Social disease

“ The disease and the crime below are to the social community what pain is to the individual, and just as the special senses become more highly organized and sensitive as the nervous system becomes more highly developed, so as the civilization of the community intensifies does the public conscience awaken to forms of mischief and crime in one generation that were unsuspected in a previous one. So social evils become intolerable and finally are removed. How then are we employing our knowledge as to the causation of disease to the public problem of its removal or abatement? ”

“ I know well that charity organization workers, court workers and others may establish just as close a relation with their clients in the end as is possible for the medical social worker. But the start is harder and needs more experience. Because disease is the common enemy of mankind, all sorts and conditions of men are instinctively drawn together when it becomes necessary to resist the attacks of disease as the enemy of the human family. ”

“ Such will now have an opportunity of learning that they have been treating the symptoms of social disease rather than the disease itself. They will see that vice is rather the effect than the cause of physical misery, and that the surest mode of attacking it is to improve the physical conditions of the lower classes; to abolish foul air, fouled water, foul lodging, and overcrowded dwellings, in which morality is difficult, and common decency impossible. They will not give up—Heaven forbid that they should give up!—their special good works ”

“ All the promises connected to the fast-growing network of networks are based on this fundamental assumption. A social immune system ought to be understood as a mechanism for preventing actions detrimental to the effective functioning of each and every member of the community. Social disease entails connotations characteristic of a system of good and bad, right and wrong. What is meant here is the possibility that individual effort and pragmatic focus become disconnected. ”

“ The analogy from individual disease to social disease is one of the safest that can be drawn, nevertheless I use it here only to set in more familiar light the proposition which stands on its own foundation of fact, that legislation for the purpose of attempting a remedy for assumed social disease is affected by this radical vice, viz.: it (the legislation) enters into the subsequent phenomena and renders extremely difficult, if not impossible, all efforts to make a correct diagnosis of the case, to tell certainly whether there is any disease or not—if any, what its character ”

“ In this system nothing at all is done to prevent or lessen the propagation of the social disease, but, on the contrary, everything is done to nurse and develop it by cutting off such direct penalties as would, in the order of nature, be connected with the evil, and would react upon it to restrict it. ”

“ Maybe it is just a commonplace, every-day story of a room full of school children, 22 per cent of them undernourished, as is the case in New York City, and the parents out of work a part of the time, and with no possibility in their lives of ever earning enough to feed the children properly. When you confront these universal facts of our present social order, you realize that the problem of disease is not merely a problem of the body, but is a problem of the mind as well; a problem of politics and religion and philosophy, of the whole way of thinking of the so-called civilized world. ”

“ Later, the anti-social man was regarded as a pathological product—the victim of disease; and it is one of the fashions of to-day to regard him as 'a social product'—the victim of adverse social environment. ”

“ There seems good proof that a few millions of men and women are bringing misery upon the rest because they are treated as unworthy of social consideration. Medical men are saying that the disease which is undermining the health of the nation is dangerous only because it is shameful. ”

“ Next, what about disease? The diseases of poverty are entirely done away with. We are now able to apply the knowledge of science to the whole community, and so we no longer have to do with tuberculosis and typhoid, or with rickets and anæmia in children, or with heavy infant mortality. We have sterilized our unfit, the degenerates and the defectives, and so do not have to reckon with millions of children from these wretched stocks. We now give to the question of public health that prominence which in the old days we used to give to war and the suppression of crime and social protest. ”

“ This tendency of the birth-rate to fall with the growth of social stability is thus a tendency which is of the very essence of civilization. It represents an impulse which, however deliberate it may be in the individual, may, in the community, be looked upon as an instinctive effort to gain more complete control of the conditions of [187] life, and to grapple more efficiently with the problems of misery and disease and death. It is not only, as is sometimes supposed, during the past century that the phenomena may be studied. ”

“ It takes no part in the bodily functions, and, therefore, is a disease. Yet it is connected with the body, grows in it, and swells hugely upon stolen blood. Social life has this possibility of morbid growth as has the physical body.
All legitimate social functions check and limit each other, as do our physical functions. No true branch of the social service can wax great at the expense of the others. If there are more in any trade or profession than are needed, the less capable are dropped out—cannot maintain a place in that line of work. ”

“ And so it is not absurd to suggest that one of those things which once made jests for the comic paper and the Victorian paterfamilias has, little by little, with the spread of wealth, become a problem of the day, a problem profound and menacing, full of intimations of social decay, not far remote in its reactions from the spread of a disease. ”

“ A high birth-rate with a low death-rate seems to have been even more exceptional than among ourselves, for under inelastic social conditions the community cannot adjust itself to the rapid expansion that would thus be rendered necessary. The community contracts, as it were, on this expanding portion and largely crushes it out of life by the forces of neglect, poverty, and disease. ”

“ These sufferings—at least in their more tangible forms—fall almost wholly upon the poorer classes, while the richer get a larger share of the increased product which the progress brings. By sufferings I mean not only the physical hardship and liability to disease, early decay, and mutilation or death by accident, which fall to the hand-worker; but also the debasement of children by premature and stunting labor, the comparative lack of intellectual and social opportunities, the ugly and discouraging surroundings, and the insecurity of employment, to which he and his are subject. ”

“ The importance of teaching the social worker all that is known about the transmission and causation of disease is due to the following fact: whatever we [Pg 22] succeed in accomplishing in our efforts at preventive medicine, whatever we do to nip disease in the bud or to check the spread of epidemics, is due to our knowledge of the causes of disease. ”

“ The massing of the people in large cities, the factory life, the much greater social life, which are all prominent features of modern civilization, would be difficult or impossible without control of the infectious diseases. ”

“ There is no doubt that public enlightenment regarding the dangers of social diseases will soon lead to legislation and public medical work which will contribute greatly towards reduction of the diseases. ”

“ if those who rule the destinies of nations would but remember this—if they would but think how hard it is for the very poor to have engendered in their hearts, that love of home from which all domestic virtues spring, when they live in dense and squalid masses where social decency is lost, or rather never found—if they would but turn aside from the wide thoroughfares and great houses, and strive to improve the wretched dwellings in bye-ways where only Poverty may walk—many low roofs would point more truly to the sky, than the loftiest steeple that now rears proudly up from the midst of guilt, and crime, and horrible disease, to mock them by its contrast. In hollow voices from Workhouse, Hospital, and jail, this truth is preached from day to day, and has been proclaimed for years. ”

“ If society is to progress on a truly humanistic basis, without being subject to mental epidemics and virulent social diseases to which the subconscious falls an easy victim, the personal consciousness of every individual should be cultivated to the highest degree possible. ”

“ It would be well if we all took a deeper interest in the welfare of each other, if we felt that any disease, epidemic, or misfortune, that affects any member of the community, must by the common law of relationship, affect us; the man who wilfully breaks the laws of health, not only injures himself and his next of kin, but he injures society, of which he is a member, by depriving society of the creative wealth of labour ”

“ Notwithstanding this remarkable power of vitality, which can brave such extreme variations in physical conditions and endure enormous privations, careful observation all over our country presents a fearful record of death, sickness, and physical degeneration produced by our own social arrangements—arrangements and habits so destructive to the human organization that they overpower even this great capability of adaptation. ”

“ Poverty, frost, famine, disease, debt, are the beadles and guardsmen that hold us to common-sense. ”

“ At first, unlike its ordinary course, the disease seemed to confine itself to the higher circles of society, selecting its victims from among the proud, the well-born and the wealthy, entering unabashed into stately chambers, and lying down with the slumberers in silken beds. ”

“ And with this physical degeneration we find mental and moral deterioration. The frequent expression of the poor, “We have no sickness, thank God,” is uttered by those whose sunken eyes, pale cheeks, and colorless lips speak more eloquently than words, of the unseen agencies which are sapping the fountains of health. Vice, crime, drunkenness, lust, disease, and death, here hold sway, in spite of the most powerful moral and religious influences. ”

“ Society suffers in the same way. It leaves districts undrained, and streets uncleaned. Masses of the population are allowed to live crowded together in unwholesome dens, half poisoned by the mephitic air of the neighbourhood. Then a fever breaks out,—or a cholera, or a plague. Disease spreads from the miserable abodes of the poor into the comfortable homes of the rich, carrying death and devastation before it. The misery and suffering incurred in such cases, are nothing less than wilful, inasmuch as the knowledge necessary to avert them is within the reach of all. ”

“ With the lightest touch, different women asking different questions at different times, and putting all our answers together like a picture puzzle, they had figured out a sort of skeleton chart as to the prevalence of disease among us. Even more subtly with no show of horror or condemnation, they had gathered something--far from the truth, but something pretty clear--about poverty, vice, and crime. ”

“ To my duty it alone belongs, in such respects, to tell you where disease ravages the people under your charge, and wherefore; but while I lift the curtain to show you this—a curtain which propriety might gladly leave unraised, you cannot but see that side by side with pestilence there stalks a deadlier presence; blighting the moral existence of a rising population; rendering their hearts hopeless, their acts ruffianly and incestuous; and scattering, while society averts her eyes, the retributive seeds of increase for crime, turbulence, and pauperism. ”

“ It is easy to propose to society a simple remedy like better housing, prohibition, or socialism, when the only correct diagnosis of conditions demands a prolonged and expensive course of treatment that involves surgical action in the social body. It is easy to raise money for charity, to endow hospitals, and to talk about made-to-order schemes for ending unemployment, poverty, and panic, but it is soon discovered that there is no panacea for the evils that infest society. ”

“ Civilization, on the other hand, tends more and more towards the preservation of psychopathic individuals. We no longer kill our sick and our weak, nor do we abandon them to a miserable, painful death,—we take care of them, and cure them. Moreover, [274] we prevent pathogenic factors from exercising a harmful, malign social selection of the “fit.” We do our best to free ourselves from the blind, merciless, purposeless selection, produced by pathogenic micro-organisms and by other noxious agencies. We learn to improve the external environment. ”

“ People adapt themselves wonderfully to bad hygienic conditions, and once so adapted, they may be able to preserve their health for a long period. But if then a family is suddenly forced to crowd itself into smaller, darker, dirtier, noisier quarters than it has been used to, or if a family group increases its numbers within the same quarters, the adaptive powers of the human organism may be overstrained and break down.
It is against these conditions especially that the social worker and the doctor should labor. Housing problems are among the most difficult of all that confront society. ”

“ The heavy and complicated social burdens and injuries it inflicts on the present generation are without compensation, while the unquestionable fact that in any degree it is highly inheritable renders it a deteriorating poison to the race; it depreciates the quality of a people. The task of Social Hygiene which lies before us cannot be attempted by this feeble folk. Not only can they not share it, but they impede it; their clumsy hands are for ever becoming entangled in the delicate mechanism of our modern civilization. ”