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 Ishift 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. (Continued on page 150) BY EDWARD R. BALDWIN, M.D., SARANAC LAKE, N. Y. The death of Dr. John H. Lowman on January 23, 1919, removes a distinguished worker and leader in the anti-tuberculosis movement. He passed away in New York City two days after his return from Italy, where he had suffered an attack of influenza. He went to Italy last fall as medical director of the American Red Cross Tuberculosis Unit in that country. He was widely known as a lung and throat specialist and pioneer in Ohio in organizing and maintaining tuberculosis dispensaries, infant welfare stations, etc., His enthusiasm was great for the foreign work he undertook, though no longer vigorous in health. He was a medical teacher for thirty-eight years, being professor of chemical medicine and ethics at Western Reserve University until his death at the age of seventy. He was especially interested and successful in bringing together many relief organizations into a united form under the name of The Anti-Tuberculosis League of Cleveland, an accomplishment of great value to that city. He was president of the National Tuberculosis Association in 1913-14, president of the Ohio State Tuberculosis Society from 1909 to 1912 and member of other national medical societies besides many local ones. Among medical leaders in the anti-tuberculosis cause, Dr. John H. Lowman was of unusual distinction by reason of his gifts of mind and heart. He was well informed by reading and travel in all that pertained to medicine and especially in tuberculosis. His intelligence was penetrating, and aided by wide interests and sympathies. His desire for human welfare and his understanding and culture would have made him eminent in any field as a teacher, publicist and organizer. Fortunate was it indeed that medicine had the benefit of his life work and tuberculosis workers the genius of his leadership. His full life is an inspiration to those who have watched the feeble beginnings of antituberculosis effort elsewhere. NEGRO HEALTH EDUCATION* By DR. F. A. McKENZIE, PRESIDENT FISK UNİVERSITY, NASHVILLE, TENN. The quoting of statistics is not necessary to remind us of the very great, if not truly alarming, disease and death rates of the American Negro, especially in our towns and cities. The general situation is too well known for that. Nor is it necessary to name the diseases to which he is especially prone, nor those from which he appears to be relatively immune. Much statistical work remains to be done to determine finally some of these questions. But, however complete or incomplete, exact or inexact, clear or vague, our information, the outstanding certainty is that of a tremendous need requiring our attention. I shall not attempt to consider what proportion of Negro disease is racial or organic, and what is environmental or personal. It is clear that, whatever the cause, disease needs treatment, and, so far as possible, cure. It is also clear that a great volume of disease among Negroes is caused by personal ignorance and carelessness, by insanitary surroundings and conditions, and by inadequate and inefficient treatment, and that this great volume of disease is therefore preventable. It is with man-made and man-controllable malady that we are chiefly concerned today. We are moved not only by sympathy for unnecessary suffering, but by social advantage, and especially moral obligation. For we are recognizing health as an ethical imperative, and disease as therefore sin, personal or social-(except perhaps when we ourselves are sick),-and to a large extent society's responsibility for the existence, the transmission, the inevitability of disease is so great that we must overlook at first the responsibility on the part of the individualnot forgetting that society is in the last analysis made up of individuals. In recognizing this fact, as we are consciously doing these days, we are laying a new foundation and basis for morality. The health movement is fundamentally an ethical movement-a chief corner stone for the building of the Kingdom of God on earth. Just in passing I raise this question with you. May we not use the volume of physical disease in the United States as a measure, (one of the measures) of the ethical health of the nation? Does it not register the effective conscience of the nation, does it not measure the pull-down from the high plane which a truly socialized conscience would insist upon? Do we not see the actual process of building, before our eyes, of a new and effective morality in the addition of new commandments not less imperative than those written by Moses:-Thou shalt not suffer from alcoholism. Thou shalt not have tuberculosis. Thou shalt not have * Read before the Southern Tuberculosis Conference, Birmingham, Ala., January 23, 1919. venereal disease. These commandments are going to revolutionize many of our customs -and many of our costumes. They are parts of the new freedom which is to result from a social order more autocratic (however, democratic) than the world has perhaps ever known. The autocracy of the common conscience will be the significant feature of the coming century. You will pardon this apparent digression into the field of social ethics. I trust, however, that it will ultimately appear that it is not a digression but a summarization of the premises upon which a thesis for Negro health must be built. What I want to build upon is the fact that the social conscience must consciously work for the elimination of all preventable disease. This is a very comprehensive idea and involves a very comprehensive program. I state it in general terms only to apply it in its benefits to the Negroes, who constitute so large a part of our tional, and particularly of our Southern group. The iniquity of Negro diseases lies first upon us who have been more highly privileged. Not until we have done all that we can, can we have a conscience void of offense toward God and toward man. I plead first for a conscious recognition on the part of the white man of his obligation in this matter. I do not and shall not plead less earnestly for a similar attitude on the part of the Negro within the limits set by forces beyond his control. na The problem of Negro health education is in the first place a problem of the health education of the whole group of which the Negro is only a part, and health education itself cannot go very far except it be built upon general education resulting in general intelligence. If we shall add to a social conscience, a universalized education, which gives intellectual and social vision, we shall have laid the foundation for a specific education in the field of health. Among many phases of the program of health education, let us mention: 1. Education by healthful conditions. 2. The imparting of health knowledge through the schools. 3. Education through the visiting nurse. 4. Education through organization and public_propaganda. 5. Education through the physician. Education by Healthful Conditions 1. An indefinite sentence to Gehenna would not contribute to the practice of good manners in heaven. Nor can we expect people sentenced to the hell on earth, commonly called the slums, to facilitate the comprehension or the practice of the laws of health. We have nearly reached the point where we cannot think of common decency, not to mention democracy or Christianity, in connection with the dirty streets, nasty toilets, poisonous water, crowded tenements, and infected quarters, which we tolerate, and even force upon those we call our brothers, the children of our common Father. The biggest work in health education would be the creation of a public conscience that would wipe out these conditions once for all. There can be no question about our financial ability. The war has settled that. The ultimate financial gain is no longer doubted in such circles as yours. The moral and spiritual advantages are not less incontestable and immeasurable. The Negro would profit perhaps even more than the white man both in immediate health and in health standards, just as he has probably suffered more in the housing wrongs of the past. But the white man in the slums and out would profit directly both materially and educationally and also indirectly from the lessened contagion to which he was exposed so long as the colored man was left in disease and distress. We should have an insistent public demand for the minimum requirements of sanitary, healthy existence for all humans. No separate policy is needed for colored people. Imparting Health Knowledge Through 2. Health through the schools means first, as already intimated, universal school opportunities, which Negroes do not have even to the extent that white people do. Herbert Spencer was perfectly correct when he said you can not get the results of intelligence out of a stupid people. A health program means primarily applied intelligence. You can impart a good deal of wisdom and secure a good deal of wise practice through definite health instruction, but there are limitations both as to speed and distance set by ignorance. I am heretical enough to be in doubt whether all our specialized and popularized health movements would not be farther along in ten years if all the health educational agencies would postpone their special propaganda for five years and work unitedly for the cause of general education. Nevertheless the way to assure a particular reform is to approach the problem through the public schools. I have no doubt that the United States has gone dry because temperance and abstinence have been taught in the public schools for more than thirty years. There were errors and extravagances in the teaching. Nevertheless the program worked. Doubtless some teachers could make a study of disease and ill health morbid and harmful to the point where the pupils would go home to sing: One sweetly solemn thought I have got one more germ to-day But wise plans will prevail. The project of handling the problem of tuberculosis through school text-books and leaflets in the elementary grades is social strategy of the highest sort. There is a wide range of physical and social truth which but waits the genius-author to ripen through school boy and school girl minds into the social reforms of the next generation. The Visiting Nurse 3. There is little I can say to this body to emphasize the educative function of the visiting nurse. She both stimulates desires and brings desire to fruition through her demonstrations and her instructions as she goes from house to house. We ought to have many more Negro nurses. We ought to have more funds and more resources to make their education possible. Especially ought we to have provisions for the training of Negro public health nurses. An institution like the one over which I preside, already gives substantially all but one or two of the courses required for the public health certificate. The institution needs the slight funds required to administer the department. Above all funds are needed for scholarships which will justify the graduate nurse in entering the advanced training here recommended. My hearers know better than I, how great a work in health education can be done by the public health nurse. They will recognize the economy of making her education possible. Organization and Propaganda 4. Very few reforms come about without special agitation and definite organization. To carry the gospel of health to the colored people will require in the last analysis the cooperation and aid of colored people. This is being secured to some extent in many places as other speakers have told you and will tell you this afternoon. It is as important for civic health as it is for physical health. It will not do to do every thing for the colored people. I beg to submit that ultimately it will not do to ask the Negro to do everything for himself. Duplicate or parallel organizations appeal to race ambition and race pride and stimulate to much of worthy endeavor. Nevertheless we must look forward to the time when colored and white shall share in a common task, however distinctly details may be distributed, rather than work out similar but separate tasks. Otherwise in the long run we shall work with different speed and with different efficiencies, if indeed we do not work at cross purposes. Education Through the Physician 5. It is probable that next to the preacher the physician is the most influential man in colored circles. In health matters his influence should be and probably is the most potent of all. Like the nurse he educates by deed and by word. His longer training and more critical power in the handling of diseases make him the key man in the reduction of mortality and disease rates and in the dif 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 there for 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 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. In Conclusion 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. |