The Compulsory Medical Inspection of School Children B. O. Flower The object of this League shall be to disseminate information pertaining to , and to safeguard through education and publicity, the rights of the American people against unnecessary , unjust, oppressive, paternal and un-American laws ostensibly related to the subject of health . — Article 11, League Constitution. Natumal Hrarjur far fHr&iral iFrrrbam 315 FOURTH AVENUE NEW YORK League Library No. 3 Price 10 Cents 1 V T\$ I . THE COMPULSORY MEDICAL INSPECTION OF SCHOOL CHILDREN I. Fundamental Facts to Be Considered The earnest-minded thinker who would reach the truth on any subject will first consider the fundamentals involved, (i) He will examine the premises and assumptions on which the argument or claim is based, and see if they are sound. (2) He will consider whether the proposed remedies are fundamental or whether they are merely aimed at effects and are palliative instead of root-searching in character. (3) If they are superficial rather than basic, being addressed to effects rather than touching root causes, he will carefully consider whether they may not be attended by ,evils greater than the evils they would remedy; and (4) he will seek to ascertain whether or not they are being advanced by interests that desire to divert attention from the root causes of the evils, or by special interests or classes looking for financial emolument and increase of power through the proposed reme- dies. II. Present Status and Trend of the Movement for Compulsory Inspection Before considering at length the question of compulsory examin- ation of school children, let us note the present status and tendency of this new innovation. The inspection of schools by medical examiners at first was demanded only as a preventive measure in times of epidemics from contagious diseases, the purpose being to protect healthy chil- dren from exposure to contagion. Next came the demand that healthy children be inoculated with virus, whether the parents consented or not. Compulsory vaccination meant an increased revenue of many thousands of dollars to the doctors in every community, but it was also followed frequently by serious and at times fatal results. In the belief of a large number of highly intelligent people, including not a few scholarly physicians and scientists, vaccination is a fruitful cause of the spread of tuberculosis and other diseases, while not preventing smallpox on the one hand and on the other rendering a community less 3 vigilant in regard to real preventive measures, such as proper sanita- tion, notification and isolation. Thus we find that the first step, the innnocent and unobjectionable examination of school children by phy-t sicians to protect the healthy from contagion, was followed by the\ insistence on compulsory medication by the employment of a treat- \ ment that was repulsive to a large number of the intelligent citizens ) and about the value of which even the dominant medical school is ( by no means of one opinion. This proposal for compulsory medica- * tion was followed by a campaign of education, conducted by the polit- ical doctors of the American Medical Association, for compulsory examination of all school children to ascertain their physical condition and determine whether or not various organs were defective or abnormal ; for example, whether, in the opinion of the political doctor, the child was suffering from adenoids, enlarged tonsils, defective teeth, impaired eyesight or hearing, whether his heart was weak or his lungs diseased. Since a tentative acceptance of the proposition in several cities and states, the demand has been further advanced that specialists for the eyes and ears, and psychologists, be added to the general corps of state-supported physicians. Thus, for example, on February the seventh, at a health conference in Baltimore, a distinguished physician, Dr. Henry H. Goddard, declared that two per cent, of the children in all public schools are mentally defective, and he insisted that psycholo- gists should be appointed to examine all public school children, while in various other cities a demand is now being advanced that nurses be added to the medical examining staff, whose duties shall be, accord- ing to a prominent medical examiner in a western state, “to go into the homes of the children and see that our instructions (those of the exam- ining doctors) are carried out.” Here the autocratic spirit of the new medical hierarchy is clearly voiced. However honeyed the words that may be used by the political doctors advocating compulsory medical examination, the fact remains that the ultimate aim and master purpose of those who are chiefly responsible for the present campaign in the interests of the trust-seek- ing medical doctors was clearly and authoritatively voiced by Dr. Samuel G. Dixson, of Pennsylvania, in a contribution to the official organ of the American Medical Association, in which he said : “Com- pulsion, not persuasion, is the key-note of State medicine. . . . These laws must reach into all the relations of life.” This brings us to an examination of the major points involved in this grave question. III. Is the Premise Sound? In the presence of conditions that are admittedly far from ideal, all right-minded citizens will admit the importance and desirability of remedies that will meet the exigencies of the case. But when remedies are advocated, it is the bounden duty of intelligent citizenship to determine whether the proposed treatment rests on false premises and whether it is fundamental or palliative in character ; whether it is the child of conservative and reactionary prejudice, of dogmatic assump- tions, of selfish interests and the lust for power and wealth on the 4 part of a privilege-seeking class, or whether it is the fruit of a broad, philosophical and statesmanlike vision that fronts the future and seeks the underlying principles that make for justice and full-orbed develop- ment of life. To illustrate : When Spain found herself possessed of large territories in the New World, and saw that they could yield in the greatest abundance every agricultural product known to Southern Europe, and had the facilities for both intercolonial and international trade, she protested that she had not discovered and peopled these territories to ruin her own agri- culture and industries and that it was preposterous for her colonies to expect the Mother Country to countenance such a suicidal policy. Accordingly each colony was kept from the slightest intercourse with its neighbor, and no foreigner, on pain of death, might enter or even trade with this vast region. Furthermore, having destroyed all outside markets, she proceeded to prohibit the exportation of agricul- tural or industrial products to her own ports. In short, obsessed with the idea that Colonial prosperity meant her own ruin, she stifled for centuries the development of an area many times larger than all Europe, and finally accomplished exactly what she set out to prevent. No one denies that it is expecting too much of a country, whether it be a proud monarchy or a republic, to injure its own resources that a distant colony may benefit thereby, but the premises in this case were absolutely and fundamentally false, and so gave rise to the most monu- mental error that political economy has any record of. Again, when the apostles of popular sovereignty proclaimed the fundamental principles of democracy, the upholders of the throne and aristocracy at once raised the cry that the best interests of society demanded orderly advance, a reign of law that should guarantee the protection of the life and property of the people from wholesale mur- der, despoliation, license and anarchy, which would follow and mark any society where the people were the ruling power. Now, the impor- tance of avoiding the chaos of a society plunged in anarchy and at the mercy of unbridled lawlessness was everywhere admitted, and on the assumption that any popular rule, or rule that secured for the people the power which the king and privileged classes had arrogated to them- selves, would result in lawlessness, murder, rapine and the destruction of property, the upholders of the old order strove to terrify the people and prevent this great fundamental advance step in government. History is full of similar illustrations, but these typical examples will serve to show the fact we wish to emphasize. In the latter case, more particularly, it will be observed that a general truism is stated about which there is no controversy, followed by inferences plausible to superficial thinkers and those who are in the habit of taking their opinions from others, yet which are seen in the light of history to be absolutely sophistical ; and the premise being false, the conclusions ad- vanced by the privileged classes desiring to continue in power are not valid. The contention that a large proportion of those who stood with the king and aristocracy in their warfare against popular sovereignty were sincere in no way affects the fundamental facts involved. The premise was unsound, and the proposals fallacious and against the best interest of the people. This impressive historic illustration shows the importance of ascertaining whether a premise is sound before we ac- cept the proposed cure. 5 We are told that a great number of school children are in poor health, and that it is desirable that the young be in physical condition to enjoy to the greatest degree the benefits of their school training; and following on the heels of this truism the American Medical Asso- ciation and its allies advance the assertion that the remedy is to be found in compulsory medical inspection by an army of political doctors or state-appointed physicians. We believe, however, that a rational consideration of this question will show that the premise is unsound and the proposed remedy not only superficial in character but fraught with far greater evils than any potential benefits that might result from its enforcement. The evils complained of among the school children, as we shall presently see, are largely, if not chiefly, due to fundamentally unjust economic conditions ; to the general indifference of society in regard to the rights of the poor and dependent, and to ignorance on the part of the unfortunate ones, concerning great and universally admitted facts relating to health and sanitation. To meet this condition, a great privilege-seeking class demands compulsory inspection of chil- dren, to be followed by compulsory medication. This, we claim, is not only a proposal for a remedy necessarily palliative in character and based on a false premise, but the remedy is fraught with the gravest evils at once to the young , to the citizen, to the nation and to the cause of scientific advancement. IV. Palliative Treatment Advanced by a Privileged Class in Lieu of Fundamental Remedies One of the greatest defects in our present-day attempts to grapple with evil conditions lies in our proneness to seize upon some superficial remedy advanced by interested parties, who claim that its adoption would afford immediate relief, without first discovering the real or root causes of the evil condition ; and as a result we adopt palliatives or remedies of doubtful benefit. Such action is analogous to applying a plaster to a repulsive sore without attempting to destroy the cause of the eating ulcer. In no field are the unhappy results arising from this kind of treatment more apparent or more far-reaching in unfor- tunate results than in the realms relating to the physical, mental and spiritual life of the people. It is assumed that the employment of an army of state-salaried physicians to examine the school children of the land would result in benefits so positive as to warrant the outlay of the enormous and constantly increasing expenses, required to meet the salary roll of an ever-augmented army of state physicians. Now at the very out- set this claim will be found to be open to serious question. Indeed, there are valid reasons for believing that the introduction and prose- cution of the proposed innovation will in the long run result in greater injury than benefit to the young; and the subject is so gravely impor- tant that conscientious educators and parents should not permit alluring sophistries or glittering generalities based on unsound premises to prevent their making a careful and impartial study of all sides of the issue. 6 (a) The evil of creating fear in the child mind. Modern psy- chological research has demonstrated few facts so conclusively as that fear is one of the greatest promoters of disease. It not only depresses the victim and makes him negative, but in cases where a physician or one in authority has suggested danger to some organ from disease, or hinted at the possible presence of disease, the fear-laden thought of the patient is constantly centered on the organ supposed to be weak or specially susceptible to disease, and this negative condition of the mind filled with brooding fear, favors as doe$ nothing else, the encroachment or rapid advance of disease. This is a fact so well established that the ablest and most scientific physicians, no less than psychologists, constantly strive to divert the patient’s mind from disease. Furthermore, what is true of the baleful effects of fear on the adult mind is doubly true of its effects on the plastic and highly imaginative mind of the child. At no time in life do we receive such lasting impressions as in childhood, and at no period of life is fear more potent for evil than then. The disastrous effect of creating alarm in the mind of the child and having those dread-laden thoughts cen- tered on its body or some organ of the body, cannot be over-estimated. Indeed, if we concede the possible good results which sinecure-seeking political doctors would have us believe would result from compulsory medical examination — something which we do not for a moment admit — we believe that the evil resulting from the compulsory dissem- ination of fear that must necessarily follow the proposed examination, would far overbalance the good claimed for it. Nor is this all. It is gravely proposed to have specialists employed for the examination of the children ; and what fact in medical history is better established than the proneness of a specialist to find what he is looking for, even though he may not be swayed by cupidity or any selfish motive? A number of years ago one of the New York World's ablest correspondents, Nellie Bly, visited some five famous New York special- ists, giving each exactly the same set of symptoms, and each, after hearing her and carefully examining the patient, declared her case to be one involving an abnormal condition of the organ he specially treated , and each prescribed special treatment for the diseased condi- tion he supposed he had discovered. Here the reporter , who was as a matter of fact, in excellent health, was declared by distinguished regular specialists to have five different diseases involving as many organs of the body. A number of similar illustrations might be cited showing this proneness of a medical specialist to find what he is looking for 0 Now under the proposed system, the arousing of fear in the child’s mind and the centering of his thoughts during the most plastic period of life on some organ supposed to be affected or liable to disease, would work incalculable injury ; while with highly sensitive and imag- inative children the doctor’s dictum would seriously impair the health, and at times prove fatal to the youthful victim. A tragic and impres- sive illustration of this character is found in the following news item from the New York American, for February 5th, 1911: 1 "Mrs. William Rague, of Sherry Lane, West New Brighton, Staten Island, appeared before Health Commis- sioner Lederle, in Manhattan, yesterday and made complaint against Dr. Millicent Hopkins, a woman doctor attached to the Richmond Borough Board of Health. "Mrs. Rague told the Commissioner that her daughter was a pupil in the West New Brighton Public School. During the early part of November, she said that Dr. Hopkins, who was examining pupils at the school, called her daughter out of a line of children and told her that she had heart trouble. Mrs. Rague said that her daughter came home to her in a highly nervous state. "Mrs. Rague says her daughter worried herself into sickness and for days refused to take nourishment. She says she called in her family physician and that the latter told her that there was nothing the matter with her daughter’s heart. "Despite this information, she says her daughter’s con- dition grew worse and that on December 5th she died. "Mrs. Rague told the Commissioner that she believed what Dr. Hopkins had told her daughter caused her death.” (b) Compulsory inspection , to be effective , must be folloived by compulsory treatment . If this compulsory medical examination of school children is to prove effective, one of two things must follow. Either the parents must carry out the treatments prescribed or sug- gested by the medical officials or other doctors, and those who do not believe in the methods of practice advocated by the state physicians or those who do not think they can afford the expensive luxury of experimenting with doctors, must be made to obey the medical officials, or else the state or city must go into wholesale dispensary business and the young of the community must be turned over to a number of doctors whose lack of success has made it necessary to seek state aid in obtaining business, in spite of the fact that a large proportion of the parents of the young look with abhorrence on the system of treatment represented by these same doctors. For it would be clearly absurd for the state or city to go to the expense of compulsory examination if there was to be no method of compulsion at the heels of the first compulsory step demanded by the American Medical Association ; hence the demand for nurses to go into the homes and compel com- pliance with the doctors’ directions. (c) Compulsion in theoretical Helds unjust to the individual and inimical to scientific advance. And this brings us to one of the most serious and, to thinking men and women, the most important point for consideration. Medicine is not a science. The most that can truthfully be said by its most enthusiastic advocates is that it is a progressive art ; and compulsion in theoretical or empirical fields is manifestly opposed to the great fundamental principle of freedom that is so largely responsible for the scientific advance of Western civilization since the dawn of the democratic era. It is opposed to the sacred rights of the people and is inimical to sound intellectual progress. In realms of research that relate to commercial business, such, for example, as the increasing of the productivity of the land and 8 other measures for adding to the material wealth of the people, in fields that are not speculative, government may rightly go far, always provid- ing it does not by such action interfere with the moral rights of the peo- ple or advance the wealth of the privileged classes at their expense.^ But when it comes to an empire of speculative thought, other grave factors are involved, as has just been pointed out, and this is especially true where the theories and assumed facts relate to matters so vital to the individual and civilization as one’s physical or spiritual health, and when the proposed legislation might add to the power, prestige and pecuniary advancement of a class that has striven to crush, outlaw and proscribe those holding contrary views and theories in regard to health, and to take from the individual the right to enjoy the medical or the spiritual adviser of his choice. The most momentous battle fought by Western civilization was for that freedom of thought which alone made scientific advance pos- sible, that enabled the human mind to emancipate itself from the slavery of ignorance, superstition and dogmatism, and whose first great victory was followed by the establishment of religious freedom in many lands, a sensible respect for the right of the individual in matters relat- ing to his spiritual as well as physical well-being, and a recognition of the political rights of man which ushered in the democratic era. In the domain of religion and medicine, speculative theories rather than scientific demonstrations hold sway. It is true that there are a few doctors who claim that medicine is scientific rather than specula- tive ; but the fact that our various great schools of medicine teach diametrically opposite theories and have armies of human documents in the way of cures where rival schools have failed, and the further fact That there are in the land millions of people whose unhappy experience with the old school practice has led them to seek and find health in schools and methods of practice that are denounced as false by the old school and which the American Medical Association, through its state organizations, is vigorously seeking to outlaw, prove that the older and more powerful school of practice is empirical rather than scientific. This is frankly admitted by many of the world’s greatest physi- cians and scientists, albeit usually on the announcement of some new system which is to forever remove this stigma of empiricism. As an example we note a popular article by Dr. Leonard Keene Hirschberg, of Johns Hopkins University, which sets forth the wonders of Sir Aimroth E. Wright’s famous ‘‘Opsonic Theory.” Says Dr. Hirschberg: “To put it briefly, Wright’s purpose is to bring order out of the chaos of medical experiment — to make diagnosis exact, to reduce dosage to figures and formulae, to make it possible to determine with accuracy not only what ails a patient, but, also, what remedies to give him and how much, and, finally, to find out exactly whether he is getting worse or getting well. The laymen may fancy that doctors know all of these things now; but it is not so.” Moreover, in no field of scientific advance have there been such constant changes in accepted theories — such discarding to-day of what was generally accepted yesterday, as in the old school of medical practice ; which further confirms our position that medicine is theo- retical rather than scientific. And since this is true of the healing art, here, as in all fields of theoretical speculation, the cause of true science, no less than that of human rights, demands freedom for the 9 individual to select the practitioner or adviser of his choice, without any legal restrictions that would render such freedom impossible. (d) An historical illustration showing the danger of compulsion. The history of medicine is not only the history of continual acceptance and discarding of widely differing theories, but the latest accepted theory that obsesses the medical imagination is always assumed to be the truth, and an army of human victims have to be sacrificed on the altar of the latest fetish before it is possible to rid the medical mind of its obsession. One impressive and thoroughly typical illustration of this character will serve at once to show how completely the medical world is frequently hypnotized by a vicious theory, and also the possi- bilities for evil that follow the giving of arbitrary or compulsory power to men in empirical or theoretical fields. In the eighteenth century the medical world came under the sway of the idea that by inoculating the people with smallpox virus, it could best handle the smallpox. At the beginning, some experimenters assumed that if a patient were first treated medically, in order to bring the body into a healthy condition, and were then inoculated, he would have smallpox in a comparatively light form. The first cases seemed to confirm the experimenters’ theory, and soon the pro- fession was as completely psychologized by the idea as it is to-day by serum therapy. Up to the time of this unfortunate experiment by physicians in inoculating smallpox, the disease was not especially dreaded, nor were epidemics of frequent occurrence, according to the best medical authority of the age ; but as soon as the doctors began their wholesale inoculation, using the virus of smallpox, the disease spread with amazing rapidity and the mortality became some- thing appalling — so much so that the eighteenth century has come to be known as the smallpox century. Yet in spite of this fearful tribute of life, sacrificed on the altar of a medical delusion, the doctors were so obsessed with the idea that this was, to voice the dictum of the Royal College of Physicians of London, in 1774, a treatment “highly salutary to the human race,” that in England Parliament found it necessary to pass a statute in 1840 making inoculation of smallpox in England a penal offense, in order to protect the people from the deadly delusion of the profession. And this is but one of numerous examples that might be cited showing how armies of men, women and children have been sacrificed on the altar of medical delusions which have possessed the brain of the doctors for a season, only at length to be discarded. Now to insist on compulsion in such an experimental or empirical realm is to turn our backs on the greatest and most civilization- advancing truths that mark the forward march of mankind since the advent of modern times and the dawn of democracy. Many good people, earnest, conscientious and philanthropic people, have been misled by the adroit, but shallow and sophistical, reason- ings of the representatives of the American Medical Association, who have pointed to the work which has been done by city, state and nation in commercial and scientific fields for the improvement of general conditions, and from this they have argued in favor of medical compulsion on the assumption that medicine was a science instead of an art where theories are ever changing and where accredited rep- resentatives hold mutually exclusive theories relating to a matter which next to man’s spiritual well-being touches vitally on the most precious and intimate things of life. If we would look for something truly analogous to the health rights of the individual, we will find it in their religious rights. It took centuries of martyrdom — aye, martyrdom that is not yet ended — to measurably establish the right of the individual freely to enjoy the spiritual physician or adviser of his choice ; and for twenty-five years the people of our various states have had to battle with an increasingly determined and aggressive organized medical body which, under precisely the same claim as that of the Church in the bloody days of the Reformation — the public good — has sought to secure medical restrictive legislation that would take from millions of intelligent citizens the right to the practitioners of their choice and compel them to accept doctors in whom they had no faith, to the immense pecuniary gain of the law-protected medical class. V. Class Interests Impair Judgment A special class, with the interest of its members ever present, is very liable to magnify out of all true proportion measures that would increase the power and revenue of the favored class and its members, while ignoring vital causes. To illustrate, let us take as a concrete example the child question in the City of New York. According to the Eleventh Annual Report of the City Superin- tendent of Schools to the Board of Education of the City of New York for the year ending July 31, 1909, there were 319,489 children exam- ined by the physicians from the Department of Health, exclusive of examinations for contagious diseases. The report of the Department of Health gives the number as 323,344, and also differs widely from the school report in its other figures. According to the report of the Department of Health, 242,048 pupils examined needed medical or surgical treatment — that is 74 per cent, of the whole number examined. The report to the Board of Education says : “Unfortunately there is no statement made by the Department of Health as to the effective- ness of the treatments given.” The physicians seem to have passed as many as they could “through the mill,” and as rapidly as possible. There is no evidence to show that the examinations were other than absolutely perfunctory. They appear to have been as casual as the counting of sheep as they are loaded into a freight car from their pens. By far the most numerous defects found, except defective teeth, were those affecting the nose and throat : “Adenoids, hypertrophied tonsils, defective nasal breathing,” etc. It is also mentioned that nearly 12,000 pupils were found suffering from malnutrition, caused by inferior food or by lack of any sort of food at all. The Bureau of Municipal Reasearch of New York City is a body that has been in existence a number of years. It is supported by private subscriptions and is famous for its honesty. It is incorruptible and has fought for honest government in every branch of the municipal administration. It is more feared by politicians than any other bureau of the sort in the city. In the New York Times of February 7th, 1910, it accused Dr. W. H. Maxwell, City Superintendent of Schools of 11 New York City, of bad faith and the use of facts known to be untrust- worthy. It said : “In attempting to make a scapegoat of adenoids and en- larged glands the Health Department and the City Superin- tendent confuse every issue involved, and prevent the public from seeing what steps it ought to take to prevent and remedy either physical defects or that waste of millions annually to which children behind their proper grade testify. Not a word do we hear of sweatshops in the schoolroom; not a word about breakdowns, due to overwork at school and at home; not a word of ventilation evils that could easily be corrected ; not a wee bit of responsibility is lodged with over- crowding, part time, unsuitable curriculum, inefficient instruc- tion, inefficient supervision, or well-intentioned, but ineffec- tive, methods and policies.” There can be no question, for instance, that a large number of children suffer from defective teeth. It does not take a physician or a physical examination, however, to impress upon their minds the necessity of a clean mouth, or to instruct them in the use of the tooth- brush. They can learn from their teachers that the toothbrush is mightier than the dentist. While bad teeth is one of the great causes of poor health among children, under feeding, due to ignorance and poverty is not far behind. It has been brought out by Dr. E. Mather Sill, in his clinic on the lower East Side, in New York City, that 83 per cent, of the juvenile population in that densely populated region get practically nothing but bread and slops to eat. Under improved diet these chil- dren gain as much as a pound and a half a week and their mentality grows quite as fast. There is not a word from Dr. Sill about adenoids or things of that sort. But he has much to say about the necessity of bathing and of adequate ventilation in the home and the school- room. The matter of proper ventilation is a practical one that needs an architect rather than a physician to solve. Bad, foul air causes all sorts of illness. To discover and to remedy this trouble no physical examination of the school children is necessary. Pure air is univer- sally recognized as one of the great necessities of life. It is interesting to note that the Department of Health claims that 74 per cent, of the pupils examined needed medical or surgical treatment. According to the doctors looking for abnormal conditions almost three-fourths of all the children examined called for medical treatment. What a tremendous increase in the doctors’ revenues would result from compulsory medical treatment. VI. Fundamental Cause of Evil Conditions The compulsory inspection of school children and its corollary, compulsory medication, are at once based on false premises or assump- tions, are palliative makeshifts of doubtful value and fraught with grave evils, wholly inimical to the rights of the citizen and the cause of scientific progress ; and they impose enormous burdens of taxation on the people, while tending to build up an autocratic, dog- 12 matic and intolerant medical trust or monopoly. Furthermore, they serve to divert the public mind from great economic ivrongs that are root causes of the evils complained of. Involuntary poverty, child labor, the disease-breeding and overcrowded tenements, the sweat- shops and other unnecessary evils — evils that would not be possible under just economic conditions, are major factors in the stunted and benumbed brains and physically defective bodies of an army of little ones to-day. The parents and ancestors of many of these children have long been the victims of social injustice, and much is doubtless due to inherited weakness, which is reinforced by our evil economic conditions. Monopoly in land, that enables men to hold from their fellow men the use of the earth, for selfish, speculative purposes, which is a large factor in the overcrowding of people in cities; the employment of great armies of children in mines and factories and mills when they should be in the open air and in school, developing body, brain and soul; the toleration of tenements in our cities that are great disease- breeding centers, innocent of proper sanitary provisions and pro- visions for air and sunshine ; the overcrowding of human beings in small apartments, in cellars and in attics of the slums of our great cities — these and similar economic conditions, due to the greed and avarice of man and the indifference of government to the demands of justice and human rights that are the fundamental principles on which democracy rests, are root causes to be considered by those who really desire to eradicate the evils complained of. And the campaign to remedy these conditions should be complemented with general instruction of the children everywhere in regard to the importance of pure air, water, sunshine, exercise and food — questions about which there are no warring opinions. But the men who wish to perpetuate unjust economic conditions, they who are coining money out of the life and health of the children, they who are getting rich on tenements that promote both moral and physical death, and they who through monopoly in land and other things are becoming abnormally rich by depriving their fellow men of things to which they are entitled — all these persons are quite ready to help the office-seeking political doctors to comfortable seats on the backs of the taxpayers, because through this aid to a great privilege- seeking class the aroused conscience of the community is being diverted from the root causes of the evil. Furthermore, they are thus aiding in building up another privilege-seeking class, which in turn will strengthen the feudalism of privileged wealth and reaction in its battle against equality of opportunities and of rights for all the people. Unfortunate conditions, here &s elsewhere, call for remedial agencies, but those agencies look to the abolition of special privileges that place the people at the mercy of protected classes and enable them to levy unjust tribute from industry at every turn, and the enact- ment of wise general legislation that shall make for economic inde- pendence and health through wholesome environment; but they do not call for legislation that shall create an army of tax-supported state doctors, who will more and more owe their positions to the favor of politicians. 13 VII. Compulsory Inspection and a Great Privilege- Seeking Organized Class The present demand for compulsory inspection of school children is due chiefly to a long campaign diligently pushed forward by the perfectly organized American Medical Association, since that body was reorganized with political doctors in control. The placing of the people in the hands of the favored doctors, so that they will be forced to employ them, and the burdening of the taxpayers with an ever- increasing army of state-paid doctors are master aims of the men who to-day control the American Medical Association. Monopoly in commercial commodities is oppressive and burden- some, but its tax is merely upon the pocketbook of the citizen. Monopoly in religion or medicine is a hundredfold more intolerable, because in addition to the tax upon the pocketbook it seeks to compel a large proportion of the people to do violence to their conscience by yielding to teachers and practitioners in whom they do not believe and whose theories in many instances are abhorrent to them. Thus it tends to make the law-loving citizen a law-defying citizen ; for in matters so intimate and vital as the spiritual or physical health, the rights of the individual are too sacred to be disregarded at the instigation of a monopoly-seeking class. Moreover, the inauguration of this compulsory medical inspection will inevitably lead to a union of the political grafters and the medical grafters and will further bulwark the political boss and the money- controlled machine. Already ugly charges are being made where the innovation has been effected. A luminous illustration of its baleful and demoralizing influence is found in the recent masterly arraign- ment of the medical-political combine in Boston, by Dr. David B. Scannell, formerly member of the school board, before the Woman’s Auxiliary of the Massachusetts Civil Service Reform Association, in Boston, on February 13th. In the course of his remarks, Dr. Scan- nell said : “Boston school doctors, after inspecting the isolation of a con- tagious case, whether the isolation is perfect or not, often go directly into the schoolroom. This is done frequently. “Some Boston school teachers help out certain of these doctors by putting a sign in the schoolroom window indicating to the doctor as he passes, that he need not stop to make the daily visit required by the city regulations. “There used to be forty inspectors and now there are eighty. Is any inquiry made as to a doctor’s ability? No! Does he take any examination? No! How is he appointed? By the Board of Health. Does it really appoint him? No! The appointments are made by the mayor at the wish of this and that friend. The regulations say the doctor must visit his school every day. Does he do so? Sometimes.” Since the American Medical Association has entered politics and perfected a nation-wide political machine of great efficiency, it has developed three definite lines of action, all looking to the one end of establishing a medical hierarchy as supreme in power as was the Church in the Dark Ages. (1) It is seeking to secure a National 14 Medical Department, with a doctor as a cabinet officer. (2) It is striving for monopoly state legislation that would take from millions of intelligent citizens the privilege of employing the practitioner of their choice, thus greatly increasing the financial revenues of the trust- protected doctors. (3) It is industriously striving to introduce com- pulsory medical inspection and kindred measures to secure an ever- increasing army of state-supported physicians, knowing that the gen- eral introduction of compulsory medical examination would be a giant stride toward the establishment of state medicine ; and, indeed, through this threefold line of advance the American Medical Association counts on establishing a gigantic medical hierarchy which shall control the people from birth to death. The proposed compulsory medical inspection, like the monopoly legislation which the association is ceaselessly striving to obtain through its state branches, and the bureaucratic rule it hopes to secure in the national government, is un-American in essence and spirit. It is monopolistic in the most offensive sense, in that it not only demands that the people be placed under tribute to the privileged class, but it disregards the conscientious scruples of intelligent citizens in a field that history and experience prove to he thoroughly empirical. VIII. It Would Enormously Increase the Burden of Taxation The question of taxation is more and more engaging the attention of serious and conscientious publicists. City after city, owing to reckless extravagance and the vicious practice of machine politicians of enlarging the army of public servants, is already approaching its borrowing limit ; while in state and nation the expenses of government, which means the burden of taxes, are being so rapidly and abnormally swelled that the question of any large increase in expenditure calls for the most serious consideration. Especially is this true when the new demand for increased taxes is in the nature of a perpetual 'and ever-growing drain on the pockets of the people, as would inevitably be the case where an army of state-supported doctors is added to the public payroll ; because expe- rience proves that when an army of pensioners, backed by a powerful privilege-seeking organization, has once fastened itself on the govern- ment, its number and the expense steadily and rapidly increase. And this is all the more certain under political conditions such as obtain at present, with political bosses and the masters of the party machines eager to make deals and enter into alliances that promise to give them added power. If the proposed innovation, however, were not open to such serious objections — objections which in the minds of hundreds of thousands of intelligent citizens far outweigh any possible good that can be derived from them — the case would be different. Furthermore, if there were not other remedial agencies that would yield far greater benefits at a less expense and that are fundamentally just, while in no way con- flicting with the rights and convictions of the citizens, instead of, as in this case, advancing the interests of a monopoly or trust-seeking class, 15 there would be far less reason for determined opposition to the pro- posed step toward state medicine. We are of those who would favor the state going far — very far — to remedy the wrongs that work injury to the weak and unfortunate, especially when the evils affect the young; but we unhesitatingly oppose the fastening on the body politic of representatives of a favored school of medicine whose theory and practice do not commend them- selves to a great number of intelligent citizens, in lieu of wise, states- manlike and sound democratic remedial agencies. Money spent for educating the people and effecting legislative changes that shall so shackle conscienceless greed as to liberate the army of little children in mines, mills and factories, is money well spent. Money devoted to effecting through education and enlightened legislation the destruction of special privilege and private monopoly, and the realization for the people of equality of opportunities and of rights, would be a wise expenditure. Money spent for transforming the slums from breeding-centers of moral contagion, mental stagnation and physical disease, into healthy and habitable spots for twentieth century civilization, would also represent wise expenditure. The con- demning, buying and tearing down of disease-breeding tenements and rookeries and the making of parks and open-air gymnasiums in con- gested districts, is another work that may well challenge the approval of enlightened citizenship. The dissemination, through books written in a popular vein and by teachers, of the universally accepted and extremely important general truths relating to the importance of fresh air, sunshine, exercise, cleanliness and food values, together with equal emphasis on the great moral health verities essential to a robust character — the teaching of the vital worth and importance of such things as honor, truth, honesty, sincerity, nobility, faith, duty and kindness — truths that make for physical health and character develop- ment, would call forth no opposition from the hundreds of thousands of intelligent and conscience-guided Americans who are resolutely opposed to the encroachments of the organized monopoly-seeking advocates of state medicine. We have long held that the children in our schools should be developed morally, mentally and physically ; that intellectual training should go hand in hand with general information relative to the value and importance of the fundamental and universally accepted truths essential to physical and moral well-being. But while believing in all these things and believing that the Republic can safely go far in advancing such wise and just work, we are unalterably opposed to state medicine, state religion or special privilege being extended to any sects or schools, in religion, philosophy or medicine, just as we are unreservedly opposed to private monopoly and special privilege in business or commercial life. 16 The Willett Press, New Yorlt'