling of this great question. Whether brewer or anti-saloon leaguist, total abstainer or moderate drinker, employer or trade unionist, it is necessary to the intelligent control of alcohol that each of us approach this momentous question of control or abolition of the saloon in the spirit expressed in this paper, whose thoroughness and whose social point of view would do credit to a church conference. The address is quoted and its questions copied because both show how much depends upon knowing whether laws are enforced and how much greater is the difficulty of coping with a conciliatory antagonist who professes willingness to submit to tests of evidence.

The regulation of the liquor business involves fundamental questions of the function and scope of government, and there is hardly any department of organized human activity that has been the subject of so much experiment and futile tinkering.... The only people who are perfectly consistent are the prohibitionists, whose policy is abolition. Let us, however, try to detach ourselves from any personal interest that we may have in the subject, and consider it impartially as a matter of public concern.

What the brewer as an individual cannot do, the brewers as an organization have done successfully in many places in spite sometimes of official negligence, corruption, or incapacity. The Texas Brewers' Association is reported as having successfully prosecuted two thousand cases against keepers of disreputable resorts during the past three years. The object of their campaign was to purify the retail liquor trade from unclean and law-defying elements.

The greatest gain that has come to society, as distinguished from the individual, through the temperance movement is its effect in unconsciously informing the public that the regulation and administration of licensing is in itself a great and vital problem; and as a secondary result of such agitation, I should cite the growing sensitiveness of all persons in the business to the power of public opinion.

The recognition by brewers of the force of public opinion is a recent affair. In former years they were totally indifferent to it, if indeed they did not openly flout it. Even now their appeal to public sentiment is mainly a special plea for defensive purposes, and has little or no educational value. Brewers have opposed practically every effort to effect a change in excise laws, often without any convincing reason, but simply because the proposed change involved temporary inconvenience and uncertainty, and perhaps a temporary loss. The brewing trade has utterly failed to develop a constructive programme in connection with the public regulation of its affairs. It does not seem to have any fixed principles or positive convictions as to excise methods and liquor laws. Its policy has been that of an opportunist, at the best,—or an obstructionist, at the worst. As in all other industries which affect the welfare of the people, reforms have been forced from the outside, with no help from within. Of course this is equally true of insurance and railroad corporations, of food purveyors, mine owners, cotton merchants, and a score of other interests. It is due not merely to human selfishness but to shortsightedness; in other words, to a lack of statesmanship.

To call your opponents hypocrites, cranks, fakirs, and fanatics may relieve your feelings, but it doesn't convince anybody, and only hurts a just cause. It is foolish to question the motives of men who, without thought of personal gain, are trying to remedy the evils of inebriety.

The church is perfectly right in urging total abstinence upon the individual. The only path of safety lies in abstinence for some individuals....

The recognition of the right of a community to establish its own licensing conditions carries with it the right of the community to determine whether there shall be any licenses at all!

To make the discussion of this subject as fruitful as possible, I venture to submit the following questions for your consideration. None of them involve any direct moral issue, but there is an honest difference of opinion about each one of them, and they are certainly of vital importance in determining the course of wise and just administration.

What has been the effect of high license?

How much public revenue should the traffic yield?

Does high license stimulate unlawful trade?

How much license tax should be imposed upon local bottlers and grocers? Should they be allowed to peddle beer or to sell it in single bottles?

Should the place or the individual be licensed?

Should the licensing authorities be appointive or elective? By whom should they be appointed, and for what term of office?

Have the courts made good or bad licensing authorities? Where the courts issue licenses, what has been the effect on the court?

Should the licensing authority alone have the power to revoke a license, and discretion to withhold a license?

How can the licensing authority enforce the law? Should it not be independent of the police?

What should be the penalty for breach of the law? Do not severe penalties miscarry?

On what plea, and under what conditions, should licenses be transferred?

What has been the effect of limiting the number of saloons?

Should limitation be according to area or to population?

Is there any relation between the number of saloons and the volume of consumption?

What should be the limit to the hours of selling?

Should saloons be allowed to become places of entertainment?

How can the sale of liquor by druggists be controlled?

How can spurious drinking clubs be prevented or controlled?

How can the operation of disreputable hotels be prevented? What should be the definition of a hotel? Who should define it? By whom should it be licensed? What special privileges should be given to it?

How can the "back-room" evil be stopped? Is it legal (i.e. constitutional) to prohibit the sale or serving of liquor to women?

Has the removal of screens reduced the volume of consumption? Has it improved the character of saloons? Has it solved the problem of Sunday prohibition for any length of time? What has been the general effect of it in the tenement districts?

Should the state undertake to regulate the liquor business or to enforce liquor laws?

Is it possible to devise any working plan which will apply with equal effectiveness and equity in communities of compact and of scattered population?

Should, or should not, the principle of self-government be carefully preserved in the whole scheme of legislation to regulate the liquor business?

Whether the present prohibition wave shall wash away the legalized saloon, as ocean waves have from time to time engulfed peninsulas, islands, and whole continents, depends upon the power of American educators and American officials to answer right such questions as the foregoing. The great danger is that we shall, as usual, over-emphasize lawmaking, underemphasize lawbreaking, and go to sleep during the next two or three years when we should be wide-awake and constantly active in seeing that the law is enforced. Unless exactly the same principles of law enforcement are applied in "dry districts" as we have urged for eradication of smallpox, typhoid, scarlet fever, and adenoids, local and city prohibition are doomed to failure. There must be:

1. Inspection to discover disease centers—"blind pigs," "blind tigers," etc.

2. Compulsory notification by parents and landlords, and by police and other officials.

3. Prompt investigation upon complaint from private citizens.

4. Prompt removal of the disease and disinfection of the center.

5. Segregation of individual units that disseminate disease, whether bartender, saloon keeper, owner of premises, or respectable wholesaler, none of whom should be permitted to shift to another the responsibility for violating liquor laws.

6. Persistent publicity as to the facts regarding enforcement and violation, so that no one, whether saloon leaguist or anti-saloon leaguist, shall be uninformed as to the current results of "dry" laws.

It is perfectly safe to assume that none of these things will be done consistently unless funds are provided to pay one or more persons in each populous locality to give their entire time to the enforcement of laws, just as the improvement of other ills of municipal government require the constant attention of trained investigators. Cogent arguments for such funds have recently appeared in the New York Evening Post's symposium on "How to Give Wisely," by Mrs. Emma Garrett Boyd, of Atlanta, and Miss Salmon, of Vassar College.

If the saloon is here to stay, we must all agree that it is a frightful waste of human energy and of educational momentum to be appealing for its abolition when we might be hastening its proper control. On the other hand, if the saloon is destined to be abolished as a public nuisance and a private wrong, as a menace to industry and social order, is it not a frightful, unforgivable waste of energy to permit prohibition laws to fail, and thus to discredit the principle of prohibition? Philanthropists have provided millions for scientific research, for medical research, for the study of tuberculosis, and for the study of living conditions. It is to be hoped that a large benefaction, or that an aggregation of small benefactions, will apply to governmental attempts to regulate the sale of alcohol those methods of scientific research which have released men from the thraldom of ignorance and diseases less easily preventable than alcoholism.



If children are taught that the most effective way of combating alcoholism is to insure the enforcement of existing laws and to profit from lessons taught by such enforcement; if children are taught that the strongest reasons for total abstinence are social, economic, and industrial rather than individual and physiological,—there is much to be gained and little to lose from telling them the truth, the whole truth, and nothing but the truth about alcohol. To stimulate a child's imagination by untruths about alcohol is as vicious as to stimulate his body with alcohol. Whisky drinking does not always lead to drunkenness, to physical incapacity, to short life, or to obvious loss of vitality. Beer drinking is not always objected to by employers. Neither crime, poverty, immorality, lack of ambition, nor ignorance can always be traced to alcohol. On the contrary, it is unquestionably true that the majority of the nation's heroes have used alcoholics moderately or excessively for the greater part of their lives. It is probably true that among the hundred most eminent officials, pastors, merchants, professors, and scientists of to-day, the great majority of each class are moderate users of one or more forms of alcoholics. Overeating of potatoes or cake or meat, sleeping or working in ill-ventilated rooms, neglect of constipation, may occasion physiological and industrial injuries that are not only as grave in themselves as the evils of moderate drinking, but, in addition, actually tempt to moderate drinking.

All of this can be safely admitted, because whether parents and teachers admit it or deny it, children by observation and by reading will become convinced that up to the year 1908 the noblest and the most successful men of America, as well as the most depraved and least successful, have used alcoholics. To be candid enough to admit this enables us to gain a hold upon the confidence and the intelligence of children and youth that will strengthen our arguments, based upon social and industrial as well as physiological grounds, against running the risks that are inevitably incurred by even the moderate use of alcohol.

Other things being equal, the same man will do better work without alcohol than with alcohol; the same athlete will be stronger and more alert without alcohol than with alcohol; the clerk or lawyer or teacher will win promotion earlier without alcohol than with alcohol; man or woman will grow old quicker with than without alcohol. Other things being equal, a man of fifty will have greater confidence in a total abstainer than in a man of identical capacity who uses alcohol moderately; a mother will give better vitality and better care to her children without than with alcohol; a policeman or fireman or stenographer is more apt to win promotion without than with alcohol. Whatever the physical ailment, there is in every instance a better remedy for an acute trouble, and infinitely better remedies for deep-seated troubles, than alcoholics.

The percentage of failure to use alcoholics moderately is so high, the uncertainty as to a particular individual's ability to drink moderately is so great, as to lead certain insurance companies, first, to give preference to men who never use alcoholics, and later, to refuse to insure moderate drinkers. Life insurance companies have the general rule that habitual drinkers are bad risks, as the alcohol habit is prejudicial to health and longevity; but they have no means of studying the risk of moderate drinkers, because, except where alcohol has already left a permanent impression upon the system, the indications are by no means such as to enable the medical examiner to trace its existence with certainty. For this reason the life insurance companies have little effect in preventing alcoholism. Though they are agreed that habitual drinkers ought to be declined altogether, only a few companies have taken the decided stand of declining them. "Habitual drinkers, if not too excessive, are admitted into the general class where the expected mortality, according to the experience of the Pennsylvania Mutual Life Insurance Company, is 80 per cent, as against 56 per cent for the temperate class. Though it is only necessary to look over the death losses presented each day to see that intemperance in the use of liquors, as shown by cirrhosis of the liver, Bright's disease, diseases of the heart, brain, and nervous system, is the cause of a large proportion of the deaths, these companies prefer to grade the premiums accordingly rather than to decline habitual drinkers altogether. While this is partly due to the difficulty and expense of diagnosis, it is more probably due to an objection to take a definite stand on the temperance question."

Thus the insurance companies' rules touch only the confirmed drinker, whose physique is often irreparably injured. One company writes: "Men who have been intemperate and taken the Keeley or other cures are never accepted until five years have elapsed from the date of taking the cure, and only when it can be conclusively shown that during the whole period they have refrained entirely from the use of alcoholic liquor, and that their former excesses have not in any way impaired the physical risk."

Thus far American insurance companies are doing little preventive and educational work on the alcohol question, though they have the very best means at their command for so doing. According to the Metropolitan Life Insurance Company nine tenths of the school children in New York City are insured by them, and an even greater proportion of workingmen. Even though this is done "at twice the normal cost," the most cursory medical examination is given and no attempt is made to instruct them in the relation of their physical condition to their working power, or in the evils of the alcohol and the smoking habits.

Naturally the moderate drinker is first rejected for positions where an occasional overindulgence would be most noticeable and most serious. The manager of a large factory tells his men: "You cannot work here unless you are sober. If you must drink at parties, stay at home if necessary until 12 o'clock the next day and sleep it off, but don't come here till you are straight. We cannot afford it." Occasionally his men stay at home and not a word is said, but the minute they are found at work in an unsteady condition they are summarily discharged. From this position it is but a step to that of an upholsterer in New York City, who prints on his order blanks, "No drinking man employed." His company recently discharged a man after twenty years of service because a customer for whom this man was working detected a whisky breath. Men reported to trade unions for frequent intoxication are blacklisted. A certain financial corporation permits no liquor on its grounds or in its lunch rooms. The head of one of its large branches was heard to say recently that he would discharge on the spot a man who showed evidences of drinking, even though he had previously worked faithfully for years.

Rejection of moderate drinkers by business houses is not done on moral grounds alone, but because experience has proved the danger of employing men who have not their faculties fully under control all the time they are at work. The rules are especially strict for men working for a railroad or street railway company. The Pennsylvania Railroad Company replied to my inquiry as to their custom of discriminating against drinking men in these words: "We have no printed rules in regard to this except in a general way,—that no employee is allowed to go into a saloon during his hours of work or wearing the company's uniform. Of course the men are promptly discharged or disciplined if they show the effects of liquor while on duty, and the whole tendency of the administration of the rules is to get rid of any men who are habitual drinkers, but the administration of the rules and discipline is left to the superintendent of each division." The Interborough Rapid Transit Company of New York has these printed rules for the physical standard required for applicants for employment:

1. Examination of heart and arteries. Rejection of candidates showing excessive or long-continued use of tobacco and alcohol, with explanation of condition, causes, and dangers of continued use. Warning to chiefs of departments regarding those accepted who show tendency to drink at times, but whose physical examination does not disclose sufficient evidence to warrant their disqualifications. Foremen and chiefs of departments to be notified and to carry out the policy of employing only men who are at all times sober and not under the influence of alcohol at all.

2. On reexamination of employees. Warning to or rejection of those showing, on physical examination, indulgence to excess of alcohol, tobacco, or drugs. Warning to chief of department of evidence of such habits on part of any employee examined for any reason, but retained in service of the company with injunction to chief of department to speak with such employee and have him under proper supervision.

The blacklisting of habitual drinkers by their union, and the growing tendency on the part of large corporations, factories, and business houses to take a decided stand against drinking, are having a marked effect in reducing drunkenness where it does most harm. This practice has been declared by John Bach McMasters, the noted American historian, to have exerted a stronger influence in promoting temperance and total abstinence than all the temperance crusades from Hartley's time to the prohibition wave of 1907. The school, by instructing children how the alcohol habit will affect their chances of business success, future usefulness as citizens, and enjoyment of life, will inevitably reduce the evils of alcohol. By teaching based on facts that intimately concern the life of the child, as well as by caring for his health and his environment, the schools can help supplant the desire for alcohol with other more healthy desires.

No truth about alcohol is more important than that the craving for alcohol or something just as bad will exist side by side with imperfect sanitation, too long hours of work, food that fails to nourish, lack of exercise, rest, and fresh air. Conditions that produce bounding vitality and offer freedom for its expression at work and at play will supplant the craving for stimulants. Finally, the great truth contained in the last chapter must be taught, that success in coping with alcoholism is a community task requiring efficient government above all else.



"It is not necessarily vicious or harmful to soothe excited nerves." This editorial comment explains, even if it condemns while trying to justify, the tobacco habit. To soothe excited nerves by lying to them about their condition and by weakening where we promise to nourish, is vicious and harmful just as other lying and robbery are vicious and harmful. Yet two essential facts in dealing with tobacco evils must be considered: tobacco does soothe excited nerves, and the harm done to the majority of smokers seems to them to be negligible. For these two reasons the tobacco user, unless frightened by effects already visible, refuses to listen to physiological arguments against his amiable self-indulgence. Cheerfully he admits the theoretical possibility that by its method of soothing nerves tobacco kills nerve energy. But in all sincerity he points to men who have found the right stopping point up to which tobacco hurts less perhaps than coffee or tea, candy or lobster, overeating or undersleeping. Therefore the physician, the bishop, the school superintendent, candidly run the necessary risk for the sake of nerve soothing and sociability.

Less harm would be done by tobacco if it were more harmful. Like so many other food poisons, its use in small quantities does not produce the prompt, vivid, unequivocal results that remove all doubt as to the user's injuries and intemperance. As inability to see the physiological effect upon himself encourages the tobacco user to continue smoking or chewing, so failure to identify evil physiological effects upon the smoker encourages the nonuser to begin smoking or chewing. A very few smokers give up the habit because they fear its results, but too often the man who can see the evil results would rather give up almost anything else. The one motive that most frequently stops inveterate smoking—fear—is the least effective motive in dissuading those who have not yet acquired the habit; every young man, unless already suffering from known heart trouble, thinks he will smoke moderately and without harm. Unfortunately, every boy who begins to smoke succeeds in picturing to himself the adult who shows no surface sign of injury from tobacco, rather than some other boy who has been stunted physically, mentally, and morally by cigarettes.

For adult and child, therefore, it behooves us to find some other weapons against tobacco evils in addition to fear of physiological injuries. Among these weapons are:

1. Enforcement of existing laws that make it an offense against society for dealer, parent, or other person to furnish children under sixteen with tobacco in any form; and raising the age limit to twenty-one, or at least to eighteen.

2. Enforcement of restrictions as to place and time when smoking is permitted.

3. Agitation against tobacco as a private and public nuisance.

4. Explanation of commercial advantages of abstinence.

Because the childish body quickly shows the injurious effects of what in adults would be called moderate smoking, the proper physical examination of school children will reveal injuries which in turn will show where and to what extent the cigarette evil exists among the children of a community. Even the scientists who claim that "in some cases tobacco aids digestion," or that "tobacco may be used without bad effects when used moderately by people who are in condition to use it," declare emphatically that tobacco "must not be used in any form by growing children or youths." Prohibitive laws can be rigidly enforced if a small amount of attention is given to organizing the strong public sentiment that exists against demoralizing children by tobacco. Thus children and youths will not need to make a decision regarding their own use of tobacco until after other arguments than physiological fear have been used for many years by parent, teacher, and society.

One effective weapon is the sign on a ferryboat or street car: "No smoking allowed on this side," or "Smoking allowed on three rear seats only." Public halls and vehicles in increasing numbers either prohibit smoking altogether or put smokers to some considerable inconvenience. The trouble involved in going to places where smoking is permitted tends gradually to irritate the nerves beyond the power of tobacco to soothe. Again, many men would rather not soothe their excited nerves after five, than have their nerves excited all day waiting for freedom to smoke. Restrictions as to time or place make possible and expedite still further restrictions. Thus gradually the army of occasional smokers or nonsmokers is being recruited from the army of regular smokers.

The anti-nuisance motive follows closely upon the drawing of sharp lines of time and place for the use of tobacco. Like treason, smoking in the presence of nonsmokers can be considered respectable only when the numbers who profess and practice it are numerous. If the two first-mentioned weapons are effectively used, there will be an increasing proportion of nonsmokers and not-yet-smokers who will give attentive ear to proof that nicotinism is a nuisance. The physical evidences of the cigarette habit can easily be made distasteful to all nonsmokers if frankly pointed out,—the yellow fingers, the yellow teeth, the nasty breath, the offensive excretions from the pores that saturate the garments of all who cannot afford a daily change of underwear. The anti-nuisance argument is always insidious and abiding. In the presence of nonsmokers accustomed to regard tobacco using as a nuisance, smokers become self-conscious and sensitive. Men and women alike would prefer a reputation for cleanliness to the pleasures of tobacco. The educational possibility of fighting tobacco with the name "nuisance" was recognized the other day by an editorial that protested against a law to prevent women from using cigarettes in restaurants. "The way for any man who has the desire to reform some woman addicted to the cigarette habit is insidiously and gently to point out the injurious effects on her appearance. Cigarette smoking stains a woman's fingers and discolors her teeth. It also tends to make her complexion sallow and to detract from the rubiness of her lips. It bedims the sparkle of her eyes. It makes her less attractive mornings." Chewing has practically disappeared, not because it ceased to soothe excited nerves but because it was seen to be a nasty nuisance.

Finally, the selfishness of the smoker is a nuisance that continues only because it has not been called by its right name. "Do you mind if I smoke?" was a polite question two hundred years ago when tobacco was rare enough to make smoking a distinction, or fifty years ago when everybody smoked at home and in public. But it is effrontery to-day when people do mind, when smoking pollutes the air of drawing room and office, and while soothing the excited nerves of the smoker lowers the vitality of nonsmokers compelled to breathe smoke-laden air. It is selfish to intrude upon others a personal weakness or a personal appetite. It is selfish to divert from family purposes to "soothing excited nerves" even the small amounts necessary to maintain the cigar or cigarette habit. It is selfish to run the risk of shortening one's life, of reducing one's earning capacity. Because the tobacco habit is selfish it is anti-social and a nuisance, and should be fought by social as well as personal weapons, as are other recognized nuisances, such as spitting in public or offensive manners.

The economic motive for avoiding and for eliminating tobacco is gaining in strength. The soothing qualities of all drugs are found to be expensive to physical and business energy if enjoyed during business hours. Strangely enough, employers who smoke are quite as apt as are nonsmokers, to forbid the use of tobacco by employees at work. Some of this seeming inconsistency is due to a dislike for cheaper tobacco or for mixed brands in one atmosphere; some of it is due to the smoker's knowledge that "soothing nerves" and sustained attention do not go hand in hand, while "pipe dreams" and unproductive meditation are fast companions; finally no little of the opposition to tobacco in business is due to fear of fire. These various motives, combining with the anti-nuisance motive among nonsmokers, have led many business enterprises to prohibit the use of tobacco in any form on their premises or during business hours, even when on the premises of others. Notable examples are railroads that permit no passenger trainman to use tobacco while on duty. (Freight trainmen are restricted more tardily because the risk of damages is less and the anti-nuisance objection is wanting.)

From penalizing excessive use and prohibiting moderate use in business hours, it is a short cut to choosing men who never use tobacco and thus never suffer any of its effects and never exhibit any of its offensive evidences. No young man expects to obtain a favorable hearing if he offers himself for employment while smoking or chewing tobacco. Business men dislike to receive tobacco-scented messengers. Cars and elevators contain signs prohibiting lighted cigars or cigarettes. Insurance companies reject men who show signs of excessive use of tobacco. Why? Because they are apt to die before their time. The Interborough Rapid Transit Company of New York City rejects applicants for motormen and conductors "for excessive or long-continued use of tobacco." Why? Because, other things being equal, such men are more apt to lose their nerve in an emergency and to fail to read signals or instructions correctly.

Armed with these weapons against tobacco, parents and teachers can effectively introduce physiological arguments against excessive use, against use by those who suffer from nervous or heart trouble, and against any use whatever by those who have not reached physical maturity. By avoiding physiological arguments that children will not—cannot—believe contrary to their own eyes, parents and teachers are able to speak dogmatically of that which children will believe,—injuries to children, evils of excess, restrictions as to time and place, and offensiveness to nonsmokers. But even here it is wrong, as it is inexpedient, to leave the physical strength of the next generation to the persuasive power of parents and teachers or to the faith and knowledge of minors. Society should protect all minors against their own ignorance, their own desires, the ignorance of parents and associates, and against the economic motive of tobacco sellers by machinery that enforces the law.



"Dhrugs," says Dock O'Leary, "are a little iv a pizen that a little more iv wud kill ye. Ye can't stop people fr'm takin' dhrugs, an' ye might as well give thim somethin' that will look important enough to be inthrojuced to their important and fatal cold in th' head. If ye don't, they'll leap f'r th' patent medicines. Mind ye, I haven't got annything to say agin' patent medicines. If a man wud rather take them thin dhrink at a bar or go down to Hop Lung's f'r a long dhraw, he's within his rights. Manny a man have I known who was a victim iv th' tortures iv a cigareet cough who is now livin' comfortable an' happy as an opeem fiend be takin' Dr. Wheezo's Consumption Cure." The Dock says th' more he practices medicine th' more he becomes a janitor with a knowledge iv cookin'. He says if people wud on'y call him in befure they got sick he'd abolish ivry disease in th' ward except old age and pollyticks.

Thus Mr. Dooley with his usual wit and insight tells the American people why they spend over two hundred million dollars annually on patent medicines. Americans consume more drugs and use more patent medicines than the people of any other country on the civilized globe. Self-medication has grown to tremendous proportions. Everywhere—in cars, on transfers, on billboards, in magazines, in newspapers, in the mails—are advertised medicines to cure disease and devices to promote health. When we consider that electric cars contain from thirty-two to fifty-two advertisements each, three fourths of which are directly or indirectly concerned with health; when we multiply these by the number of cars actually in use in American cities; when we consider the number of advertisements in magazines and daily papers, and the enormous circulation of these papers and magazines; when we consider that an increasingly large proportion of advertising space is devoted to health,—we begin to realize the cumulative power for good or for evil that health advertisements must have.

To illustrate advertisements devoted to health to-day, I have kept clippings for one week of news items, editorials, and advertisements in a penny and a three-cent paper, and had them classified according to the subjects treated:

================================================================== PENNY PAPER THREE-CENT PAPER - - - News Editorial Adver- News Editorial Adver- Item tisement Item tisement - - - - Milk 3 2 3 2 Teeth 1 2 1 Shoes 4 1 Food 1 1 4 Alcohol 1 5 3 7 Tuberculosis 1 1 Patent medicine 17 Constipation cures 4 5 Eyes 3 5 1 Beauty 2 5 8 6 General 8 3 3 5 - - - - Total 18 9 51 14 26 ==========================================================

The following list of health topics was treated in the advertisements, editorials, and articles of a popular monthly periodical devoted to women:

======================================================== ARTICLE EDITORIAL ADVERTISEMENT - - - - Babies 1 11 Soaps and powders 5 Beauty 3 6 Quack cures 2 Tooth powders 4 Household 1 5 Food and cooking 1 14 Clothes 13 5 Teaching sex laws 1 2 Medicine 4 1 - - - - Total 24 5 50 ========================================================

Besides the classic patent medicines, such as Lydia Pinkham's Vegetable Compound, Castoria, Cod Liver Oil, etc., there are "Colds Cured in One Day," "Appendixine," health foods, massage vibrators, violet rays, Porosknit underwear, sanitary tooth washes, soaps, vitopathic, naturopathic, and faith cures. New ones appear every day,—enough to make a really sick person dizzy, let alone a person suffering from imaginary ailments. All seem to outline my particular symptoms. After they have flamed at me in red letters in the surface cars, pursued me in the elevated and underground, accompanied me out into the country and back again to the city, greeted me each morning in the daily paper and in my daily mail, each week or each month in the periodical, the coincidence of a familiar package on a drug-store counter seems to be providential and therefore irresistible. I know that I ought to be examined by a physician, but I am busy and not unwilling to gamble for my health; it cannot kill me and there is a chance that it will cure me. If there is nothing the matter with us, we may be cured by our faith. If we are taking a cure for consumption, the morphine in it may lull us into thinking we feel better. If we are taking a tonic for spring fever, the cheap alcohol may excite us into thinking our vitality has been heightened. Soothing sirup soothes the baby, often doping its spirit for life, or soothing it into a sleep from which it never wakes.

In spite of the fact that the "Great American Fraud" has been exposed repeatedly in newspapers and magazines of wide circulation, the appeal of the quack still catches men and women of intelligence. The other night a friend went out to a dinner and conference with a lawyer in the employ of the national government. Annoyed by a nagging headache, he made for the nearest drug store and ordered a "headache powder." He admitted that it was an awful dose, but he had been told that it always "did the business." He knew the principle was bad, confessed to a scorn for friends of his whom he knew to be bromo-seltzer fiends, but he had the headache and the work to do—a sure cure and a quick one seemed imperative. The headache was due to overwork, indigestion, constipation. Plain food and quiet sleep was what he needed most. But the dinner conference plus the headache was the unanswerable argument for a dose with an immediate result.

Last winter an Irish maid slowly lost her rosy cheeks and grew hollow-eyed and thin. She was taken to a specialist who discovered a rapidly advancing case of consumption. He said that owing to the girl's ignorance, stupidity, and homesickness, her only chance of recovery was to return to the "auld countrie" at once. The girl agreed to go, but insisted on a few days "to talk it over with her cousins in New York." After two weeks had elapsed she was found in a stuffy, overcrowded New York tenement. She had found a doctor who had given her a little bottle of medicine for two dollars, which would cure her in the city. It was futile to protest. Days in the unventilated tenement and nights in a "dark room" meant that she would never live to finish the bottle.

For a year Miss H. took a patent preparation for chronic catarrh. It seemed to "set her up"; but it so undermined her strength, through its artificial nerve spur, that chronic catarrh was followed by consumption. It later transpired that the cure's chief ingredient was whisky, and cheap whisky. A good grandmother, herself a vigorous temperance agitator and teetotaler, offered to pay for it as long as my friend would take it faithfully. The irony of it makes one wonder how many earnest advocates of total abstinence are in reality addicted to the liquor habit.

Last summer a district nurse of the summer corps who visited city babies under two years of age encountered in the hallway of a tenement a bevy of frenzied women. A baby lay on the bed gasping and "rolling its eyes up into the top of its head." The nurse asked the frightened mother what she had been giving it. "Nothing at all," said the woman. But a telltale bottle of soothing sirup showed that the child was dying from morphine poisoning. Happily the nurse came in time to save it.

Is it not pitiful, this grasping for a poison in an extremity; this seizing of a defective rope to escape the fire?

The patent-medicine evil cannot be cured by occasional exposure or by overexposure. Nor can it be cured by legislation, legislation, legislation, unless laws are rigidly enforced.

Occasional exposure is no better than occasional advertising of good things. The patent-medicine business thrives on constant, not occasional, advertising. Leading advertisers expect so little from the first notice that they would not take the trouble to write out a single advertisement. That is the reason merchants charge advertising in the programmes of church, festival, and glee-club concert to charity, not to business. Warning people once does no more lasting good than sending a child to school once a month. The exposure of patent-medicine evils must be as constant as efforts to sell the medicines.

Overexposure is ineffective. It is the evils of patent medicines that do harm, not their name and not their patents. The medical profession has in vain protested against proprietary medicines. Ethical barriers cannot be erected by resolution. Calling things unethical does not make them unethical. The mere patenting of medicines for profit does not make the medicine injurious any more than the mere mixing of unpatented drugs makes a physician safe. Physicians who would not themselves patent a drug will use certain patented drugs whose ingredients are known to be safe and uniform. True exposure of patent-medicine evils will enable the average physician and the average layman to distinguish the dangerous from the safe, the fraud from the genuine, lies from truths.

Legislation is needed to crystallize modern knowledge and to establish in courts the right to protection against the evils of patent medicines. The national Pure Food Law, passed January 1, 1907, and now in force throughout the country, requires on the "labels of all proprietary medicines entering into interstate commerce, a statement of the quantity or proportion of any alcohol, morphine, opium, heroin, chloroform, cannabis indica, chloral hydrate, or acetanilid, or any derivative or preparation of any such substance contained therein; this information must be in type not smaller than eight-point capital letters; also the label shall embody no statement which shall be false or misleading in any particular." This law does not forbid patent medicines nor the use of alcohol and narcotics in patent medicines; it merely says, "Let the label tell, that all who buy may read." It does not require that all who run may read, for it does not say that advertisements of a patent medicine shall tell the truth about its ingredients or its action on the human body; only that the label on the bottle shall tell. The object of this law is to explain to the consumer the exact nature of the medicine. But to the majority of people the word "acetphenitidin" on the label of a headache medicine does not explain. The new order that requires manufacturers to substitute acetanilid for acetphenitidin does no more than replace fog with mist. Protection requires legislation that cannot be evaded by technical terms. The present law requires that packages must be properly labeled on entering the state. To carry out the national law, state laws should make it an offense for dealers to have in their possession proprietary medicines without explanatory labels that explain. Where state laws to this effect do not exist, the packages once in the state may be deprived of their labels and sold as secret remedies, thus nullifying the whole effect of the national law.

Enforcement must be insured. Impure drugs may do as much harm as patent medicines containing harmful drugs. In New York a vigorous campaign was recently inaugurated by the department of health to drive out impure drugs. Drugs are dangerous enough at their best. When they are not what they pretend to be, whether patented or not, they may take life. One extreme case where a patient's heart was weakened when it ought to have been strengthened, led to the discovery that practically all of one particular drug offered for sale in New York City was unfit to use and calculated to kill in the emergency where alone it would be used. Yesterday four lives and several million dollars were lost in a New York fire because the hose was rotten or weak. As inspection and testing were needed to insure hose equal to emergency pressure, so inspection and testing of patent medicines and drugs are needed to make legislation effectual.

Legislation and enforcement should reach the newspaper, magazine, billboard, street car, that advertises a falsehood or less than the essential truth regarding drugs, foods, and patent medicines. Public sentiment condemns the advertising of many opportunities to commit crime or to be disorderly or indecent or to injure one's neighbor. The facts about hundreds of nostrums can be absolutely determined. The advertising agency, whether secular or religious, that carries misrepresentation of drugs and foods should be forbidden circulation through the mails. The existence of such advertisements should be made evidence of complicity in a public offense and punished accordingly. Treat them as we treated the Louisiana lottery. Boards of health, instead of furnishing names to druggists and manufacturers who want to sell patent foods and medicines, should print circulars exposing frauds, and punish so far as the law permits.

While trying to secure adequate legislation and efficient administration of the above-mentioned standards, there is much that can be done by individuals and clubs. We can give preference to those journals that refuse drug and food advertisements unless evidence is produced that the truth is told and that the goods are not harmful. We can refuse to have in the house a paper or journal which prints notices that lie or that conceal the truth. If this drastic measure would cut us off entirely from daily papers, we could choose the least offensive and petition it to exclude specific lying methods. When it preaches health, honesty, and philanthropy, we can cut out of one issue the noble editorial and the exploiting advertisements and send them to the editor with our protest. Knowledge of the ingredients and dangers of patent medicines should be a prerequisite for the practice of medicine or pharmacy. We can help bring about such conditions, and we can patronize physicians who send patients to drug stores that cater to intelligence rather than to ignorance.

Fighting patent-medicine evils is a civic duty to be accomplished by civic cooeperation, not private effort. It is impossible to organize unofficial educational agencies that can offset the cumulative, lying advertisement. Personal opposition is but the beginning. Official machinery must be set running and kept running so as to protect the public health against the commercial motive that preys upon ignorance and easily inspired faith.



It is usually considered futile to attempt to defeat the devil with his own methods, because he knows so much better how to use them. But abuse does not do away with use, and the success of quacks in reaching the people demands our respect. There is no reason why their methods, based on a knowledge of human nature and human psychology, should not be employed to appeal to needs rather than to weaknesses. A good thing may lie unused because of lack of advertisement. Vitality is coming to be the passion of the American people. It is on this sincere passion that fakirs have so long traded.

There can be no doubt that advertisements of health-promoting goods are quite as profitable as health advertisements that injure health, when equally effective methods are used to make them reach the public. The tradition has been repeatedly mentioned in this book that the better the doctor, the less he advertises himself, except in medical and scientific journals that notoriously fail to reach the people. The same is too often true of reputable remedies and goods. The theory that these things stand or fall on their merits is not borne out by practical experience,—conspicuously in the case of "fake" remedies. Purely philanthropic undertakings for the advancement of health fail, if not placed before the people whom they aim to help in an attractive, convincing form. Failure to advertise a worthy cause limits its usefulness, and is therefore unjustifiable, whether we speak of medicine, legal aid, or dental clinics.

An intensive study of the methods used to advertise patent medicines will suggest means of extending the usefulness of health-promoting goods. Aside from clever methods of suggestion that lead many people to take medicine for imaginary ailments, especially seasonal ailments, patent-remedy advertisers have employed (as an argument for the efficiency of their cures) scientific theory, bacterial origin of diseases, recent medical or physiological discoveries, and state and national movements for promoting health. In fact, they have turned to their own uses the very law that seeks to control them and the exposures that seek to exterminate them. Whatever may be the merits of Castoria, the "Don't Poison Baby" advertisement on the following page, printed just after the accompanying "Babies Killed by Patent Medicines," which appeared in a home journal, was surely a clever bit of advertising. Upon an editorial in a daily paper on the relation of eyeglasses to headache and indigestion, an optician based a promise of immediate relief for these ailments if he himself were patronized. The recent investigations of the Department of Agriculture, and of Professors Chittenden and Fisher, in regard to foodstuffs, are proving helpful to food quacks and advertisers of pills for constipation and indigestion. Since the passage of the Pure Food Law one health food is advertised in a column headed "Pure Food."

When the season for pneumonia comes around numerous medicines are "sure cures" for grippe and pneumonia. "Rosy teachers look better in the schoolroom than the sallow sort," is surely a good introduction to a new food. Woman's vanity sells many a remedy advertised to counteract the "vandal hand of disease, which robs her of her beauty, yellows and muddies her complexion, lines her face, pales cheek and lip, dulls the brilliancy of her eye, which it disfigures with dark circles, aging her before her time." Who in your town is as good a friend to "owners of bad breath" as the advertiser who tells them that they "whiff out odor which makes those standing near them turn their heads away in disgust"? The climax of effective educational advertising as well as of consummate presumption and villainy is reached in the notice of an alcoholic concoction that uses the headline, "Medical Supervision Needed to Prevent the Spread of Consumption in the Schools." Thus grafting itself on the successful results of the medical examination in the Massachusetts schools, it enlists the aid of teachers, trades on the fear of tuberculosis, even indorses the fresh-air treatment. So convincing was this appeal that it was reprinted in the news columns of a daily paper in New York as official advice to school children.

So clever are these methods of advertising and so successful are they in reaching great numbers of people, that if reputable physicians would take lessons of them, they might conduct a health crusade that would exterminate tuberculosis, diminish the use of alcohol and tobacco, and save thousands of babies that die unnecessarily. The theory of patent-medicine advertising is sound. It emphasizes the joys of health, the beauty of health, the earning power of health. It adapts its message to season, event, and need. It offers testimonials of real persons cured. It is all-appealing, promising, convincing,—a fearful menace to health when the remedies offered are dishonest, a universal opportunity for promoting health if the cure is genuine.

A classic example of health advertising that promotes health is Sapolio. The various hygiene lessons that have promoted Sapolio have done much to raise the standard of living in the United States. Few eminent physicians have done so much for public health as the "Poor M.D. of Spotless Town who scoured the country for miles around, but the only case he could find was a case of Sapolio."

Recent press discussions about furnishing free eyeglasses to the children in the public schools have so enlightened people as to the need for expert examination of their eyes that opticians will be forced to employ competent oculists to make the preliminary examination and to see that the glasses are properly adjusted. In spite of the long mis-education by makers of corsets, the persistent advertising of "good health" and "common-sense" waists has gained an increasing number of recruits from the ranks of the self-persecuting. It is only a matter of time when the term "stylish" will be transferred to the advocates of health, because advertisers who tell the truth will, if persistent, gain a larger patronage than advertisers of falsehoods; there is profit in retaining old customers. The advertisement of a window device for "Fresh air while you sleep" will make prevention of tuberculosis more profitable than "sure cures" that lie and kill.

A man deserves profit who sends this message to millions of readers:

There are three kinds of cleanliness:

First, the ordinary soap-and-water cleanliness.

Second, the so-called "beauty" cleanliness.

Third, prophylactic cleanliness, or the cleanliness that "guards against disease."

But the man who sells soap ought to be the one to use this advertisement, not a man who sells toothwash that, when pure, is little better than water, that is seldom pure, and that always hurts the teeth. Many children and adults are being cured of flat foot by men who make money by selling shoes designed to strengthen the arch of the foot. Millions would never know how to discover the evil effects upon themselves of coffee and alcohol except for money-making advertisements. Little Jo's Smile taught a nation that the majority of crippled children are victims of neglect on the part of adult consumptives.

Certain it is that advertising is an art promoted by the severest competition of the cleverest brains. It is a force which we cannot afford to ignore. If we can harness it to the promotion of aids to health, it will do more good than all the hygiene books ever written. To this end we must educate ourselves to distinguish between goods which do what they profess to do and those which do not. A good eye opener would be to keep for a week clippings from a high-priced daily paper, a penny daily paper, and one or two representative magazines, including a religious paper. Teachers and parents can very easily interest children in such clippings. Moreover, they can use the bulletin method, the stereopticon exhibit, the cumulative illustration of a fact, which is the essence of successful advertising. Boards of health can use all the typographical aids to clear understanding,—cuts, diagrams, interesting anecdotes. In New York both the health board and the school board have issued circulars and given illustrated lectures, some of them being in school and some on public squares. Medical and sanitary societies and other educators can be induced to follow what a successful business man has called the three cardinal rules of advertising:

First, put your advertisement where it will be seen. (Tell your story where it will be heard.)

Second, write it so that people will read it. (Tell it so that people will understand it.)

Third, tell the truth, so that people will believe it.



Among remedies for preventable disease and preventable poverty, the following was urged at a national conference for the betterment of social conditions: "We have been too prudish. Because we have been unwilling to teach school children the evils of violating sex hygiene, we have been unsuccessful in combating evils justly attributable to ignorance on the part of girls as to the duties and dangers of motherhood." This point of view is shared by so many men and women that a national body was organized in 1905 to promote the teaching of sex hygiene,—the Society for Sanitary and Moral Prophylaxis. This society has its headquarters in New York, and distributes at cost lectures and essays. The second of its educational pamphlets is addressed to teachers, and is entitled "Instruction in the Physiology and Hygiene of Sex." The introduction asks eleven questions of the teachers as follows:

1. Do you wish a pamphlet on sex subjects to hand to your pupils? Why?

2. Do you wish separate pamphlets for boys and girls?

3. For what age limits and social conditions do you wish them?

4. What topics do you wish the pamphlets for boys to "handle"?

5. What topic do you wish the pamphlet for girls to "handle"?

6. If you think one pamphlet sufficient for both sexes, what should it consider?

7. How far do you go in teaching sexual hygiene or reproduction? By what method?

8. What special difficulties do you find in teaching it?

9. What special need of teaching it have you found?

10. What special benefits (or otherwise) have you noticed from teaching it?

11. What criticisms (favorable or otherwise) do you encounter?

The difficulty of introducing formal instruction in sex hygiene, even in the upper grades of public and private schools, is hinted at in the pamphlet. The purpose of the publishing society as given in its constitution is "to eliminate the spread of diseases which have their origin in the social evil." Although sex hygiene does not begin with sex immorality, almost every text-book on sex hygiene, and almost every pamphlet urging class instruction in sex hygiene, begins with sex immorality. Yet only the exceptional school child is in danger of violating sex morals, while every school child needs instruction in sex hygiene.

Instruction in sex hygiene, whether at school or at home, should deal with sex normality, sex health, sex temperance. Instruction in sex immorality is objectionable, not merely because it offends prudists, not because it is difficult, but because it can be shown by experience to be less efficacious than training in sex health.

To expect fear to prompt sex hygiene is to make a mistake that has retarded the development of sound measures in the treatment of offenders against criminal law. For centuries man failed in attempts to fit the punishment to the crime. To deter men from committing crime by holding up a threat of prolonged and dreadful punishment has been found futile. Individuals take the risk because they think they will escape detection. It is an axiom of criminal procedure that a would-be offender is deterred by the certainty, not by the severity, of punishment. The modern theory of probation is, that children and adults may be best led away from evil practices by crowding out old influences with newer and stronger interests. Occupations that are wholesome are made to rival diversions or occupations that are harmful and criminal.

Abnormal conditions of mind and body in regard to sex can almost always be traced to general physical ill health or to an unhealthy moral environment. Cure and prevention require two kinds of treatment within reach of parents and teachers: (1) build up the child's physical condition; and (2) give him other interests. Proper physical care, and work adjusted to body and mind, may be relied upon to do infinitely more to promote sex hygiene than instruction, either at home or at school, in immoral sex diseases. That sex morality is weak and untrustworthy which is based upon fear of sex diseases. Like alcoholism and nicotinism, the saddest results of sex diseases are social and economic. The strongest reasons against such diseases are economic and social, not physiological.

Once having made up our minds to concentrate the teaching of sex hygiene upon sex health rather than upon sex immorality, upon sex functions rather than upon sex diseases, the chief objection to school instruction and to instruction in class will disappear. Our school text-books in history, literature, and biology abound in references to sex distinctions, sex functions, and sex health. In enumerating the daily routine of health habits I mentioned daily bathing of the armpits and crotch. There is nothing in this injunction to offend or injure a boy or girl. If studies and physical training are to be adapted to physiological age, and if children are to know why they are graded according to physiological age as well as mental brightness, we shall soon be talking of mature, maturing and not-yet-maturing girls and boys, so that everybody will be instructed in sex hygiene without offense. Any teacher who can explain the family troubles of King Henry VIII without becoming self-conscious can easily learn to look a class of girls and boys in the face and explain how a mother's health will injure her baby before its birth, why breast-fed babies are more apt to live than bottle-fed babies, why it is as important for the mother to keep a nursing breast absolutely clean as to clean the nipple of a nursing bottle. Words whispered by children, or marked in dictionaries, to be stealthily and repeatedly looked upon and talked over with other children, lose all their glamour when pronounced by a teacher.

In these days of state subsidy of school libraries the child is hard to find who has not free access to books of fiction full of voluptuous allusions that make undesirable impressions which only blunt, candid discussion of sex facts can make harmless. Children now learn, whether in fashionable private schools or crowded slums, practically all that is lascivious and unwholesome about sex. For teachers to explain that which is wholesome and pure will disinfect the minds of most children and protect them against miseducation.

Class instruction in hygiene is practicable for all matters pertaining to normal sex health. Girls of thirteen should be taught in classes the fact and meaning of menstruation, and its grave importance to the health, in order that they may care for themselves not only before, during, and immediately after the menstrual period, but throughout the month, in order that menstruation itself shall not be unnecessarily painful, enervating, and harmful to efficiency. It is not yet advisable to discuss dangers peculiar to girls or dangers peculiar to boys in mixed classes. Generally speaking, it is undesirable that men teachers discuss girls' troubles with girl pupils. But why should it not become possible for women teachers to explain health dangers peculiar to girls to classes of boys?

Individual instruction in sex matters should be reserved for the diseased mind, for the boy or girl who has already been morbidly instructed. Discussion of immoral sex diseases should be confined to individual talk. This field teachers have already entered. Repeated physical examination of children will detect symptoms of sex abnormality. When detected, the fact and the meaning should be explained to the individual by school physician, school nurse, or school-teacher. While much can be done through mothers' meetings and through individual instruction of parents, the most effective means of improving the general attitude towards sex health is to give the simple truth to the millions of children who have not yet left school. Armed with the A B C's of sex hygiene at school, boys and girls will be prepared to select employment, associates, and newspapers that will permit normal, healthy sex development. Men and women who are leading normal lives, who have plenty of work, sleep, fresh air, nourishing food, amusement, and exercise are unlikely to be sexually abnormal.

After all, the question of instruction in sex hygiene will quickly settle itself when it is made a condition of a teacher's certificate that the applicant shall himself or herself know the personal and social reasons for sex health. The woman who does not know how to take care of her own sex health, the man who is ignorant of a woman's special needs, cannot do justice to the requirements of arithmetic, language, and discipline. Whether men and women teachers are mentally, physically, and morally equipped to be sexually normal and to teach the law of sex health will be disclosed as soon as trustees and superintendent dare to ask the necessary questions. Whether an instructor's personality will enable him to fill the minds of children with interests more wholesome, more absorbing than obscene stories or morbid sex curiosity can also be learned. When school-teachers are prepared to teach the social and economic aspects of general health they will quickly solve the problem of instruction in sex health.

Just one word about country morality. It is customary to deplore the influence of large cities on the young. Of late, however, there has been a tendency to question whether, after all, sex morality is apt to be higher in the country than in the city. Parents and teachers in small towns and in rural districts will do well to take an inventory of the influences surrounding their children. It will always be impossible to give country children city diversions. One great disadvantage of country children frequently counter-acts the beneficial influence of out-of-door living; namely, isolation. The city child is practically always in or about to be in the sight of, if not in the presence of, other people. Numbers and close contact with people, though they be strangers, mean restraint and pervading social conscience. City children find it difficult to have good times in pairs. No amount of instruction of rural pupils in sex hygiene will take the place of amusements and entertainments for groups of children, forming thus a special antidote for "two's company, three's a crowd." Liberating and standardizing normal intersex relations and discouraging cramped social intersex relations are more urgent needs than instruction in sex diseases. A working environment that permits pure-mindedness will do more to inculcate a reverence for sex cleanliness and for parenthood than lectures and essays on moral prophylaxis.



Patent medicines and other forms of quackery could not pay such enormous dividends unless there was some truth in their claims; unless their victim found some beneficial return for his money. They win confidence because they raise hopes and combat fear. They do cure thousands of people of fear and of "ingrowing thoughts." In so doing they remove the sole cause of much disability.[17] In so doing they are merely applying by wholesale principles of mental hygiene that are legitimately used by physicians, tradesmen, teachers, and parents who deal successfully with nervousness.

Quackery makes cures and makes money because of the undoubted influence of mind in causing and in removing those ailments that originate in fear, imagination, or morbid introspection. A few years ago a little out-of-the-way town in southern Minnesota was visited by train loads of the sick and crippled from miles around. Miraculous cures were heralded broadcast. Life-long cripples left wagon loads of crutches and braces to decorate the little church with the enchanted transom. People who had not walked for years returned to their homes cured. The marvels of famous shrines were fast being duplicated when the church authorities at St. Paul issued an explanation of the alleged miraculous appearance of biblical figures in the transom of the new church. The outlines of a mother carrying a baby had been vaguely impressed in the transom glass when molten. When the mystery was explained the excursions and the cures stopped.

Nearly every physician and practically every medical charlatan can count scores of cures of ailments that had previously defied the skill of eminent physicians. A child's bumps actually stop aching after the mother or nurse kisses the abused spot. Invalids forget their limitations under stress of some great excitement or some intense desire for pleasures incompatible with invalidism. Many a physician of reputation owes his success in great part to the discriminating use of the placebo,—a bread pill designed to supplant the patient's fear with confidence. Hypnotism and "suggestion" have been successfully used to cure alcoholism and to fill patients' minds with conviction stronger than the fear that produced the sickness. A well-known writer and preacher cures insomnia by auto-suggestion, telling himself he is sleepy, is very sleepy, is going to sleep, is almost asleep, is fast asleep. Treatment by osteopathy has been followed by disappearance of diseases that cannot possibly be cured by osteopathy. Christian Science has restored to health and happy usefulness hundreds of thousands of chronic invalids. Verily is hygiene of the mind an important factor in the civics of health.

Fear can originate with mind. Fear produces fear. Fear disarranges circulation of the blood and the nourishment of muscle and nerve. Fear can produce many bodily disorders which in turn feed fear. Fear cannot last unless bodily symptoms exist or arise to justify and feed it. Fear can be cured and removed in two ways: (1) by driving away fear and releasing bodily disorders from its thraldom; (2) by removing the disorders and making fear impossible to the logical mind. An enforced sea voyage begins with the disorder; a clever, buoyant physician begins with the fear. Patent-medicine proprietors, quacks, and fakes of every kind begin by displacing the fear with hope or cheer; the physical disorders frequently vanish by the same window as fear. For fear write self-pity, morbid self-consciousness, hypertrophied submission; to hope and cheer add smile, relaxation, and zest; and we have the chief elements of mental hygiene and the reason why intelligent as well as unintelligent men like to be swindled by medical or other quacks.

The social aspects of mental hygiene are particularly important. Once admitting the power of the mind to decrease vitality, we recognize the duty of seeming happy, buoyant, cheerful, vital, at least when with others, for the sake of others' minds and bodies. Secondly, we find the duty to refrain from commenting on others' appearance in a way that will start "ingrowing thoughts." A "grouchy" foreman can give blues and indigestion to a roomful of factory girls. A self-pitying teacher can check the heart beats of her class, cause arteries and lungs to contract, and deprive the brain of fresh blood. An oversympathetic neighbor can put a strong man to bed by discovering signs of nervous disintegration. Shall we gradually work out a code of mental hygiene rights and nuisances that will require compulsory notification of the "blues" and compulsory segregation of every person unable to "smile dull care away"? Is the time coming when boards of health will accompany infection leaflets with messages such as this from James Whitcomb Riley:

Talk health. The dreary, never-changing tale Of mortal maladies is worn and stale. You cannot charm or interest or please By harping on that minor chord, disease.

"Whatever the weather may be," says he, "Whatever the weather may be, It's the songs ye sing, and the smiles ye wear, That's a-making the sun shine everywhere."

Mental hygiene has hitherto enjoyed an evil reputation and has been condemned to generally evil associations, because the rank and file have been ignorant of hygiene of every kind. Medical science has so long enveloped itself in mystery that it is in danger now of becoming discredited and of falling heir to the mantle of quackery.

Quacks often get social and economic results more agreeable to the patient and more helpful to society than orthodox medicine. "When traitors become numerous enough treason becomes respectable." So when mental hygiene succeeds, it becomes science for the case in question, and for that case orthodox medicine loses its respectability. For the layman there is no safety except in having intelligence enough to know whether his trouble has defied the sincere application of mental treatment, auto-suggestion, and loyalty to the health ideal.

Mental hygiene admits the existence of dental cavities, scarlet fever germs, adenoids, cross-eyes, uncleanliness, broken legs, inflamed eyes, overeating. The organic, structural defects which are to be sought by physical examination are all admitted by mental hygienists. They work for an orderly, daily routine and affirm the penalties of its violation. They would even favor going periodically to a physician, provided that we never go to him except when organic or structural disorders may safely be assumed from the fact that cheer and relaxation treatment does not give relief. Unhygienic living and mind cure cannot go together. The mind that tries to deceive itself cannot cure either mind or body. The man who violates the habits of health cannot patch his injuries or conceal the ravages of dissipation by mental hygiene. Here is the great advantage of knowing how to live hygienically, of observing habits of health, and then concerning ourselves not with ourselves, but with conditions of living for all those whose health can be affected by our health, or can affect our health and efficiency.

The most recent practical application of mental hygiene for moral and physical uplifting is the "moral clinic" or "psychotherapeutic" clinic established by Emmanuel Church in Boston. This clinic represents the union of three forces,—religion, medical diagnosis, mental hygiene. As a result of this alliance it is anticipated that both religion and medicine will be humanized, socialized, vitalized, made to express more accurately and more consistently that community consciousness and that yearning for equal opportunity and equal happiness which constitute the profoundest religious impulse. No person is treated at this moral clinic whose trouble is organic or structural. In determining whether the case belongs to this clinic, expert medical diagnosis is relied upon rather than the credulity of the patient or the zeal of the clergyman. Medical scientists of highest repute can consistently cooeperate, because they recognize two scientific facts: first, that many troubles are due primarily to mental disorder; and, second, the greatest asset of the human mind is that something called religion, which is no less real and potent because peculiar to each individual. Whatever may be that deepest current of thought and feeling, whatever that synthetic philosophy, that explanation of being, which guides my life, it can be of inestimable aid if enlisted in an effort to secure normal vitality of mind and body.

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