HEAD OFFICE: MONTREAL, JANUARY 1954

CONSERVATION OF LIFE

CONSERVATION of life is foremost amongmaterial things in the minds of men. BenjaminDisraeli, one of history s most distinguished

~ractitioners of political science, remarked: "theealth of the people is the foundation upon which all

their happiness and all their powers as a State depend."

We know of nothing that causes more unhappinessthan being subject to disease and the threat of unsea-sonable death. Our bodies need to be in the bestpossible condition for both manual labour and think-rag. The penalty for weakness is severe.

Still, many of us have gone through five, ten ortwenty years of suffering, all but forgetting the sensa-tion of genuine health. Some are careless, some arefatalistic, some forget that science marches on and thata disease which was untouchable a few years ago maynow yield to enlightened chemical or surgical orother therapy.

No man should take his illness for granted.

This century has experienced the greatest advancein knowledge of health and disease of any period inhistory. As Will Durant says satirically, but truly, inThe Mansions of Philosophy: "Our wealth allows us totreat and cherish and master illnesses from whichprimitive men died without even knowing their Greeknames."

Human life has been lengthened through the appli-cation of scientific knowledge and the improvement inour standard of living. Persevering and profound re-search has increased our knowledge of effectivediagnostic and treatment methods. Progress in publichealth measures is saving millions of lives every year.Engineering and technology add their important con-tributions in the way of improved housing, filteredwater, sewage disposal, refrigeration, drainage tocontrol mosquitoes, and in a hundred other ways.

In These Times

Nevertheless, a large number of people still dieprematurely, and it is to draw attention to the possibil-ity of conserving these lives that this Letter is wrkten.

There will always be some small tax that our bodiesmust pay for the privilege of living in this boisterousage. We seem to be always under tension even abouttrivial matters. We indulge in compulsive activity,and when we are asked to tell why we do so we find noreal reason for pushing and being pushed. Some of ourfeverish energy, we suspect wryly, is merely an escapefrom being quiet.

"Stress" is a word frequently used by medical peopleto cover the conditions--external or internal, phy-sical or emotional m that are imposed upon the humanbody in these times. Professor Hans Selye, of theUniversity of Montreal, is quoted as listing threediseases which are examples of the effect on our bodiesof stressful living: thyrotoxicosis, a disease resultingfrom excess activity of the thyroid gland; duodenalulcer; and hypertension, or high blood-pressure, ofthe variety which comes from causes other thandiseased kidneys.

Not all stress can or should be avoided. We cannotalways live under glass. It is when we allow stress tocontinue without taking common sense steps torelieve it that we suffer needless damage.

Price and Penalty

Neglect of health may expose us to disease whichbrings in its train a crushing burden of expense.Preventive attention does not cost nearly so much.

In Canada the cost of health care is substantiallyshared by all citizens through public health program-rues financed out of taxes. Though under our constitu-tion the health of citizens is a provincial governmentresponsibility, the federal government stepped intothe picture six years ago with a national programme.As an outcome, thousands of hospital beds have beenmade available, medical research has expanded, train-ing has been provided for public health workers, andlong strides have been made toward control of certaindiseases such as tuberculosis, cancer, mental illness,and other miseries that afflict mankind.

A sickness survey was made in Canada from theautumn of 1950 to the autumn of 1951, results of which

were published recently by the Dominion Bureau ofStatistics.

Out of an estimated 41~ million family units, therewere 621,000 which spent nothing for medical, dental,hospital or any other sort of health care during thatperiod, while 757,000 spent less than $20. Beyondthat sum the figures were:

As will be seen, family units spending $100 or morein the year made up 27.4 per cent of all family unitsin Canada.

While the cost of repairing and maintaining healthmay be high, the price we pay for neglect is heavy.Dr. Arnold A. Hutschnecker remarks in his book TheWill to Live on the number of people who devote thefirst half of their lives to making money, only to spendit in the second half getting back their health.

Physicians often marvel at the indifference of manyintelligent persons to serious thought about the com-mon functions of their bodies. Doctors, who have beenlong enough tinkering careless humans to have growna little worn in the effort, lament the way people haveof taking no notice of disease until it is upon them infull force.

Illness begins usually as a slight deviation fromnormal function. That is where the wise person be-comes alert, and takes steps to restore normality. Theunwise person resents anything that meddles with theroutine of his life. He belittles the idea of doing some-thing effective about it, even when symptoms clamor-ously intrude on the pattern of his daily business.Sometimes, one doctor remarked reproachfully, thisgoes on until the scene is more fittingly presided overby a clergyman than by a physician.

We may not go so far as Samuel Butler in his Utopia,wherein if a man becomes subject to ill health beforehe is seventy years old he is tried before a jury andsentenced to public scorn, but we can say for certainthat by refusing to accept the reality of human frailty,and by postponing medical consultation until a crisisforces it, many of us are bankrupting our lives of thehealth happiness we might enjoy.

Worry about Health

Taking thought about preserving health does notby any means imply worry about health. The ordinaryroutine of digesuon goes on very well without anyhelp from our brains, but we can demoralize it if wefret and meddle. Some doctors have said that the mosttrying patients are those who have read up on theirills, real or fancied. They are likely to be carried awayby delusions, as in the thought Shakespeare expresses:"In the night, imagining some fear, how easy is abush supposed a bear."

Some people worry because they think they may havean incurable disease. They delay going to a doctor,avoiding the moment when their fear may be con-firmed. They contribute in this way to their self-destruction. If there is a disease the delay has wastedtime in which it might be tackled and arrested orcured, while if there is no disease the continued fearhas worn them down in needless anguish.

Some amount of fear is necessary to survival in thisworld. Rashness does not pay off any more than doesfeverish concern. But the thing to do about fear is toface it, recognize it as a signal of warning, and thenstart in to fight the cause of it. Passive invalidism is asingularly unattractive state of life.

What we need is a felicitous compromise betweenover-care and not caring.

Somepersons must readjust their habits so as to livewithin tlieir competence of physical resources. Certainactivities may have to be eliminated, and others willhave to be cut down. But most people will find that bygiving attention to rest and relaxation they may livefuller lives than before. No imposing schemes ofrecreation are needful. Pepys, our favourite diarist,relaxed from his duties as virtual builder of the Britishnavy by pulling off his stockings and dangling his feetin the water while his launch was rowed back toLondon from the naval dockyard.

The Physician’s Place

The office of Medicine is but to tune the curious harpof man’s body and to reduce it to harmony. The physi-cian seeks to make sick folks well, and to keep them so.

This demands co-operation. Only with help of theailing person can the doctor be expected to bringabout speedy, gentle and enduring restoration ofhealth; only with the interest and help of healthypersons can the doctor make progress toward blottingout disease.

To ascertain what is wrong with an ailing person isno light undertaking. A medical man’s success indiagnosis depends upon his knowledge of nature’sresponse to various insults and injuries, and upon hisability to evaluate the evidence of disease and inter-

Pthret it correctly. He forms his judgment not only one basis of what the patient says, but under guidance

of the whole network of signs and symptoms aftera complete survey.

Symptoms are never imaginary. If a man says he hasa headache, he is either truthful or not: he is notimagining he has a headache. But the knowledge heconveys may be inaccurate because it is coloured bysomething he has been doing. He may have "doctored"himself, thus changing the trend and extent of hissymptoms. Knowledge of this not uncommon practiceleads physicians to move carefully:, they sometimesexasperate patients by refusing to give them an easyand quick remedy, and by requiring them to comeback for a second consultation.

It may be necessary for the physician to call uponsome of his colleagues, speciaUy trained in variousaspects of medicine. Rapid advances in medicalresearch have produced a vast and complex science,one which is too immense and complicated to begrasped and applied in its entirety by any one individ-ual. There are, said an article in The Annals of theAmerican Academy of Political and Social Science,twenty-three different classifications of specialists andsubspecialists certified by the various AmericanMedical Specialty Boards. In addition, the teamdevoted to the conservation of human life includes thedentist, the physical therapist, the dietitian, the psy-chologist, and others specially trained.

One way to live longer is by having regular medicalcheck-ups by a physician who knows us and ourmedical history. Has it occurred to men to think thatthe more favourable life expectancy of women may bedue in some part to their greater readiness to seek andto follow medical advice?

Public Health Agencies

Mustering the medical resources of the country inan attempt to meet all the needs of all the people is amost difficult enterprise, because of the complexityand wide ramifications of the problem. Legislationdoes not in itself automatically create health. There isgreat variation in need and resources between differentparts of Canada and between rural and urban com-munities.

It is recognized that providing health care requiresvoluntary organizations as well as governmental sup-port and the services of the medical team. The volun-tary organizations have pioneered in many healthfields. The Canadian Tuberculosis Association wasformed more than 50 years ago; the Victorian Orderof Nurses was set up by royal charter in 1897; theCanadian Mental Health Association and the CanadianNational Institute for the Blind were established in1918; the Canadian Cancer Society, working with theNational Cancer Institute of Canada, started its activ-ities in 1938; the Canadian Arthritis and RheumatismSociety, with branches in the provinces, was foundedin 1948; and in addition there are many others withspecial fields of activity; such as the Canadian Councilfor Crippled Children, the Canadian Red CrossSociety, the St. John Ambulance Association, and theCanadian Diabetic Association.

Attacking every phase of disease and propagatinghealth in community, school and legislature, theHealth League of Canada has been operating since1921. Its National Health Week, dedicated to increas-ing the interest of Canadians in maintaining thehighest possible standard of health that can be theirlot, is planned for January 31st to February 6th thisyear, the tenth in its history.

The life insurance companies have played an im-portant part in bringing, about our present highstandard of life conservatlon. Some have distributedvast quantities of health literature; some have providedpolicy-holders with visiting nurse service; many

officers have been closely associated with healthorganizations; a large number of companies havemade generous financial contributions to voluntaryhealth agencies concerned with the control of tuber-culosis, cancer, infantile paralysis, and other diseases.

On a world-wide scale, concerted efforts are beingmade for control of infectious diseases. The WorldHealth Organization of the United Nations is movingtoward promotion of health and longevity in under-developed areas, a task in which Canada has played animportant part.

Medical Research

Because an ounce of preventive medicine is betterthan a pound of curative medicine, much research inrecent years has been devoted to discovering the causesof disease. The cost is great, the difficulties tremen-dous, but achievements have been well worth while.

Private bounty and industrial support have put thetools into the hands of research staffs, with the resultthat scores of thousands of people with diabetes,pernicious anaemia, and a variety of other diseasesare kept alive today who would have been lost inexor-ably only yesterday. No child need have rickets; thereneed be no sacrifices to beri-beri and peUagra; small-pox and diphtheria and tetanus may be controlled.The brilliant campaign of analyses by Doctors Banting,Macleod, Collip and Best, of the University of Toron-to, discovered the use of insulin, thereby making theworld a safer and brighter place for hundreds ofthousands of diabetics.

People Live Longer

As a result of all this we can measure medical

~rogress, not in terms of how many people die, butow long they live before they die. What has been

accomplished during the past few decades in extend-ing the average length of life is marvellous.

From the time of prehistoric man to the presentthere has been a progressive increase in the averagelength of life, but the increase has been greater in thepast century than the total of all preceding centuries.

We have no written records of man’s early days,but judged by fossil remains the average life of a manin the dim past was perhaps 18 years. The astronomerHalley drew up a life table based upon records forBreslau in 1687-1691, showing 331~ years as theaverage length of life; life tables for England andWales in 1838-54 showed the average length of lifeto be 40.9 years; in the United States in 1900-1902the average length of life was 49.2 years. Then,incredible though it might appear, within the briefperiod of ten years- 1940 to 1950 m the populationat age 65 and over in the United States increased by37 per cent, while the number at ages under 65 roseby only 13 per cent.

In Canada, the Metropolitan Life Insurance Compa-ny reports in its Statistical Bulletin, the crude deathrate dropped more than 40 per cent, from 8.9 deathsper thousand of its industrial policy-holders in 1924-1926 to 5.2 per thousand in 1946-1948.

Taking the same period, and again confining thefigures to Canada, there are other gratifying statistics¯Influenza and pneumonia death rate dropped from120.4 to 30.5; tuberculosis from 105.6 to 35.8;diarrhoea and enteritis from 102.7 to 10.9. Death ratesfrom all causes fell 41.5 per cent. The significantchanges toward a worse rate were in cancer (up45.7 per cent); diabetes mellitus (up 77¯5 per cent);and cardiovascular renal diseases (up 40.8 per cent)¯

If we take a comparison of deaths from all causes wefind a decline of 21 per cent in Canada between 1937and 1948. The rate of 8.22 deaths per 1,000 popula-tion in Canada compares with 9.01 in the UnitedStates, 7.99 in England and Wales, 9.77 in NorthernIreland, 9.34 in Scotland, and 7.48 in New Zealand.

Another way of saying this is that the averageperson who now reaches age 25 has as many years oflife before him as did the average newly born babyof 1900.

If, as we hope, medical science is now on the thresh-old of discoveries in cancer and the degenerativediseases, a whole new aspect of longevity and healthconservation will open before us.

Not All Diseases Kill

The fight against diseases which kill is dramatic, butthere are other diseases. We all know people whosefaces are deeply lined with the accumulated pain ofyears¯

Allergies, which are seldom fatal, give muchtrouble; inflammation of the sinuses is a widely spreadailment with minimal compensations and muchmisery; hay fever, in its seasonal or year-round varie-ties, precipitates days and weeks of annoyance andpain; arthritis is a leading cause of disability (thereare 600,000 Canadians who have the disease in oneof its many forms).

Dental decay and other ills associated with theteeth do not ordinarily come under the heading of"killers", but they cause untold suffering¯ Few peopleobtain what can be called complete dental care.According to an announcement by the CanadianDental Association called A Charters[or Dental Healthnine out of ten Canadians are detrimentally affectedby dental diseases and the ailments that follow them.

The hard fact is that Canada has not enough dentists.If you multiply the number of dentists in Canada bythe number of hours a dentist can work, says Dr. DonW. Gullett, secretary of the Association, and divide bythe population, you will find it works out roughly toa half hour for each person in a year. As Dr. Gullettgoes on to point out, dentistry is time-consumingwork, and not much can be done in half an hour.

Mind and Body

A day can be thought of when we will possessgreatly improved health, longer life, and more abun-dant physical comfort, but it will not come by medica-tion alone¯

The idea of purely mental and purely physicaldisease is a myth. The ancient Greek pr, ests operateda sanitarium named after their god of medicine, where,

if a patient did not get well they ascribed the failure toimpurity of his soul.

We know today that there is no such thing as adisease of the body which does not affect the mind,and many an uncomfortable state of affairs physicallyhas its origin in our thoughts.

Halleck says in his book Psychology and PsychicCulture that health is largely determined by the centringof attention upon things which make for mentalhappiness. Anger, hatred, grief and fear are amongthe influences most destructive of vitality. Emotionslike these tire our organism more than do the mostintense physical or intellectual work--and they areemotions which can be controlled by our brains.

In Time of October 12th, Dr. William Menninger,famed psychiatrist, is quoted as saying that emotionaltroubles account for 85 per cent of "stomach trouble"and a very large percentage of heart difficulties.

Health requires a periodicity in work and rest, anatural rhythm in which relaxation and laughter havetheir proper place. A German philosopher once wrote:Ten times must thou laugh during the day, and be

cheerful; otherwise thy stomach, the father of afflic-tion, will disturb thee in the night."

Conservation oJ LiJeNot much is demanded of us in conserving life and

health: merely that we apply to our lives the ideal wementioned in connection with conserving naturalresources: use without using up. We have about sixtimes more of everything--heart, lungs, kidneysthan we need; all we are charged with is keeping themin trim¯

Right here is the heart of our trouble¯ Time andagain someone will say to you that he has just finishedreading such and such a book, or a Monthly Letter,and "it makes sense." Yet you will observe no changein his life. We are all too apt to see how advice appliesto others, and ignore its application to ourselves.

There is no magic about conservation of life andhealth. Disease is not caused exclusively by gremlins,germs and viruses. Some of it can be averted if onlywe give over our neglectful carelessness and takesome positive actions. One of these is to have a familydoctor and see him for regular check-ups, thus spottingtroubles before they blaze into emergencies.

Obey the rules, remembering that some of them aredifferent for various people. Tonics that are good foreveryone are hope, joy, and contentment; all of us needgood diet and lively interests; but special conditions

¯ " ’~ imay prompt the physician to say to one man: avo dhard physical exertion", and to another "abstain fromalcohol", and to a third "increase your sleep periodand take a short rest at mid-day."

The great majority of us can enjoy good health ifwe will co-operate with nature. No ivory-towerism orhand-washing indifference to the consequences of ouractions or our neglect will give us continuing goodhealth. We must close our ears to the siren voiceswhich say everything is going to be all right, and dosomething, instead, to bring about and maintain thatgreatly-to-be-desired state.

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