While scanning early literature on the acknowledgement of the complexity of organising and studying healthcare in societies, I got a bit distracted into my favourite pre-occupation of understanding early doctors. While the natural-history work (especially in British India; see Shyamal’s essay on Edward Balfour for example) had been an early pre-occupation of the military surgeons, there is also the early essays on deforestation and its effects coming from European colonialist doctors and physicians (see Richard Grove’s work on origins of western environmentalism).
Something prompted doctors to dwell upon the human impact on environment a lot. Perhaps the more and more they saw the colonial administration’s lack of efforts in public health in their colonies, the more and more they understood the effects of the lack of occupational and environmental health. Over time, of course, ridiculous specialisation has eroded the medical profession of its origins in social sciences and its preoccupation with humanities….its biomedical science dominance has over time clouded out the other pre-occupations of early physicians.
I chanced upon the proceedings of the 27th annual meeting of the American Public Health Association held in Minneapolis, USA in October 1899. One striking speech by Dr. Salvador Garciadiego (1842-1901), the then Director of the Escuela de Medicina, Guadalajara captures very well the prevailing sentiment of the effects of deforestation and loss of natural environments and their effects on human health, something that is still not yet well entrenched among our urban planners and country policymakers, who are making deep strides at “development” at the cost of human environment. See this extract from his speech titled Some Considerations on the Hygienic Influence of Forests (Download full article) where he nicely explains
When these phenomena take place on a large scale,that is,when a district is covered with extensive forests, the concentration of the watery vapors held in the atmosphere is greater, and therefore rains are more abundant and regular. On the other hand, in arid districts the soil rapidly absorbs the solar heat which it communicates to the surrounding atmosphere, and the ascending currents of warm air carry off with them the watery vapors brought from the seas; and these are only condensed into rain, when contrary winds check the ascending current, compressing the atmospherical strata and bringing about the fal of the water they contain.
Experience has shown that the destruction of the forests in many regions has greatly diminished the water supply as well as the amount of rainfall,and has produced irregularities in the seasons and meteorolo- gical disturbances which have disappeared when woods have been again established.
Of course, after this he goes on to extol the virtues of Eucalypti near Rome
The healthful result obtained by planting Eucalypti in marshy soil, such as that near Rome, is well proved, for the absorbent power of these trees is prodigious.
A summary from around the same time by John C. Smock (apart from his racist observations on the temperate zones where highly intelligent people exist – sic!) (See full article here)
The influence of forests in conserving the quality and quantity of the water-supply; in providing shelter against the violence of the winds; in favoring the more highly ozonized and dust- free air; and in lessening the range of temperature, and making the climate more equable, is evidence of a close relation to the healthfulness of a district or country and to the well-being of its inhabitants.
What is certainly interesting is the choice of the topic for the public health association (the need for forests) and the extensive knowledge-base the doctors draw from (meteorology, climatology, soil sciences etc.) in advocating strongly that doctors should strive for afforesting their districts to ensure good health and well-being among the inhabitants. See for example, this speech by Dr. Juan Brena of Zacatecas, Mexico (most such speeches seem to be coming from Mexican doctors). He says:
It is so universally recognized today that the proximity of forests is favorable in different ways to collections of human beings, that any discussion on this head would be useless, and, at starting, we may accept this fact as a point gained.
In all this distraction, the main object of the search being the reflection on complexity of organising and researching healthcare in a society as a social science pre-occupation in addition to being a biomedical one, I came across this gem from the opening session on bacteriology and chemistry of the American Public Health Association meeting in Indianapolis in October 1900. It summarises so well this struggle to widen the scope of health research from being a mere extension of medical science, a debate that is still raging unabated today!
When in the study of public health problems,we pass beyond the confines of the laboratory, we enter a quite different field because we are likely to encounter so many buried links in the chain of causation and so many known elements which cannot be controlled or eliminated. Hence the larger study of nature’s problems must appeal to the laboratory for aid in disentangling the interwoven lines of force which enter into the making of disease. To the undefined factors we as laboratory workers must turn for our subjects of study, ever and again. We must bring them together with those we have studied and thus by gradually enlarging our sphere of experiment, we slowly but steadily approach the real conditions,those that present themselves in the everyday life of the community and the State. The nearer we approach this limit the more applicable and hence the more useful our work becomes, either by establishing new, positive facts,or by destroying current but false beliefs. This steadily progressive march of the analysis of phenomena of health and disease from simple to complex is, however, not always maintained. Much laboratory work is like the movement of acrab, backwards, a continual disavowal of conclusions deemed well established for a time. The difficulty lies less in the perversity of the experimenter than in the perversity of his environment. He is forced by circumstances to take up problems not in the order in which they seem to him most accessible to solution, but in the order in which they happen to occur in the world he is serving. He is set down in a clearing in the forest with his instruments of precision and directed to survey it in its relation to landmarks to him inaccessible and invisible.
Again, the work thrust upon us through the accidents of the world at large must be attended to promptly, if at all, because the very material under observation is changing and will not suffer delay, or else because the pressure from without is too great. Hence our work is likely to be fragmentary and unfinished and to have that flavor of the practical which does not commend itself to more academically placed brethren. However, work done with some practical end in view may be fully as scientific in its spirit, method and outcome, and as valuable to the progress of science as any of the traditional work of college or university. Whoever unearths a few consecutive links of the phenomena of cause and effect is entitled to the world’s gratitude, be these links near one end of the chain or the other. In all things, nature has applied the same principles and displayed the same degree of ingenuity, and where can it be said has she exercised more of it than in the ever-shifting battle-ground of the infectious diseases, where the cunning of two different orders of living beings is exerted not only to protect themselves, but to find a breach in the other’s armor?