230 
Modern  Medicine. 
f  Am.  Jour.  Pharm. 
t       May,  1915. 
These  facts  are  well  known  to  all  physicians.  They  are  not  as 
well  known  nor  their  importance  as  well  understood  by  the  public  as 
they  should  be.  The  work  of  Pasteur  and  his  successors  has  entirely 
changed  the  relation  of  the  State  to  public  health.  A  danger  which 
is  visible  to  all  and  readily  recognized  needs  only  to  be  stated  to  be 
avoided.  Dangers  to  life  and  health  which  the  average  normal  man 
and  woman  can  see  require  little,  if  any,  legislation.  The  instinct  of 
self-preservation  is  sufficient,  if  the  danger  is  known.  But  in  dis- 
eases caused  by  microorganisms  the  cause  is  not  only  invisible,  but 
the  specific  cause  can  only  be  recognized  by  men  of  expert  technical 
training,  equipped  with  delicate  instruments  of  scientific  precision. 
The  avoidance  of  such  diseases  clearly  cannot  be  left  to  the  in- 
dividual. It  therefore  becomes  the  duty  of  society  to  do  for  the 
protection  of  the  individual  what  he  cannot  do  for  himself,  and  to 
utilize  scientific  knowledge  in  protecting  him  from  harm  which  he 
alone  cannot  avoid.  The  entire  relation  of  the  State  to  the  people 
and  of  the  medical  profession  to  society  and  to  organized  government, 
whether  of  the  city,  the  State,  or  the  nation,  has  changed  entirely 
during  the  last  forty  years  through  the  development  of  our  knowl- 
edge regarding  the  causes  of  disease.  The  moral  and  legal  justifica- 
tion for  State  activity  for  the  prevention  of  disease  lies  not  in  the 
demands  of  the  medical  profession,  but  in  the  fact  that  it  is  the  duty 
of  the  State  to  protect  its  citizens  against  dangers  from  which  they 
cannot  safeguard  themselves. 
The  justification  for  public  education  is  the  prevention  of  disease 
and  the  prolongation  of  life.  Such  objects  need  no  argument.  It 
is  necessary,  however,  to  convince  the  mass  of  the  people  of  the 
possibility  of  their  accomplishment. 
When  we  look  over  the  history  of  public  health  legislation 
during  the  last  fifty  years  it  is  difficult  to  say  whether  surprise, 
indignation  or  amusement  is  most  predominant.  The  misunderstand- 
ings, antagonisms  and  conflicting  efforts  on  the  part  of  physicians 
and  the  public  might  well  be  cause  for  amusement  were  the  results  of 
such  misunderstanding  not  so  serious.  Prior  to  the  middle  of  the 
last  century  there  was  practically  no  recognition  of  the  responsibility 
of  society  and  of  the  State  in  the  prevention  of  disease.  The  State 
was  in  the  same  position  as  the  medical  profession :  it  had  nothing 
to  tell  the  people;  it  could  only  wait  until  a  man  or  woman  was 
stricken  with  disease  and  then  care  for  them,  if  they  were  without 
other  protectors.  Late  in  the  '6os  growing  conceptions  regarding 
the  duties  of  the  State  toward  its  citizens  began  to  take  definite  form. 
