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that of a handful of rude natives and an occasional more polished visitor from the city, but ever under the stimulus and encouragement of a strong and sympathetic comrade who shared his isolation with him, he fought down his disease. A new decade opened and the exile saw inherited taint and Villemin's virus give way to Koch's bacilli. His imagination took fire. He must acquire the custody of these bacilli and learn all about them. Having taught himself that consumption can be driven into the background he must impart to others what experience had proved to him. And if consumption were really due to living particles which came from without and if these could be caught and imprisoned and worked on at will, then the future held out all sorts of unbelievable possibilities as regards the conquest of consumption.
Trudeau had already in mind the germ of a plan to translate his own experience into some form of help for the tuberculous. He was already familiar with the work of Brehmer and Dettweiler, and had discussed with one or two friends the feasibility of founding an institution somewhat similar to theirs. But there can be no doubt that his plans received a marked impetus and took on more concrete form after he learned of the discovery of the tubercle bacillus. If the tubercle bacillus had not been laid bare at this time, Trudeau would have been merely the founder and guiding spirit of an abode for consumptives, and probably nothing more, great though this work might have been. The news of the discovery of the bacillus brought to light another Trudeau that up to this time had lain buried to his friends, and which, if dwelt upon, would probably have been a matter of astonishment to himself. It kindled within him talents of study and investigation that he had never before made use of; and once ablaze the fire never went out until that dreary day of November, 1915, at last delivered the flickering spark of life to the tubercle bacillus. To me it has always appeared that it was by no means a minor effect of Koch's discovery that it gave birth to Trudeau the scientist, Trudeau the student and Trudeau the man of sure and penetrating instincts. When, as now and again happened, Trudeau the man with the sanatorium became a-weary and afraid, it was Trudeau the scientist, the man aflame with the passion to know and sallying out once more to give battle to the foe in in his little home-made laboratory, that refreshed him and gave him courage. There, facing one of the few corners of a bleak mountain village, Trudeau could look across the wastes of snow and green tufts of hillside pines that separated him from the life that he was brought up to love; yet in the presence of his poor little outfit of test tubes and flasks of tubercle bacilli and his inoculated guinea pigs and fired with the hope that he was thus going to learn more about tuberculosis, the yearning to go back to the attractive surroundings of the past faded into oblivion and he became unmindful of the hardships of his
life and the trials that threatened to blot out the life of his pet venture,—the sanatorium. Trudeau to-day is known mainly by reason of his sanatorium: and on it his fame will always lean. Yet it is absolutely certain that the spirit of this sanatorium is what it is because of certain remarkable traits in Trudeau which Koch's discovery fanned into activity.
It is not possible for an ordinary pen to draw an accurate and satisfying picture of what in these pregnant years was going on under the same sun, in widely scattered places, in the fight against tuberculosis. The already immortal Koch, at the pinnacle of fame, Professor at Berlin, director of great projects, guide and teacher of scores of students, soon to become famous, who flocked from the ends of the earth to learn method from the master and thus equipped to hurl themselves against the microscopic enemies of mankind, - this Koch, busy with cultures of tubercle bacilli and tuberculous animals in a mighty effort to cure and prevent the greatest of all plagues, -this Koch, the acclaimed of all, to whom every one looked, whose every word carried the weight of finality, surrounded by every facility and necessary implement for work, claims perhaps the centre of the stage. We shift the canvas. And now appear the associates of Pasteur and Grancher and Martin, employing every method that Pasteur's immortal work on anthrax and silk worm disease and rabies and a host of other affections made promising,--they too with the machinery of attack that would have made any American professor of the time green with envy. Last of all, across the ocean, almost off-stage, obscure and thoroughly alone, with a handful of animals and apparatus, carried along by an indominatable purpose to discover, taught by the instinct of genius and a few pamphlets that irregularly filtered through the mountain barriers,—Trudeau. In Germany, in France and in America the same work was going on. Independently of one another Koch, the French school and Trudeau were experimenting on the prevention and cure of tuberculosis. But under what different conditions !
It was August 4, 1890, when Koch announced that by the use of a secret and undescribed substance he had been successful.
It was November 22, 1890, when Trudeau published in the Medical Record that he could not immunize animals against tuberculous infection by first inoculating them with dead germs or with the filtered and sterilized cultures of tubercle bacilli. Trudeau published every detail of the preparation of his materials that were used for immunization. As was discovered later, there was no essential difference between Koch's substance and Trudeau's. Yet one man had made remarkable claims while the other confessed that in his hands the substance did not have the desired effect. Trudeau published negative results and his paper was passed over without notice; Koch made startling positive assertions and his announcement created a furore.
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DR. JOHN H. LOWMAN
AN APPRECIATION By EDWARD R. BALDWIN, M.D., SARANAC LAKE, N. Y. The death of Dr. John H. Lowman on Jan- He was president of the National Tuberuary 23, 1919, removes a distinguished worker culosis Association in 1913-14, president of and leader in the anti-tuberculosis movement. the Ohio State Tuberculosis Society from 1909
He passed away in New York City two days to 1912 and member of other national medical after his return from Italy, where he had suf- societies besides many local ones. fered an attack of influenza.
Among medical leaders in the anti-tubercuHe went to Italy last fall as medical director
losis cause, Dr. John H. Lowman was of unof the American Red Cross Tuberculosis Unit
usual distinction by reason of his gifts of mind in that country. He was widely known as a and heart. He was well informed by reading lung and throat specialist and pioneer in Ohio
and travel in all that pertained to medicine and in organizing and maintaining tuberculosis dis
especially in tuberculosis. His intelligence was pensaries, infant welfare stations, etc.,
penetrating, and aided by wide interests and His enthusiasm was great for the foreign sympathies. His desire for human welfare work he undertook, though no longer vigor- and his understanding and culture would have ous in health. He was a medical teacher for made him eminent in any field as a teacher, thirty-eight years, being professor of chemical
publicist and organizer. Fortunate was it inmedicine and ethics at Western Reserve Uni
deed that medicine had the benefit of his life versity until his death at the age of seventy.
work and tuberculosis workers the genius of He was especially interested and successful in bringing together many relief organizations
his leadership. into a united form under the name of The His full life is an inspiration to those who Anti-Tuberculosis League of Cleveland, an have watched the feeble beginnings of antiaccomplishment of great value to that city. tuberculosis effort elsewhere.
NEGRO HEALTH EDUCATION*
The quoting of statistics is not necessary venereal disease. These commandments are
health must be built. What I want to build I shall not attempt to consider what pro- upon is the fact that the social conscience portion of Negro disease is racial or must consciously work for the elimination of ganic, and what is environmental or personal. all preventable disease. This is a very comIt is clear that, whatever the cause, disease prehensive idea and involves a very compreneeds treatment, and, so far as possible, cure. hensive program. I state it in general terms It is also clear that a great volume of dis- only to apply it in its benefits to the Negroes, ease among Negroes is caused by personal who constitute so large a part of our naignorance and carelessness, by insanitary sur- tional, and particularly of our Southern group. roundings and conditions, and by inadequate The iniquity of Negro diseases lies first upand inefficient treatment, and that this great
on us who have been more highly privileged. volume of disease is therefore preventable.
Not until we have done all that we can, can It is with man-made and man-controllable we have a conscience void of offense tomalady that we are chiefly concerned to- ward God and toward man. I plead first for a day. We are moved not only by sympathy conscious recognition on the part of the white for unnecessary suffering, but by social ad- man of his obligation in this matter. I do vantage, and especially moral obligation. For not and shall not plead less earnestly for a we are recognizing health as an ethical im- similar attitude on the part of the Negro withperative, and disease as therefore sin, per
in the limits set by forces beyond his control. sonal or social-(except perhaps when we
The problem of Negro health education is ourselves are sick),—and to a large extent
in the first place a problem of the health society's responsibility for the existence, the education of the whole group of which the transmission, the inevitability of disease is
Negro is only a part, and health education so great that we must overlook at first the itself cannot go very far except it be built responsibility on the part of the individual- upon general education resulting in general not forgetting that society is in the last an- intelligence. If we shall add to social alysis made up of individuals.
conscience, a universalized education, which In recognizing this fact, as we are consci- gives intellectual and social vision, we shall ously doing these days, we are laying a
have laid the foundation for a specific edunew foundation and basis for morality. The
cation in the field of health. health movement is fundamentally an ethical
Among many phases of the program of movement-a chief corner stone for the build- health education, let us mention: ing of the Kingdom of God on earth.
1. Education by healthful conditions. Just in passing I raise this question with
2. The imparting of health knowledge you. May we not use the volume of phy
through the schools. sical disease in the United States as a meas
3. Education through the visiting nurse. ure, (one of the measures) of the ethical
4. Education through organization and pubhealth of the nation? Does it not register
lic propaganda. the effective conscience of the nation, does
5. Education through the physician. it not measure the pull-down from the high plane which a truly socialized conscience
Education by Healthful Conditions would insist upon? Do we not see the ac- 1. An indefinite sentence to Gehenna would tual process of building, before our eyes, of a new and effective morality in the ad
not contribute to the practice of good mandition of new commandments not less im
ners in heaven. Nor can we expect people
sentenced to the hell on earth, commonly perative than those written by Moses :--Thou shalt not suffer from alcoholism. Thou shalt
called the slums, to facilitate the comprehennot have tuberculosis. Thou shalt not have
sion or the practice of the laws of health,
cannot think of common decency, not to men-
tion democracy or Christianity, in connection
with the dirty streets, nasty toilets, poisonous
through school text-books and leaflets in the water, crowded tenements, and infected quar
elementary grades is social strategy of the ters, which we tolerate, and even force upon highest sort. There is a wide range of physthose we call our brothers, the children of
ical and social truth which but waits the our common Father. The biggest work in
genius-author to ripen through school boy health education would be the creation of a
and school girl minds into the social reforms public conscience that would wipe out these
of the next generation. conditions once for all. There can be no question about our financial ability. The war has
The Visiting Nurse settled that. The ultimate financial gain is no longer doubted in such circles as yours.
3. There is little I can say to this body to The moral and spiritual advantages are not
emphasize the educative function of the visitless incontestable and immeasurable.
ing nurse. She both stimulates desires and The Negro would profit perhaps even more
brings desire to fruition through her demon
strations and her instructions as she goes than the white man both in immediate health
from house to house. We ought to have and in health standards, just as he has probably suffered more in the housing wrongs of
many more Negro nurses. We ought to have the past. But the white man in the slums and
more funds and more resources to make their
education possible. Especially ought we to out would profit directly both materially and
have provisions for the training of Negro educationally and also indirectly from the lessened contagion to which he was exposed so
public health nurses. An institution like the long as the colored man was left in disease
one over which I preside, already gives suband distress. We should have an insistent
stantially all but one or two of the courses public demand for the minimum requirements
required for the public health certificate. The
institution needs the slight funds required to of sanitary, healthy existence for all humans.
administer the department. Above all funds No separate policy is needed for colored people.
are needed for scholarships which will justify
the graduate nurse in entering the advanced Imparting Health Knowledge Through
training here recommended. My hearers
know better than I, how great a work in health the Schools
education can be done by the public health 2. Health through the schools means first, nurse. They will recognize the economy of as already intimated, universal school oppor
making her education possible. tunities, which Negroes do not have even to the extent that white people do. Herbert
Organization and Propaganda Spencer was perfectly correct when he said 4. Very few reforms come about without you can not get the results of intelligence special agitation and definite organization. To out of a stupid people. A health program carry the gospel of health to the colored peomeans primarily applied intelligence. You can ple will require in the last analysis the coimpart a good deal of wisdom and secure a operation and aid of colored people. This is good deal of wise practice through definite being secured to some extent in many places health instruction, but there are limitations as other speakers have told you and will tell both as to speed and distance set by ignorance. you this afternoon. It is as important for I am heretical enough to be in doubt whether civic health as it is for physical health. It all our specialized and popularized health will not do to do every thing for the colored movements would not be farther along in ten people. I beg to submit that ultimately it years if all the health educational agencies will not do to ask the Negro to do everything would postpone their special propaganda for for himself. Duplicate or parallel organizafive years and work unitedly for the cause tions appeal to race ambition and race pride of general education.
and stimulate to much of worthy endeavor. Nevertheless the way to assure a particular
Nevertheless we must look forward to the reform is to approach the problem through the
time when colored and white shall share in public schools. I have no doubt that the common task, however distinctly details United States has gone dry because temper- may be distributed, rather than work out simiance and abstinence have been taught in the lar but separate tasks. Otherwise in the long public schools for more than thirty years. run we shall work with different speed and There were errors and extravagances in the with different efficiencies, if indeed we do not teaching. Nevertheless the program worked.
work at cross purposes. Doubtless some teachers could make a study of disease and ill health morbid and harmful
Education Through the Physician to the point where the pupils would go home 5. It is probable that next to the preacher to sing :
the physician is the most influential man in One sweetly solemn thought
colored circles. In health matters his influComes to me o'er and o'er
ence should be and probably is the most po
tent of all. I have got one more germ to-day
Like the nurse he educates by Then ever I knew before.
deed and by word. His longer training and
more critical power in the handling of disBut wise plans will prevail. The project eases make him the key man in the reduction of handling the problem of tuberculosis of mortality and disease rates and in the dif.
colored people and of Negro medical education there are those who believe it has been a mistake to force Class A standards and requirements, on the ground that under existing conditions of general education and of Negro poverty, it will be impossible to get a sufficient number of Negro doctors.
Personally I think it wise to insist upon high standards, but I believe to do so makes it socially imperative to aid by scholarship funds a sufficient number of worthy and able students at least during the last two years of the course, so that the ranks of competent practicioners and health educators shall be be kept full. Public wisdom as well as public philanthropy should see to these two practical needs.
fusion of the principles of health among the people. The greater his knowledge and skill and wisdom the more powerful he will be. It is important therefor that he be well educated in the technique of his profession and broadly educated in the principles of preventive medicine and of social welfare.
I maintain that in the long run Negro health education will function most importantly through the Negro doctor. It is strategically necessary then, if the battle of health for health is to be won, (1) that the medical education provided for Negro physicians shall be of as fine a quality as is provided for physicians of any race; and (2) that it shall be made financially possible for a sufficient number of Negros to get this fine medical education.
This association, when it considers the volume of Negro tuberculosis and of its relation or possible relation to white tuberculosis, can not fail to be vitally interested in these last two points. Doubtless you all know that there are practically only two medical schools exclusively attended by colored students. The one at Washington, D. C., serving the North and East is a part of the larger institution, Howard University. The other, Meharry Medical College at Nashville, stands by itself and serves the rest of the South. These two institutions are sufficient to handle the present numbers of students. They are now both rated as Class A schools, but compared with the recent standards set for white medical schools I fear they still have great needs. Will an intelligent public not insist that in every respect they shall have and they shall do whatever the highest efficiency requires ?
As to the second point, among the most intelligent and most sympathetic friends of the
All that I have said boils down to this:
(1) We must have an active social conscience that recognizes our imperative obligation to assure the health of the Negro.
(2) We must have a higher public intelligence through a universalized public education that shall give a public backing for essential health programs and continuing progress.
(3) We must teach the doctrine of health in every grade in every school.
(4) We must organize public sentiment both colored and white.
(5) We must carry on public education through the convincing labors of nurses and doctors.
(6) We must make it financially possible for the public health nurse and the physician to get the training which they must have for their work.