Chapter X: Section 3: The term “State” as used herein is to be construed to mean (5)

Periodical health examinations would detect these chronic diseases in time to check or cure them, but aside from the efforts of the Equitable Life Assurance Society and another smaller company, no public campaign to educate our people to this vital need is being carried on.

All of our money, all of our energy, seem to be directed against diseases that can be communicated. Is not a life lost from Bright’s disease as valuable as one lost by typhoid fever?

The annual loss from pneumonia aggregates 135,000 lives, a large portion of which is due to weakened bodily resistance resulting from these degenerative affections.

Cancer, a baffling disease to which our people in their present physical condition are highly susceptible, claims 75,000 lives annually and is increasing very fast. Deaths from external cancer alone have increased 52 per cent. in ten years.

Pellagra, a deadly plague new to this country, is increasing rapidly in some of our Southern States, and it excites but slight public concern.

Over 150,000 Americans are destroyed annually by tuberculosis. We know how to prevent it, but our taxpayers object to the expense and leave the battle almost wholly to charity.

Nearly a million afflicted people are spreading the poison of tuberculosis to the well, with virtually no official restraint or supervision because of the expense.

Over 25,000 Americans are still sacrificed annually to the preventable filth disease—typhoid fever. About 300,000 suffer from it and are more or less impaired by it.

Other germ diseases are wasting more lives than typhoid and tuberculosis combined. We are warring against them, but compared to the lives still being lost our efforts are feeble and only partially effective.

Over 90,000 Americans are killed annually by accidents and various forms of violence. Our efforts to prevent the steady increase of this waste have failed.

The annual economic loss due to preventable disease and death is conservatively estimated at $1,500,000,000, and our life loss at about $250,000,000.

To prevent fire waste our cities spend through the public service approximately $1.65 per capita, and to prevent life waste, 33 cents per capita.

It is estimated that 1,500,000 of our people are constantly suffering from preventable disease, and that during the next ten years American lives equaling the population of the Pacific Coast and Rocky Mountain States (about 6,000,000) will be needlessly destroyed if the present estimated mortality from preventable and postponable disease continues.

_These are the conditions we are asking our people to correct. Is there anything unreasonable in the request?_

The money loss is stupendous, but if this does not impress our people, surely they should be stirred to action when they reflect upon the immeasurable sum of sorrow, suffering, poverty, immorality, crime and the hereditary degeneracy which results from this wholesale wrecking and destruction of human life from preventable cause.

RACE SUICIDE.

We are not only reducing the fertility of our race and also shortening the span of life, but we are permitting at least 650,000 lives to be destroyed annually which we could save by the application of simple and well-known precautions.

This is the real race suicide problem.

If we would save these lives, they together with their natural offspring would solve the problem of maintaining an adequate surplus of births over deaths. What we need is not necessarily larger families, but _more_ families. A larger number of small families is surely preferable to a smaller number of large families.

THE DOLLAR AND THE DEATH RATE.

The primary duty of conserving our human assets resting with the State, it is obvious that the State must lead in the national movement. It is, therefore, the first duty of every individual and of every unofficial organization interested in this efficiency and life-saving campaign to rally to the support of the public health service.

We must not only teach the individual how to guard his life against preventable disease and accident, we must educate our communities to the need of an effective public health service to enforce sanitary regulations and otherwise guard the health and lives of their members.

But it takes money to carry on a great educational movement, and it takes money to conduct the public health service.

The war against preventable disease and death is therefore in the final analysis, a struggle between the dollar and the death rate.

So far the dollar is ahead. The body politic seems still to prefer a high death rate to a slight and temporary increase in the tax rate.

“How much,” says the American taxpayer, “will it cost to reduce this annoying death rate to the lowest possible limit?”

“About $1.50 per capita at first, much less later on,” answers the health officer, “and you will gain immeasurably by the increase in the wealth and happiness of the community.”

“Very well,” says the taxpayer, “here is 25 cents; we will save two bits’ worth of these lives. The rest will have to die. We have much more important places for our money; we must improve the streets and roads, beautify our cities with much needed parks and public structures. We must improve our harbors and rivers, build canals, and encourage commerce generally. Besides, we are absolutely obliged to use about two and a half billion dollars this year for automobiles, jewelry, candy, alcoholic drinks, tobacco, diamonds and other similar urgent needs of life. What is the loss of a few hundred thousand lives compared to these vital necessities?”

And so the health officer plods along with his two-bit appropriation and naturally runs a two-bit health service. His own fitness and efficiency may be 100 per cent., but the effectiveness of his department only 15 per cent. because of the 25-cent limit.

TRIFLING WITH A SOLEMN DUTY.

_National Government._—Of all the money provided by the people for the expenses of the National Government only about 1.3 per cent. is used for the conservation of health and life.

Our national health corps has an international reputation for efficiency and achievement. Although the service is under-manned and its personnel underpaid, the patriotism and high sense of duty of these able and energetic men have spurred them to the performance of the very highest service to their country and to humanity. They have not only jeopardized their lives, but numbers of them have sacrificed health and life in the performance of duty.

Through their discoveries in the science of prevention, they have been the means of saving thousands of lives, not only for one year but for all years to come. They have won the admiration of the American people and deserve their most hearty support.

And yet, when it is proposed to co-ordinate the various public health activities of the Government in order to increase the efficiency and usefulness of this splendid body of men, the interest of our countrymen in this service seems to end with admiration. For notwithstanding our confidence and appreciation we have permitted a small but active body of people who are more concerned in treating disease than in preventing it to block the consummation of this thoroughly sensible and business-like consolidation of the various bureaus under one responsible head.

We have many educational agencies at work throughout the country which are directly or indirectly arousing public interest in health conservation, but this experience emphasizes the need for a permanent central organization to stimulate interested people to back up their judgment with action, and no organization is better fitted to render this invaluable service than this National Conservation Congress.

At the last session of this Congress Dr. Harvey Wiley told you something about the dangers of impure food, drink and drugs, and what was being done to guard the public against them. Your individual interest was excited. How long did it continue? Were any of you inspired to give actual support and assistance in the enforcement of the pure food laws or to any other official public health activity? To be interested and to agree is not enough—again, we must act, individually as well as collectively, and stimulate others to act.

_States._—The same lack of practical support of the public life-saving service exists in most of the States. The appropriations for the public health work of our State departments can only be characterized as trifling. The exception is Pennsylvania, which is paving the way for a fully adequate health service, as was explained to you at the third session of this Congress in the able paper of Mr. A. B. Farquhar.

The appropriation for the Pennsylvania State Health Department is about 48 cents per capita. Arkansas makes none at all, the State of New York spends about 1.7 cents; Massachusetts, 4.2; Florida, 10; Indiana, 1.8; Kansas, 2.7; Virginia, 1.9, and so on.

_Municipalities._—We have many cities with active and efficient health officers, but there is not a city in this country with an adequately equipped and financed health department. Not one of them has sufficient financial support to successfully perform its task, which must be measured by the preventable sick and death list in each community. And we must not confine this list to contagious affections. It must include an educational campaign against all preventable diseases.

The duty of the State to teach our people, through the health departments, how to avoid preventable disease of all kinds that they may live healthful and productive lives, is just as imperative as is the duty of teaching them, through our schools, how to avoid illiteracy and how to live intelligent and useful lives.

While health appropriations have increased over former years, all of our cities place the value of property far above that of human life in applying measures to prevent waste. Here are a few examples:

In 1911, fifty of our important American cities, with an annual preventable death list of 117,724 people (which means an economic loss of at least $200,000,000) spent through their public service to prevent life waste, an average of 30 cents per capita, and through their fire departments to prevent fire waste, $1.63 per capita.

Here are a few examples: Providence, R. I., spent for health conservation, 11 cents; for fire prevention, $1.99 per capita; Portland, Ore., health, 13 cents; fire, $1.91; Minneapolis, health, 14 cents; fire, $1.67; Louisville, health, 12 cents; fire, $1.36.

In 1910, 184 American cities could spare but two per cent. of their total public appropriations for the public health service. The average for all expenses was $16.54 per capita. Of this but 33 cents was for the public health. Seventy-one of these 184 cities spent less than 15 cents per capita for the public health, and among these are such cities as Quincy, Ill., 2 cents; Lansing, Mich., 5 cents; Rockford, Ill., 6 cents; Scranton, Pa., 7 cents; Bridgeport, Conn., 9 cents; Portland, Ore., 10 cents; Harrisburg, Pa., 12 cents; Jersey City, N. J., 13 cents; Springfield, Ill., 14 cents.

There are many of our largest cities that are well below the average of 33 cents per capita. Among them: Toledo, 15 cents; St. Paul, 17 cents; Minneapolis, 18 cents; Indianapolis, 20 cents; Kansas City, Mo., 20 cents; Milwaukee, 20 cents; Cincinnati, 21 cents; Chicago, 22 cents; St. Louis, Mo., 26 cents; Buffalo, 27 cents; San Francisco, 28 cents.

The natural result of this sort of economy is that the health laws we have are not properly enforced.

How can we benefit from the pure food laws, for example, while we refuse to provide the means of enforcing them?

The great city of New York has an ably administered health department, but it has only thirty inspectors to supervise over 27,000 food dispensing establishments. The request of the health officer for an inspection force of 209 men has been steadily ignored for years.

How do you suppose the meat ordinances of Philadelphia are enforced where the people allow the health department but seven inspectors to watch over 8,000 meat shops and slaughter houses?

How can the eight pure food inspectors in Kansas be expected to enforce the pure food laws in the drug and grocery stores, the meat shops, bakeries, etc., in 800 towns? These inspections must be made frequently to be of any value.

These are not exceptions, they are examples.

Could anything be more absurd from a business point of view than this record of “economy” in providing for the public life-saving service?

HOW SOME COMMUNITIES SAVE MONEY.

Some prosperous American communities hold human life so cheaply that they maintain no public health service at all. Others—and there are many of them—have a mere skeleton service. The citizens imagine that if they appoint a health board consisting of doctors, all will be well with them. The suggestion that the board be provided with money to carry on its functions would be regarded as wanton extravagance.

There are scores of cities and towns which select a doctor to head the health department and expect him to earn his living by practicing his profession among the very people over whom he is supposed to exercise police authority in enforcing sanitary and other health regulations.

There are cities of from 5,000 to 100,000 population that hire a doctor on the “part time” plan as chief health officer, and pay him a trifling salary. Whether he is a competent sanitarian or in any way skilled in the prevention of disease is a matter of little concern to them. The fact that they are saving a few dollars in his salary fills them with joy and indifference as to the consequences to the community.

I know of a thriving, wealthy young city in the South of 130,000 population with a substantial preventable death rate which saves as much as $800 annually in this way.

I know of a prosperous New England city of 40,000 population with but three people in its health department—two of them are “part time” employes. It is a six cents per capita department _and 50 per cent. of the annual deaths in that city are of children under five years of age_.

In theory, we must all stand ready to serve the State when called upon, even at personal loss. But does it not seem the height of absurdity to expect a competent professional man to leave his practice to take charge of these under-manned and under-financed health departments at the small salaries which our States and cities offer them? If he does his duty, he is sure to make enemies during his term of service, and if he is an able man he will certainly lose money by leaving his practice.

Surely we offer our health officers every inducement to follow the line of least resistance.

A SAMPLE GROUP OF CITIES.

An investigation was recently made of forty-four Illinois cities averaging in population about 16,000; fifteen of them had over 20,000 population, and three had over 50,000.

The average salaries paid the chief health officer amounted to the magnificent sum of $300 annually.

Twelve of these cities paid nothing for health protection—and this included three cities of 22,000 population and one of 30,000 population.

One city of 26,000 population employed a layman as a health officer.

In one of 22,000 the police matron served as “health officer” when she was not otherwise engaged.

Twenty-nine of these cities made no pretense of supervising their milk supply.

Only nine of them had isolation hospitals for contagious diseases.

Thirty-one of them kept no mortuary records whatever.

These conditions exist in a prosperous agricultural and manufacturing State—and they can doubtless be found to exist in almost any State in the Union.

AGENCIES THAT CAN HELP.

These are unpleasant facts, but they give us an idea of the way we are performing the primary function of government—the guarding of human life against avoidable destruction.

We have now briefly considered the extent of the waste of the most vital asset of the nation, and how we are conserving it, or rather how we are not conserving it.

Now let us rejoice over the fact that we not only know how to reduce this waste, but that thanks to those who have aroused the life conservation sentiment in this country, a general improvement in the public health service is taking place in many States and cities. The experiment has been successful. We now know what we can do. We have the wealth and knowledge, and the machinery is organized throughout the country to rapidly correct our appalling record of life waste. Our work is to induce our people to use it.

Every business and social organization should do its full share of this work.

The life insurance institutions of this country have a constituency of 25,000,000 policyholders. These policyholders are directly interested in the promotion of longevity, not only from the humanitarian but from the financial viewpoint; for the lower the mortality among policyholders, the greater will be the saving and the larger the dividends to policyholders, which means a reduction in the cost of their life insurance. It is estimated that about $50,000,000 is lost annually by postponable mortality among the insured.

The Equitable Life Assurance Society, with which I have the honor to be connected, is endeavoring to do its part not only in conserving the lives of its policyholders, but in stimulating community action. The Metropolitan Life Insurance Company of New York is also rendering a valuable public service in Conservation along somewhat different lines. Two or three of the small companies, and perhaps the same number of fraternal insurance societies, have also given it attention. Let us hope that the time is near at hand when the other two hundred-odd life insurance companies, and the fraternal societies as well, will also increase their usefulness to their policyholders and the public by joining in this great work.

SOME SUGGESTIONS.

This Congress will be asked to do and to advocate many things, for there are a multitude of independent activities connected directly or indirectly with this general subject. Among others I sincerely trust the following suggestions will be duly considered:

1. To encourage business institutions, civic, social and religious organizations which have influence over any considerable number of people to join in at least some of the many phases of the life conservation campaign.

2. To encourage the education of the individual to adopt healthful habits of life—to avoid the intemperate life, which means excess in eating, drinking, working, playing—and unhealthful indulgence in indolence as well.

3. To encourage communities to establish and maintain ample public health organizations consistent with the magnitude of the work in hand.

4. To advocate the organization of local health leagues as a stimulus to public interest and to give aid and support to the public health service.

5. To encourage the slowly growing sentiment for a rigid supervision (and isolation if necessary) of tubercular victims, which is the only way in which this devastating plague can be stamped out.

6. To advocate the employment of civic nurses in the health service, who may also act as health inspectors and aid in educational work.

7. To advocate the issuance and distribution by the States or municipalities of an official prevention manual to teach the public how to avoid preventable disease.

8. To urge every individual to go to his or her doctor for periodical health inspections to detect disease in time to arrest or cure it.

9. To urge employers of labor to give their employes these examinations free as a part of their efficiency and welfare program.

10. To encourage philanthropy, now so generously contributing for the care of the sick, to also enter the field of disease prevention which it has so far quite generally neglected.

Human life is our paramount asset. Its conservation should be your paramount issue.

President WHITE—The audience is certainly indebted for this great and interesting paper. It is hard to get over stubborn facts and figures, especially where figures are facts.

A great doctor once shocked the people of the country by saying that everybody should be chloroformed when they arrived at the age of sixty. From this paper it would seem we ought at least to reach the age of sixty, the age of being chloroformed, and, better still, we had better so conduct the board of health and so support liberally the board of health in our city that people may just begin to live when they get to be sixty.

I now have the pleasure of introducing Prof. Irving Fisher, of Yale University, who has given this subject many years of study and research and will now speak to you upon the “Public Health Movement.” (Applause.)

Prof. FISHER—The Conservation movement is a movement to prevent waste. When the Conservation Commission was appointed, four years ago, emphasis was placed on the wastes of our natural resources, but by the time the Commission made its report, it had come to the conclusion that by far the most serious as well as the most preventable wastes are the wastes of human life.

A generation ago it was a common impression that the average human lifetime was fixed as by a decree of fate. When I was in college one of our reverend instructors showed us a mortality table and said with great impressiveness: “There is no law more hard and fast than the law of mortality.” I believed it, and even yet many people are under this delusion. Pasteur did much to introduce a more optimistic view. He stated his belief in these immortal words, “It is within the power of man to rid himself of every parasitic disease.” He staked this opinion on his own wonderful laboratory revelations as to germ life. Today we can confirm his words by absolute statistics. And now his successor, Metchnikoff, has surpassed even Pasteur in optimism. Metchnikoff is devoting himself to the question of the prolongation of human life and already gives us a vision of the time when centenarians will be regarded merely as in the prime of life and when the normal span of a century and a quarter will be a frequent occurrence.

The growing consciousness that human life is not a fixed allotment, which we must accept as our doom, but a variable, which is within our power to control, has recently led to extraordinary exertions all over the world to save human life. This impulse has gained strength also from the great and almost universal decline in the birth rate. Old countries like France, and new countries like Australia, are confronted with the specter of depopulation. Consequently, as human life becomes scarce, it becomes precious—like any other commodity! These two facts, the consciousness that much mortality is preventable, or at any rate postponable and the fact that increasingly fewer babies are being born in the world, are together operating to produce a great health movement throughout the world. Nothing will stop it until the whole world is convinced of the paramount importance of this problem of human Conservation.

This world-wide movement for the conservation of human life has expressed itself in many ways—in medical research; in societies for preventing tuberculosis, infant mortality, social diseases, alcoholism, and vice; in the growth of sanatoria, dispensaries, hospitals and other institutions; in an immense output of hygienic literature, not only technical books and journals, but also popular articles in the magazines and daily news papers; in the constant agitation and legislation for purer foods, milk supply, meat supply and water supply; in the movement to limit the labor of women and children and to improve factory sanitation; in the establishment of social insurance in Germany, England, Denmark and other countries; in the improvement of departments of health; in the spread of gymnastics, physical training and school hygiene; in the revival of the Olympic games and the effort to revive the old Greek ideals of physical perfection and beauty, and last, and most important, in the sudden development of the science of eugenics.

In the summer of 1911 was held in Dresden a unique world’s fair, devoted exclusively to health—the International Hygiene Exhibition. In this were shown the fruits of the whole movement in all lands—except, alas, our own; for to our shame it must be said that we, as yet, are among the backward nations in this movement for the conservation of human life. Our Congress was asked to appropriate $60,000 to erect a building and supply an exhibit to show what we have done for our part in this movement, but Congress thought it could not afford so large an expenditure for so small (!) an object, and the result was that from the millions of people who visited this exhibition one constantly heard the question asked: “Where is the United States?”

And those few Americans who did go to visit the exhibition found that other nations had far outstripped us in this movement for national sanitation and health. Some of the achievements already attained by other nations should be recorded among the wonders of the world. One is the striking decline of the death rate in the city of London. Within two decades, London’s death rate has virtually been cut in two and is now only thirteen per thousand, or less than that of most cities one-fiftieth its size.

Probably, however, the greatest achievement of any country is that of Sweden, where the duration of life is the longest, the mortality the least and the improvements the most general. There alone can it be said that the chances of life have been improved for all ages of life. Infancy, middle age and old age today show a lower mortality in Sweden than in times past, while in other countries, including the United States, although we can boast of some reduction in infant mortality, the mortality after middle age is growing worse and the innate vitality of the people is, in all probability, deteriorating. The reason why Sweden of all countries has succeeded in improving the vitality of middle age and old age, while other nations have failed, is, I believe, to be found in the fact that Sweden, of all nations, has seen the problem of human hygiene as a whole instead of partially. In most other lands, and particularly in the United States, public health has been regarded almost exclusively as a matter of protection against germs; but protection against germs, while effective in defending us from plague and other epidemics of acute diseases, is almost powerless to prevent the chronic diseases of middle and late life. These maladies—Bright’s disease, heart disease, nervous breakdowns—are due primarily to unhygienic personal habits. Medical inspection and instruction in schools, as well as Swedish gymnastics, have aided greatly in the muscular development of the citizens of Sweden. Swedish hard bread has preserved their teeth. The Gothenburg system is gradually weaning them from alcohol. There has even been a strong movement against the use of tobacco. Other countries are tardily following in the path which Sweden has trod so successfully.

The significant fact is that Sweden has not hesitated to attack the problems of personal habits. I believe we must have a revolution in the habits of living in the community if we are going really to realize the promise of Metchnikoff and others as to the prolongation of human life. Health officers in this country have not regarded it as a part of their duty either to live personally a clean, hygienic life, or to teach others to do so, or even to investigate what those conditions of well-being are which make for personal vitality.

I can remember, thirteen years ago, talking with a doctor in Colorado as to the habits of living of his patients. I said to him, “You tell me that tuberculosis is a house disease, and that the reason it exists is because people do not open their windows. Why, then, do you not tell your patients they must open their windows, or sleep out of doors?” He said, “I wouldn’t dare to do that; I would lose my practice. They would think I was a crank and meddling in their personal affairs.” Today that battle has been largely won. Today, not only in Colorado and California, and in the places where there is perpetual sunshine, sleeping out of doors is common and not confined to invalids, but indulged in by the community generally. Even in New England and throughout the country you will find sleeping balconies going up all over. The change has even affected in some degree the architecture of the country, and while as yet only a minority of the people sleep out of doors, yet I believe it is true that the majority of the people in the United States have far more air in their sleeping and living rooms today than ten years ago. The fact which the doctor in Colorado did not dare tell his patients thirteen years ago, has in some way been told to the people of the United States.

But there are many other things that need to be told, after we are sure that they are true. When we have, through our National, State or municipal officers made thorough investigation and have been able to discover the actual truth as regards eating and drinking, hours of work, recreation and play—all those facts that go into what may be called personal habits, then we may gradually overturn existing unhygienic habits of living. John Burns attributes a large part of the great reduction in London mortality to the improved personal habits of working men, particularly in regard to alcohol. In this country, Dr. Evans, both as health officer of Chicago and later as health editor of a Chicago newspaper, has shown how public instruction in personal habits can be made effective, and it will be largely through affecting personal habits that the life insurance companies will improve the longevity of their policy holders.

Scientific men today have reached substantial agreement that alcohol is a poison. When everybody understands this, the days of alcohol as a beverage will be numbered. Sweden in the thirties was called drunken Sweden, but today the antialcohol movement there has converted Sweden into one of the soberest of countries.

But the use of tobacco, tea and coffee ought also to be investigated, so that we may know how far they are deleterious, and to spread this knowledge among the people.

Fashions are in their essence changeable and the time will come when the world will not be built on fashion but on reason. Japan has made more rapid progress in civilization than any other nation, because the late Mikado resolved and publicly stated that the institutions of Japan must not be tied by tradition but must be based on reason. When we have replaced tradition by reason, we shall have gotten a solid basis for civilization, and this must apply to ancient customs and habits of every kind. I am firmly convinced that we are looking at only one-half of this public health movement as long as we confine ourselves to the acute or infectious diseases. We shall not get more than half the results obtainable until we realize that there must be a revolution in the personal habits of the people.

Yet the United States, in spite of its shortcomings, has some special triumphs to record. We have, through hygiene under Colonel Gorgas, made it possible to dig the Panama Canal. We have virtually abolished yellow fever on our shores and in Cuba. We have nearly eliminated hook worm disease in Porto Rico and are gradually doing the same in the Southern States. We have found a cure for spinal meningitis. We have, in New York, made an object lesson in the last year of reducing the summer death rate of infants in a striking manner. We have, by individual milk stations in Boston and other cities and in individual sanatoria, dispensaries and other institutions, demonstrated that the death rate from specific diseases can often be cut in two.

Yet we have depended altogether too much on private initiative. In New York the summer death rate of infants was reduced chiefly through the work of the milk committee and individuals like Nathan Straus. The elimination of hook worm disease and the discovery of the cure of spinal meningitis came through the gifts of Mr. Rockefeller. It is well that individuals should apply themselves to these problems and without such personal interest they could never be solved. Nevertheless, progress will be many times as rapid when the problems for the nation are managed in a national way. There are three great agencies to which we must look for the saving of human life in the future and it has been the object of the Committee of One Hundred on National Health, of which I am President, to help stir these three agencies into activity in this country. They are the public press, the insurance companies and the Government.

To a limited extent, all of these agencies have increased their health activities in recent years. A few years ago, popular articles on public health were seldom seen because the public and the press thought the subject of disease uninteresting and repulsive. Today, on the other hand, one can scarcely pick up a popular magazine without finding not only one but several articles dealing with questions of public health; and it has been found possible not only to make these articles interesting, but, by emphasizing the positive, or health side, instead of the negative, or disease side, to render them attractive and beautiful. And yet, as Dr. Wiley has said, the newspapers in spite of all the good they are doing with their right hands are, with their left hands, in their advertising columns trying to undo that good by advertising the fraudulent part of the “healing” profession who are trying to line their own pockets at the expense of the lives of the public.

The second great agency from which I believe we may expect wonderful results in the future is life insurance. As our committee pointed out to the Association of Life Insurance Presidents several years ago, life insurance companies can save money by preventing deaths just as fire insurance companies have saved money by preventing fires, and steam boiler insurance companies have saved money by preventing explosions. Since this suggestion was made, a number of progressive life insurance companies have tried the experiment. The Metropolitan and the Equitable have established departments of human conservation and a number of other and smaller companies have undertaken similar enterprises. The Postal Life Insurance Company has recently published the statistical results of their experience, worked out in a most careful manner, and have demonstrated absolutely that it pays life insurance companies to save human life. This being the case, we may expect life insurance companies in the future to become active in life conservation. Already there are probably fifteen million policy holders in the United States insured in companies which are trying to do something for their health—through medical examinations, instruction in hygiene, utilization of visiting nurses, participation in civic health movements and otherwise. To save human life merely to save money is sordid enough, but it is well to harness commercial motives, when possible, in the service of humanity.

The third, and most important, agency is the government. State and National health offices are becoming yearly stronger and more efficient; and yet much remains to be done, particularly by the National Government. We need a National Department of Health or a Department of Labor which shall include in its operations the conservation of human life. We have already passed the phosphorus match bill to prevent one of the worst industrial diseases—phossy jaw. We have passed effective legislation in regard to interstate commerce in prostitution. We have established a Children’s Bureau and a Bureau of Mines to prevent industrial accidents in mining. We have enacted suitable legislation in regard to cocaine and habit-forming drugs. We have a Pure Food Law and laws for the inspection of meats. Yet, as Dr. Wiley, Mrs. Crane and others who have watched the operation of these laws at close range well know, they need to be executed with a stronger hand.

The truth is that as yet we have only made a feeble beginning in public health work, especially in this country. We need first of all to do what Sweden has done for a hundred and fifty years—namely, to keep proper vital statistics. Vital statistics are the bookkeeping of health, and we cannot economize health any more successfully than we can economize money unless we keep books. At present only a little over half of the population of the United States has statistics of its deaths, while the statistics of the births are as yet nowhere sufficiently accurate to be called real statistics.

Our National Statistician, Dr. Wilbur, illustrates by a story how much better we keep our commercial books than our books of vital statistics. In a Western State a girl was entitled to a fortune when she became twenty-one. Reaching, as she supposed, her twenty-first birthday, she laid claim to the fortune. Much to her surprise, her father said, “But you are only nineteen;” and then the two tried to look up the records. They had no family Bible, they had no public record office to go to, and they were at sea as to how to discover exactly the date when she was born. However it suddenly occurred to her father, who was a farmer, that the very day his daughter was born a calf was born on his farm and the birth of the calf had been recorded. In that way he established the date of the birth of his daughter.

In view of the great slack of our vital statistics, therefore, we cannot measure even the death rate, much less the number of preventable deaths in the United States. All that we can do is to study carefully the registration area and on this basis to work out certain minimum figures.

Four years ago, as a member of President Roosevelt’s Conservation Commission, I endeavored to do this and to report on the condition of our “National Vitality.” I found, after getting together all the statistics available and taking account of the degree of preventability of different diseases as estimated by experts that, out of some 1,500,000 deaths annually in the United States, at least 630,000 are preventable. Of these preventable deaths, the greater number are from seven causes. These seven causes include three great diseases of infancy, then typhoid fever, which usually makes its attack in the twenties, then tuberculosis, accidents in industry, and pneumonia which come in the thirties.

Now 630,000 unnecessary deaths per year mean over 1,700 unnecessary deaths per day or more than the lives lost on the Titanic disaster. The nation cannot continue indifferent to hygiene as it gradually dawns on the public that for lack of hygiene we suffer a Titanic disaster every day of the year. The popular imagination was deeply stirred by the image of 1,600 helpless human beings suddenly engulfed in mid-ocean. That was a vivid dramatic picture which the blindest of men could see and understand. It led to immediate official action on both sides of the Atlantic to safeguard human life at sea. Yet on land we lose three hundred and sixty-five times as many lives as this every year and never stop to add it up. They are scattered and diffused throughout the land—a Wilbur Wright lost from typhoid, a handful of miners in an explosion, some railway employes in an accident, some victims of lead poisoning, a little army of infants, here a few and there a few. Yet these deaths are just as real and mean an infinitely more serious loss than were the deaths from the Titanic disaster. Moreover, they could be as easily prevented.

And concomitant with this unnecessarily great death rate, there is, of course, a colossal aggregate of needless sickness. We have no real statistics, but by analogy with English statistics we may assume that, on the average, for every death per annum there are two persons sick during the year. This makes about three million people constantly lying on sick beds in the United States, of which, on the most conservative estimate, at least half do not need to have been there.

If, now, on the basis of these figures, we try to compute how much human life is needlessly shortened in the United States, we find that it is shortened at least fifteen years. Again, if we translate these preventable losses into commercial terms, we find that, even by the most conservative reckoning, this country is losing over $1,500,000,000 worth of wealth producing power every year.

What does this mean? To us individually, it means that we are losing a large part of our rightful life not only by death itself which cuts off many years we might have lived, but also from diseases and disabilities which are not fatal but cripple the power to work and mar the joy of living. I believe I am far within the facts when I venture the opinion that the average man or woman in the United States is not doing half of the work nor having half of the joy of work of which the human being is capable.

With all this room for improvement before our eyes, it is not surprising that the zeal of the health movement is growing fast. Each success serves as justification for further effort.

One of the most encouraging symptoms of progress is the great attention which is being paid to public health in the present political campaign. All three of the party platforms included planks in behalf of public health. The Democratic and Progressive platforms were particularly explicit and emphatic and all the candidates have emphasized health in speeches and in their record in public life. The Democratic campaign managers are carrying out plans to make progressive health legislation prominent in the campaign.

These and other indications augur well for better legislation, more energetic enforcement of the law and, above all, a more appreciative public sentiment as to the transcendent importance of the conservation of human life. It is now reported that the Hon. Dr. Roche, Secretary of State in Canada, is in strong sympathy with the proposal there for the establishment of a Federal Department of Health and the Republic of China is reported to have already established such a department.

From all these indications of actual activity as well as from the logic of the situation we are justified in predicting that an age of human conservation is at hand. Men and women are waking to their responsibility to the race. Eugenics will be a watchword of the future. To squander our natural resources is ignoble indeed, but far worse is it to squander our vital resources. The most sacred obligation of each generation is to bequeath its life capital unimpaired to the generation which comes after. Scourges like typhoid and tuberculosis must be swept off the face of the earth. Habit-forming drugs, including alcohol (and even tobacco, especially for young boys) must be recognized in their true light as means of depleting the vitality of nations. Prostitution and the white slave traffic must be condemned anew as robbers of the race. Industries which kill and maim, poison or infect their workers, which deform and stunt little children, which incapacitate women for normal motherhood, which through overlong hours of toil close each successive day’s work with progressive exhaustion, must be controlled. Machinery was made for man, not man for machinery. Immigration which drains European public institutions of their criminal, insane, feeble-minded and other defectives and delinquents and sets these creatures loose in America to breed with and contaminate our population, must be regulated. Marriage laws and customs must be adjusted so as to discourage or forbid the procreation by the unfit. All these and other hygienic and eugenic reforms will be realized as fast as public sentiment becomes educated to the solemn responsibilities and higher valuations of human life.

The noblest task, therefore, which I can conceive for any man is to aid in erecting true ideals of perfect manhood and womanhood. Our ideals, though improving, are not yet worthy to be compared with those of Japan or Sweden and the ideals even of these countries have not yet reached the level of those of ancient Greece still imaged for us in imperishable marble. With superior knowledge our health ideals should excel those of any other age. These ideals should not stop with the mere negation of disease, degeneracy, delinquency and dependency. They should be positive and progressive. They should include muscular development, a sound mind in a sound body, integrity of moral fiber, a sense of the splendor of the perfect human body as a temple of the human soul, a sense of the enjoyment of all life’s proper functions. As William James said, simply to breathe or move our muscles should be a delight. The thoroughly healthy person is full of joy and optimism. He rejoiceth like a strong man to run a race. Said Emerson, “Give me health and a day and I will make the pomp of emperors ridiculous.” Our health ideals should be nothing short of an abiding sense of the sweetness and beauty, the nobility and holiness, of human life.

President WHITE—We have had wonderful addresses this morning from the distinguished speakers upon this question of conservation of human life.

I wish now to announce the Committee on Credentials: Mr. E. T. Allen of Portland, Ore., Mr. Volney T. Foster of Chicago, and Col. W. A. Fleming Jones of Las Cruces, N. M.

I wish also to announce the Chairman of the Committee on Resolutions: Mr. Walter H. Page of New York. The different State organizations will report to him a member for that committee from each particular State. It will be well to report to Mr. Page either tonight or early in the morning.

We all need to be put under authority. We find people are not taking good care of their health, of themselves or of the community. We will now hear from Dr. L. E. Cofer of Washington, D. C., Assistant Surgeon-General of the United States Public Health Service, who will address the Congress on the subject of “Authority In Health Control.”

Dr. COFER—Mr. President, Ladies and Gentlemen: I do not think any invitation has ever been received with more satisfaction than the one for a representative of our service to appear before you. It was received with the greatest gratification.

The Public Health Service is absorbed in the work of health conservation and Surgeon-General Blue evinced the greatest interest in your invitation for him to send a representative to explain the scope of the work being performed and discuss the question of authority in connection therewith.

This topic is now receiving the consideration of many authorities on public health matters, and on this account one may approach the subject in a hopeful attitude. I say “hopeful” because public health as an institution is rapidly growing, and its practical value is becoming more and more manifest, and sanitary science is not now nearly so far in advance of its practical application as it was even a few years ago. The possibilities of sanitation in the general advancement are being made a part of all high ideals of government, so that it is not to be wondered at that the general government should be called upon to do its share. The difficulty lies in determining just what the government should do in aid of public health and just what should be left to the States and municipalities.

History furnishes no precedents for this Nation to follow. It is almost useless to seek a model for our guidance in some foreign country. A nation with our conditions of boundary and magnitude, with millions of immigrants coming to our shores from all parts of the earth, has its own salvation to work out in the public health as well as in many other problems. In other words, we must rely upon ourselves, whether we proceed in haste or by feeling our way step by step. There is a marked divergence of sentiment growing in regard to national health control. One is that the government should do far more than it is now doing towards the protection of the public health, another that too much is expected of the National Government, and that there is a tendency on the part of State governments to call upon the Federal Government for service which should be performed by the States themselves, but which service is asked for largely in the interest of economy. These widely differing ideas in regard to the apportionment of public health responsibility lead us to a consideration of the provisions of the Constitution of the United States relative to this matter. These provisions are contained in Section VIII, paragraphs I and 3: