FOURTH SESSION.

FOURTH SESSION.

The Congress convened in the Murat Theater, Indianapolis, on the morning of October 2, 1912, and was called to order by President White.

President White—I want to take this occasion to state that there is a child’s welfare exhibit richly worth seeing. It is an education in itself and is installed at the Capitol building. Every one should embrace the opportunity of seeing it.

The audience will now arise while the Rev. Dr. Harry G. Hill, of Irvington, invokes Divine guidance.

INVOCATION.

INVOCATION.

Father of us all and maker of all that is good, source of all light and life and love, early upon this morning, the second day of this Congress, we bring our respects to Thee and bow before Thee as the One worthy of worship, and invoke Thy blessing and benediction upon all who meet with us. We thank Thee that Thou hast so bountifully blessed us, and would have Thee, through these ministrations, at this time impress upon our minds that we are stewards of a great wealth, and we ask Thee to help us that we may so minister that there may be an equal distribution to all Thy people of the great goods with which Thou hast endowed us. May we hold above everything else the wealth of human life, and may we look to our work as that of making a better world, a better place for men.

May Thy blessing rest upon the deliberations of this hour, on all those who are participating in this Congress, and may it go on and do much good in the years that are to come, that Thy knowledge shall be in the hearts and minds of men, and they shall serve Thee and make this is a great opportunity to increase Thy rule and kingdom through Christ, our Lord and King. Amen.

President White—In the study of Conservation in this Congress we are getting around to the fundamental basis of all vital conservation. We are getting to the point where Conservation should have first begun—the study of human life as a national asset. It was Pope who said “The proper study of mankind is man.”

I take please in introducing to you, as the first speaker of this morning session, one who has had a great deal to do in the actual figures, the actual statistics, the actual knowledge of why human life is a national asset and why it should be conserved. I take pleasure in introducing to you Mr. E. E. Rittenhouse, of New York City, Conservation Commissioner of the Equitable Life Assurance Society of the United States, whose subject is “Human Life as a National Asset.” (Applause.)

Address, “Human Life as a National Asset”

Mr. Rittenhouse—The National Conservation Congress has been engaged in the noble task of guarding posterity against the waste of our natural resources by the present generation. It has had a most far-reaching influence, for its purposes are in tune with public sentiment, and with the spirit of the age. It has now given another and still more commanding reason for its existence by joining earnestly in the campaign for the conservation of our “human assets.” This is a field of usefulness that will endure for all time. However important the protection of our natural material resources may be, our greatest obligation to posterity is to preserve the health, virility and morality of our race.

The first and most important item in humanity’s Bill of Rights is the right to live.

The primary purpose and function of organized society is to guard the lives of its members from needless destruction. Liberty, education, wealth and other earthly blessings are important—but we must be alive to enjoy them.

The nation with the keenest sense of justice and the highest standard of intelligence and morals—virtues which some of us modestly claim for our people—is the one which should place the highest value upon human life and surround it with the greatest protection.

How would our civilization rank by this method of measurement? What have we already accomplished in preventing life waste? What is our present loss? How can it be reduced?

We may well rejoice over the achievements of the patient heroes of the laboratory and of the unselfish and devoted men of medicine who have provided, disseminated and applied the knowledge of prevention so far as it has gone. To them, to the press, the clergy, and the other good men and women who have helped spread the gospel of disease prevention belong the chief credit for the reduction of the death rate by nearly 25 per cent. in the past thirty years.

To these benefactors of our race is also due the honor of initiating and developing the widespread interest which now prevails throughout our country in the conservation of health and life. They have demonstrated that morbidity and mortality can be reduced—that human life can be prolonged by spreading and applying our present knowledge of the science of disease prevention. At the close of last year we had to the credit of these life savers over 400,000 lives that would have been lost that year if the death rate of 1880 had still prevailed.

If the present thirst for knowledge of health and life conservation continues to increase, it is not only possible, it is reasonably certain that during the next thirty years the present death rate of 15 per 1,000 population in the registered area will be reduced to 10.

While we have every reason to felicitate ourselves upon this wonderful result of the spread of life-saving intelligence, we must not overlook these facts:

1. That this great life-saving movement is still in its infancy.

2. That it has been directed almost wholly against preventable contagious diseases, and that the waste of life from these maladies has only been reduced—the loss is still excessive.

3. That while we have reduced the mortality from these diseases common to infancy and early adult life, the degeneration diseases of middle life and old age, against which we have waged no war, have been steadily increasing.

4. That we have increased the average length of human life only by increasing the proportion of people living in the younger age periods, while the average duration of life of those who pass into middle life and old age has been constantly shortened.

In other words, we are still furiously burning the candle at both ends—slower at one but faster at the other.

It is important that this point should be clearly understood. It is natural to conclude at first glance that if we are saving these lives of the younger age period that naturally there are more older people to die, but that does not follow. In the first place, we are dealing with a death rate, the death rate for 1,000 population not in the bulk, and while it is true that the passing of these lives over into the older age period does affect that rate, it only affects it slightly. It has been asserted also that the lives saved from these communicable diseases have been weakened and that they die early after passing into middle life. It is also true that that does not explain the extraordinary increase in the death rate in the older age period. In England and Wales they have the same reduction in the death rate of communicable diseases common to the earlier age period, but not any increase above forty.

With all its blessings modern civilization has introduced hazards, habits and conditions of life which may not only invite, but which have increased in many ways, physical, mental and moral degeneracy.

What excuse have we Americans to offer for the excessive waste of human efficiency and human life from which the Nation is now suffering?

Surely we can not plead ignorance nor poverty, for we have both the knowledge and the money wherewith to stop this annual sacrifice.

How can we explain our growing contempt for the value and sacredness of human life? There is no other civilized country where this greatest of all assets—the most precious gift of the Almighty,—is held so cheaply as in this glorious land of ours.

And why do we continue to view with indifference the constantly multiplying evidences of the mental and physical degeneracy of our race?

We may agree that in the long run the trend of humanity is ever upward, and that this is but a temporary reaction, but can we afford to rest wholly upon the hope that race deterioration will automatically cease when our people have had time to adjust themselves to modern conditions? Wise men doubt it. This problem will not solve itself; this adverse tendency will be checked only when our people are made to see conditions as they actually exist, and are aroused to the need of correcting them.

This is our task. Let us briefly survey it.

In order to measure the effectiveness of the Nation’s life Conservation work, and the magnitude of the task remaining undone, we must now compare our efforts not with those of the past, nor with those of other communities or countries, but with our present loss from preventable and postponable sickness and mortality.

What are the principal items of life waste?

What evidence have we of degenerate tendencies? Here are some of them—the estimates are from competent sources and are based upon official records.

AN INDICTMENT.

Our birth rate is steadily declining, and at the same time the span of life is steadily shortening.

Twenty-seven per cent. of our annual deaths are of babies under age 5; 200,000 of them die from preventable disease; about 150,000 of these are under age 1.

To offset this waste of life, large families are demanded. Would it not be well to stop this needless destruction of infants before asking for an increase in the supply?

Of the 20,000,000 school children in this country not less than 75 per cent. need attention for physical defects which are prejudicial to health.

Insanity and idiocy are increasing.

Diseases of vice, the most insidious enemy of this and future generations, are spreading rapidly according to medical men. So far we have lacked the moral courage to openly recognize and fight this scourge.

The alcohol and drug habits are constantly adding new victims to the degenerate list and to the death roll.

Suicides are increasing and now reach the enormous total of about 15,000 annually.

Lynchings and burnings-at-the-stake continue, and are common only to our country.

Attempts upon human life by individuals and mobs under trifling provocation, or none at all, are obviously increasing.

Over 9,000 murders are committed every year, and it is estimated that but an average of 116 murderers are executed for these crimes. We have the appalling estimated homicide record of over 100 per million population as against 7 in Canada, 9 in Great Britain and 15 in Italy.

In the United States the death rate above age 40 has increased steadily for years (about 27 per cent. since 1880), while it has remained virtually stationary in England and Wales.

The important organs of the body are wearing out too soon—the diseases of old age are reaching down into the younger age periods.

The death rate from the degenerate diseases of the heart, blood vessels and kidneys, including apoplexy, has increased over 100 per cent. since 1880. These diseases claim over 350,000 lives annually.

The doctors tell us that fully 60 per cent. of these deaths are preventable or postponable if the disease is discovered in time.

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.)

Address, “Public Health Movement”

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.

Announcement by the President

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.

Committee on Resolutions

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.”

Address, “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:

Section VIII. The Congress shall have power—

Par. 1. To lay and collect taxes, duties, imposts and excises, to pay the debts and provide for the common defense and general welfare of the United States; but all duties, imposts and excises shall be uniform throughout the United States.

Par. 3. To regulate commerce with foreign nations and among the several States, and with the Indian tribes.

It has been held by some that the powers of the National Government, relating to public health, are restricted to paragraph 3, which gives the right to Congress to regulate commerce, and, in regulating commerce, to so regulate it as to prevent its being a carrier of disease. Others have held that under the general welfare clause, in paragraph 1, Congress has the right to legislate for the public health.

Should the latter interpretation be the correct one, Congress could establish the national health control over States and municipalities with regard to municipal and domestic sanitation, with all details as to house drainage, plumbing, sewerage, and disposal of garbage, water supply, ventilation, school houses and public buildings ventilation, examination of milk supply, food and drugs, disposal of the dead, disinfection of dwellings, etc. Would it be desirable for the National Government to have such authority? Would it be tolerated by the people? It is a fact that the American people have already decided this question when the old National Board of Health was abolished.

The National Board of Health was created by an act of Congress, approved March 3, 1879. Another act was approved June 2, 1879, clothing the board with certain quarantine powers, but this last act was limited to a period of four years, at the expiration of which time Congress declined to renew it. The National Board of Health, therefore, had an active existence from 1879 to 1883. The act establishing the board remained upon the statute books until February 15, 1893, when it was formally repealed by Congress.

To state the case concisely, the National Board of Health was not in accord with the spirit of American government, and the people rejected it. Now, what do the American people want? I will not attempt to answer this question, but will suggest that they want a general sanitary administration which is capable of steady development, and yet may be subject to such modifications as the changing conditions of our country may necessitate, a sanitary policy which can be made to expand until it will answer the public needs not only for the present but even for decades to come.

Its direct aim should be the ultimate intelligence and education of the average citizen in matters relating to his personal health, and the health of his commonwealth. No better plan for sanitary government appears at the present time than one modeled upon the structure of the general government itself. Broadly stated, this sanitary policy expects of each State a sanitary autonomy whose influence should be appreciated by every individual in every hamlet, however small, in its domain. It contemplates a State pride in the development of sanitation, a self-reliance and an unwillingness to surrender functions or call for aid from the general government excepting after the clearest convictions of propriety or necessity. This policy expects from the general government that since it controls commerce, both maritime and interstate, it will prevent commerce from conveying disease; that it will respect the sanitary institutions of the States; that it will have such organizations and establishments as properly belong to its sphere of action to supplement where States fail, and to enable it to wield its peculiar power when urgency demands.

As an apt illustration of this conception of authority in health control, let us consider the present activities of our Federal Public Health Service. These are as follows:

1. The prevention of the introduction of infectious and contagious diseases.

2. The sanitary regulation of foreign commerce.

3. The observance of international sanitary treaties.

4. The prevention of the spread of infectious and contagious diseases from one State to another through co-operation with State and municipal health authorities.

5. The collection and dissemination of sanitary information.

6. The conduct of scientific research in matters pertaining to the public health.

7. The enforcement of sanitation in Federal territory and in connection with Federal administrative affairs.

THE PREVENTION OF THE INTRODUCTION OF INFECTIOUS AND CONTAGIOUS DISEASES.

The chief national quarantine law is that approved February 15, 1893, amended and extended by acts of Congress approved August 12, 1894, March 2, 1901, and June 19, 1906.

Under these acts the maritime quarantine administration has become national, many state stations having been voluntarily surrendered to the Government, others supplanted by the General Government, because of failure to comply with government regulations, and others superseded by direct authority of law.

The diseases excluded from the country by the national quarantine establishment are cholera, yellow fever, smallpox, typhus fever, leprosy and plague.

Some quarantine stations are inspection stations only, but many are large institutions, comprised of hospitals, quarters, barracks for detention of crews and passengers, wharves and disinfecting machinery, and boarding vessels, all requiring good administrative ability on the part of the commanding officer, who must also be expert in the detection of disease.

When a ship from a foreign port arrives off a port of the United States, it is met by a quarantine officer for inspection under the national regulations. Fifty medical officers of the service are engaged in this work at forty-seven separate stations, extending along the Pacific, the Gulf and Atlantic coasts from Alaska to Portland, Me. Without the quarantine certificates given these officers and the bill of health obtained at the foreign port, the ship would not be allowed entry by the collector of customs and without his permit it would be unlawful for the ship to unload its cargo.

At a few ports, not more than three or four in number, this inspection is made by a State quarantine officer, a relic of the system which prevailed prior to 1893, when quarantine was considered a State rather than a National function. They are obliged, however, to enforce the National regulations, and are subject to inspection by the Federal officers, and if they fail or refuse to comply with the United States regulations the President is authorized to detail an officer of the Government for that purpose.

In addition to the diseases remanded by quarantine, others are excluded under laws relating to immigration, and for this purpose at the principal ports of entry there are also stationed seventy medical officers, who, during the past year, for example, examined more than 1,280,000 immigrants, certifying more than 30,000 of them on account of physical and mental defects. The immigration laws exclude persons afflicted with any loathsome or any dangerous contagious disease, or having mental or physical defects which may affect their ability to earn a living.

Humanity requires the treatment in hospital of immigrants arriving sick with ordinary as well as prohibitive diseases, and the large hospitals connected with the stations are under the professional conduct of service officers.

Although the immigration stations are under the control of commissioners attached to the Department of Commerce and Labor, nevertheless the medical officers are subject in their professional work to supervision by the Public Health Service, and their instructions as to the medical inspection of aliens are prepared by the Surgeon-General and approved by the Secretary of the Treasury.

THE SANITATION OF FOREIGN COMMERCE.

At certain foreign ports and at certain times, depending upon the presence of the various quarantinable diseases, either in the foreign ports of departure or in the country contiguous thereto, officers of the Public Health Service are detailed by the President to serve in the offices of the American consuls, to assist them in enforcing the quarantine regulations for foreign ports. These officers keep themselves informed of the prevalence of contagious disease in these cities and the surrounding country. They sign a bill of health which certifies that all the regulations required to be enforced at foreign ports on vessels leaving for the United States have been complied with.

This involves a knowledge of the point of origin of the freight and passengers, disinfection of material from an infected locality, the personal inspection of passengers, particularly steerage passengers, and their detention if necessary. The power of enforcement of these regulations lies in the above mentioned act of Congress approved February 15, 1893, which imposes a penalty of $5,000 upon any vessel from a foreign port seeking to enter a port of the United States without this consular bill of health. The consul can legally refuse a bill of health if the regulations are not complied with.

In this connection it may be said that officers of the Public Health Service are stationed constantly at such ports as Hongkong, Shanghai and Amboy, in China; Yokohama and Kobe in Japan; Salina Cruz, Manzanillo and Puerto Mexico in Mexico; Guayaquil, Ecuador; La Guaira, Venezuela, and Havana, Cuba. During the summer of 1911, on account of cholera conditions prevailing in Italy, Russia and France, there were officers of this service detailed in the offices of the American consul at Naples, Genoa, Palermo, Messina and Catania, in Italy, at Libau in Russia, and at Marseilles, France. In addition to this, officers were ordered to several other foreign ports of departure, there to confer with the American consular officers as to the enforcement of the regulations for foreign ports, and for the purpose of insuring uniformity of procedure.

The State Department has done much to assist in the quarantine and sanitary work in foreign ports, through the interest it has aroused in the said work on the part of its consular corps.

THE OBSERVANCE OF INTERNATIONAL SANITARY TREATIES.

These treaties or conventions establishing them have been ratified by the Senate of the United States, as well as by the other governments.

The International Sanitary Bureau of American Republics at Washington was founded by the International Conference of American States held in the City of Mexico in 1901. That conference also called for international sanitary conventions, which are now held every two years. Two have been held in Washington. The object of the conventions is to freely discuss all matters relating to the public health and particularly those which affect the American Republics, and the purpose of the international Sanitary Bureau is to encourage the execution of the resolutions or agreements decided upon by the conventions. The convention held in Washington in 1905 drew up a treaty with regard to the quarantine treatment of cholera, plague and yellow fever, which was signed ad referendum by the official delegates, and has been confirmed by practically all of the American Republics. At the meeting in Mexico in December, 1907, action was taken which has brought the International Sanitary Bureau at Washington into relations with the International Office of Public Hygiene at Paris.

The International Office of Public Hygiene at Paris was formally inaugurated December 9, 1907. It is the outgrowth of international sanitary conferences at Rome, Venice and Paris, with regard to the bubonic plague. The following governments are represented: Algeria, Argentina, Australia, Belgium, Bolivia, Brazil, British India, Bulgaria, Egypt, Canada, France, Great Britain, Holland, Italy, Mexico, Peru, Persia, Portugal, Roumania, Russia, Servia, Sweden, Spain, Switzerland, Tunis, Turkey and the United States.

Each of these governments has agreed to pay its pro rata of the expenses necessary to maintain the international office. The principal object of the office is to collect and bring to the knowledge of the participating States facts and documents of a general character relating to public health, especially as concerns infectious diseases—notably cholera, plague and yellow fever—as well as the measures taken to combat these diseases.

PREVENTION OF THE SPREAD OF INFECTIOUS AND CONTAGIOUS DISEASES.

These operations are conducted under two laws. One is the national quarantine act of 1893, already referred to, which contains practically the same provisions for interstate as for maritime quarantine. The other is the annual law passed by Congress appropriating an “epidemic fund” which contains a provision that it may be used in aid of State and local boards of health in the enforcement of their quarantine regulations, as well as those of the national service—to be used, however, only against certain specified epidemic diseases, viz., cholera, yellow fever, smallpox, typhus fever and bubonic plague.

Now, with these two laws in hand, and when the appearance of any of the above-named diseases in any State so require, the officers of the Public Health Service are at once upon the scene with the double object of seeing that the Treasury Interstate Quarantine Regulations are enforced by the State or local authorities and to offer aid, as authorized by law.

When aid is extended, the Government’s funds must be expended by its own officers, and the latter are therefore placed in charge and have the co-operation and assistance of the State or local authorities. They have, therefore, the support of the State and local laws and regulations, as well as those of the Federal Government. This is fortunate, since experience has shown the importance, in a Republic like ours, of local sympathy and support.

THE COLLECTION AND DISSEMINATION OF SANITARY INFORMATION.

The Public Health Bureau, through its Division of Sanitary Reports and Statistics, compiles and publishes each week a pamphlet called the Public Health Reports. It contains a statistical report from all cities in the United States of more than 10,000 inhabitants, and some others, giving the morbidity and mortality in each city with regard to twelve diseases and the total mortality from all diseases. It contains also a statement of the weekly mortality in some 120 foreign cities from thirteen communicable diseases. It gives special information concerning quarantinable diseases and sanitary measures in the United States and foreign countries. The foreign information is received through the United States consuls and service officers abroad.

Collective investigations are being made of the prevalence of pellagra, infantile paralysis and leprosy.

A compilation has been prepared of state laws bearing upon reporting diseases, with a view to increasing the collection of morbidity statistics and bringing about improved methods and greater uniformity in their collection.

CONDUCT OF SCIENTIFIC RESEARCH.

In the District of Columbia, in a commodious building, the Public Health Service has its hygienic laboratory, a research laboratory exclusively for public health investigations. It is conducted in four divisions, viz., bacteriology and pathology, chemistry, zoölogy and pharmacology. This organization brings under the same roof, and in intimate association, scientific workers in each of these several branches, interesting facts developed in one line of investigation being made freely known to the investigators in other lines of research.

Officers are detailed to receive instruction in this laboratory, thus enhancing the scientific attainments of the corps and giving opportunity for selection of those best qualified for permanent detail in research work. In this manner specialists have been and are being developed on various subjects, such as typhoid fever, pellagra, hookworm disease, infantile paralysis, scientific disinfection, etc.

Public Health Service officers may be found in the States investigating other diseases than those named in the epidemic law, viz., typhoid fever, infantile paralysis, cerebro-spinal meningitis, hookworm disease, malaria, pellagra, dengue fever, milk sickness, etc. These investigations are usually made at the request of State health authorities. The bureau at Washington, on receiving a request from a city or locality for expert aid, invariably refers the request to the State Board of Health before compliance.

The laws permitting these investigations are, first, the interstate section of the quarantine law of 1893; and second, the act of Congress approved March 3, 1901, providing a building for the hygienic laboratory for investigations of contagious and infectious diseases and matters relating to the public health. As the investigations require laboratory examinations, they come within this last named law and the appropriation which supports it.

In various States of the Union, there are thirteen establishments engaged in the production of vaccines, antitoxins and serums, which play so important a part in modern therapy. The variation in the potency and the occasional impurity of these products caused Congress to pass an act July 1, 1902, requiring a license for their manufacture for sale in interstate traffic.

ENFORCEMENT OF SANITATION IN FEDERAL TERRITORY.

In the Philippine Islands, where the government is by commission and a legislature, much work of value to the public health is performed in the bureau of science under the insular government. There are, however, in the several ports of the Philippines medical officers of the Public Health Service under appointment from the Treasury Department in Washington, engaged in the transactions of both incoming and outgoing quarantine. Two of these officers, in addition to their supervision of the national quarantine, are also director and assistant director, respectively, of the public health of all the Philippines.

In Hawaii you will also find medical officers conducting the national quarantine. They are also assisting the territorial health board in preventing the recurrence of plague by the extermination of rats and continuous bacteriological examination of those captured. One of these officers is the official sanitary adviser of the Governor of Hawaii, and is carrying on a campaign for the eradication of disease-bearing mosquitoes.

Here also may be observed the leprosy investigation station, also controlled by our officers, both on the island of Molokai, where hospital and other accommodations have been erected under the law of March 3, 1905, appropriating $100,000 for this purpose, and at the receiving station at Honolulu, where cases are seen in the earlier stages.

In Porto Rico public health officers are enforcing the United States quarantine regulations under the acts of Congress relating to Porto Rico and national quarantine. The campaign which has practically eradicated plague from San Juan is being conducted by the Federal Public Health Bureau.

In the Canal Zone you will find two commissioned officers enforcing quarantine regulations at Ancon on the Pacific and Colon on the Atlantic. These officers are loaned to the Isthmian Canal Commission. This is an important adjunct to the work of the canal, because it would be useless to clean the zone if fresh importations of disease were permitted.

I will now devote a few words to the Health Bureau organization in Washington by means of which all the functions or activities above described are administered under one head.

THE ORGANIZATION OF THE BUREAU OF PUBLIC HEALTH SERVICE.

The law which changed the name of the Marine Hospital Service and made it a Public Health Service was approved July 1, 1902. This law fixed the status of the officers, enlarged the hygienic laboratory and gave it an advisory board, provided for the conferences with the State and Territorial Boards of Health, provided for compilation and publication of statistics, and directed that the President should prescribe rules for the conduct of the service and the uniforms of its officers and employes.

It also provided for a Public Health and Marine Hospital Bureau at Washington.

By an act of the Congress approved August 14, 1912, the name of the Public Health and Marine Hospital Service was changed to Public Health Service. The public health functions and duties of the service were extended and certain changes were made in the salaries of the officers.

The Public Health Service is under the supervision of the Secretary of the Treasury, and is in charge of the Surgeon-General, who has six Assistant Surgeons-General in charge of the Bureau Divisions. These divisions are as follows:

1. Foreign and Insular Quarantine and Immigration.

2. Domestic (Interstate) Quarantine.

3. Personnel and Accounts.

4. Marine Hospitals and Relief.

5. Scientific Research and Sanitation.

6. Sanitary Reports and Statistics.

The above lengthy description of our present public health activities has been necessary not only in order to demonstrate their character, and scope, but also as an illustration of the variety of legal authority existing for the enactment on the part of the general Government of public health work.

This paper will not admit of the incorporation into it of the national laws relating to public health which are now operative, but a careful inspection of these laws will demonstrate that they will admit of such interpretation as would make possible an almost unlimited amplification of our present public health activities, the limit being only one of appropriations and officers.

Careful analysis of the present health laws and activities will also show that the Government is seeking to control nothing which any other public health organization would wish to control. The foundation of the national public health service is in the quarantine law of February 15, 1893, referred to above. The quarantine service is today almost entirely national, notwithstanding a local sentiment for State or municipal control, which exists in two or three cities only, and which it is believed is destined to a short tenure for the following reasons:

It must be admitted that maritime quarantine should be a national affair. It is a concomitant to commerce, over which under the Constitution the national government has absolute control, and it naturally belongs to that department of the government regulating commerce in other respects. In other words, it seems especially appropriate that quarantine should be one of the functions of the Treasury Department which registers, licenses and enrolls all merchant vessels of the United States, inspects the hulls, boilers and machinery of such vessels, determines the number of passengers which said vessels may carry and provides for the housing and rations of the crews.

Besides this, it carefully examines all pilots upon American vessels and determines upon granting them licenses. It enforces the navigation laws and aids vessels in distress by an efficient revenue cutter service. It also provides for the care of the sick of our merchant marine. Then why should it relegate to a State authority, or health officer of some small port, the one remaining act of surveillance over vessels, namely, the determination as to whether they may be admitted to entry from a sanitary standpoint? Why should it be left to a local appointee, responsible only to a mayor or governor, the power to determine whether all the people and the merchandise on vessels destined for all ports of the United States, shall be permitted to enter without detention; and why should it give this local officer power to detain such vessels; and further than that, why should such local officers desire that power?

In the same way, the other activities of the Public Health Service conflict in no way with the functions and prerogatives of the State and local boards of health. Therefore, the term “national health control” is a misnomer. The term “national health co-operation” would be much more descriptive of the conditions actually existing. The interstate health activities above described must of necessity be governmental functions. The duties and responsibilities connected with them could not be discharged by States with any degree of uniformity. Therefore, interstate commerce laws are considered as appropriate national enactments, and their operation encroaches upon no State or municipal rights.

It may be said with a feeling of conviction that the health control in the United States today is just exactly in accordance with the desires of the people. The people know that their State and municipal boards are being aided by the health activities of the national government rather than being encroached upon. In addition to this the Federal Public Health Service and the State and municipal boards are acting in harmony to the following ends: They are controlling commerce, in order that commerce may not be clogged, and where necessary they are laying the net of healthful restraint for purposes of good.

The government is receiving the good-will and co-operation of the State and local health authorities in its work of catching and throwing back the diseased persons who seek entrance to our shores in the great Waves of immigration. They stand together to check the merchant or the manufacturer when he is ready or willing to risk the lives of the people by furnishing improper or impure food or drug products. They stand together to frustrate the lawyer who seeks by illegal technicality in the behalf of an individual, or steamship company perhaps, to force a way around a sanitary barrier erected for the protection of the people at large. Again, the municipal, State and government health authorities are standing together to stimulate the knowledge of our legislators in public health needs and are combining their knowledge to insure reasonable appropriations for the carrying out of general public health projects.

The mission of the three classes of sanitarians above mentioned may go still further. It may go to the extent of prodding the conscience of the tardy doctor, and even to the sweeping aside of the sentimental obstructions which the unenlightened are able to put in the path of the conservation of life. There is ample law for present and probably for future needs, and the control of national health remains, after all, today where it has remained in the past, and where it always will remain, that is, with the American people, not solely with the government, nor with the State or municipal health agencies. Each of the great nations of the world has gone about the direction of its public health work in its own way, and always with the realization that the ideal is not necessarily the practical, and what is best today may be supplanted by better tomorrow.

To summarize the situation, we have today State boards of health in control of State sanitation, operating under proper and ample State law. We have municipal health organizations operating under their own legal authority, and finally we have the United States Public Health Service, operating under several laws, as stated before, more far-reaching in their scope than is indicated by the activities pursued under their authority. The people, apparently, are satisfied so far as the Public Health Service is concerned. When the people want anything more they will demand it, and if available appropriations will not admit of compliance with such requests they will be forthcoming. Therefore, I am at a loss to suggest what additional health legislation is necessary or desirable to be engrafted upon that already existing in this country, and I am unable to see the necessity for any different plan of organization so long as the people, in whose behalf the organization is being maintained, are satisfied.

In closing, I wish to say that I have endeavored simply to place various facts before this Congress, and while I do not pretend to have exhausted this branch of the subject, I fear that I can not say the same with regard to your patience.

President White here requested Dr. Henry Wallace, of Des Moines, Iowa, to take the Chair.

Address, “Land Frauds”

Chairman Wallace—We are now ready to hear the report of the Committee on Lands and Agriculture. The first speaker will be Dr. George E. Condra, of Lincoln, Neb., whose subject is “Land Frauds, or Get-Rich-Quick Schemes.”

Dr. Condra—Mr. President and Delegates: Some of you may recall the fact that the speaker has briefly outlined this subject at each of the preceding Congresses, under the head, “Conservation of Business.” The discussion offered at this time is based on reliable information secured from many States. It is largely the result of field work. The data are presented according to the viewpoint of Conservation and should be so considered.

Do you fully realize that the principles of Conservation are permeating every department of human industry, improving the processes, increasing efficiency, and promoting common honesty, that the idea of equity is increasing in force? That it is being extended to business not for the purpose of holding it in check, but primarily for protection against fraud? This movement for square dealing certainly is in order for business is sore with graft and tracked by fraud at every turn. Plain it is that many transactions in the realm of commerce fall outside the sphere of true business. They grade from those that are doubtful on through to those that are plainly fraudulent and therefore criminal. The term “business,” however, has a splendid meaning which should be conserved. It symbolizes honesty, stability, honor and reliability. Sharp practice, double dealing and doubtful promotion are but parasites and should be so regarded. They have no legitimate place in business and are being eliminated.

Several persons have spoken in this Congress on pure food, eugenics, etc. Their messages will tend to make people healthier and better fit to be fathers and mothers. All this is good. Dr. Wiley and others have emphasized the importance of pure food and health laws, but how many go back of this matter of health and food to the land, or source of our food and raiment and show the great need for pure land laws? (Applause.) The State trains its sanitary engineers, lawyers and physicians for their life work. It examines the lawyers and doctors before permitting them to practice, but how about land agents? They are good and bad. Many of them have no special qualifications for their work and should not be permitted to do about as they please without restriction, promoting this and that deal which may or may not have merit. Grant me your closest attention and I will point out certain classes of fraud that operate in connection with the development of mineral lands, irrigation, fruit lands, eucalyptus culture, drainage, dry land farming and the small tract propositions.

Promotion of Mineral Land.—The amount of money sent from the country and town and city to doubtful mine promoters is enormous. The return for this outlay is small, in some places less than one cent for each dollar. Yet the public does not fully realize that nearly all reasonably sure propositions are not available for wanton promotion, that a mere prospect is not a mine, and that fraudulent promoters are hurting the mining business.[3]

Oil and Gas Promotion.—The excitement caused by a developing oil field is intense. Agriculture gives way to a spirit of speculation and overvaluation and everything looks good to an investing public. Fabulous returns appear to be in sight for all who invest in time. This gives opportunity for professional promoters to do their work, sometimes on a large scale. They claim a sure thing even when wildcatting. So they send unwarranted prospectuses broadcast and the money harvest is on. It is difficult to place the criminality of such procedure. We only know that it works out badly as a rule. You should know that it is bad business to accept the unqualified statements of most oil and gas promotion concerns as a basis for investment. These persons and concerns interfere with legitimate development and should be brought under control.

Irrigation Schemes.—The Federal Government spends vast sums in developing the irrigation resources of several dry land States. Such reclamation is of economic importance. Furthermore, many reliable individuals and private companies do as well and even better in developing some projects. As a result of successful irrigation thousands of happy homes are made where once was only dry land. Notwithstanding this fact there are fraudulent irrigation promoters. Scheming individuals sell illegitimate propositions which can not succeed because of lack of water, unsuitable land or heavy graft. Such promotion has gone on to such an extent as to call for severe criticism by many practical irrigationists of the West, and the Reclamation Department of the Federal Government is increasing its diligence in checkmating the work of persons who attempt to promote bad projects.

Fruit Land Promotion.—Have you visited the great fruit districts of Oregon, Washington and other Northwestern States? Do you know what care is there given to the cultivation and marketing of apples especially? The fruit is so perfect in form and color. It is accurately graded for the Eastern and foreign markets. These splendid successes are widely known and are taken advantage of by scheming persons who promote the sale of any and all kinds of land in and near fruit districts. One of the leading fruit men of Washington says that thousands and thousands of dollars are going into the hands of concerns that are sure to fail and that the fruit business is being hurt by such operations. The trouble of it is that the average investor does not know that the fruit business is highly specialized, and that many matters concerning soil, exposure, climate, markets, etc., not known to him, are the features that determine success and failure. Furthermore, the fraudulent promoter does not know, neither does he care.

Doubtful promotion of this kind is not confined to the Northwest alone. It has hurt the South and may do damage to New York and other States in which are lands well suited for fruit raising, if the proper authorities do not conserve the larger interests of the industry and State against promoters.

Eucalyptus Promotion.—For many years the forests of the United States have been in process of depletion. Some have seen in this, and with good reason, an approaching timber famine. The alarm has been sounded, and the demand has gone forth for better methods in timber utilization, for fire protection, and tree planting. This is the right thing without doubt, but it affords a loop-hole for promoters. It is understood, also, that some trees grow faster and are more all-purpose than others. The eucalyptus are of this kind. They are of many kinds. Such trees can not be grown on any and every type of soil and are limited somewhat by climate. It so happens that California, because of its soil and climate, is the leading State in culture of eucalyptus. It has several successful groves and larger plantings, yet the situation is promoted for all it is worth, and perhaps more. The public (in the Central and Western States) is worked by carefully-planned selling schemes. The fact is that there is too much graft in some of them. The process has gone on to such an extent as to cause the friends of eucalyptus planting to sound a warning against such procedure. This should cause investors to make a more careful inquiry of reliable persons, not controlled by the promoters, before parting with money. The trees must have suitable soil, climate, and care.

Drainage Schemes.—One of the largest lines of development in the United States is in the field of drainage, whereby swamp and flood lands are improved. The amount of land that either has or can be reclaimed by drainage is said to be about 75,000,000 acres. The Federal Government, various States, companies, and individuals, are doing this work. Much of such development is well founded, yet there are bad deals, which might be called deliberate steals in some cases. Examples of these exist in a few States and much money has been squandered on projects that can never succeed. Teachers, ministers, farmers, merchants and others are victimized. In the language of one of Florida’s representatives at the National Irrigation Congress of this year, “Persons selling certain wet lands of Florida are practicing fraud and should be prosecuted as criminals. They are hurting the good name of Florida and swindling people in the North.” This person severely criticized certain cities of the North as being promotion centers. Further comment is not necessary.

Dry Land Deals.—Much dry land promotion is fraudulent, caused in part by misinformation on the part of agents, but due to some extent to deliberate misrepresentation. For instance, there are places in Texas, Oklahoma, Kansas, Colorado, western Nebraska, Wyoming, and other States subject to such promotion. The fact is that a part of the land in the dry area of each State named is well suited for dry farming, but that unscrupulous agents sell anything and everything to unsuspecting persons as being good, awaiting the plow and successful development. So it is that geographic position has been overworked. The following points are sometimes overdrawn in securing sales: